Abstract

The over 65 age group forms an ever increasing proportion of the population, particularly of Western countries. In the USA, for example, the fastest growing segment of the population is among those living 85 years or longer. The impact that these demographic changes have on the health care system is already being noticed in acute, chronic and long-term care facilities. Although the recent European Seneca survey showed a low incidence of malnutrition in the community among the healthy elderly, protein energy malnutrition (PEM) accompanied by micronutrient deficiencies is a major problem in the elderly suffering from poor health. Severe PEM has been found in 10–38% of older out patients, 5–12% of the homebound, 26–65% of elderly hospital in-patients and 5–85% of institutionalised individuals. Morley also reported some degree of malnutrition in 15% of community–dwelling older subjects. In 1977 Exton Smith and colleagues reported a 4% incidence of malnutrition in the elderly United Kingdom population in the community. Their scheme shown in Figure 8.5 describes its main causes, which may also be remembered using the mnemonic MEALS-ON-WHEELS. In a large general practice database in the South of England, using BMI and anthropometric measurements, Edington found a 10% prevalence rate of malnutrition among patients living at home and suffering from cancer or chronic disease. McWhirter and Pennington found that not only were 40% of elderly patients malnourished on admission to hospital, but that this went largely unrecognised, only 5% of the undernourished being referred for dietary help. These gained weight whereas the majority lost weight during their hospital stay.

Learning objectives

• To understand some of the relevant physiological changes of aging
• To understand the mechanism of malnutrition in the elderly
• To know the prevalence, causes and consequences of malnutrition in the elderly
• To be able to screen and assess elderly patients for malnutrition in the context of health and disease
• To be able to manage and treat malnutrition in the elderly