Malnutrition: changes that favor it

In the elderly there is a decrease in energy needs. These are estimated to decline 10% every decade after age 60, but overall there are not too many differences from younger adults in nutrient needs.

In older people there are certain biological, psychological and social changes that interfere with the process of feeding and obtaining nutrients. They can be summarized as follows:

• Dental and gum problems, which often lead to tooth loss and difficulty chewing.
• Decreased saliva production.
• Alteration of the detection of flavors; especially the salty flavor is lost, the sweet being the one that is preserved the most.
• Slower digestive tract motility, leading to early satiety, slow digestion and a tendency to constipation.
• Alteration in the secretion of various hormones that regulate the sensation of appetite.
• Decrease in energy expenditure, with which there is a lower need for caloric intake.
• Presence of diseases that limit both the craving for food (for example, depression) and the possibility of obtaining it (osteoarthritis that makes it difficult to wander to go shopping).
• Any problem that limits the ability to obtain or prepare food, if there is no caregiver or support network.
• Taking medications that reduce the sensation of appetite, by themselves or because they cause dry mouth, nausea, constipation, etc.
• Social isolation, living alone; you don't feel like cooking.
• Economic difficulties; there is simply no money to maintain a correct diet.

If one or more of these factors produces an imbalance and / or deficit in the supply and availability of nutrients, a picture of malnutrition occurs. It is estimated that this occurs in 5% of the elderly who live at home, between 17 and 44% of those admitted to acute pathology hospital units and between 50 and 80% of the elderly institutionalized in residences.

This malnutrition can be due to a lack of the minimum required calories (energy), a lower protein intake or a lower contribution of macro- or micronutrients (iron, calcium, vitamins, etc.). Depending on the element that is deficient, the consequences of said deficiency will vary.

In general, there is weight loss at the expense of muscle mass, impaired immune function, loss of bone mass, difficulties in repair functions (for example, wounds and sores), dehydration, problems in kidney and liver functions. and cardiac, and even in higher mental functions. In short, there is an increase in the frailty of the elderly, which worsens the prognosis and evolution of chronic diseases, and increases the risk of complications, hospital admissions or in residential centers, increases the possibility of dependence on third parties and increases mortality in general.

Due to all these consequences, it is very important that the elderly, their caregivers and their environment ensure a correct intake of water and nutrients, taking into account the special and individual needs of each patient.