Newsletter 002 January 12,2024
Malnutrition in the elderly
Malnutrition is commonly misunderstood as simply not enough food to eat. In the elderly population malnutrition is more complex than that. There are many factors that can cause malnutrition in the elderly. Risk for malnutrition depends on their mobility, cognition, economics, dentition ,existing diseases and mental status. To the elderly living alone, simple cooking becomes a task that is difficult to perform, leaving them with limited food choices, like eating a can of microwaved heated soup and crackers, or the salt infused ramen noodles, tea with cookie, ordering home delivered foods which is high in fat and salt, ill fitting denture, poor dentition, etc. Loss of taste and smell due to aging or covid 19 can cause poor appetite. Prolong intake of this nutrient deficient food will result in unplanned weight loss leading to malnutrition.
To the elderly that lives alone and is ambulatory with family and friends and sufficient income, free of chronic diseases and has good appetite, Lucky you.
As we grow older our body cannot efficiently metabolize the food we eat into nutrients that can be absorbed by our body. Carbohydrate and Protein absorption is compromised due to lack of digestive enzyme needed to breakdown protein and other foods into useable nutrients that can be absorbed by the body. Metabolic processes such as building muscle protein becomes less efficient. Sarcopenia or loss of muscle occurs due to aging. The physical evidence is your sagging muscles in the arms and neck. Another risk factor of malnutrition for the young and the elderly is a genetic disorder called Long chain FA oxidation disorder LC-FAO is a rare genetic disorder that prevents the body from breaking down long chain FA (fatty acid) into energy during metabolism, depriving the body of needed calories when needed.
Below are additional nutritional risk factors that can lead to malnutrition in the elderly population.
- Lack of Exercise and activity
- Poor dentition
- Economics
- Medication
- Mobility
- Loss of taste and smell
- Cognitive impairement’s
- constipation
- Early satiety
- Prescense of disease such as cancer,ESRD ,DM, COPD, thyroid disorder, etc that requires a restrictive diet
- Alcohol and smoking
- Limited social interaction/depression
Aging is a significant factor for the development and progression of nutritional problem in older adults due to various physiological changes that occur in aging.
One of the physiological changes that affects malnutrition is loss of taste and smell, this makes eating a necessity without pleasure. Cognitive impairement , is when a person does not recognize a feeling of hunger or thirst . Early satiety, poor dentition, need to follow a therapeutic diet for treatment of a disease, etc.
As we age,the digestive enzyme that populates our gut becomes inefficient or impaired. Maybe because of prolong alcohol use, drug use, anti- acids use due to reflux, prescription medication, diet pills, high intake of saturated fats,elevated triglycerides, Non alcoholic cirrhosis, poor diet and limited income, inability to cook etc. If you are in the US, the government have several nutrition programs for seniors such as Meals on meals. Food is delivered to your doorstep by volunteers which includes a full meal and beverage and a sandwich for snack. If you are unable to ambulate or prefer to stay home, otherwise there are senior centers where you can go and get picked up by Dial a Ride or by volunteers to go to Senior Meals Program where they serve hearty meals. Sometimes your appetite is stimulated when you are in a social seating. Activities such as dancing and learning a hobby is also offered at the centers. There is also Food Banks and Food Pantries that are located in your areas that provides meat and groceries when you qualify for assistance.
Another nutritional problem of senior is poor protein intake, even if they eat meat. Seniors are at risk for impaired or diminished gastric enzyme production to digest meat due to the aging process. The undigested meat is excreted as waste. There are gastric enzymes that you can use if you think this is your problem, however it is best that you contact your primary physician to see if it will benefit you. Protein from liquid supplement such as Ensure or Boost remain unabsorbed and so is liquid protein supplement like Prostat or Prosource. Inadequate protein due to poor absorption can result in malnutrition. Prealbumin is an indicator of one’s nutrition status. If you want to know your nutrition status, ask your doctor to test for prealbumin.
Probiotic and prebiotic work together to improve your microbiome. Prebiotic is the indigestible ifiber from fruits, vegetables and whole grains, this fiber is food to the probiotic. This means that you need to eat fruits and vegetable to feed the probiotic and to keep your gut healthy. If eating fresh fruit and vegetable is difficult due to poor dentition, make smoothie out of your fruits and or vegetables. Pureeing does not destroy the fiber. However, the blending process release fructose sugar to make it easier to absorb. This can cause blood sugar spikes. If you are diabetic, use less fruit and more vegetables in your smoothie. Drink it between meals or as a snack. Drink water after you finish eating. Drinking water or beverage before or while eating a meal can cause early satiety. Fuel your body with calories from healthy food, not sugar infused drinks. Unplanned weight loss is a risk for developing malnutrition. Eat slowly. If you need fluids while eating, take sips. The risk for malnutrition due to unplanned weight loss is greater in the obese person.
Keep your microbiome healthy . Eat lean meat, more vegetables and fruit for fiber and vitamins. Choose whole grain breads, low fat dairy such as yoghurt and root vegetables and include them in your diet daily as a source of calories, nutrients and fiber. Eat frequent small meals instead of large meals. Limit your intake of fat which you get from meats, dairy, butter, fried foods and pastries. Reduce intake of processed foods. Limit your intake of fast food. A one a day vitamin when taken daily may help offset a nutrient deficit diet but does not replace the need to eat fruits and vegetables daily. Consult your doctor if it is beneficial for you to take, multivitamins (MVI). Keep active. Ask your doctor what physical activity you should undertake. Gardening, walking, dancing and exercising are some of the ways to keep you tone. Intake of healthy foods and exercise may delay the onset of metabolic disorders caused by aging. Losing your sense of smell and taste contributes to poor appetite . Ask your primary physician if Zinc with Vit C is appropriate for you. There are appetite stimulants in the market,but the benefit outweighs the Risk and the product is too sweet. The maven’s say that bone broth is benefical in keeping your microbiome healthy. Bone broth can be purchased in your major grocery stores like whole foods and Walmart or if capable prepare it yourself or ask your homemaker if you have one. It is a hearthy broth. I will post a recipe on how to make it. Check it out.
Malnutrition in the elderly is easy to identify but maybe difficult to recover if it remains uncorrected for a prolong period of time. If you need further assistance contact me. A 3 minute chat is free. A 30 minute consult is $25.00