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Nutrition for the Elderly

Renuka Berry

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Nutritional Requirements in Illness
Good nutrition is essential for maintaining health but is also very important during periods of ill health and during recovery from illness. If periods of ill health occur repeatedly, nutritional status may gradually decline over several months or years and remain unnoticed because of its slow, progressive nature.

Illness may affect:Food intakeNutritional requirements - e.g.
  • A rise in body temperature of 1oC increases energy requirements by 10%
  • An elderly person with pressure sores is likely to have higher requirements for energy, protein and nutrients such as vitamin C, iron and zinc to help heal the wound.
Nutrient absorption - e.g.
  • Will be reduced in any condition where the nutrients are lost, such as vomiting or diarrhoea
  • Many commonly prescribed drugs can affect absorption and therefore nutritional status.
Malnutrition in the elderly
Factors contributing to malnutrition in elderly people may be divided into primary and secondary:
  • Primary Social & Environmental
  • Secondary Physical & Mental
  • Ignorance
  • Impaired appetite (due to disease or depression)
  • Poverty
  • Poor dentition
  • Social Isolation and loneliness
  • Reduced absorption
  • Mental Disturbance
  • Increased requirements (E.g. disease trauma, surgery, burns, pressure sores)
  • Physical Disability
  • Alcohol Intake
  • Chronic disease states
  • Drug therapy
  • Iatrogenic (E.g. low fat diet for gallstones, Problem if patients underweight)
Examples of drug-nutrient interactions include:
  • antibiotics (neomycin) which results in malabsorption of fat soluble vitamins and impairs iron absorption; tetracycline
  • steroids which impair vitamin C status
  • metformin may result in vitamin B12 deficiency
Malnutrition is high among the elderly with studies showing that institutionalised elderly are at the greatest risk. Elderly in the community fare better, although living alone may result in impaired nutrition for a variety of reasons.

Detection of Malnutrition
Malnutrition is difficult to diagnose but risk factors such as pressure sores; burns; fractures and other trauma increasing catabolism, e.g. surgery, anorexia, successive periods of starvation for test i.e. the NBM syndrome, renal/liver failure, and should be considered in all elderly patients.

Indicators of malnutrition include clinical features such as weight loss, bruising/bleeding gums, angular stomatitis, poor wound healing and osteomalacia, together with laboratory evidence of anaemia or hypoalbuminaemia.

Over the years, the presence of free radicals (highly unstable molecules generated in the body during the processes that create energy that have a damaging, destructive effect) can cause widespread damage within the body, leading to increased susceptibility to various disorders and the outward signs of ageing. The effects of free radicals include damage to cell walls which may predispose to heart disease and stroke, damage to the internal mechanism of the cells leading to a genetic damage and a possible predisposition to cancer, reduced immune function and damage to proteins in the skin leading to a loss of tissue elasticity.

Fortunately, the body has ways of dealing with free radicals. Molecules called antioxidants can quench free radicals. So ageing is to a degree, determined by the relative balance of free radicals to antioxidants-the greater the ratio of antioxidants to free radicals, the slower the ageing process. The main anti-oxidant nutrients are vitamins A, C and E and the mineral selenium.

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