MALNUTRITION IN THE ELDERLY

Malnutrition in the Elderly

Malnutrition in the Elderly

Prevalence of malnutrition in the elderly Malnutrition - defined as a state of energy, protein or other specific nutrient deficiency is reported to occur frequently in elderly people, the prevalence, however, showing great variation from about zero to 65%. This observation can be partly explained by methodological problems in assessing malnutrition, but in particular by the enormous heterogeneity of the elderly population group. Old age includes a time span of more than 30 years, and a wide range of different life styles, physical and medical conditions, health and nutritional states.

Among "younger" elderly up to about age 75 the prevalence of malnutrition is reported to be low (below 10%). The vast majority of these generally healthy elderly people living in their own homes, show marks of nutritional status in the normal range. Overweight is by far more prevalent than underweight. (White, 2008)

A great number of studies in different countries confirm the high prevalence of under nutrition particularly in geriatric patients. Clinical anthropometric and biochemical signs of protein-calorie malnutrition as well as biochemical evidence of micronutrient deficiencies are frequently observed at hospital admission. Further weight loss and deterioration of nutritional status often occur during hospitalization.

Causes of malnutrition

Malnutrition in the elderly is of Multifactorial origin. In general, it results from an imbalance between energy expenditure and dietary intake.

A variety of age-related changes predispose the elderly to malnutrition by complicating and reducing dietary intake. These changes include a reduction in the sensitivity of olfactory and gustatory receptors as well as alterations in the hormonal and neurotransmitter mediated regulation of hunger and satiety. The decrease in lean body mass and basal metabolic rate with age may also contribute to the development of a physiological anorexia of ageing. (Mamhidir & Ljunggren, 2006)

In addition, various concomitants of old age may play a role in suppressing food intake. Physical disabilities, including restricted mobility, upper-extremity dysfunction, chewing problems or swallowing disorders, if present, give rise to difficulties in shopping food, preparing meals and eating. Many elderly cannot eat and drink unaided and, thus, need personal help for eating.

In older persons with confusion, dementia or depression poor appetite, forgetting to eat or refusal to eat may result in an inadequate dietary intake. Poverty as well as social isolation may further add to the problem. In hospitalized patients inadequate food intake may result from unattractive hospital food and surroundings, unjustified restrictive diets or the lack of help for eating dependent patients.

As in younger adults, the presence of disease is an important factor in the etiology of malnutrition.

Catabolic or hyper metabolic processes are characteristic features of many common diseases and may compromise the nutritional status of the ill elderly. In chronic diseases a subclinical inflammatory state is discussed, which lead to increased production of catabolic cytokines, depressed appetite and increased rate of muscle catabolism. Loss of muscle mass however, already physiologically occurring with age (sarcopenia), implies a decrease in metabolic reserves and results in a reduced ability ...