What are the common nutrition related problems in the elderly?

Nutrition: Age old nutrition problems

Certain groups of older people may be at risk of nutritional deficiencies, writes Sheena Rafferty

Adequate nutritional status is vital for any age group and is particularly important for older people. While the vast majority of older people in Ireland are well nourished, there are some who are housebound, living in poor social circumstances or cognitively impaired and who are at a significant risk of nutritional deficiencies.

Studies of older people in the community found that 14% of people over the age of 65 had physical difficulties in cooking a hot meal. Combined with other physical factors such as difficulties doing heavy grocery shopping (34%) or difficulties in walking to the shops (27%), this has potentially serious implications for the nutritional status of older people.

Ageing is characterised by a loss of lean muscle mass, a reduced basal metabolic rate and a reduction in physical activity. Therefore, the energy requirements of the older population are reduced.

Specific problems which may occur in the elderly population include:

• excess weight
• underweight
• constipation
• diabetes mellitus.

Factors which can identify those at risk of poor nutritional status include being housebound, living alone, depression, chronic ill health, polypharmacy, poor dentition or no regular cooked meals.

Inadequate energy and nutrient intake has several effects which can be identified easily in some cases. However, in many cases the effects of an inadequate dietary intake will be difficult to identify before clinical symptoms occur.

Weight loss is a common indicator of inadequate energy and nutrient intake in older adults.

Percentage weight loss can be calculated as follows:

% weight loss = (usual weight-actual weight) x 100 / usual weight

This is a useful indicator of nutritional status. A weight loss of 10% or more during the preceding three months is cause for concern.

Some older patients may have practical difficulties which affect their intake of food. Their physical environment and social circumstances affect mealtimes.

Special nutritional needs

The nutritional requirements of older people are generally similar to the general population. However, some nutrients require special attention (see Table ).

Therapeutic diets

Special therapeutic diets may be required for the older patient. The common types include diabetic and weight reducing diets.

When tailoring a therapeutic diet to the needs of an older person some points need to be taken into account. Any dietary changes should be simple and kept to a minimum.

At all times remember that you are trying to change the habits of a lifetime. Quality of life is often associated with enjoyment of food, therefore the benefits of the diet must be weighed up against the quality of life of the person.

A dietitian may be available to adapt dietary intake for therapeutic diets in the elderly.

Other factors such as immobility or inactivity often contribute to the condition of the older person. It is therefore important to account for this. The benefit of physical exercise on health has been shown in people in their 90th year, so it is never too late to start.

Nutritional supplements

Nutritional supplements are commonly prescribed for specific conditions, post operatively or in the community setting.

These are nutritionally complete feeds used for patients who are being artificially or sip fed. Patients will have a medical reason for using these supplements.

Chronic illness

There are many illnesses which require an increase in nutritional intake such as:

• cancer cachexia
• recovery from surgery or major trauma
• weight loss due to prolonged illness
• poor wound healing and immune function .

There are three ways in which the dietary intake can be increased:

• foods can be fortified
• sip feeds can be used
• artificial feeding is indicated if the patient is at long-term risk of nutritional deficiencies or poor dietary intake.

* Sheena Rafferty is community nutritionist, Eastern Regional Health Authority

1. Krznarić Ž, Vranešić Bender D, Ljubas Kelečić D, Reiner Ž, Tomek-Roksandić S, Kekez D, et al. Hrvatske smjernice za prehranu osoba starije dobi-dio II,(klinička prehrana). Lijec Vjesn. 2011;133:299–307. [PubMed] [Google Scholar]

2. Landi F, Picca A, Calvani R, Marzetti E. Anorexia of aging. Assessment and management. Clin Geriatr Med. 2017;33:315–23. doi: 10.1016/j.cger.2017.02.004. [PubMed] [CrossRef] [Google Scholar]

3. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúńiga C, Arai H, Boirie Y, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014;43:748–59. doi: 10.1093/ageing/afu115. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

4. Nagano A, Nishioka S, Wakabayashi H. Rehabilitation nutrition for iatrogenic sarcopenia and sarcopenic dysphagia. J Nutr Health Aging. 2019;23:256–65. doi: 10.1007/s12603-018-1150-1. [PubMed] [CrossRef] [Google Scholar]

5. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36:49–64. doi: 10.1016/j.clnu.2016.09.004. [PubMed] [CrossRef] [Google Scholar]

6. Nicholson JA, Dowrick AS, Liew SM. Nutritional status and short-term outcome of hip arthroplasty. J Orthop Surg (Hong Kong) 2012;20:331–5. doi: 10.1177/230949901202000313. [PubMed] [CrossRef] [Google Scholar]

7. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyčre O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res. 2019;31:799–805. doi: 10.1007/s40520-019-01128-3. [PubMed] [CrossRef] [Google Scholar]

9. Valentini A, Federici M, Cianfarani MA, Tarantino U, Bertoli A. Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects. Clin Interv Aging. 2018;13:1237–44. doi: 10.2147/CIA.S164174. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

10. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33:929–36. doi: 10.1016/j.clnu.2014.04.007. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

