What is it about ?
By nutritional disorders we mean both the excess and the deficiency of one or more nutrients. For example, if your diet is not balanced enough, it is possible that you are eating enough sugars and fat, but you are lacking in protein and vitamins.
Undernutrition is a global nutrient deficiency. Conversely, over-nutrition with weight gain also exists.
Aging brings about many changes in the body. Muscle mass decreases, and body fat increases. Physical activity decreases, and metabolism slows, as does stomach emptying and food digestion.
In addition, the elderly can present various risk factors for undernutrition such as:
- socio-economic factors: loneliness, isolation and insufficient financial resources can have an impact on shopping, meal preparation and the desire to eat. Hidden poverty can also have a negative influence on the quality of food.
- physical factors: neuropsychiatric disorders (dementia, depression and Parkinson disease), chronic diseases (diabetes, cancer and diseases of the heart and lungs), disturbances of the senses (decrease in vision, smell or taste), changes in body constitution and function due to age (damage to teeth, consequences surgical interventions and reduced mobility, resulting in loss of autonomy).
- metabolic factors: changes in metabolism due to side effects of drugs, excessive alcohol consumption, influence of diseases on food absorption. During infections and periods of rehabilitation after illness or surgery, energy (calories) and especially protein requirements increase.
- dietary factors: unnecessary or unnecessarily strict diet, reduction of the number of meals to only two per day.
All of this can lead to greater susceptibility to disease and lead to death, slowing wound healing and recovery from illness, as well as an increased risk of falls and fractures.
What is their frequency?
In Western countries, 5-10% of the elderly population suffers from undernutrition. A Belgian study shows that, among people aged 70 or over living at home, 45% are at risk of undernutrition and 12% suffer from undernutrition. In our residential care centers, the risk is 57% while 16% of residents are undernourished. Malnutrition is observed in 30 to 40% of hospitalized patients.
How to recognize them?
Deterioration in nutritional status is often not recognized. The right parameters are weight and BMI (body mass index). A unintentional weight loss (without dieting) by more than 5% in the last three months or more than 10% in the last 6 months is a red flag. A BMI below 18.5 indicates underweight.
Certain signs can also indicate that something is wrong: delayed healing, reduced activity, presence of pressure sores, confusion, decreased interest … The “Mini Nutritional Assessment” is a good test to assess and confirm undernutrition. This questionnaire was specially designed to detect undernutrition in the elderly.
How is the diagnosis made?
The doctor will first perform a general clinical examination with weight measurement and BMI calculation. Using a blood test, he will look for the possible presence of diseases such as infections, thyroid disease, cancer and diabetes. The blood test can also detect specific deficiencies, such as iron deficiency or certain vitamins.
There are also scales to assess the nutritional status of the elderly. The MNA questionnaire is considered the most reliable tool. It measures six factors: decreased food intake, recent weight loss (last three months), mobility, presence of acute stress in the past three months, neuropsychiatric problems and BMI. A score is assigned to each factor. The total score gives an idea of nutritional status.
What can you do ?
A slight overweight in the elderly is not a problem. You should only lose weight if there are good reasons to do so, for example in case of diabetes or heart disease. People over the age of 75 rarely benefit from weight loss. If a diet is necessary, it should preferably be gradual to avoid loss of muscle and deterioration of general condition.
The most important thing is to avoid undernutrition. In healthy elderly people, the diet should be balanced and varied, with at least 1 to 1.2 grams of protein per kilogram of body weight each day. They should eat enough fresh vegetables and fruits. Due to changes in the body, older people are better off eating smaller amounts; therefore rather small portions 4 times a day than a large portion 2 times a day. It is also important that they eat at set times. This not only ensures a routine, but also gives structure to the day. Meals then become something that we look forward to. Eating is a social event. The elderly will therefore eat more and with more pleasure if they are in company.
Make sure you get enough physical exercise, both indoors and outdoors. A minimum of sun on the skin is necessary to have enough vitamin D.
If the older person is less mobile or becomes ill, it may be helpful to talk to them and all caregivers to develop a general plan of care. The advice of a dietitian or a nutritionist may be requested. Have a hot meal delivered to your home every day or several times a week. Try to arrange for someone from the family or home nurses to be present during the meal. If supervision is difficult, the elderly person can also be cared for a few days a week in a day care center. These procedures can be initiated through the general practitioner, home care services or home care of the CPAS.
What can your doctor do?
The doctor will start by detecting and treating the underlying illnesses. It will correct specific deficiencies such as iron, vitamin B12, calcium or vitamin D deficiency, and it will monitor whether the nutritional status improves as a result of the measures taken. If necessary, he seeks the advice of a geriatrician (specialist in the care of the elderly).
Want to know more?
- The food pyramid – Eat Move – Health Question
- Food advice for seniors – Hôpital Erasme
- Move at any age… After 50 too! – Eat Move – Health Question
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