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1 in 3 Older Persons

living independently are at risk of malnutrition 1

Malnutrition in older people

Older people are at risk of malnutrition when living in the community, as well as in hospital and in care homes. Malnutrition in older patients can be multifactorial and can present due to loss of appetite, social isolation, reduced activity, dysphagia and digestive or metabolic impairments and the impact of multiple co-morbidities.2,3
A poor quality diet, loss of body weight and/or muscle mass may also result in progression of sarcopenia and frailty. When the required intake of energy, protein and important micronutrients (e.g. vitamin D) cannot be met by oral nutrition, then enteral tube feeding may bridge the gap and help manage the consequences of malnutrition.2,4-8

Who is at higher risk?9

  • People of 65+ living alone or in care homes
  • Older adults after a stroke
  • People with neurological conditions (such as dementia or Parkinson's disease)
  • People with problems chewing or swallowing, loss of appetite or immobility, psychological stress or depression, a changed sense of taste or medications

First signs and symptoms of malnutrition10,11

  • Unintentional weight loss (>5 %) in the past 3-6 months
  • Low BMI (e.g. <22kg/m2)
  • Weak muscle strength (e.g. low hand grip strength)
  • Loss of / low muscle mass
  • Poor physical function/performance (e.g. slow gait speed)
  • Reduced quality of life
  • Feelings of exhaustion

 

How to manage malnutrition for older patients?

The enclosed decision tree helps to find the right nutrition management based on the latest ESPEN Guidelines.

Early EN Decision Tree.pdf

Filename
Early EN Decision Tree.pdf
Size
1 MB
Format
pdf

ESPEN Geriatrics-Guidelines.pdf

Filename
ESPEN Geriatric-Guidelines.pdf
Size
875 KB
Format
pdf

References:

1) World Health Organization (WHO) 2016. https://www.who.int/features/qa/malnutrition/en/

2) Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47.

3) Granic A, Mendonca N, Hill TR, Jagger C, Stevenson EJ, Mathers JC, et al. Nutrition in the Very Old. Nutrients. 2018;10(3).

4) Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017;18(7):564-75.

5) Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018;22(10):1148-61.

6) Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodriguez-Manas L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771-87.

7) Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.

8) Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10(1):207-17.

9) Malnutrition Advisory Group. A Guide To Managing Adult Malnutrition in the Community. 2nd Ed. 2017

10) Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.

11) Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10(1):207-17.

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