Undernutrition in the elderly is common and can be associated with adverse medical consequences, contributing to frailty, morbidity, hospitalisation and mortality. Objective This article provides guidelines for screening for undernutrition in general practice, and suggests strategies to address undernutrition in older patients. Discussion
How does nutrition help the elderly?
Nutrition can help the elderly in various ways such as improving their health, reducing risk for disease, and preventing excessive loss of strength Elderly people have a higher risk of being malnourished because they not only have a harder time digesting food but because food is also harder to chew.
Are screening tools appropriate for older adults with incident malnutrition?
The most appropriate screening tools for use among older adults in various settings have been identified, the determinants of incident malnutrition have been distinguished from factors associated with the condition and sex-specific predictors of incident malnutrition have been identified in a large, Irish population dataset.
What are the effects of undernutrition in the elderly?
Nutritional disorders in the elderly Undernutrition is common in older people and has serious adverse effects. Weight loss and low body weight are key markers. Correctable causes, such as depression, are common and should be sought. Structured efforts to encourage food intake, together with nutritional supplements, often are of benefit …
What constitutes an adequate nutritional status in the elderly?
Hence, there is also no definition of what constitutes an adequate nutritional status. In elderly people, assessment of nutritional status is complex and is complicated by multi-morbidity and disabilities combined with nutrition-related problems, such as dysphagia, decreased appetite, fatigue, and muscle weakness.
What is the role of leptin in the body?
What is the purpose of the malnutrition universal screening tool?
How does malnutrition affect the elderly?
What are the clinical signs of nutritional deficiencies?
How many mechanisms of weight loss have been identified in older people?
How does age affect appetite?
What causes muscle mass to be lost?
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About this website
Why is it important to determine the nutritional needs of elderly people?
Good nutrition is important, no matter what your age. It gives you energy and can help you control your weight. It may also help prevent some diseases, such as osteoporosis, high blood pressure, heart disease, type 2 diabetes, and certain cancers.
What is the importance of nutritional screening?
The purpose of nutritional screening is to rapidly identify patients who are at high nutritional risk or have poor nutritional status at hospital admission.
Why is it important to assess a patient for malnutrition?
Malnutrition is an independent risk factor that negatively influences patients' clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support.
Why are the elderly at risk for nutritional deficiencies?
Aging adults tend to eat fewer calories, due to decreased appetite and activity levels. This decrease in caloric intake can also lead to deficient levels of vitamins and minerals. These dietary deficiencies have been linked to chronic diseases such as: heart disease, cancer, and osteoporosis.
What is the purpose of nutritional screening and associated risk assessment?
To identify patients at risk of malnutrition or who are already malnourished.
What does nutrition screening mean?
This is the first step in identifying subjects who may be at nutritional risk or potentially at risk, and who may benefit from appropriate nutritional intervention.
How do you assess nutritional status in the elderly?
BEST TOOL: The Mini-Nutritional Assessment Short-Form (MNA®-SF) is a screening tool used to identify older adults (> 65 years) who are malnourished or at risk of malnutrition. The MNA®-SF is based on the full MNA®, the original 18-item questionnaire published in 1994 by Guigoz and colleagues.
How do you assess malnutrition in the elderly?
Nutritional assessment The MNA-SF is the short version of MNA, a tool for nutritional screening specifically designed for elderly people. It consists of six questions that consider recent weight and appetite loss, mobility, acute disease or psychological stress and body mass index (BMI).
When should nutritional screening be carried out?
2.6 Screening for risk of malnutrition should take place on admission, or at least within 24 hours of admission.
What is the primary goal of diet intervention for the elderly?
access to healthier food and drink options and food poverty. ability to prepare healthier food. functional and cognitive impairment and ability to eat healthier food including poor oral health.
What are 3 nutrition concern risk factors for older adults?
This article explores the medical, social, and physiological factors affecting nutrition in older adults.Appetite. ... Dental health. ... Ability to swallow. ... Depression. ... Disease. ... Taste and smell. ... Nutrient metabolism. ... Ability to shop and cook.More items...•
Which are the nutrients of concern in the elderly population?
