The association of xerostomia and inadequate intake in older adults

Recent studies indicate that nearly one in five older adults has xerostomia (dry mouth). Salivary gland dysfunction and/or inadequate saliva increases the difficulty of these older adults in obtaining proper nutrition. Problems in lubricating, masticating, tolerating, tasting, and swallowing food contribute notably to the complex physiological and psychological manifestations of aging. To our knowledge, the literature has not demonstrated an association between xerostomia and malnutrition in the elderly. We randomly selected 67 older adults from institutionalized and free-living geriatric populations. Nutritional intake analysis was performed on both groups of study subjects, who were found to have xerostomia by use of sialometry, and on control subjects matched for age, sex, and physical status. Intake of total energy, protein, dietary fiber, total fat, saturated fat, cholesterol, sodium, potassium, vitamin A, vitamin C, thiamin, riboflavin, vitamin B-6, calcium, iron, and zinc was compared with the 1989 Recommended Dietary Allowances. Subjects' intakes were also compared with that of a control group. Medical systemic information and number and types of medications were compared among the groups. Statistical analysis of the data indicated significant (p less than .001) inadequacies in the nutritional intake patterns of institutionalized and free-living older adults with xerostomia. Subjects with xerostomia (more than 75% of the free-living and institutionalized seniors) had significant deficiencies of fiber, potassium, vitamin B-6, iron, calcium, and zinc. Taste and food perception were significantly reduced in the elders with xerostomia. Our study indicates the potential contribution of xerostomia to the high prevalence of geriatric malnutrition in the United States.     

Malnutrition in the institutionalized older adult.

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.     

Energy balance and malnutrition in institutionalized elderly people

Screening tools and more extensive assessment methods have signaled that malnutrition is common in institutionalized elderly. There are multiple factors - physiologic and non-physiologic - which hereby increase the risk of negative energy balance leading to weight loss and subsequent undesirable outcomes. Addressing this problem a number of controlled intervention studies have shown positive effects of 'simple' nutrition interventions in institutionalized older persons.     

Malnutrition: another health inequality?

Malnutrition (undernutrition) is one of the many health inequalities facing governments in the 21st century. Malnutrition is a common condition affecting millions of individuals in the UK, particularly older adults, the sick and those cared for within the healthcare system. It costs the National Health Service > pound sterling 7.3 x 109 annually. New data highlight marked geographical differences in the prevalence of malnutrition across England and an inter-relationship between deprivation, malnutrition and poor outcome. As malnutrition is a largely treatable condition, prompt identification and effective prevention and treatment of this costly condition is imperative. Routine screening for malnutrition in high-risk groups (e.g. the elderly and those in areas with high deprivation) and within the healthcare system should be a priority, with screening linked to appropriate plans for the management of malnutrition. Use should be made of specialised interventions, including oral nutritional supplements and artificial nutrition, to aid recovery and improve outcome, with skilled health professionals, including dietitians, involved where possible. Equity of access to nutritional services and treatments for malnutrition needs to occur across the UK and, although complex and multi-factorial, the effects of deprivation and other relevant socio-economic and geographical factors should be addressed. Ultimately, as malnutrition is a public health problem, its identification and treatment must become a priority for governments, healthcare planners and professionals.     

Nutrition and dietetics in aged care

Aim: The global trends of rapid population ageing and increased risk of malnutrition among older people have a tremendous impact on nutrition care for the elderly. The present paper offers an overview of the challenging nutritional needs and problems of the elderly and explores strategies related to nutrition and dietetics to improve care for this particular segment of the population. Methods: A narrative review on monitoring malnutrition and improving food services was undertaken with reference to the literature and drawing on the experience of the author. Results: There is a wide range of problems associated with malnutrition in the elderly that have implications on strategies of intervention for addressing these problems. Conclusions: The current challenges for dietitians include identifying and monitoring the nutritional needs and malnutrition problems of the elderly, improving the quality of food services in health‐care facilities, and initiating innovative approaches to nutrition and dietetic services in the community.     

What do we know about... nutrition and older people?

Nutrition is important to the health and functioning of elderly people. This paper summarises the evidence that many old people suffer from undernutrition and outlines the insidious effects of this form of malnutrition. It discusses the physiological and practical difficulties elderly people face in achieving good nutrition, and the challenge this poses to health workers. Given the UK's ageing population, undernutrition in older people is a significant public health issue as well as one that should concern all health professionals involved in individual or group contacts with elderly clients.     

The unhealthy lifestyle factors associated with an increased risk of poor nutrition among the elderly population in China

Objectives

The associations between nutritional status and lifestyle factors have not been well established. This study aimed to investigate the prevalence of poor nutrition and to examine the relationships between nutritional status and unhealthy lifestyle and other related factors among the elderly.

