Assessment and management of nutrition in older people and its importance to health

Tanvir Ahmed, Nadim Haboubi, Tanvir Ahmed, Nadim Haboubi

Abstract

Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements.

Keywords: anorexia of aging; malnutrition; nutritional assessment; older people; sarcopinia.

Figures

Figure 1
Figure 1
A depiction of the “anorexia of aging”. Abbreviation: GI, gastrointestinal.

References

    1. Stratton RJ, Green CJ, Elia M. Disease Related Malnutrition: an Evidence Based Approach to Treatment. Oxford: CABI; 2003.
    1. Office of National Statistics . Population trends. PT 118, table 14 (population age and sex) London: ONS; 2004.
    1. Office of National Statistics . Living in Britain: results from the 2002 General Household Survey. London: ONS; 2004.
    1. Morely JE. Anorexia of aging: physiological and pathological. Am J Clin Nutr. 1997;66:760–773.
    1. Chapman IM. Nutritional disorders in the elderly. Med Clin North Am. 2006;90:887–907.
    1. Saffrey MJ. Aging of the enteric nervous system. Mech Ageing Dev. 2004;125:266–271.
    1. Cowen T, Johnson RJ, Soubeyre V, Santer RM. Restricted diet rescues rat enteric motor neurones from age related cell death. Gut. 2000;47:653–660.
    1. Santer RM, Baker DM. Enteric neuron numbers and sizes in Auerbach’s plexus in the small and large intestine of adults and aged rats. J Auton Nerv Syst. 1988;25:59–67.
    1. Moore JG, Tweedy C, Christian PE, Datz FL. Effect of age on gastric emptying of liquid-solid meal in man. Dig Dis Sci. 1983;28:340–344.
    1. Fich A, Camilleri M, Phillips SF. Effect of age on human gastric and small bowel motility. J Clin Gastroenterol. 1989;11:416–420.
    1. Bitar Kn, Patel SB. Aging and the gastrointestinal smooth muscle. Mech Ageing Dev. 2004;125:907–910.
    1. Elphick H, Elphick D, Sanders D. Small Bowel Overgrowth. An unrecognised cause of malnutrition in older adults. Geriatrics. 2006;61:21–25.
    1. McEvoy A, Dutton J, James OF. Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly. BMJ. 1983;287:789–793.
    1. Parlesak A, Klein, Schecher K, Bode Jc, Bode C. Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in non hospitalized older adults. J Am Geriatr Soc. 2003;51:768–773.
    1. Gullo L, Ventucci M, Naldoni P, Pezzilli R. Aging and exocrine pancreatic function. J Am Geriatr Soc. 1986;34:790–792.
    1. Laugier R, Benard JP, Berthezene, Dupuy P. Changes in pancreatic exocrine secretion with age: pancreatic exocrine secretion does decrease in the elderly. Digestion. 1991;50:202–211.
    1. Dreiling DA, Treibling AT, Koller M. The effect of age on human exocrine pancreatic secretion. Mt Sinai J Med. 1985;52:336–339.
    1. Popper H. Aging and the liver. Prog Liver Dis. 1986;8:659–683.
    1. Cao SX, Dhabbi JM, Mote PL, Spindler SR. Genomic proliferating of short term and long term effects in the liver of aging mice. Proc Natl Acad Sci U S A. 2001;98:10630–10635.
    1. Aging and the intestine. World J Gastroenterol. 2006;12:7578–7584.
    1. Marin K, Kirwood TB, Potten CS. Age changes in stem cells of murine small intestinal crypts. Exp Cell Res. 1988;241:316–323.
    1. Hohn PR, Pascal RR, Kotler DP. Effect of aging of the rat intestinal mucosa. II. Morphological aspects of the aging of the small intestinal mucosa. Mech Ageing Dev. 1978;7:217–226.
    1. Keelan M, Walker K, Thompson AB. Intestinal morphology, markers enzymes and lipid content of brush border membranes from rabbit jejunum and ileum: effect of aging. Mech Ageing Dev. 1985:49–68.
    1. Wurtman JJ, Leiberman H, Tsay R, et al. Caloric and nutrient intake of elderly and young subjects measured under identical conditions. J Gerontol. 1988;43:B174–B180.
    1. Villareal DT, Apovian CM, Kushner RF. Obesity in older adults: technical review and position statement of the American Society of Nutrition and NAASO. The Obesity Society. Am J Clin Nutr. 2005;82:923–924.
