Undernutrition amongst the elderly:

To diagnose early

Note : exponent numbers refer to articles or studies listed in "References"

According the consensus report published in 2007, ¹ the French High Health Authority (HAS) selected the following definitions :

• Thinness is a clinical conditiions characterised by a weight inferior to a common average value, even if this condition is not considered as pathological. It can be a constitutional condition.
• Malnutrition is an English word which means that the food intakes are not balanced,  and refers to undernourishment due to deficiencies as well as over-eating by excess.
• Undernutrition is a physiological term that means « lack of assimilation », phenomenon that implies that the  principles that constitute the live organs split from the latter and become residues.
• Protein-energy malnutrition is a health condition diagnosed with four criteria:

This condition contributes to an increased risk of fall and infectious diseases. This definition is for the elderly people for whom the common threshold usually considered is 70 years old. The MNA® interpretation is as follows:

• >24 : not undernourished;
• between 23.5 and 17.5 : risk of undernutrition ;
• < 17 : undernourished.

The main risks of undernutrition are:

• Chronic and acute diseases,
• Impairment of cognitive functions,
• Poverty and social isolation,
• The intake of more than 3 to 4 drugs per day,
• Changes in taste and smell functions,
• Oral health problems (drymouth, oral pain, dental mobilities, lack of teeth and inadequate dentures).

Many studies demonstrate that hospitalisation or life in medical institutions are also risk factors for undernutrition: change of environment, of meal times, dietary habits and lack of assistance for eating.

Beyond these elements, undernutrition diagnosis can call upon a range of arguments: interview about food intakes, biological data (mainly rate of albumine and prealbumine) and complex assessment methods. None of the latter on its own is specific to undernutrition.

A minimum overview can be carried out by a team who is not specialised in nutrition, it involves:

1- BMI in kg/m² : weight (kg)/height² (m²). Schematically, it is estimated that an old person is undernourished with an IMC < 17, and presents a risk of undernutrition for an IMC < 21.

2 – The percentage of weight loss in comparison to the usual weight (before hospitalisation). Schematically, it is considered that an old person is undernourished if there is a weight loss > 10% of the original weight. This involuntary weight loss occurs essentially at the expense of the muscle mass.

3 – The MNA-SF® includes 6 questions rated on 14. This screening questionnaire can be carried out in 3 minutes. A mark < 11 is considered to indicate a possibility of undernutrition, which justifies a global assessment with 12 additional questions, which can be achieved in 10 minutes.