The efficacy of nutritional support in the elderly

Enteral nutrition and enteral tube feeding. Review of the evidence

Improvements in delivery systems for enteral feeding, in formulas, and in the understanding of complications have made the technology for enteral feeding easy to apply. Adequate nutrients can be delivered, and individual tolerance for feeding is acceptable. The remaining question is when to apply the technology. Formula selection should be as simple as possible. Aspiration and other early complications are a serious risk and are not diminished by route of feeding. Long-term enteral feeding is associated with a high complication rate, with high mortality, and may not be effective.

Aging: a barrier to renutrition? Nutritional and immunologic evidence in rats

BACKGROUND

Previous reports suggest that correcting the malnourished state is more difficult in elderly people than in younger ones and that protein requirements may be higher in elderly than in younger adults.

OBJECTIVE

The aim of this study was to establish whether malnourished old rats respond to protein-supplemented nutritional repletion as do young adult rats.

DESIGN

Adult (3 mo old) and old (22 mo old) rats were submitted to dietary restriction programs that induced similar metabolic and nutritional alterations. Malnourished adult and old rats were then killed (R groups) or refed for 1 wk with a high-protein diet (HPD; 23% protein) or a very-high-protein diet (VHPD; 27% protein). Control groups at both ages were fed ad libitum throughout the experiment. Effects of food repletion were evaluated in terms of protein metabolism, intestinal histomorphometry, and nonspecific immune status.

RESULTS

In adult rats, HPD sufficed to increase body weight and restore basal values of liver weight and protein content (P: < 0.01 compared with the R adult group), nitrogen balance (P: < 0.01 compared with the R adult group), and hydrogen peroxide production by polymorphonuclear neutrophils and monocytes (P: < 0.01 compared with the R group); VHPD had no supplementary effect except on nitrogen balance. In old rats, HPD was less effective and greater benefit was observed with VHPD in terms of body weight gain (10%; P: < 0.01 compared with the old group fed HPD), albuminemia, muscle weight and protein content, plasma arginine concentration, and hydrogen peroxide production by stimulated polymorphonuclear neutrophils and monocytes compared with the old R group (P: < 0.01).

CONCLUSION

Aging is a significant variable affecting the response to nutritional support.

Undernutrition in the nursing home: prevalence, consequences, causes and prevention

Approximately 5% of Americans over age 65, or 1.5 million individuals, currently reside in the nation's 20,000 nursing homes. The authors present material that lead to three conclusions about this population. First, nutritional deficiencies are common underlying causes of adverse clinical outcomes. Second, nutritional deficiencies are frequently not recognized. Third, opportunities for preventing or correcting undernutrition exist, provided that the significant and reversible nature of the nutrient deficiencies are identified.

Nutritional Assessment and Support in Long-term Care Facilities

In recent years, malnutrition has become recognized as a widespread phenomenon with significant potential for complicating the course of medical treatment and compromising quality of life for hospitalized patients, many of whom are elderly. Added to this has been a heightened awareness of the needs of the institutionalized geriatric segment of our population. This group is now acknowledged as being at significant risk for nutritionally related morbidity as a result of advanced age, chronic or underlying disease, multiple drug therapy, and/or a host of social, psychological, and economic factors. The questions arise of how to identify those at risk, define the extent of their nutritional problems, and then how to best address their needs in a safe and effective manner. Recent technological advances in parenteral and enteral nutrition coupled with increasing clinical experience have greatly improved the care of the malnourished patient in the hospital, and have fostered the development of programs for outpatient nutritional management as well. Along with more sophisticated methods of providing nutritional care, various strategies are evolving for coordination and administration of nutritional assessment and support in the nation's long-term care facilities based on experience with hospitalized patients and home nutritional support programs. Clearly, there is a need for research and further attention to providing such services to these individuals. Pharmacists are now finding great professional opportunity in responding to the demand for specialized nutritional support services in this rapidly growing elderly segment of our population.

Nutrition, cancer, and aging: an annotated review. II. Cancer cachexia and aging

The interactions of cancer and malnutrition are discussed with the focus on aging. To establish whether the elderly are more likely to develop cancer cachexia and its complications, this review encompasses the pathogenesis of malnutrition in cancer; the age-related alterations of appetite, gastrointestinal function, energy expenditure, and protein turnover; the diagnosis of malnutrition; and the effectiveness of nutritional support in the elderly. Although metabolic and physiologic changes induced by cancer and age appear synergistic in causing cachexia, more frequent complications of malnutrition have not been observed in the geriatric cancer patients. This may be due to only a small proportion of the elderly with cancer being enrolled in clinical studies or to a reduced cachexia-inducing ability of tumors in these patients. A limited number of studies indicate nutritional replenishment is obtainable in malnourished elderly by hyperalimentation. As restoration of the lean body mass may be slower in older patients, early institution of nutritional support is recommended in malnourished elderly or elderly at risk for malnutrition during neoplastic treatment.