Healthy eating is a key part of aging well. It is an important part of maintaining independence and quality of life. Healthy eating can help to:
Healthy eating can be more challenging as people age. There can be a decrease in appetite and disinterest in food or preparing balanced meals. The body may need less food, but need more of a certain nutrient. It is important to encourage a variety of healthy foods to make sure patients are getting enough nutrients. This includes:
"Inadequate intake of protein and/or energy over prolonged periods of time resulting in loss of fat stores and/or muscles wasting" (Dorner & Friedrich, 2018).
This includes starvation-related malnutrition, chronic disease or condition-related malnutrition and acute disease-related/injury-related malnutrition.
The consequences of malnutrition can be physiological, biochemical, or psychological. Forty-five percent of patients admitted to hospital are malnourished, with the mean age being 66 years old (Allard, et al., 2015). Malnourished adults in acute care are at greater risk for loss of independence and/or mortality if nutritional risks are not addressed in hospital or at discharge.
A priority of nutrition care is to have frail adults consume enough food to prevent unintentional weight loss. Older adults lose weight as they age, but the amount lost is variable. The primary concern with weight loss in frail older adults is that lean skeletal muscle is lost rather than unwanted adipose (fat) tissue.
Low appetite secondary to side effects such as:
This can be the result of many different factors such as:
|Chronic and Acute Illness-related Malnutrition||
Many disease states can result in unintentional weight loss in this population, including:
*Surgery increases demands on your body. Additional energy and protein is needed for successful healing because muscle is often broken down during surgery!
Screening tools can be used to determine patients who are malnourished or at risk of being malnourished. Tools are typically completed within 1-3 days of being admitted to hospital and can be completed by any health care professional.
Currently, diet technicians at Nova Scotia Health Central Zone acute care hospitals are screening patients within 1-3 days of admission for malnutrition. If your hospital or unit does not have a tool in place and/or you are concerned that a patient is at risk of malnutrition, the Integrated Nutrition Pathway for Acute Care (INPAC) tool can be completed.
The INPAC tool is a validated screening tool that can be completed by any health care professional. The tool consists of the following questions:
If a patient answers YES to both questions, they should be referred to a dietitian who will complete a further assessment which may include a Subjective Global Assessment (SGA). (Canadian Malnutrition Task Force, 2019)
Loss of Appetite
Fatigue/Difficulty Obtaining/Preparing Food
Chewing and Swallowing Difficulties
Oral Nutrient Supplements (ONS)
Older adults are vulnerable to dehydration due to physiological changes. This can be complicated by disease states. Risk factors include:
Dehydration is associated with poor health outcomes, including urinary tract infections, pressure sores, constipation, and increased risk of death.
Many older adults are reluctant to drink because it may increase time in the washroom, especially at night. Approaches to encourage patients to increase fluid intake include:
Allard, J. P., Keller, H., Jeejeebhoy, K. N., Laporte, M., Duerksen, D. R., Gramlich, L., Payette, H., Bernier, P., Vesnaver, E., Davidson, B., Teterina, A., & Lou, W. (2015). Malnutrition at hospital admission-contributors and effect on length of stay: a prospective cohort study from the Canadian Malnutrition Task Force. Journal of Parenteral and Enteral Nutrition, 40(4), 487-497.
Canadian Malnutrition Task Force. (2019). https://nutritioncareincanada.ca/
Dorner, B., & Friedrich, E. K. (2018). Position of the academy of nutrition and dietetics: individualized nutrition approaches for older adults: long-term care, post-acute care, and other settings. Journal of the Academy of Nutrition and Dietetics, 118(4), 724-735.
Fávaro-Moreira, N. C., Krausch-Hofmann, S., Matthys, C., Vereecken, C., Vanhauwaert, E., Declercq, A., Bekkering, G. E., & Duyck, J. (2016). Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Advances in Nutrition, 7(3), 507-522.
Government of Canada. (2019). Healthy Eating for Seniors. Retrieved from: https://food-guide.canada.ca/en/tips-for-healthy-eating/seniors/
Gramlich, L. (2016). The Prevalence and Impact of Malnutrition in Canadian Hospitals: MIND THE GAP. Retrieved from Canadian Malnutrition Task Force: https://www.cag-acg.org/images/cddw/diet_gi_health_nutrition_in_canada_gramlich.pdf
Nowson, C., & O'Connell, S. (2015). Protein requirements and recommendations for older people: a review. Nutrients, 7(8), 6874-6899.
Robinson, K. (n.d.). Guide to good nutrition and hydration in older age. British Dietetic Association.
Wells, J. L., & Dumbrell, A. C. (2006). Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clinical Interventions in Aging, 1(1), 67-79.