Assessment of nutritional status is an important part of comprehensive health assessment. Changes associated with ageing increase the risk of malnutrition.
Sufficient intake of energy, proteins and other nutrients through the diet should be guaranteed.
An overweight person less than 75 years of age may slim with caution if he/she has comorbidities. Patients aged over 75 years rarely benefit from slimming.
Prevalence and pathophysiology
The prevalence of malnutrition among the elderly population is 5-10%. Check also local data concerning the prevalence.
Muscle tissue is lost and the proportion of adipose tissue increases.
Slowing basal metabolic rate, reduced muscle mass and decreasing physical activity lead to a decreasing experience of hunger.
Delayed gastric emptying and longer presence of energy-rich metabolism products (glucose, free fatty acids) in the circulation prolong the feeling of satiety.
Glucose tolerance is reduced.
Susceptibility to fluid imbalance increases.
Malnutrition has numerous harmful consequences.
Increased morbidity and mortality
Delayed recovery from illnesses
Prolonged hospitalisation, increased demand for health services
Impaired resistance to infection, slower wound healing, increased risk of sepsis
Accelerated muscular wasting, diminished muscle function and strength, increased risk of falls and fractures
Causes
Problems in obtaining food
Financial (small pension, unwillingness to spend money on food)
Mobility issues, reduced functional capacity, lack of personal assistance
Nutritional supplementation, as required, appears to reduce mortality and complications.
The minimum daily dietary energy requirement is 1 600 kcal (6.5 MJ). This can be achieved by eating 2-3 meals and 2 snacks every day.
Further energy and protein should be included to enhance the diet, as necessary.
In people over 64, the daily intake of protein should be 1.2-1.4 g per kg of body weight (15-20% of energy intake).
During convalescence, the protein requirement is about 1.5 g per kg of body weight.
For elderly persons living at home, it is important to check eating and to use food delivery services and oral nutritional supplements, particularly after discharge from hospital.
Family style mealtimes in care institutions improve the quality of life and increase the intake of energy and nutrients.
Vitamins and minerals
Routine use of vitamins or minerals has not been proven beneficial.
10 µg (400 IU) daily is recommended for persons aged over 60 years, primarily from the diet.
For persons aged over 75 years, 20 µg (800 IU) daily is recommended as vitamin supplementation.
Vitamin D deficiency is common in those who mainly reside indoors, and routine vitamin D supplementation is justified.
800-1 500 mg/day of calcium should be taken primarily through the diet.
Vitamin B deficiency may cause neuropathies or changes in blood count.
Folate deficiency is common.
Check also local recommendations that may vary due to different populations, diets and geographical areas.
Obesity
A BMI exceeding 30 is termed obesity.
Being slightly overweight (BMI 24-29) is rarely an indication for treatment.
An obese person may also have malnutrition (fat frail).
Weight loss and fluctuating weight can easily lead to muscle wasting and a relative increase in fat tissue.
In a patient aged less than 75 years, cautious weight reduction with the aid of increased physical exercise together with ensuring of sufficient protein intake is feasible in the treatment of diabetes, cardiac insufficiency, hypertension and osteoarthritis.
People aged over 75 years rarely benefit from slimming.
Volkert D, Beck AM, Cederholm T, et al. ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022;41(4):958-989 [PubMed]
Baldwin C, Kimber KL, Gibbs M ym. Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults. Cochrane Database Syst Rev 2016;12():CD009840. [PubMed]
Tieland M, Dirks ML, van der Zwaluw N et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 2012;13(8):713-9. [PubMed]