Malnutrition is common among older adults, and the risk increases with age.
The presence of malnutrition is approximately 3% among community dwelling older adults, 22% among hospital inpatients, and nearly 30% in older adults in nursing home, long-term care or rehab rehabilitation and post acute care settings.
The problem is particularly acute in healthcare settings, where up to 50% of elderly patients are hospitalized due to malnutrition-related conditions.
The global prevalence of malnutrition in older adults is 18.6%, with the highest rates in Africa at 35.7%
Current estimates suggest that around a quarter of older adults (65 years and older) are malnourished or at risk of malnutrition
Malnutrition for prevalence in low resource community settings can be as high as 18%.
This number can reach approximately 30% among old patients who are hospitalized have cancer or heart failure or who are in geriatric rehabilitation settings or nursing homes.
Malnutrition can be caused by reduced food intake, increased nutritional requirements, impaired gastrointestinal uptake, or increased excretion of nutrients.
Nutrition among younger adults, usually occurs in the context of illness while malnutrition in older adults is more strongly associated with reduced food intake.
Age related changes of appetite regulation are responsible for anorexia of aging.
Older adults are particularly vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity.
Anorexia of aging is an increasingly recognized cause of reduced food intake in older adults.
Changes in peripheral G.I. hunger and satiety signaling patterns, and central hypothalamic control mechanisms result in reduce feeling of hunger and faster and longer satiety after a meal.
Age related declines in the perception of smell and taste contribute to age related anorexia.
These changes are also reasonable adaptation to generally decreasing energy requirements associated with aging, but may cause older adults to be susceptible to chronic malnutrition, especially in the presence of other risk factors.
Malnutrition in older adults is associated with increased mortality and morbidity, as well as physical decline.
Poor oral health can lead to malnutrition related to chewing problems, inadequate dentures, inflammation or infection of the mouth or xerostomia that hinder food and swallowing disorders related to neurological diseases of stroke, dementia, and Parkinson’s disease.
Impaired cognition and dementia, can affect nutrition reducing intake and may increase energy expenditures.
Eating disorders are rare, but need to be considered in old age.
Health impairments are a major threat to nutritional intake and status, especially an older adults related to a higher incidence of acute disease and greater prevalence of chronic illnesses than younger adults.
Acute and chronic illnesses reduces appetite, increases energy, and nutrient requirements, impairs digestion, and nutrient absorption.
The severity of inflammation present is associated with the reduced food intake.
Most medications have at least one G.I. side effect, such as impaired appetite, nausea, constipation, or xerostomia, and can reduce food intake.
Polypharmacy may adversely affect the viability of nutrients.
Meals are an important social event for older adults, and in the presence of loneliness, and social isolation can diminish appetite and reduce food intake.
Negative major life events can affect the person‘s desire to live and eat and be associated with serious weight loss.
The risk of malnutrition increases with the number of individual risk factors that are present.
Diagnosing malnutrition in older adults is based on assessment of five criteria, three that are phenotypic, including weight loss, lower body mass index and low muscle mass and two that are of etiologies nature with low intake or maldigestion or malabsorption and inflammation.
Diagnosis requires at least one criteria of each group.
Serum albumin and pre-albumin levels are not used as nutritional markers for the diagnosis of adult malnutrition.
The most common ideologic factor of malnutrition at any age is low, nutritional intake, owing to limited access to high-quality food.
In developed countries, malnutrition in older adults is usually the result of a geriatric syndrome.
The target for energy intake in older adults is 30 kg per kilogram of body weight adjusted for nutritional status, physical activity, disease, status, and dietary tolerance.
The protein requirements for older adults should be at least 1 g of protein per kilogram per day.
Malnutrition encompasses various forms, including undernutrition, such as wasting, and underweight, micronutrient-related malnutrition, as well as overweight and obesity.