11. Vranešić Bender D, Giljević Z, Kušec V, Laktašić Žerjavić N, Bošnjak Pašić M, Vrdoljak E, et al. Smjernice za prevenciju, prepoznavanje i liječenje nedostatka vitamina D u odraslih. Lijec Vjesn. 2016;138:121–32. [PubMed] [Google Scholar]

12. Sohl E, de Jongh RT, Heijboer AC, Swart KMA, Brouwer-Brolsma EM, Enneman AW, et al. Vitamin D status is associated with physical performance: the results of three independent cohorts. Osteoporos Int. 2013;24:187–96. doi: 10.1007/s00198-012-2124-5. [PubMed] [CrossRef] [Google Scholar]

13. Cruz-Jentoft AJ. Beta-hydroxy-beta-methyl butyrate (HMB): from experimental data to clinical evidence in sarcopenia. Curr Protein Pept Sci. 2018;19:668–72. doi: 10.2174/1389203718666170529105026. [PubMed] [CrossRef] [Google Scholar]

14. Beaudart C, Dawson A, Shaw SC, Harvey NC, Kanis JA, Binkley N, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. 2017;28:1817–33. doi: 10.1007/s00198-017-3980-9. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15. Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y) 2013;9:784–95. [PMC free article] [PubMed] [Google Scholar]

16. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98. [PMC free article] [PubMed] [Google Scholar]

17. Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–28. doi: 10.2147/CIA.S107750. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

18. Poljaković Z, Vodanović D, Vranešić Bender D, Ljubas Kelečić D, Starčević K, Kolundžić Z, et al. Smjernice za rano prepoznavanje, dijagnostiku i terapiju neurogene orofaringealne disfagije. Lijec Vjesn. 2017;139:118–35. [Google Scholar]

19. EPUAP (European Pressure Ulcer Advisory Panel). Volume 7, Issue 2, 2006. Pressure Ulcer Prevention in all hospital and home-care settings. Available from: https://www.epuap.org/wp-content/uploads/2019/11/quick-reference-guide-digital-npuap-epuap-pppia-jan2016-croatian.pdf. Accessed: January 20, 2020.

20. Quain AM, Khardori NM. Nutrition in wound care management: a comprehensive overview. Wounds. 2015;27:327–35. [PubMed] [Google Scholar]

21. Fontaine J, Raynaud-Simon A. Pressure sores in geriatric medicine: the role of nutrition. Presse Med. 2008;37:1150–7. doi: 10.1016/j.lpm.2007.11.016. [PubMed] [CrossRef] [Google Scholar]

22. Singer P. Nutritional care to prevent and heal pressure ulcers. Isr Med Assoc J. 2002;4:713–6. [PubMed] [Google Scholar]

23. Ogura Y, Yuki N, Sukegane A, Nishi T, Miyake Y, Sato H, et al. Treatment of pressure ulcers in patients with declining renal function using arginine, glutamine and β-hydroxy-β-methylbutyrate. J Wound Care. 2015;24:478–82. doi: 10.12968/jowc.2015.24.10.478. [PubMed] [CrossRef] [Google Scholar]

24. Sanders CL, Wengreen HJ, Schwartz S, Behrens SJ, Corcoran C, Lyketsos CG, et al. Nutritional status is associated with severe dementia and mortality: the cache county dementia progression study. Alzheimer Dis Assoc Disord. 2018;32:298–304. [PMC free article] [PubMed] [Google Scholar]

25. Jones S. Nutritional interventions for preventing malnutrition in people with dementia. Nurs Older People. 2019 doi: 10.7748/nop.2019.e1144. [PubMed] [CrossRef] [Google Scholar]

26. Herke M, Fink A, Langer G, Wustmann T, Watzke S, Hanff AM, et al. Environmental and behavioural modifications for improving food and fluid intake in people with dementia. Cochrane Database Syst Rev. 2018;7:CD011542. [PMC free article] [PubMed] [Google Scholar]

27. Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, et al. ESPEN guidelines on nutrition in dementia. Clin Nutr. 2015;34:1052–73. doi: 10.1016/j.clnu.2015.09.004. [PubMed] [CrossRef] [Google Scholar]

28. Cummings J, Passmore P, McGuinness B, Mok V, Chen C, Engelborghs S. Souvenaid in the management of mild cognitive impairment: an expert consensus opinion. Alzheimers Res Ther. 2019;11:73. doi: 10.1186/s13195-019-0528-6. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

29. Zhang DM, Ye JX, Mu JS, Cui XP. Efficacy of vitamin B supplementation on cognition in elderly patients with cognitive-related diseases. J Geriatr Psychiatry Neurol. 2017;30:50–9. doi: 10.1177/0891988716673466. [PubMed] [CrossRef] [Google Scholar]

30. Ayman AR, Khoury T, Cohen J, Chen S, Yaari S, Daher S, et al. PEG insertion in patients with dementia does not improve nutritional status and has worse outcomes as compared with peg insertion for other indications. J Clin Gastroenterol. 2017;51:417–20. doi: 10.1097/MCG.0000000000000624. [PubMed] [CrossRef] [Google Scholar]