Malnutrition In Old Age - Malnutrition: Causes And Treatment

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Malnutrition and malnutrition in old age

Malnutrition (malnutrition) is a common problem among senior citizens, with the proportion of those affected increasing with age. The changes in eating and drinking behavior often lead unnoticed to an insufficient energy intake, the body weight decreases, sometimes to severe underweight (old age anorexia). At the same time, those affected are undersupplied in essential nutrients, vitamins and minerals. Malnutrition is often not recognized as such, but incorrectly referred to as "old age". It can have a negative impact on the course of many diseases and even increase the mortality rate. Therefore: look closely, recognize early and act immediately.

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• What is malnutrition?
• What are the causes of malnutrition?
• How can malnutrition be diagnosed?
• What are the consequences of malnutrition?
• How is malnutrition treated?
• Tips for malnutrition and malnutrition

What is malnutrition?

Malnutrition results in a lack of energy, protein or other nutrients (e.g. vitamin B12). A distinction can be made between quantitative and qualitative malnutrition. If less energy is consumed over a longer period of time than what is actually required, it is a question of quantitative malnutrition. If there is a lack of protein or another nutrient (e.g. vitamins, bulk and trace elements), it is a question of qualitative malnutrition. In addition, senior citizens often suffer from a combination of quantitative and qualitative malnutrition.

Younger senior citizens are more often affected by qualitative malnutrition, which can often be associated with obesity. Because even with an unbalanced composition of the food, too many calories can lead to a lack of important essential nutrients. Quantitative malnutrition is primarily a problem for the elderly.

Note Malnutrition can worsen the course of many diseases and have a negative impact on many body functions (e.g. wound healing and susceptibility to infection).

Further information on "Important nutrients for seniors".

What are the causes of malnutrition?

Malnutrition can have various causes. These include numerous physical and psychological factors, such as chewing and swallowing disorders, decreasing sense of smell and taste, reduced stomach distension and increased activity of the satiety hormones, loss of appetite (e.g. due to medication) and social factors (e.g. loneliness, loss of the partner, fear and Shame, for example when asking for help with eating). In addition, numerous acute and chronic diseases (e.g. dementia, the tremors in Parkinson's disease and paralysis after a stroke) can make eating more difficult and thus reduce it.

How can malnutrition be diagnosed?

There are various methods of determining malnutrition or the risk of malnutrition. Not only one method should be used alone (e.g. BMI or measurement of the calf circumference), but a combination of several, as is done in a screening (e.g. MNA). Which includes:

• Regular weight control and careful observation of the senior (e.g. behavior while eating, amount of food, etc.).
• Measurement of calf circumference and triceps skin fold thickness.
• Calculation of the BMI: According to the DGE, a senior citizen (aged 65 and over) is considered malnourished if the BMI is below 20. Seniors with a BMI of 20 to under 22 are considered to be at risk of developing malnutrition. This classification differs significantly from the BMI classification for adults (19 to under 65 years of age). More information under The Body Mass Index.
• Documentation of the weight history of the last months to years: The BMI alone is not sufficient to assess the nutritional status. Therefore, the weight history is very important for assessing the current body weight. If, for example, a senior citizen has always been “a little firmer” and has lost significant body weight within a short period of time (over five percent in three months or over ten percent in six months), this is a clear warning signal for possible malnutrition.
• Carrying out a screening (e.g. Mini Nutritional Assessment - MNA) in care facilities: This screening should take place as part of an anamnesis immediately after admission to a care facility, for example. The screening should be repeated regularly every three months, but at least once a year. If there are risks or signs of malnutrition, a detailed record of the nutritional status and all influencing factors is recommended (assessment). Appropriate therapeutic measures can be derived from this information (German Network for Quality Development in Nursing - DNQP).

What are the consequences of malnutrition?

The insufficient supply of energy and nutrients over a long period of time has serious effects on numerous body functions. As a result, malnourished senior citizens have a higher mortality rate and a significantly higher risk of numerous diseases. These include, among others

• Decreasing muscle mass and strength (sarcopenia) as well as frailty ("Frailty"); this can also affect breathing or digestion (intestines), as the internal organs are also dependent on strong muscles.
• Decreasing mobility.
• Slowed recovery time (convalescence).
• Impaired wound healing and increased risk of pressure ulcers ("bedsores").
• Increased risk of falls and broken bones (fractures).
• Neurological and cognitive disorders (e.g. in memory and perception).
• Increased risk of various diseases (e.g. various cancers).
• Increased mortality risk.
• Decreased quality of life.

