The burden of malnutrition in the elderly
Underdiagnosed and all too common, this condition is a public health challenge. However, glimmers of hope are emerging both in prevention and actions.
In medicine, individuals aged 65 and older have a specialized medical field dedicated to them, called geriatrics. The reason for this distinction is quite simple: elderly individuals have a different, more fragile body that ages, and their needs are distinct. This has a particular impact on their nutritional requirements. Unfortunately, there is often a significant lack of understanding of these needs, leading to the frequent occurrence of malnutrition. Studies estimate that 4 to 11% of elderly individuals living at home are affected by it. However, the actual figures are likely much higher due to a lack of diagnosis.
Specific Nutritional Needs
Elderly individuals must adapt their diet to the aging process of their bodies. Firstly, there is an increased need for water. Not only do bodily changes due to aging often trigger thirst too late, sometimes when dehydration has already set in, but the sensation of thirst is relieved by a much smaller amount of water. The real risk of dehydration can contribute to loss of appetite and the impairment of certain functions, such as renal activity. It is crucial to avoid dehydration.
Secondly, contrary to common belief, their energy needs must be maintained, if not increased. While the decrease in physical activity due to aging causes a slight reduction in energy needs, aging itself is very energy-demanding. Any stress on the body, such as viruses or the onset of chronic illness, may require a significant amount of energy to return to a situation close to normal and maintain it. At this stage, there is no longer a distinction between men and women when considering energy needs. It is crucial to individualize their estimation as much as possible, as calorie ranges are often given for adults (between 1,800 and 2,200 kilocalories per day depending on gender and physical activity). Thus, energy needs are calculated based on the weight of the elderly person, considering a requirement of 36 kilocalories per kilogram per day. It is very important to ensure that the intake remains balanced and even slightly enriched in proteins to limit the loss of muscle mass inherent in aging. If not properly applied, malnutrition may occur.
At what point do we speak of malnutrition?
Malnutrition is basically defined by an imbalance between nutrient intake and the body's needs. It can occur at any age but is much more common in older individuals. Outside the context of hospitalization in geriatric services, where monitoring is very strict, it is rather difficult to establish a diagnosis of malnutrition. Weight loss is the first warning signal. Other elements, even if non-specific, can also be suggestive and should be considered: a decrease in walking speed (due to reduced muscle strength from protein deficiency), hollowed facial features (a visible area sensitive to weight loss), disengagement from activities the person loves, or difficulty concentrating.
The diagnosis is based on several criteria:
- The proportion of weight lost (not the exact weight value)
- Biological markers measured through a blood test to assess protein stores
- A specific questionnaire addressing the patient's nutritional daily life
- The Body Mass Index (BMI) is also considered. If it is below 21, it is an argument in favor of malnutrition. Unfortunately, even above 21, one can be malnourished. Obesity does not prevent malnutrition, and this complexity further complicates the diagnosis.
Hunger is just the beginning of the problem.
The primary cause of malnutrition in individuals over 65 is insufficient food intake. Loss of appetite or interest in meals, age-related taste changes, and the onset of neurodegenerative diseases like Alzheimer's and related conditions are potential reasons for this decrease in food consumption.
As a result, the elderly person enters the spiral of malnutrition, defined in 1993 by Dr. Monique Ferry, a french geriatrician and nutritionist. Certainly, the gradual reduction in food intake results in a cascade of effects, starting with reversible outcomes like weight loss and minor immune system impairments. However, over time, these effects become irreversible, giving rise to psychiatric disorders, heightened susceptibility to adverse reactions from even common medications, and the development of pressure sores. These wounds can vary in severity and occur when a particular position is sustained for an extended period, causing compression of blood vessels at specific pressure points.. Usually, as the consequences progress toward irreversibility, the person gradually loses autonomy and often needs hospitalization or care in a specialized facility.
Fig 1. Spiral of malnutrition (https://www.nutrisens.com/en/malnutrition/)
The major challenge of prevention
Degradation of general health, depressive state, or even real depression, dependence, increased susceptibility to infections, are symptoms of malnutrition that greatly vary between individuals. Malnutrition is not to be taken lightly as it will have numerous consequences. The risk of mortality is multiplied by a factor of five on average. When malnutrition is established, dietary intervention with individualized advice is essential to enrich the diet again. Sometimes, this is not sufficient, and enteral nutrition may be necessary.
As in many situations, prevention remains the best tool we have to avoid the onset of the disease. The french National Nutrition and Health Plan (PNNS) 2019-2023 had, among its objectives, the goal of improving malnutrition prevention. Actions have been implemented at different levels in recent years. Recently, digital programs such as C-Diet or E-Nutriv have been launched with the support of departmental councils. These tools are intended to enable early and systematic screening of the elderly population in France.
For some years now, companies have been developing products to counteract the condition when it is established. Perfectly adapted to the nutritional needs of those over 65 and the deficiencies caused by malnutrition, these developed products help the body reverse the malnutrition process. The key for development teams: pleasure! Yes, the first point that will help a malnourished person return to normal eating is the pleasure of eating. One example is a relatively new company, La Picorée, which offers very appetizing sweet and savory mini-cakes, eaten in a flash, providing a sufficient dose of protein and calories to help counteract malnutrition.
If the reception of these preventive actions and solutions against malnutrition is positive, it could help change the course of malnutrition and significantly improve the daily lives of the elderly.
1. Marie Mével. Aversions alimentaires face à la dénutrition en unité de soins de longue durée. Thèse de doctorat de pharmacie. Université Lyon 1. 2018
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