8 months ago

Malnutrition in the elderly

Nutrition is essential for maintaining physical and mental health. Eating fulfills many vital normal physical processes that regularly occur in their body, but is also a source of pleasure, especially for the elderly.

For seniors, calorie intake should be between 25 and 30 kcal per kg of bodyweight per day, and between 30 and 35 kcal per kg of bodyweight per day for those with medical conditions, as their energy expenditure is higher than average. Increasing calorie intake during illness is essential in fighting infections, limiting fevers, to avoid drawing on muscle reserves  or when patients have to undergo rehabilitation. 

Food consumption in the elderly is not that different from that of adults, apart from the fact that the elderly have more issues with dentition, chewing and swallowing, as around 56% of the senior population over the age of 80 have lost all of their teeth. These issues can be made easier to manage with an adaptive diet, such as modifying the texture of foods. 

As well as dental issues, changes in physiological, psychological, sociological and pathological factors can lead to anorexia in the elderly population. Food intake gradually decreases with age, and this is how malnutrition can set in, which then leads to deficiencies and the deterioration of overall health. 

How can you prevent malnutrition?

Certain dietary habits can be adopted to avoid the risk of malnutrition in the elderly. For instance, when caloric intake is at a deficit, enriching daily food portions with more calories is an effective method of increasing the nutritional value of food. This fortification increases the caloric intake for the elderly without greatly modifying their food portions. For example, adding butter, milk or cheese to soups, mashed potatoes to increase the caloric content of foods. Other examples include adding milk powder, eggs and protein. 

In theory, if fortification of foods is not sufficient, ONS’s (oral nutritional supplements) can be added. A maximum of 2 oral supplements is recommended per day. These supplements are rich in protein and calories, and can help to increase caloric intake.  ONS are often prescribed directly and for practical reasons in nursing homes or for use at home. 

If ONS’s aren’t sufficient, enteral and parenteral (in cases where enteral nutrition is not possible) nutrition systems can be implemented. 

How to recognise when malnutrition has settled ?

The high authority for health (HAS) has established criteria to determine whether someone is in  a state of malnutrition. The criteria are at least 1 phenotypic characteristic and 1 etiological characteristic, which are required to validate the diagnosis of malnutrition. 

The phenotypic criteria are as follows:

  • Loss of 5% body weight in 1 month or 10% in 6 months
  • BMI of < 22 kg/m2
  • Sarcopenia : loss of strength AND muscle mass

The phenotypic characteristic must be associated with at least one of the following etiological criteria, which are as follows: 

  • The elderly person suffers from an acute or chronic pathology
  • Malabsorption or maldigestion of food
  • Reduction of food intake >50 % for more than a week, or a total reduction for 2 weeks

Malnutrition can also be determined with the use of various tools. Firstly by measuring body composition, by using questionnaires (MNA questionnaires), or by doing protein assays. 

So, if you believe your loved one is suffering from malnutrition, don’t leave it to time or the next doctor’s appointment. Don’t let the elderly potentially suffer from the risks of deficiencies and loss of weight and muscle mass! 

Lorine TRAMEAU
Nutritional Engineer at Nutrimis