NUTRITIONAL SUPPORT FOR ELDERLY PATIENTS 7
Geriatric patients require nutritional supportdue to their age-related degenerative disorders and the many chronicillnesses associated with the elderly. Geriatric patients arepatients at and above 65 years of age (WHO, 2002). Elderly patientsare at risk of many chronic illnesses such as hypertension, heartfailure, stroke, dementia, malignant neoplasms, Alzheimer’s,diabetes, renal failure, liver failure and musculoskeletal disorderslike pathological fractures and Sarcopenia (Wells & Dumbrell,2006). All these disorders compounded with age-related degenerationof tissues require a meticulous dietary schedule to improve onpatient comfort, care and health. Elderly patients require a balanceddiet with all the three basic components, carbohydrates, proteins andlipids (Wells & Dumbrell, 2006). They also require supplementalvitamins, minerals and electrolytes to maintain healthy andfunctioning body systems. This paper will address the reasons fornutritional support in geriatric patients and advise on mechanisms toimprove the nutritional support.
Reasons for Nutritional Support
Geriatric patients are more vulnerable toage-related malnutrition which is non-specific in nature because thevarious body and disease conditions require specific nutritionalsupport. To provide adequate nutrition to elderly people encountersmany practical challenges since nutritional requirements for them arenot clearly defined due to the age-related lean body mass anddecreasing basal metabolic rates (Wells & Dumbrell, 2006). Theelderly patient’s daily energy requirements also reduce with age,although, some nutrients requirements may increase with age.
Most of the disease processes experienced bygeriatric patients is attributed to dietary factors since young age(Drewnowski & Evans, 2001). These dietary factors are reinforcedby the degenerative changes in old age. For instance, highcholesterol fat in diet is associated with pancreatic, colonic andprostatic cancers. It is also associated with atherogenic changesthat occur in blood vessels, especially coronary vessels, resultinginto myocardial infarction, hypertension, heart failure and stroke(Drewnowski & Evans, 2001). Degenerative disorders affecting thecardiovascular system and cerebrovascular systems are also dietrelated. Diabetes, malignant neoplasms and osteoporosis alsoaffecting the geriatric population and are attributed to dietarychanges (Drewnowski & Evans, 2001).
Micronutrients deficiencies are common ingeriatric populations. Micronutrients are foods which are needed insmall or minute quantities in the body and include vitamins andminerals such as iron, selenium, zinc, copper, cobalt and iodineamong others (Wells & Dumbrell, 2006). Micronutrients are veryimportant in the physiological mechanisms of the body such asenzymatic actions, metabolic processes, nerve and muscle functionsand production of body cells like red blood cells. Micronutrients arealso very important in the immune system.
Elderly patients lack major macronutrients andmicronutrients such as iron, calcium, Vitamin A and iodine due toreduction in food intake, reduced food varieties, and expensivenature of foods supplemented with these micronutrients (Holmes,2006).This increases both morbidity and mortality among thispopulation. Geriatric patient’s low dietary intake can also beattributed to decreased senses such as smell and taste, poor chewingdue to ill-fitting dentures, other oral disorders and poor swallowing(Holmes, 2006).
Deteriorating health changes contribute togeriatric malnutrition. Cognitive and visual changes which occur inold age prevent the elderly from proper food intake (Holmes, 2006).Cognitive changes like dementia and Alzheimer’s as well as loss ofvision contribute to their inability to access dietary supplementsand account for their reduced dietary habits (Holmes, 2006).
Improving Nutritional Support
Improving nutritional support for the elderlyis important because it improves quality of life and health. Variousrecommendations have been put forward to determine the recommendedintake of carbohydrates, proteins and fats and micronutrients for theelderly population (WHO, 2002).The mode of feeding is dependent onthe nature of the patient, for instance, nasogastric and entericfeeding is preserved for the critically ill patients with poor intakewhile oral feeds are recommended for the active ill patients orhealthy people (WHO, 2002).
