Malnutrition in the elderly. Malnutrition results from an imbalance between the body's needs and the nutritional intake. In the elderly, it is often linked to insufficient food consumption and manifests itself as weight loss, in particular muscle mass. Too often ignored, malnutrition in the elderly is a major public health problem. Malnutrition leads to or worsens a state of fragility and/or dependence in the elderly. It adversely affects quality of life and life expectancy.
Malnutrition, what are the causes ? With age, several factors can lead to modifications in food consumption. A decline in the ability to perceive the taste of food, poor dentition, the appearance of swallowing disorders or a dry mouth make eating unattractive, uncomfortable, and sometimes painful. A fall in income, solitude or a lack of cooking skills leads to reduced food variety. Neurological diseases, such as Alzheimer disease or Parkinson disease or the consequences of stroke are often associated with food behaviour disorders. Finally, depression, the onset of disease, hospitalization or the taking of drugs is often linked to a loss of appetite.
Malnutrition, what are the consequences ? Muscle wasting accentuates the risk of falling and therefore fractures. Malnutrition also causes immune deficiency and thus increases the risk of infection or an aggravation of existing disease. We often speak about the «spiral of malnutrition». Malnutrition leads to a deterioration in general health and triggers the onset of a health problem (for example, a fall). This in turn aggravates the malnutrition (for example, weight loss during hospitalization), which may lead to immune deficiency. Other more serious disease episodes occur, until a point is reached where it is no longer possible to return to the initial situation.
Malnutrition in key numbers. According to a review of the literature conducted by the Health Care Authorities (HAS), malnutrition affects 4% of autonomous elderly people, 25 to 30% of elderly people who receive help for everyday tasks, 15 to 38% of those living in care homes and 50 to 60% of hospitalized elderly people (HAS, 2007).
Screening for malnutrition : simple way to prevent and to screen for malnutrition is to weigh yourself regularly – once a month. In the elderly, significant and involuntary weight loss is never normal. Weight loss of 5% or more in one month or 10% in 6 months compared with usual weight is an alert signal. In cases of doubt, the doctor will prescribe a blood analysis (levels of albumin and pre-albumin). Screening for malnutrition, also means recognising high-risk situations :
- The onset of disease, hospitalization, bed-ridden for long periods
- Depression, pain
- Taking a large number of drugs
- Financial problems, isolation, loss of a spouse
- Swallowing disorders
- Poor dentition, badly-fitting denture, buccal mycosis, dry mouth, when eating becomes painful
- Restrictive diets
- Dependence, the delegation of everyday tasks (notably shopping, the preparation of meals) to others
Fighting against malnutrition. Once malnutrition has been diagnosed, it is important to act fast. Indeed, if nothing is done, it will rapidly deteriorate to reach a stage when it will be impossible to return to normal healthy aging. Depending on the severity, several strategies can be implemented:
Nutritional support implemented by the primary care doctor or a dietician. The aim is to determine what the person eats and to propose modifications to the diet to increase nutritional intake. For example, the person can be advised to have an evening snack to reduce the period of fasting between the evening meal and breakfast (less than 12h to avoid morning hypoglycaemia and prevent the burning up of muscle reserves), to eat more energy-rich or protein-rich foods (dairy products, ham, egg-based desserts…).
An enrichment of everyday diet. This consists in including energy-rich or protein-rich food in the elderly person's usual diet. For example, add melted cheese to soup, or an extra egg in a quiche or flan, or add fresh cream to pasta, or powdered milk to yoghurt or cottage cheese or to replace the drop of milk in tea or coffee.
Oral nutritional supplements. These are high-energy and/or high-protein mixtures, prescribed by a doctor. There are different types: soups, drinks, creams … These nutritional supplements can be consumed during a meal or as a snack.