As we get older our bodies have different needs, so certain nutrients become especially important for good health.Calcium and Vitamin D. Adults older than 70 need more calcium and vitamin D to help maintain bone health than they did in their younger years. ... Vitamin B12. ... Dietary Fiber. ... Potassium. ... Know Your Fats.
What are the types of nutritional screening?
What are the different types of nutrition assessment? An easy way to remember types of nutrition assessment is ABCD: Anthropometric, biochemical, clinical, and dietary.
What is the purpose of a food frequency questionnaire?
FFQs provide information on consumption of queried foods and beverages over the specified period. Depending on the breadth of items queried, data can be used to assess total dietary intake and/or particular aspects of diet.
What are the four main steps of the nutrition assessment process?
The Nutrition Care Process is a systematic method that dietetics and nutrition professionals use to provide nutrition care. It is comprised of four steps: nutrition assessment and reassessment, nutrition diagnosis, nutrition intervention and nutrition monitoring and evaluation.
How do you assess the nutritional status of a patient?
Nutritional assessment includes patients history, physical examination, anthropometric measurements, laboratory dates and changes of immunocompetence. Anthropometric assessment, like skinfold and muscle area measurements, is not an extremely accurate method predicting nutritional status of an individual patient.
Nutrition in Older Adults: Intervention and assessment can h ... - LWW
Nutrition in Older Adults Intervention and assessment can help curb the growing threat of malnutrition. DiMaria-Ghalili, Rose Ann PhD, RN, CNSN; Amella, Elaine PhD, APRN, BC
Nutrition assessment in the elderly - PubMed
The prevalence of malnutrition, which is relatively low in free-living elderly persons (5-10%), is considerably higher (30-60%) in hospitalized or institutionalized elderly persons. As a result, nutritional assessment should be part of routine clinical practice in elderly patients who are frail, sic …
Optimizing nutrition in older people - PubMed
Older adults are at increased risk of malnutrition, for a variety of physiological and psychological reasons. This has implications for health, quality of life, independence and economic circumstances. Improvements in nutrition are known to bring tangible benefits to older people and many age-relate …
Nutrition and Aging: Assessment and Treatment of Compromised ...
Nutrition is an important determinant of health in persons over the age of 65. Malnutrition in the elderly is often underdiagnosed. Careful nutritional assessment is necessary for both the successful diagnosis and development of comprehensive treatment plans for malnutrition in this population.
What is a Well-balanced Diet for the Elderly?
A healthy diet should have various natural foods like fruits and vegetables. Whole grains and protein should also be included in your diet. It is critical to consume a good portion of fruits and vegetables, and protein should be obtained from lean meats and poultry, and low-fat dairy products.
Why is Nutrition Important for the Elderly?
While your elderly loved one may not want to eat or may prefer sugary or salty foods , getting proper nutrition is essential for their health. Here are some important aspects of good nutrition for elders:
Why Talk About Proper Nutrition in the Elderly?
While nutrients are important for everyone, the topic is particularly relevant for seniors, as they are more at risk of undernutrition due to their decreased metabolism which can lead to various health problems.
Do Seniors Need More Nutrients?
It’s easy to assume that seniors need fewer nutrients than younger people. However, this isn’t the case at all. Instead, seniors still need a decent amount of important nutrients, including protein, calcium, iron, folate, and vitamin B12.
What is MaNuEL in Europe?
The ageing of the European population and its known association with PEM has stimulated research into this topic. The Malnutrition in the Elderly (MaNuEL) project is a Joint Programming Initiative under the A Healthy Diet for a Healthy Life theme that ran from early 2016 until September 2018. The focus of the project is on PEM in older persons aged 65 years and older and the project consortium comprises twenty-two research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) in addition to a stakeholder advisory board of experts in geriatric nutrition, representative of all relevant European expert societies. The project had four main objectives: to gain knowledge; to strengthen evidence-based practice; to build a better research network and to harmonise research and clinical practice across Europe. The design and objectives have previously been explained in detail (#N#Reference Visser, Volkert and Corish#N#14) but a brief outline is given below.
What is PEM in health?
Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) ...
What countries are involved in the MaNuEL project?
