We publish a new article on nutrition and the elderly extracted from the Food Guide for Seniors edited by him . On this occasion, specialists in nutrition and endocrinology Samara Palm Mile and Carmen Gomez Candela address the treatment of malnutrition in the elderly.Treatment of malnutrition in the elderly
an article of Samara Palm Mile (Specialist in Endocrinology and Nutrition. Clinical Nutrition and Diet Unit. La Paz University Hospital), and Carmen Gomez Candela (Specialist in Endocrinology and Nutrition. Head of the Clinical Nutrition and Dietetics Unit. La Paz University Hospital).
As in other stages of life, the malnutrition is associated with increased morbidity and mortality. Bearing in mind that the elderly population already presents high morbidity, we would be talking about a problem of significant magnitude. The malnutrition It is associated with depression of the immune system, which translates into a higher rate of infections. The loss of weight, lean and bone mass leads to a decrease in respiratory capacity, greater ease for falls and fractures, pressure ulcers, etc. Likewise, malnutrition in the elderly supposes an increase in health costs associated with any process.
at the time of address malnutrition in an elderly patient, it is necessary to take into account the quality of life of the patient and the vital prognosis, and although age is a factor to consider, this fact should not prevail over the previous aspects. Usually, the intervention criteria in the elderly they are more flexible; Thus, it is more convenient to liberalize dietary recommendations as far as possible to improve the quality of intake, even if this means discreetly giving up some therapeutic objectives with other diseases.
The objectives of nutritional support enteral/oral in the elderly patient are:
– Guarantee an adequate contribution to their energy, protein and micronutrient needs.
– Maintain or improve the nutritional status of the patient.
– Maintain or improve the functional capacity and activity of the patient or their rehabilitation.
– Maintain or improve your quality of life.
– To reduce the rate of morbidity and mortality in this population, which is somewhat immunocompromised and frequently multipathological.
In elderly patients diagnosed with or at risk of malnutrition, oral supplements They are a modality of artificial nutritional support recommended with a high level of evidence with the aim of increasing the intake of calories, proteins and micronutrients, as well as to improve nutritional status and survival and reduce the number of complications. Oral supplements are nutritional formulas with a known proportion of macro and micronutrients, complete or not, that are ingested orally with the aim of increasing caloric and/or protein intake in patients at risk or with an established diagnosis of malnutrition.
The range of oral supplements available on the market is wide and, in general terms, they are classified according to the following items:
– Kilocalories contributed in a milliliter: isocaloric when they provide 1 kcal/ml; hypercaloric when a ml contributes more than 1 kcal and finally hypocaloric, when the contribution is less than kcal/ml.
– Protein intake: they are hyperproteic when they provide more than 18% of the total caloric value in the form of proteins; normoproteicos when they contribute between 16 and 18%. There are formulations with reduced protein intake for medical use in situations such as renal failure or chronic liver disease. Taking into account the form of presentation of the proteins, the supplements can be classified according to whether the proteins provided are intact or whether they are a hydrolyzate of the same.
– Depending on the fiber intake: with or without fiber, usually in the form of a mixture of soluble and insoluble fiber.
– Depending on whether they contribute or not special or specific nutrients, such as supplementation with fatty acids, omega 3, arginine; most beneficial carbohydrate profile for the diabetic patient, etc.
Therefore, when prescribing an oral supplement, we must choose the one that best suits the nutritional needs of our patient. All oral formulas are flavored, this being an important aspect if we take into account that the ultimate goal is for the patient to take them. Oral supplements should eat between meals to favor their taking, because, although it has been seen that taking these products half an hour after ingestion does not compromise the total volume of that one, it is preferable to take advantage of the periods between meals.
Hydration and intake are considered basic support measures, so they should be maintained even in the terminal patient. However, sometimes a certain ethical conflict arises in the patient with artificial nutritional support. In such cases, the characteristics of the patient, the opinions of the physicians in charge, as well as family members and the patient himself, must be considered.