Malnutrition in the elderly. Is it simply a matter of not eating enough?

Abstract

Malnutrition is a common finding in elderly patients, especially at hospitalization. In those whose nutritional status is borderline, the stress of illness may bring about deficiency. Failure to correct malnutrition delays recovery and prolongs hospital stay. Inadequate intake is only one of many causes of nutritional deficiency in the elderly. Traditional height-weight tables are inexact in the elderly. To increase diagnostic accuracy in suspected malnutrition, several methods should be used (eg, calculation of weight loss over time; muscle mass-height comparisons; biochemical and hematologic measurements). After daily energy needs are determined--according to metabolic, activity, and stress expenditures--the best method of nutritional replacement must be determined. Enteral supplementation is the first choice because it sustains the integrity of the gastrointestinal tract. However, delaying implementation of parenteral nutrition when it is required is a common error that should be avoided. Continued supplementation is often needed after discharge. Depending on the health status of the patient, nutritional support can range from temporary admission to a skilled-nursing or extended-care facility to home supplementation through such programs as Meals on Wheels.