    1. Wallace JI, Schwartz RS, LaCroix AZ, et al. Involuntary weight loss in older outpatients: incidence and clinical significance. J Am Geriatr Soc. 1995;43(4):329–337.
    1. Newman AB, Arnold AM, Burke GL, et al. Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography. The Cardiovascular Health Study. Ann Int Med. 2001;134:182–190.
    1. Calle EF, Thun MJ, Petrelli JM, et al. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med. 1999;341:1097–1015.
    1. Potter JF, Schafer DF, Bohi RL. In hospital mortality as a function of body mass index; an age dependant variable. J Gerontol. 1988;43:M59–M63.
    1. Prentice AM, Jebb SA. Beyond body mass index. Obesity Rev. 2001;2:141–147.
    1. Cree MG, Newcomer BR, Katsonos CS, et al. Intramuscular and liver triglycerides are increased in the elderly. J Clin Endocrinol Metab. 2004;89:3864–3967.
    1. Roubenoff R. The path physiology of wasting in the elderly. J Nutr. 1999;121(Suppl 1):256–259S.
    1. Yeh SS, Schuster MW. Geriatric cachexia: the role of cytokines. Am J Clin Nutr. 1999;70:183–197.
    1. Evans WJ. Exercise, nutrition and aging. Clin Geriatr Med. 1995;11:725–734.
    1. Roubenoff R. Sarcopenia and its implications for the elderly. Eur J Clin Nutr. 2000;54(Suppl 3):S40–S47.
    1. Doty RL, Shaman P, Applebaum SL, et al. Smell identification ability: changes with age. Science. 1984;226:1441–1443.
    1. Schiffman SS. Taste and smell losses in normal aging and disease. JAMA. 1997;278:1357–1362.
    1. Mathey MF, Siebelink E, de Graff, et al. Flavour enhancement of food improves dietary intake and nutritional status of elderly nursing home residents. J Gerontol A Biol Sci Med Sci. 2001;56:M200–M2005.
    1. Morley JE. Decreased food intake with aging. J Gerontol A Biol Sci Med Sci. 2001;56:81–88.
    1. Roberts SB, Fuss P, Heyman MB, et al. Control of food intake in older men. JAMA. 1994;272:1601–1606.
    1. Morton GJ, Cummings DE, Baskin DG, Barsh GS, Schwartz MW. Central nervous system control of food intake and body. Nature. 2006;443:289–295.
    1. Strader AD, Woods SC. Gastrointestinal hormones and food intake. Gastroenterology. 2005;128:175–191.
    1. Di Francesco V, Zamboni M, Dioli A, et al. Delayed postprandial gastric emptying and impaired gallbladder contraction together with elevated cholecystokinin and peptide YY serum levels sustain satiety and inhibit hunger in healthy elderly persons. J Gerontol A Biol Sci Med Sci. 2005;60:1581–1585.
    1. Batterman RL, Cowley MA, Small CJ, et al. Gut hormone PYY physiologically inhibits food intake. Nature. 2002;418:620–653.
    1. MacIntosch GC, Andrews JM, Jones KL, et al. Effects of age on concentrations of plasma cholecystokinin, glucagon-like peptide-1 and peptide YY and their relationship to appetite and pyloric motility. Am J Clin Nutr. 1999;69:999–1006.
    1. Zamboni M, Zoico E, Fantin F, et al. Relation between leptin an the metabolic syndrome in elderly women. J Gerontol A Biol Sci Med Sci. 2004;59:396–400.
    1. Van der Lely AJ, Tschop M, Heiman ML, Ghigo E. Biological, physiological and pharmacological aspects of ghrelin. Endocr Rev. 2004;25:426–427.
    1. Doucet E, St-Pierre S, Almeras N, et al. Quebec Family Study: Fasting insulin levels influence plasma leptin levels independently: evidence from both a cross sectional and an intervention study. J Clin Endocrinol Metab. 2000;85:4231–4237.
    1. Murdolo G, Lucidi P, Di Loreto C, et al. Insulin is required for prandial gherlin suppression in humans. Diabetes. 2003;52:2923–2927.
    1. Pirlich M, Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol. 2001;15:869–884.
    1. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part 1: history examination, body composition and screening tools. Nutrition. 2000;16:50–53.
