Elsevier

Nutrition

Volume 17, Issue 6, June 2001, Pages 496-498
Nutrition

Workshop: anorexia during disease
Clinical pictures of malnutrition in ill elderly subjects

https://doi.org/10.1016/S0899-9007(01)00558-5Get rights and content

Abstract

Malnutrition in ill elderly subjects is common in hospitals, nursing homes, and home care. Depending on the type and composition of the groups of patients under consideration, the prevalence of malnutrition is cited at up to 60%. With advancing age, the amounts of food consumed daily diminish and become significantly smaller than the amounts consumed by the younger population. The elderly mostly eat food of low nutrient density. Especially at times of high energy requirements such as acute or chronic illness, this results in an energy deficit and general malnutrition. Precise diagnosis of malnutrition can be facilitated by determination of a number of biochemical parameters. Knowledge of these permits individualized nutrition therapy. The most important deficits affecting ill elderly subjects are those relating to proteins, iron, zinc, selenium, and vitamins B12, B1, B6, and D. Malnutrition prolongs hospital stays, imposes enormous costs on health services, and causes considerable mortality. The present, very rapid increase in the size of the elderly population will exacerbate the problem of malnutrition. Therefore, more attention should be paid to malnutrition by treating it as a disease in its own right and including it in the training of doctors and nurses.

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

References (21)

There are more references available in the full text version of this article.

Cited by (109)

View all citing articles on Scopus
View full text