How is malnutrition treated?

The treatment of malnutrition is all the more effective, the earlier it takes place and above all before a significant weight loss occurs. Because in old age, weight loss is difficult or impossible to compensate. It is important to find out the cause (s) of the malnutrition. In addition, the treatment takes place individually on the basis of the eating biography (e.g. what people liked to eat in the past? Which foods don't taste good?).

Note Good communication between different professional groups (medicine, nursing, dietology, speech therapy, kitchen) and relatives are the best prerequisites for optimal care, care and therapy for senior citizens.

Nutritional therapy for malnutrition follows a step-by-step plan. The goal is by means of oral nutrition(possibly with supplements and / or drinking foods) to ensure a complete diet with foods that have a high nutrient density. Food or individual food components such as sauces, soups, porridges, mashed potatoes and various desserts can be enriched to increase the calorie intake. For example, high-quality vegetable oils or margarine, ground nuts and seeds, whipped cream, creme fraiche and butter are suitable for enriching food. If the requirement cannot be met through oral nutrition, the meals can be supplemented with carbohydrate and protein concentrates, vitamin or mineral supplements. In addition, specially fortified foods and drinks are available.

The enteral feeding becomes necessary when (ev. Enriched with nutrient concentrates and / or sip feeds) by the oral nutrition can not be met the energy and nutrient requirements. The aim is to compensate for the energy and nutrient deficits caused by enteral nutrition. Therefore, a combination of oral and enteral nutrition often makes sense.

If the nutrition is neither oral nor enterally sufficient, parenteral nutrition is the only way to ensure the supply of energy and nutrients. The gastrointestinal tract is bypassed by means of parenteral nutrition. In addition, mixed forms of oral, enteral and parenteral nutrition are possible.

Note The use of supplements and sips should always be discussed with a doctor and a dietician. They can also provide information about any cost reimbursement by the health insurance company and give in-depth advice on nutrition.

Enteral as well as parenteral nutrition must be ordered by the attending physician.

Tips for malnutrition and malnutrition

• Recognize causes and investigate them: Even small changes can eliminate the cause of malnutrition or malnutrition (e.g. adjusting a denture).
• Observe behavior: If meals and drinks are sometimes completely refused and the person concerned no longer has an appetite or enjoys eating, these can be alarm signals.
• Observe the weight trend: does the belt have to be tightened or do rings slip off your fingers? Regular weight checks can be recognized in good time and make countermeasures easier. Measuring the circumference of the upper arm is also helpful in identifying a weight trend. Eating and drinking logs help to estimate the amounts consumed.
• Increase energy and nutrient density : Food with a high energy density (e.g. high-fat dairy products) and the enrichment of dishes (e.g. sauces, soups and porridges with high-quality vegetable oils, ground nuts or seeds) can remedy an insufficient supply of energy. Milk and dairy products, as well as grains and legumes, provide valuable protein that older people are often lacking. Measures should only be taken after consulting a doctor and a dietician.
• Stimulate appetite & taste: Strong seasoning with herbs and spices intensifies the smell and taste of the food and stimulates the appetite. Warning: Salt should no longer be used!
• Improve the handling of food: Small dishes (e.g. finger food) in bite-sized form are easier to chew and the sometimes arduous handling of knives and forks can be avoided. For example, small pieces of fruit and vegetables, bread canapes, cheese cubes, small patties made from meat, vegetables or fish, croquettes, solid casseroles, dried fruit, fruit bars, etc. are suitable. Special crockery and cutlery as well as accessories can also make things easier. Advice on aids can be provided by an occupational therapist.
• Distribute adequate intake over the day: Since the stomach of older people can no longer stretch as well and saturation sets in faster, only small portions are usually consumed. Many small (between) meals that are spread over the day are more suitable than a few large meals. A late meal (e.g. yoghurt, milk drink, fruit or cheese cubes) can prevent an undersupply.
• Creating a pleasant dining atmosphere, observing individual needs and providing variety: This promotes appetite and the willingness to eat and drink.

Note Elderly people sometimes have to take a lot of medication (multi-medication or polypharmacy). Unwanted side effects (e.g. dry mouth, nausea, loss of appetite and the reduced absorption of certain nutrients, such as vitamin B12 via the gastrointestinal tract) can lead to malnutrition. Discuss this with your doctor and your dietician.