    1. Sullivan DH, Walls RC. The risk of life threatening complications in a select population of geriatric patients: the impact of nutritional status. J Am Coll Nutr. 1995;14:29–36.
    1. Ellia M, editor. Screening for Malnutrition. A multidisciplinary Responsibility. Development and use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for Adults. British Association of Parenteral and Enteral Nutrition; 2003.
    1. Knodrup J, Allison SP, Ellia M, Vellas B, Plautg M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–421.
    1. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. Br J Nutr. 2004;92:799–808.
    1. Beck Am, Ovesen L, Osler M.The ‘Mini Nutritional Assessment’ (MNA) and the ‘Determine Your Nutritional Health’ Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population Br J Nutr199;8131–36.
    1. Ek AC, Unosson M, Larsson J, et al. Interrater variability and validity in subjective nutritional assessment of elderly patients. Scand J Caring Sci. 1996;10:163–168.
    1. Cena H, Madini N, Zaccardo A, Rondanelli, Roggi C. Nutritional assessment of elderly people. Minerva Gastroenterol Dietol. 2008;54:295–306.
    1. WHO Physical status: the use and interpretation of anthropometryReport of a WHO Expert Committee WHO Technical Report Series 854.Geneva: World Health Organization; 1995
    1. Stevens J, Cai J, Pumuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body mass index and mortality. N Engl J Med. 1998;338:1–7.
    1. Hickson M, Frost G. A comparison of three methods for estimating height in the acutely ill elderly population. J Hum Nutr Diet. 2003;16:13–20.
    1. WHO document Measuring obesity – classification and description of anthropometric dateNutrition Unit EUR/ICP/NUT 125.Copenhagen: WHO Regional Office for Europe; 1989
    1. Allard JP, Aghdassi E, McArthur M, Mcgeer A, Simor A, Abdolell M, et al. Nutrition risk factors for the survival in elderly living in Canadian long term care facilities. J Am Geriatr Soc. 2004:59–65.
    1. Haboubi N, Haboubi H, Kennedy J. Obes Facts. 2009
    1. Suttmann U, Selber O, Boker K, et al. Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. Journal of AIDS and Human Retrovirology. 1995;8:239–246.
    1. Pritchard C, Kyle Ug, Bracco D, et al. Reference value of fat free masses by bioelectrical impedance analysis in 3393 healthy subjects. Nutrition. 2000;16:245–254.
    1. Alpers DH, Klein S. Approach to the patient requiring nutritional supplementation. In: Yamada T, editor. Textbook of Gastroenterology. 4th edition. Baltimore: Lipponcott and Wilkins; 2003.
    1. Jeejeebhoy KN, Baker JP, Wolman St, et al. Critical evaluation of the role of clinical assessment and body composition studies in patients with malnutrition and after total parenteral nutrition. Am J Clin Nutr. 1982;35:1117–1127.
    1. Garibella SE, Sinclair AJ. Nutrition, aging and ill health. Br J Clin Nutr. 1998;80:7–23.
    1. Azad N, Murphy J, Amos SS, Toppan J. Nutrition survey in an elderly population following admission to a tertiary care hospital. Can Med Assoc J. 1999;161:511–515.
    1. Steele J.National Diet and Nutrition Survey: people aged 65 years and over, Vol 2Report of the oral health survey. London: The Stationary Office; 1998
    1. Nakanishi N, Hino Y, Ida O, et al. Associations between self assessed matiscatory disability and health of community-residing elderly people. Community Dent Oral Epidemiol. 1999;27:366–371.
    1. Evers MM, Marin DB. Mood disorders. Effective management of major depressive disorder in geriatric patients. Geriatrics. 2002;57:36–40.
    1. Morely JE, Kraenzle D. Causes of weight loss in a community nursing home. J Am Geriatr Soc. 1994;42:583–585.
