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Malnutrition: the risks for the elderly
Prevalence of malnutrition varies from 5 to 10% amongst the elderly who live at home and from 15 to 65% amongst the elderly living in Care Homes for dependant seniors
The chronic decrease of muscular strength affects 30% of the elderly people aged more than 60, and can go beyond 50% for the elderly people over 80. 30
Note : the superior numbers are references to articles and studies listed in the "References" page.
 The protein-calorie malnutrition is a common situation in geriatrics. It reduces the autonomy, increases the risks of decubitus ulcers, infections, fractures (hip, vertebra), increases the risk of complications when there is hospitalisation and it increases mortality. It impacts the quality of life. 29, 31-33
In economic terms, malnutrition amongst the elderly increases the costs of care, and the number of health examinations and hospital stays. The annual costs triggered by malnutrition reach an estimated 18.5 billion dollars in 2000 in the USA (apprx. 13.6 billion euros) and 7.3 billion pounds in 2003 in the United Kingdom(apprx. 8 billion euros), which represents 10% of the total health expenditure. Half of the costs triggered by malnutrition amongst people over 65 is linked to the elderly people in long stay in hospitals and elderly people homes. 29, 30, 33, 34
There is a physiological decrease of the muscle quotient. However if a person carries on having a constant quantity of good quality proteins whilst ageing, there won't be any change in the person's metabolism for the protein synthesis. 32 41
The nutritional risk exists when there is an insufficient nutritional intake, or an undesired weight loss > 5% in 3 months or > 10% in 6 months, or a body mass index (BMI) < 20 kg.m-². 33
Malnutrition is multifactorial, favoured by :
- anxiety, apathy, tiredness and depression,
- drugs intake (adverse drug reactions),
- chronic diseases,
- need of assistance for eating,
- hospital stays: acute disease, increase of metabolic needs (disease, surgery), stress due to hospitalisation,
- Alzheimer disease and other cognitive disorders,
- deglutition disorders (following a stroke, oral surgery),
- oral and dental problems,
- minced, mixed or mashed food (15 to 26% of patients in long stay), 35
- early sensation of being fed to appetite, and slow down of the gastric drainage of liquids for elderly people. 28-30, 33
It is easier to prevent than to treat malnutrition. 32, 36 In case of undesired weight loss, the early intake of enriched food, or nutritional complements, increases significantly the chances of success: re nutrition, improvement of the autonomy and general condition. 29, 33
The minimum protein intake for elderly people is 0.8 g proteins/kg/day. 39-42 The majority of ill elderly people require at least 1 g of proteins/kg/day and approximately 30 Kcal/kg/day, depending on their physical activity. 33 For malnourished elderly people, French National Health Authorities (HAS) recommends 1.2 to 1.5 g proteins/kg/day and 30 to 35 Kcal/kg/day. 29 For people who are confined to bed or are affected by limited mobility, a caloric intake of 20 Kcal/kg/day can be sufficient. 29
Despite differences in the use efficiency, the age does not alter the synthesis ability of the muscular proteins after the intake of protein rich food. 32 It has been demontrated that the protein intake increases the weight and decreases mortality. 28 It is preferable to distribute the protein intake in several intakes during the day (lunch, dinner, and two snacks at 10am and 4pm) rather than offer protein rich food (meat, fish, eggs) at lunch and dinner only. 40 Moreover, a recent circular precises that elderly people should not remain more than 12h without eating: it is thus recommanded to give an additional snack at 9pm. (French National Food Council, notice n°53 of 15 December 2005).
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