Workshop: anorexia during diseaseClinical pictures of malnutrition in ill elderly subjects
Introduction
An increasingly high number of the chronically ill elderly show suboptimal nutrition parameters, i.e., suffer from malnutrition. Whereas “only” 4% to 31%1 of elderly people living autonomously at home have subnormal nutrition parameters, up to 60% of geriatric patients in acute hospitals,2 long-term hospitals,2, 3, 4 and nursing homes5 have shown evidence of malnutrition on admission or develop nutrition deficits before discharge.6
Section snippets
Diagnosis of malnutrition
History, physical examination, and anthropometric measurements are essential parts of any nutrition assessment. However, these tools can be highly subjective in evaluating ill elderly and rely heavily on the knowledge and experience of the evaluator. Incorporating biochemical measurements in the routine nutrition assessment provides an often-needed objective dimension. At present there are no generally accepted criteria for the diagnosis of malnutrition, so I am defining the term malnutrition
Clinical symptoms of malnutrition
All early symptoms of undernutrition are unspecific and progress slowly (Table II), and malnutrition often is regarded as a normal age-associated phenomenon and tolerated as “signs of old age.” Thus, an early diagnosis of a beginning malnutrition is difficult. The most typical early sign at the onset of malnutrition is the diminished appetite and dislike for meat consumption. Early laboratory findings are low plasma zinc and low lymphocyte count. Other laboratory parameters can remain normal
Caloric deficiency
The elderly eat considerably smaller amounts of food and eat less often than the young. Especially at times of high energy requirements such as acute or chronic illness, this leads to an energy deficit and general malnutrition.8 Forty percent of elderly hospital admissions in the United Kingdom are undernourished, half severely so. In a recent study Allison et al.6 showed that elderly patients consume less than 70% of their energy (30 to 35 kcal · kg−1 · d−1) and protein (1 g · kg−1 · d−1)
Preventive nutrition
Preventive nutrition in the elderly needs a multifactorial preventive approach. Risk indicators and risk factors in old age might differ from those in middle life. Steen et al.21 have dealt with the public-health aspects and “hospital malnutrition.”
Summary
Elderly subjects always have inadequate nutrition parameters after a few weeks of illness. Therefore, malnutrition is the most common comorbid condition of the elderly. Notwithstanding, scant attention has been paid to it because it does not yet form part of the training of doctors and nurses. Planned changes in medical courses should take into account demographic shifts, in particular the current very rapid increase in the size of the elderly population, by including the diseases likely to be
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