The funding agencies supporting the work are (in alphabetical order of participating Member State): Austria: Federal Ministry of Science, Research and Economy; France: Ecole Supérieure d'Agricultures; Germany: Federal Ministry of Food and Agriculture represented by the Federal Office for Agriculture and Food; Ireland: Department of Agriculture, Food and the Marine, and the Health Research Board (grant number 15/RD/HDHL/MANUEL); Spain: Instituto de Salud Carlos III and the SENATOR trial (FP7-HEALTH-2012-305930); The Netherlands: The Netherlands Organisation for Health Research and Development.
What are the determinants of malnutrition?
This meta-analysis identified six determinants of incident malnutrition; these were increasing age, being unmarried/separated/divorced status ( vs. married but not widowed status), difficulties walking 100 m, difficulties climbing a flight of stairs, hospitalisation in the year prior to baseline and hospitalisation during the follow-up period. Across these six datasets, the determinants of malnutrition appear to be predominantly from the demographic and physical functioning domains.
What is the MaNuEL Knowledge Hub?
The MaNuEL Knowledge Hub comprised five connected work packages ( Fig. 1 ): (i) defining malnutrition; (ii) screening for malnutrition; (iii) determinants of malnutrition; (iv) interventions to prevent and treat malnutrition; and (v) policies and education regarding malnutrition screening and interventions. The final, sixth work package focuses on the management of the overall project.
Is malnutrition more prevalent in older people?
Malnutrition is more prevalent in older adults compared with their younger counterpart s (#N#Reference Kyle, Unger and Mensi#N#21). There are many social, environmental and health-related factors which can contribute to the development of malnutrition in this population group (#N#Reference Volkert#N#22). Although there are a plethora of studies which have set out to establish the determinants of malnutrition in older adults, by and large, these studies are cross-sectional in design and their ability to accurately identify those factors which predict and are not solely associated with malnutrition is poor. Hence, the results of these studies are highly heterogeneous (#N#Reference Boulos, Salameh and Barberger-Gateau#N#23–#N#Reference Kvamme, Gronli and Florholmen#N#30) and have done little to clarify accurately the true determinants or predictors of malnutrition in older people. There are only a small number of longitudinal studies that have been conducted among older populations to explore the factors that can predict malnutrition prior to its development (#N#Reference Schilp, Wijnhoven and Deeg#N#31–#N#Reference Mamhidir, Ljunggren and Kihlgren#N#34). A number of systematic reviews have been published on this topic in recent years (#N#Reference Tamura, Bell and Masaki#N#35–#N#Reference Fávaro-Moreira, Krausch-Hofmann and Matthys#N#37). These are summarised in Table 2. These reviews predominantly comprise cross-sectional studies, thus emphasising the need for high-quality longitudinal studies in older populations that investigate the broad range of factors which could influence the development of malnutrition (#N#Reference van der Pols-Vijlbrief, Wijnhoven and Schaap#N#36). Identification of determinants is vital to enable nutrition and healthcare strategies to be implemented that could potentially reduce the incidence of malnutrition in the older population.
Does eating alone cause malnutrition?
Interestingly, disease-related (with the exception of hospitalisation), food intake, lifestyle, psychological and social factors had no association with incidence of malnutrition in this meta-analysis. Furthermore, across all six studies, appetite falls in the year prior to baseline, living alone, polypharmacy, smoking status and social support consistently showed no association with incident malnutrition. Although further meta-analyses are warranted to confirm these factors as the true determinants of malnutrition in older adults, the meta-analysis study methods are strong; a uniform definition of incident malnutrition was applied across all datasets, a wide range of harmonised potential determinants was assessed and a standardised protocol for data analysis was implemented. Furthermore, this meta-analysis included six longitudinal cohorts of older adults from Western populations. The findings from this meta-analysis should be incorporated into strategies to identify older persons vulnerable to developing malnutrition. This is particularly relevant for determinants which are potentially modifiable (e.g. mobility limitations).
What is the medical term for weight loss and undernutrition?
Can encompass both overnutrition and undernutrition, but often used to refer to undernutrition only. 2. Undernutrition: A clinical syndrome characterised by weight loss associated with significant depletion of fat stores and muscle mass. Also known as protein energy undernutrition. 3.
