Research paperNutritional status, chewing function and vitamin deficiency in geriatric inpatients
Introduction
Undernutrition and malnutrition have a paramount negative impact on morbidity and mortality of elderly persons. Even patients with obesity aged 65 years and older show an increased mortality when losing more than 5% of their actual body weight [27]. Due to decreased physical activity, the energy requirements decrease with age in most persons. Energy intake of older men (40–74 years old) is nearly a third less (2100–2300 calories/day) compared to the intake of men aged 24–34 years old (2700 calories/day) [18], [24]. In contrast, the requirements for vitamins and trace elements do not decrease with age [26].
When assessed by the Mini Nutritional Assessment (MNA), only 20% of elderly community dwelling people have no risk of malnutrition whereas 71% are at risk and 9% suffer from severe malnutrition [28].
In German hospitals, the prevalence of malnutrition in geriatric inpatients is exceeding 50% [33]. Caloric supplementation improves outcomes in malnourished hospital patients and malnourished older persons [25]. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care [45]. For hospitalized elderly patients, fat mass is associated with a decreased risk of adverse events [3].
Depression is the most common cause for malnutrition (30% of cases), followed by malignant diseases (9% of cases) [44]. Difficulties in purchasing and preparing food can also contribute to the development of malnutrition [38]. Handgrip strength and Barthel's Index show an association with the assessment by MNA [28].
The chewing function has an influence on the nutritional status too. Publications focused on this topic are rare [42], [46]. In Japanese edentulous outpatients, the self-evaluation of the masticatory function improved after the switch from old to new dentures [17].
The aim of this study is to find out if the levels of relevant vitamins and the levels of Selenium are decreased in patients defined malnourished or at risk of malnutrition by the MNA and if decreased levels of Selenium or Vitamin C are associated with decreased scores in the Basic Activities of Daily Living (BADLs). Furthermore, it is aimed to find out if patients with poor chewing function, defined by the carrot test have decreased levels of micronutrients.
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Materials and methods
All patients aged 70 years and older admitted with an acute illness to the Department of Geriatrics of the Bonifatius-Hospital Lingen (Ems) between February and March 2003 were included into the study. Patients aged 70 years and older that were admitted to another department of the hospital were not included into the study. The Bonifatius Hospital Lingen is an Academic Teaching Hospital of the Medical School of Hannover in Niedersachsen (Germany) with 416 beds for acute care. The study protocol
Results
Thirty-one patients (18 female, 13 male) were included into the study. The patients had an age between 70 and 91 years. The mean age was 78.2 years.
Only two patients had less than three diagnoses, 13 (42%) had more than six diagnoses.
Only one patient did not take any medication. Four (13%) took more than 10 medications. Two patients (6.4%) were taking multivitamin preparations. Fourteen patients (45%) reported involuntary weight loss. Fifteen patients (48%) were cared for by relatives, 15
Discussion
This study recruited older patients, most of them with significant restrictions in their Activities of Daily Living (ADL): The mean Barthel's Index was 60 points. Most patients had restricted cognitive function.
The mean BMI was 26.78 kg/m2. According to the WHO definition, 19 patients (61%) were overweight. Only one patient had a BMI of < 18.5 kg/m2, which is defined as underweight. However, the WHO definition of normal ranges of BMI is not accepted in older people [29]. In contrast to the
Conclusions
Many geriatric inpatients have deficiencies in vitamins and trace elements. Vitamin C and selenium are particularly low with serum levels below normal limits in more than half of the patients investigated. Vitamin and trace element deficiencies are not restricted to underweight patients but are also of concern in patients with normal BMI and even in overweight patients. Even through geriatric (Barthel's Index, MMST) and nutritional (MNA, Carrot test) assessments cannot predict which patient
Conflict of interest statement
The study was supported by a grant from the German Society for Geriatrics (Deutsche Gesellschaft für Geriatrie, DGG).
Acknowledgements
The authors thank Petra Landwehr, Secretary at Bonifatius Hospital, for her excellent technical assistance.
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