Nutritional Problems of the Elderly

Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients

OBJECTIVES

To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight, plasma nutrients and activities of daily life.

DESIGN

Double-blind, placebo-controlled 12-week intervention study.

SETTING

Two nursing homes in Boxtel, The Netherlands.

SUBJECTS

Forty-two (body mass index (BMI) <23 kg/m2 for men or <25 kg/m2 for women) psycho-geriatric nursing home patients aged 60 y or over.

INTERVENTIONS

Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ (135 kcal) or placebo twice daily during daytime between main meals. Study parameters were assessed at 0, 6 and 12 weeks. MAIN OUTCOME FOR MEASURES: Weight, Barthel index of daily activities, several plasma values (albumin, C-reactive protein (CRP), homocysteine, thiamine, thiamine diphosphate (TDF), vitamin B6, vitamin B12, folic acid, vitamin D), bowel function.

RESULTS

The supplement was well accepted. Thirty-five patients completed the intervention period (16 control group; 19 supplement group). Baseline daily nutrient intake was low. A statistically significant improvement was observed for body weight (difference between groups 2.2 kg, P=0.03), and homocysteine, vitamin B1, TDF, vitamin B6, vitamin B12, folate and vitamin D in the supplement group compared to the placebo group. No significant difference was observed in the Barthel index (mean difference -0.3+/-1.1 for both groups). No difference in occurrence of diarrhoea was observed.

CONCLUSIONS

The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients.

SPONSORSHIP

Numico Research BV.

Dementia, nutrition, and self-feeding: a systematic review of the literature

SUMMARY The outcomes of feeding training are typically evaluated in terms of feeding skills and swallowing abilities rather than the ultimate goal of feeding, namely, adequate nutritional status. To increase occupational therapy practitioners' awareness of nutritional status as an outcome of feeding training, a systematic review of the research literature was conducted to examine the relationship between nutritional status and self-feeding skills in people with dementia. Studies were evaluated by the strength of their evidence and analyzed to determine the relationships among dementia, nutritional status, and the ability to feed one's self. Results revealed that although nutritional status in people with dementia is variable, there is a tendency for lower body weight, lower measures of body composition, and lower body mass indexes in persons with dementia compared to those with no cognitive impairment. Individuals who feed themselves tend to weigh more compared to those who need assistance for feeding. There is also evidence to support that as feeding status improves or declines, body weight similarly increases or decreases.

[Zinc: pathophysiological effects, deficiency status and effects of supplementation in elderly persons--an overview of the research]

Zinc is an essential micronutrient. Several studies have shown that zinc deficiency is common in older people. Zinc has been extensively studied with regard to its role in wound healing, infections, immune system, cardiovascular disease, and several other medical conditions. Several investigators have published intervention studies using zinc supplements in older people with favorable outcomes. This paper will briefly review the pathophysiologic effects of zinc, nutritional deficiency, and effects of zinc supplementation in older people.

Involuntary weight loss in older outpatients: incidence and clinical significance

OBJECTIVES

To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients.

DESIGN

Four-year prospective cohort study.

SETTING

University-affiliated Veterans Affairs Medical Center.

PATIENTS

Two hundred forty-seven community-dwelling male veterans 65 years of age or older.

MEASUREMENTS

Anthropometrics (weight, height, skin-folds, and circumferences), health status measures (Sickness Impact Profile scores, health care utilization, self-reported ratings of health), and bloodwork (cholesterol, albumin, others) were obtained at baseline and followed annually for 2 years. Outcome measures (hospitalization, nursing home placement, and mortality rates) were followed for a minimum of 2 years after any identified weight change.

MAIN RESULTS

The mean annual percentage weight change for the study population was -0.5% (SD: +/- 4.0%; range: -17% to +25%). Four percent annual weight loss was determined to be the optimal cutpoint for defining clinically important involuntary weight loss using ROC curve analysis. The annual incidence of this degree of involuntary weight loss was 13.1%. At baseline, involuntary weight losers were similar to nonweight losers in age (73.9 +/- 7.9 vs 73.3 +/- 6.7 years), body mass index (26.8 +/- 3.9 vs 26.9 +/- 4.1 kg/m2), and all other anthropometric, health status, and laboratory measures. Relative to nonweight losers, involuntary weight losers had significantly (P < or = .05) greater decrements in central skinfold and circumference measures (subscapular skinfolds, -2.9 vs -0.4 mm; suprailiac skinfolds, -4.2 vs -0.2 mm; and waist to hip ratio, -.01 vs + .00). Both groups had significant decreases in their triceps skinfolds (an estimate of peripheral subcutaneous fat), whereas arm muscle area and albumin levels did not decline significantly in either group. Over a 2-year follow-up period, mortality rates were substantially higher (RR = 2.43; 95% CI = 1.34-4.41) among involuntary weight losers (28%) than among nonweight losers (11%). Of interest, a similar increase in 2-year mortality (36%) was also observed among subjects with voluntary weight loss (by dieting). Survival analyses adjusting for differences between weight losers and nonweight losers in baseline age, BMI, tobacco use, and other health status and laboratory measures yielded similar results.