What are the consequences of undernutrition in elderly people?
Undernutrition in the elderly is common and can be associated with adverse medical consequences, contributing to frailty, morbidity, hospitalisation and mortality.
Why is screening for undernutrition important?
Screening for undernutrition in general practice helps focus time and resources on people at greatest risk. Early identification and management of people at risk of undernutrition is important because it is difficult to reverse its adverse effects, once established.
What age can you incorporate a nutritional status screening tool into your annual health assessment?
for patients aged ≥75 years, incorporate a simple nutritional status screening tool (discussed below) into the 75+ annual health assessment.
How often should elderly patients weigh?
weigh elderly patients at every visit or twice yearly if a patient is seen frequently, with any recorded weight loss triggering nutritional screening (in the elderly, weight loss over time is a better indicator of undernutrition than BMI)
Why is nutritional therapy important?
Nutritional therapy is an important component in the management of undernourished patients, and should be provided alongside medical and social/functional interventions. Dietary requirements change in elderly people.
Why is resistance training important for elderly?
While not an intervention for undernutrition, resistance training is essential to maximise muscle mass and strength in the elderly. Physical activity provides an opportunity for linking to social activities as well, which can improve general wellbeing and contribute to better energy intake.
What is the role of leptin in the body?
Leptin is a hormone produced by adipose cells whose main role is maintaining energy balance. Low leptin signals loss of body fat and a need for energy intake, while high leptin level implies adequate body fat and no need for further food intake.41Older people tend to have higher levels of leptin.46
What is the purpose of the malnutrition universal screening tool?
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool to identify adults who are malnourished or at risk of malnutrition.53It includes management guidelines that can be used to develop a care plan. The tool is being used both in hospitals and in the community. The tool is easy to use and can be used by all care workers to derive a malnutrition risk score of either low, medium or high. It consists of three components: BMI, history of unexplained weight loss, and acute illness effect. Studies have shown that it has a high predictive validity in the hospital environment (length of stay, mortality in older people, and discharge destination in orthopedic patients).54It is more efficient and faster than most other screening tools (3 to 5 minutes).55It has been recommended as a screening tool by the National Institute of Clinical Excellence (NICE), the British Association for Parental and Enteral and Nutrition (BAPEN) and the British Dietitian Association (BDA).
How does malnutrition affect the elderly?
Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements.
What are the clinical signs of nutritional deficiencies?
A large number of clinical signs indicate nutritional deficiencies. The general impression is a wasted, thin individual with dry scaly skin and poor wound healing. The hair is thin and nails are spooned and depigmented. Patients complain of bone and joint pain and edema. Specific nutritional deficiencies are associated with specific clinical signs (see Table 1).
How many mechanisms of weight loss have been identified in older people?
Three distinct mechanisms of weight loss in older people have been identified32
How does age affect appetite?
With increasing age appetite declines and food consumption declines. Healthy older people are less hungry and are fuller before meals, consume smaller meals, eat more slowly, have fewer snacks between meals and become satiated after meals more rapidly after eating a standard meal than younger people. The average daily intake of food decreases by up to 30% between 20 and 80 years.24Most of the age-related decrease in energy is a response to the decline in energy expenditure with age. However in many older people the decrease in energy intake is greater than the decrease in energy expenditure, and therefore body weight is lost. This physiological age-related reduction in appetite and energy intake has been termed the “anorexia of aging” (Figure 1).4
What causes muscle mass to be lost?
Cachexia is an involuntary loss of fat-free mass (muscle, organ, tissue, skin and bone) or body cell mass; it is caused by catabolism and results in changes in body consumption. An acute immune response occurs. Cytokines are released (interleukin [IL]-1, IL-6, tumor necrosis factor alfa [TNFα]) that have profound effects on hormone production and metabolism causing increased resting energy expenditure.33Amino acids from muscle to the liver, an increase in gluconeogenesis and a shift of albumin production to acute phase proteins causes nitrogen balance to become negative, so muscle mass is lost. Cachexia is seen in many chronic diseases such as heart failure and rheumatoid arthritis. It is also seen in malignancy.