    1. Incalzi Ra, Capparella O, Gemma A, et al. Inadequate caloric intake: a risk factor for mortality of geriatric patients in acute care hospital. Age Ageing. 1998;27:303–310.
    1. Volicer L, Selzer B, Rheaume Y, et al. Progression of Alzheimer’s disease. J Am Diet Assoc. 1989;89:392–396.
    1. Gilbert PE, Pauk E, Barr PJ. Differences in olfactory and visual memory in patients with pathologically confirmed Alzheimer’s disease and the Lewy body variant of Alzheimer’s disease. Journal of the International Neurophysiologist Society. 2004;10:835–842.
    1. Institute of Medicine . Dietary reference intakes for energy, carbohydrates, fibre, fat fatty acids, cholesterol, protein and amino acids. Washington DC: National Academy Press; 2005.
    1. Wolfe RR, Miller LM, Miller KB. Optimal protein intake in the elderly. Clin Nutr. 2008;27:675–684.
    1. Fukagawa N. Protein and amino acid metabolism and requirements in older persons. Clinic Geriatr. 1987
    1. Calvo MS, Whiting SJ, Barton CN. Vitamin D fortification in the United States and Canada: current status and data needs. Am J Clin Nutr. 2004;80(Suppl):1710S–1716S.
    1. Krasinski SD, Russell RM, Samaloff IM, et al. Fundic atrophic gastritis in an elderly population: effect on haemoglobin and several serum nutritional indicators. J Am Geriatr Soc. 1986;34:800–806.
    1. Abyad A. Prevalance of vitamin B12 deficiency among demented patients and cognitive recovery with colbalamin replacement. J Nutr Health Aging. 2002;6:254–260.
    1. Bonaa KH, Njolstad I, Ueland PM, et al. Homocystine lowering and cardiovascular event after myocardial infarction. N Engl J Med. 2006;354:1578–1588.
    1. McLean RR, Jacques PF, Selhub J, et al. Homocystine as a predictive factor for hip fracture in older persons. N Engl J Med. 2004;350:2042–2049.
    1. Ramersaud GC, Kauwell GP, Bailey LB. Folate a key to optimizing health and reducing disease risk in the elderly. J Am Coll Nutr. 2003;22:1–8.
    1. Drewenowski A, Warren Mears VA. Does aging change nutrition requirements? J Nutr Health Aging. 2001;5:70–74.
    1. Rolls BJ, Phillips PA. Aging and disturbances of thirst and fluid balance. Nutr Rev. 1990;48:137–143.
    1. Barton AD, Beigg CL, MacDonald IA, Allison SP. High food wastage and low nutritional intakes in hospital patients. Clin Nutr. 2000;19:445–449.
    1. Barton AD, Beigg CL, MacDonald IA, Allison SP. A recipe for improving food intakes in elderly hospitalised patients. Clin Nutr. 2000;9:451–454.
    1. Gall MJ, Grible GK, Reeve NJ, Thomas SJ. Providing fortified meals and between meal snacks significantly increases energy intake of hospital patients. Proc Nutr Soc. 1998;57:94A.
    1. Desai J, Winter A, Young KW, Greenwood CE. Changes in type of foodservice and dining room environment preferentially benefit institutionalised seniors with low body mass indexes. J Am Diet Assoc. 2007;107:814–815.
    1. Simmons SF, Schnelle JF. Individualised feeding assistance care for nursing home residents;staffing requirements to implement two interventions. J Gerontol A Biol Sci Med Sci. 2004;509:M966–M973.
    1. Chapuy MC, Arlot ME, Buoeuf F, et al. Vitamin D and calcium to prevent hip fractures in the elderly woman. N Engl J Med. 1992;327:1637–1642.
    1. Bourdel-Marchasson I, Barateau M, Rondeau V, et al. A multicentre trial of oral nutritional supplementation in critically ill older patients. Nutrition. 2000;16:1–5.
    1. Flegal KM, Caroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults 1999–2000. JAMA. 2002;288:1723–1727.
    1. Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–1200.
    1. Heiat A, Vaccarino V, Krumholtz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to older persons. Arch Int Med. 2001;161:1194–1203.
    1. Chapman IM. Obesity in old age. Obes Metab. 2008;36:97–106.

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