CONCLUSIONS

These results indicate that involuntary weight loss occurred frequently (13.1% annual incidence) in this population of older veteran outpatients. When involuntary weight loss occurred, the predominant anthropometric changes were decrements in measures of centrally distributed fat (trunkal skinfolds and circumferences). Finally, involuntary weight loss greater than 4% of body weight appears to be clinically important as an independent predictor of increased mortality.

Causes of weight loss in a community nursing home

OBJECTIVE

To determine the causes of weight loss in nursing home residents.

DESIGN

Retrospective chart review of all weights over the previous 6 months and an in-depth examination of all residents who lost 5 or more pounds over that period.

SETTING

A for-profit community nursing home in an urban area.

SUBJECTS

All residents who had been in the nursing home for 3 or more months. Their mean age was 80.1 years, and 89% were female.

RESULTS

Weight loss of 5 pounds or more occurred in 19% of subjects. Only 15% of subjects had lost 5% of body weight, and 4% had lost more than 10% of their body weight. Depression accounted for 36% of the weight loss. Other causes of anorexia included medications, psychotropic drug reduction, swallowing disorders, paranoia, dementia with apraxia, gallstones, and obsessive-compulsive disorder. Increased energy utilization as a cause of weight loss was seen in two residents who wandered incessantly, one with tardive dyskinesia and one with chronic obstructive pulmonary disease. Dehydration was the cause of weight loss in two residents, and one resident had international weight loss for obesity. Cancer was the cause of weight loss in two residents. Four of 30 residents had more than one cause of weight loss. One of 25 tube-fed residents displayed weight loss.

CONCLUSIONS

A single cause of weight loss can be identified in most nursing home residents. Depression is the most common cause of weight loss. Psychotropic drug reduction may cause weight loss. The majority of causes of weight loss in a community nursing home are potentially treatable.

Nutritional intake. Use of touch and verbal cuing

1. Many hospitalized elderly patients have inadequate nutritional intake. 2. Inexpensive, practical means of improving the nutritional status of elderly patients are needed. 3. Touch, verbal cuing, and the combination of touch and verbal cuing may be effective methods for increasing the nutritional intake of hospitalized elderly patients without severe cognitive dysfunction.

Diet in the elderly. Needs and risks

Aging individuals have decreased caloric intake associated with increases in body fat and decreases in lean body mass. Calcium and vitamin D supplements are necessary for certain elderly populations, whereas the recommended intake of fat, protein, and trace elements does not change substantially with age. Malnutrition is very common in ill, elderly patients and is frequently missed or often not treated by physicians. This article reviews these findings and recommendations.

Observations on the prevalence of protein-calorie undernutrition in VA nursing homes

OBJECTIVE

To determine the prevalence of underweight and hypoalbuminemia in Veterans Affairs nursing home residents and the frequency with which physicians, nurses, and dietitians documented their awareness of the presence of underweight and hypoalbuminemia.

DESIGN

Retrospective survey of medical records.

SETTING

Twenty-six Department of Veterans Affairs nursing homes located in the Department's Central Region.

PATIENTS

2811 residents.

MAIN OUTCOME MEASURES

(1) Prevalence of underweight (defined as body weight less than 80% of standard) and hypoalbuminemia (defined as serum albumin less than 3.5 g/dl); (2) frequency with which physicians, nurses, and dietitians documented the prevalence of underweight and hypoalbuminemia in the records.

RESULTS

Three hundred thirty-two (11.8%) of the patients were underweight and 772 (27.5%) were hypoalbuminemic. The prevalence of the two conditions varied widely across nursing homes. The prevalence of low serum albumin ranged from 5% to 58% in the 26 institutions, and the prevalence of body weight less than 80% of standard ranged from 2% to 20%. In the Region as a whole, the dietician's notes in the medical charts mentioned underweight in an average of 95% of affected cases but mentioned the suboptimal albumin level in only 82% of the hypoalbuminemic individuals. In the nurses's notes, these figures were only 80% and 45%, respectively, and in the physician's notes, only 62% and 46%, respectively. The frequency of documented awareness of underweight and hypoalbuminemia by nurses and physicians varied tremendously across the 26 facilities (as few as 7% of the undernourished cases in one nursing home, 100% of the affected individuals in another).

CONCLUSIONS

This study showed a high prevalence of calorie and protein undernutrition in the nursing home residents of VA nursing homes, wide variation in the prevalence across nursing homes, and frequent lack of documentation of these nutritional deficiencies by physicians and nurses.