Malnutrition and dietary treatment in older adults: a conference report

Harriët Jager-Wittenaa, Stacey Jones, Elisabet Rothenberg, Dorothee Volkert

Forskningsoutput: KonferensbidragArbetsdokument

Sammanfattning

Aims: With an ageing population worldwide,pressure on health and social care systems grows. Strategies to preventage-related conditions as malnutrition, sarcopenia, and frailtyare therefore of ultimate importance, to enable older adults remainingphysically and mentally active and independent as long aspossible. Good nutrition plays a significant role in maintainingand improving functioning. The aim of the conference session wasto 1) elucidate and discuss nutritional challenges faced and strategiesto improve nutritional intake and nutritional status amongolder adults, and 2) to share knowledge and best practices gainedfrom both national and international (research) projects on nutritionand ageing conducted in Europe.

Methods: In this conference session, three presentations about different aspects of malnutrition in older persons were given. Firstly,an overview of current practices in different European Countriesto prevent malnutrition in older adults were presented anddiscussed. Data were collected via the European Specialist Dietetic Network for Older Adults who reported on the most recent statistics,guidelines and practice for screening, prevalence and interventions for identifying, preventing and treating malnutrition. Secondly, the relationship between dietary intake, physical performance(gait speed and hand grip strength) and body composition(dual energy x-ray absorptiometry) in two cohorts from the GothenburgH70 Birth Cohort Studies, i.e., one Swedish cohort at age70 (born in 1944) and one Swedish cohort at age 85 (born in 1930)[1] were discussed. Thirdly, a range of strategies to support adequate nutrition in older adults were discussed.

Results: Information was provided by representatives fromSpain, The Netherlands, United Kingdom, Switzerland, Greece,Turkey, and Portugal, which identified commonalities in practiceas well as variations that were specific for each country. Mandatory nutritional risk screening is not in place for every country andfor some countries, even when malnutrition screening is mandatorythe rate of screening uptake remained low. Many countriesreported staffing/dietetic capacity as a limitation, and the need fordietitians to raise awareness of the importance of nutrition amongstother medical and allied health professionals was raised. There isconsensus that dietitians should be regarded as integral membersof the multidisciplinary team and whilst there were some examplesof good practice, there is still room for improvement in this area. A variety of screening tools are used and reported malnutritionprevalence varied between countries, however with the latest GLIM consensus on the diagnosis criteria for malnutrition, thismay encourage consistency in criteria in the future.Data from the Gothenburg H70 Birth Cohort Studies [1]showed good dietary intake in relation to recommendations [2 although intake for some nutrients were somewhat lower in the 85-year olds compared to the 70-year olds. In both cohorts vitaminD was the nutrient with highest proportion of low intakes. Amongthe 70-year olds, alcohol intake had increased significantly indicatingchanges in lifestyle over time. Significant differences werefound in prevalence of low muscle mass, slow self-selected walkingspeed, and hand grip strength, with a higher proportion havingsarcopenia among the 85-year olds compared to the 70-year old(3% vs. 55% respectively) [3]. Differences were also found in mealpatterns among 85 year-olds in risk of malnutrition compared tothose without with lower meal frequency and less snack meals/dayamong those in risk of malnutrition.Strategies to support adequate nutrition range from strategiesto identify those in need of nutritional support to strategies regardingthe provision of nutrition [4]. As an important prerequisite, allolder persons should be routinely screened for malnutrition in regularintervals in order to identify an existing risk early. Various validated screening tools specifically for older persons are availablefor different healthcare settings [5]. Potential risk factors or causesof malnutrition, e.g. chewing or swallowing problems, medicationside effects or depression, need to be identified and eliminated asfar as possible [4]. Direct dietary strategies to support adequateintake include the recommendation or provision of energy andnutrient dense food and enriched meals in an appealing and appetizingway. Particular attention should be paid to sensory characteristics,adequate texture and food variety, always consideringindividual likes and dislikes. Dietary restrictions should generallybe avoided since they may limit food choice and eating pleasureand thus bear the risk of limiting dietary intake [4].Besides regular main meals, snacks should be available as needed.Furthermore, older persons should be encouraged to sharetheir mealtimes with others and eat in a pleasant, relaxed atmosphere. In case of dementia, finger food may help to maintain independenteating and allow for eating while walking for personswho are constantly pacing. Depending on individual resources andneed of assistance for shopping, preparing meals and eating, adequatesupport should be arranged. If oral nutrition is insufficientor impossible despite all these efforts, e.g., in case of dysphagia,enteral and parenteral nutrition should be taken into consideration[4].As often several persons – relatives as well as different healthcare professionals – are involved in nutritional care, communicationand close cooperation of these persons is important to ensureconsistent approaches and avoid double effort.

Conclusions: Older adults are at increased risk of malnutrition,which in turn is related to poor health outcomes. Nutritional interventionsaim to maintain autonomy through physical independence,preventing disability, and to ensure quality of life among older adults. Nutritional care and support of older adults at risk or affected by malnutrition is thus an important public health concern, but adequate structures and strategies to prevent and treat malnutrition are not implemented everywhere. Future efforts should aim to put adequate nutritional care into practice as an integral part of geriatric healthcare in all settings in all countries. 

OriginalspråkEngelska
StatusPublicerad - 2019
Evenemangthe 12th EFAD Conference -
Varaktighet: 1980-jan-01 → …

Konferens

Konferensthe 12th EFAD Conference
Period80-01-01 → …

Nationell ämneskategori

  • Naturvetenskap (1)
  • Näringslära (30304)

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