Geriatric population requires an increaseddietary protein nutritional support than the younger population(Bauer, 2013). The higher amount of proteinous diet promotes goodhealth, body functionality and improves recovery time from variousdiseases. Due to the degeneration of tissues in old age, geriatricsneeds to make up for the lost tissue mass. They need to replace thechanges in protein metabolism experienced at old age such as reducedanabolic mechanisms towards dietary fats and increased splanchnicextraction (Bauer, 2013).Geriatric population also require higherproteins to counter the inflammatory as well as catabolic effects ofacute and chronic illnesses in old age.
According to the PROT-AGE Study Group, therecommended geriatric daily dietary protein intake is between 1-2g/kg of body weight (Bauer, 2013). The study also recommendsendurance and resistance exercises which should be individualizeddepending on safety and tolerability. These exercises help to restoreboth the muscle mass and their oxidative capacity. Higher proteingreater than 1.2 g/kg body weight is recommended for active andexercising geriatrics. Geriatric patients with acute or chronicillnesses such as malignant cancers and sarcopenia also requireincreased dietary protein intake of more than 1.5 g/kg of body weightexcept those with severe kidney disease to avoid fluid overload inthe body (Bauer, 2013).
Proper micronutrients supplementation is veryimportant for the geriatric population based on the prevailing healthconditions. Increasing the levels to at least 1-2 times theRecommended Dietary Amounts is recommended for older patients.Patients with cognitive disorders may benefit from supplementalVitamin A, C, E and thiamine in addition to other dietary support(WHO, 2002). Zinc supplementation is necessary in patients withdementia and Alzheimer’s. Folic acid is an important ingredient topromote cell regeneration especially in bone marrow and nervousneurotransmission. Supplemental iron and iodine is necessary preventanemia and thyroid problems respectively (WHO, 2002).Calcium andVitamin D is required to subvert osteoporosis. Overall, supplementalmicronutrients are required. This population also requires reducedsalt intake to reduce the risk of cardiovascular problems.
Carbohydrates intake should be limited toindividual needs. Patients at high risk of obesity should reduce highcaloric intake to prevent further deterioration of weight balance(WHO, 2002). Elderly population should maintain a regular schedule ofat least three meals with moderate carbohydrates daily. Diabeticpatients should regularly check their sugar levels to avoidhyperglycemic or hypoglycemic episodes and supplement any deficitswith additional snacks (WHO, 2002).
Dietary fat especially the poly unsaturatedfatty acids found in fish, soy beans and green leaves are necessaryfor immune protection (WHO, 2002). Increased intake of such fats isrecommended for elderly population to boost their immune response andwhite blood cells population. These fats should be limited to 35% and30% for adults with active and sedentary lifestyles respectively.Obese patients should be encouraged to reduce fat intake. Saturatedfats should be minimized to around 8% of energy requirements (WHO,2002). Patients should also be advised to remain hydrated by takingadequate water per day.
In conclusion, elderly patients requirenutritional support to counter the degenerative changes of old ageand chronic illnesses experienced by this population. Adequatesupplementation of carbohydrates, fats, proteins and micronutrientsis recommended to maintain a healthy body and good quality of life.
Bauer, J., Biolo, G., Cederholm, T., Cesari,M., Cruz-Jentoft, A. J., Morley, J. E.,& Visvanathan, R. (2013).Evidence-based recommendations for optimal dietary protein intake inolder people: a position paper from the PROT-AGE Study Group. Journalof the American Medical Directors Association, 14(8), 542-559.
Drewnowski, A., & Evans, W. J. (2001).Nutrition, physical activity, and quality of life in older adult’ssummary. The Journals of Gerontology Series A: Biological Sciencesand Medical Sciences, 56(suppl 2), 89-94.
Holmes, S. (2006). Barriers to effective nutritional care for olderadults. Nursing Standard, 21(3), 50-54.
Wells, J. L., & Dumbrell, A. C. (2006). Nutrition and aging:assessment and treatment of compromised nutritional status in frailelderly patients. Clinical interventions in aging, 1(1), 67.
World Health Organization. (2002). Keep fit forlife: meeting the nutritional needs of older persons.