Undernutrition of seniors

In France, more than 2 million elderly people suffer from undernutrition , particularly the elderly who represent 60% of cases in health establishments. Indeed, according to INSEE, nearly one in five senior citizens is concerned. Any involuntary weight loss in an elderly person should lead to a consultation with the general practitioner. Depending on the severity of the malnutrition, the doctor has several options: increased energy intake (richer and more frequent meals, oral nutritional supplements), enteral or parenteral nutrition. To treat the malnutrition of seniors, oral intake will always be preferred first.

Definition and symptoms of undernutrition in seniors

What is undernutrition?

The malnutrition is defined by the HAS as “an imbalance between nutrient intake and requirements of the body resulting in tissue loss, including muscle, which have deleterious functional consequences.” This nutritional state is characterized by a lack of energy and a deficiency of proteins and nutrients. Several risks can result: muscle weakness, infections, delayed recovery, or even death.

In the elderly, undernutrition corresponds to a decrease in their food intake that can cause various deficiencies and weakened health. A state of undernutrition can develop gradually or rapidly.

Official recommendations assess the nutritional intake of seniors at around 35kcal / kg / day, or 1,800 kcal, including 1g / kg / day of protein.

Several behaviors can alert loved ones and the healthcare team:

• Loss of appetite, that is, when the patient does not finish his meal or skips it;
• Involuntary weight loss;
• The withdrawal into oneself.

The social, psychological or pathological situation of a senior can lead to or worsen undernutrition. Thus, several situations can be at risk in an elderly person:

• A psycho-social event, for example bereavement, mistreatment or financial difficulties;
• A pathological event such as pain, surgery, fracture, etc. ;
• Oral diseases (poor oral hygiene, poorly adapted equipment);
• Psychic and neurological damage, for example Alzheimer’s disease or Parkinson’s disease , certain behavioral disorders or depression  ;
• Dependence in daily activities such as food or mobility;
• A diet (slimming, without salt, etc.);
• Taking medicines, for example certain treatments, can cause drowsiness, digestive problems or dry mouth.

What symptoms?

One of the main warning signs of undernutrition is weight loss:

• More than 3 kg in 1 month;
• More than 6 kg in 6 months.

The other symptoms are diverse and can include fatigue, listlessness, a sunken face, dull hair, dry skin, a limp handshake, decreased social interactions, loss of interest in hobbies. , etc.

Indeed, it is not essential to be a doctor or a caregiver to detect the signs of undernutrition. They are easily identified by:

• Wearing clothes that are too loose;
• Observation of eating habits and appetite;
• Loss of muscle mass (slow walking, decrease in thigh volume, etc.);
• Weight measurement every month: undernutrition is proven if the weight loss exceeds 5% in 1 month.

The consequences of undernutrition in the elderly can be dramatic. Weak people can contract all kinds of infections and pathologies. It is therefore essential to quickly detect the first signs of this nutritional state.

Diagnosis and treatment of malnutrition in seniors

What diagnosis?

Weight loss is the symptom that should alert health professionals or not. Indeed, an involuntary weight loss of more than 5% in 1 month should lead to a consultation, or at least to corrective measures.

The doctor can refer the patient to a dietitian in addition to his care.

What treatment?

The earlier the treatment, the more effective it will be. It will depend on several parameters such as the nutritional status of the person, the associated pathologies and disabilities and the opinion of the patient and his family.

Three types of therapy can be considered:

• First-line oral feeding. It breaks down into various nutritional advice, food enrichment, whether or not associated with oral nutritional supplements (complete nutritional mixtures) and human or technical assistance with food intake.
• Enteral nutrition is considered as a second option when oral nutrition is not possible or insufficient. It requires hospitalization of a few days in order to proceed with the placement of a catheter (prescribed for 14 days) and the therapeutic education of the patient and his entourage. When returning home, a specialist service provider or a home nurse take over for the care.
• Parenteral nutrition, artificial nutrition by intravenous route, is indicated only in the event of special situations such as intestinal obstruction (partial or even total interruption of transit), failure of enteral nutrition or in the event of severe malabsorption.

There are several stages of undernutrition. The doctor adapts his treatment according to the severity of it.

We speak of moderate undernutrition when the patient can still eat. An increase in energy intake, whether or not associated with a prescription for oral nutritional supplements, is sufficient.

We speak of severe undernutrition when the patient no longer eats alone. In this case, the doctor may prescribe oral nutritional supplements, and possibly enteral nutrition.

Malnutrition of seniors and Prevention

To prevent undernutrition, it is important to eat properly, and to enjoy eating. First of all, you should know that the elderly have greater food needs than the rest of the population. Indeed, contrary to popular belief, food requirements do not decrease with age. Thus, after 70 years, it is advisable to avoid fasting by eating three meals a day and if possible two snacks.

Some tips for a good diet:

• Consume in priority foods rich in protein such as meat, fish or eggs, once a day;
• Increase the number of snacks per day;
• Drink plenty of water, around 8 to 10 glasses, during the day;
• Fight against osteoporosis by consuming dairy products;
• Don’t forget about vitamins!

To note ! It is important to maintain physical activity (gardening, walking, etc.) for at least 30 minutes a day, consecutive or not, in order to maintain sufficient muscle mass. The practice of a physical activity also makes it possible to avoid situations of isolation, even of depression.