Methods

This cross-sectional study was conducted in Liaobu Town, Dongguan city, China. A total of 708 community-dwelling older adults aged ≥60 years were recruited by stratified random sampling. Data on sociodemographic characteristics, health and lifestyle factors, and the Mini Nutritional Assessment (MNA) scores were collected using structured questionnaires via face-to-face interviews. A multivariate logistic regression model was constructed to identify the risk factors of poor nutrition.

Results

The prevalence of malnutrition among the elderly adults in this study was 1.3%, and 24.4% were at risk of malnutrition (RM). Poor nutrition was significantly associated with female gender, older age, lower education, a high number of self-reported chronic diseases, and hospitalization in the last year. Unhealthy lifestyle factors associated with poor nutrition included current smoking status, higher alcohol consumption, lack of physical activity, longer duration of sitting, negative attitude towards life, and a poor family relationship.

Conclusions

While the prevalence of malnutrition was low, RM was high in the elderly population in China. The determinants of malnutrition were explored and the relationships between nutritional status and unhealthy lifestyle factors were examined. The results of this study provide information for future longitudinal studies with multi-factorial interventional design in order to determine the effects of the causal relationships.

     

Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review

Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.     

High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults–A Systematic Review and Meta-Analysis

Background

Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other.

Clinical pictures of malnutrition in ill elderly subjects

Malnutrition in ill elderly subjects is common in hospitals, nursing homes, and home care. Depending on the type and composition of the groups of patients under consideration, the prevalence of malnutrition is cited at up to 60%. With advancing age, the amounts of food consumed daily diminish and become significantly smaller than the amounts consumed by the younger population. The elderly mostly eat food of low nutrient density. Especially at times of high energy requirements such as acute or chronic illness, this results in an energy deficit and general malnutrition. Precise diagnosis of malnutrition can be facilitated by determination of a number of biochemical parameters. Knowledge of these permits individualized nutrition therapy. The most important deficits affecting ill elderly subjects are those relating to proteins, iron, zinc, selenium, and vitamins B12, B1, B6 and D. Malnutrition prolongs hospital stays, imposes enormous costs on health services, and causes considerable mortality. The present, very rapid increase in the size of the elderly population will exacerbate the problem of malnutrition. Therefore more attention should be paid to malnutrition by treating it as a disease in its own right and including it in the training of doctors and nurses.     

Temporal Trends in Incidence of Nutritional Deficiency among Older Adults in China: A Secondary Analysis of the Global Burden of Disease Study 1990–2019

Nutritional deficiency is prevalent among the elderly, and it is associated with many adverse health consequences. China is rapidly moving toward an aging society with a large population; however, evidence on the epidemiological trends in nutritional deficiency among the Chinese elderly is limited. Data on the incidence of nutritional deficiency among Chinese adults aged 65 years or above from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. We used the joinpoint regression method to estimate the average annual percentage change (AAPC) and to describe trend patterns. Age, period, and cohort effects were determined using age–period–cohort models. From 1990 to 2019, the incidence of vitamin A deficiency and iodine deficiency among Chinese older adults decreased from 1784.12 and 8.20 to 304.27 and 7.26 per 100,000, with AAPCs of −0.41 (−0.44, −0.38)% and −5.86 (−6.29, −5.43)%, respectively. A continually increasing trend was seen for incidence rates of protein-energy malnutrition, from 1342.02 to 2275.87 per 100,000 person-years, with an AAPC of 1.70 (1.40, 2.01)%. These trends were more pronounced among men than women. A strong age effect and birth cohort effect were present. Specifically, the population that was older or born later had a lower incidence of deficiencies in vitamin A and iodine but a higher incidence of protein-energy malnutrition. The results show a substantial reduction in vitamin A and iodine deficiencies among the Chinese elderly, and health policies and public awareness are needed to address the burden of protein-energy malnutrition in this population.     

Nutrition and health of the elderly: osteoporosis

Osteoporosis is a debilitating disease that affects many older people. Its aetiology is complex and nutrition is only one of many factors which influence bone mass and the risk of fragility fractures. This review briefly describes the biology and epidemiology of osteoporosis and focuses on role of nutrition in the bone health of older people. An overview of the current evidence relating calcium intake and vitamin D status in the elderly to bone mass and fractures is presented and set in context of recent population-based surveys that have identified important nutritional inadequacies among sub-groups of the elderly population in Europe.     

Understanding chronic malnutrition in childhood and old age: role of energy balance research

Undernutrition is commonly associated with chronic disease in children and the elderly. Overnutrition is also, but less commonly, associated with chronic illness. In most diseases malnutrition arises because energy intake does not match energy output. Traditionally, the focus of research has been on abnormalities in energy expenditure, in the belief that these factors were the main determinants of energy imbalance. Recent studies using the doubly-labelled-water method to measure total energy expenditure, combined with more complex study design, have suggested an alternative conclusion. In many chronic diseases patient behaviour, and particularly energy intake, is responsible for energy imbalance and malnutrition. Energy balance studies have therefore provided a useful foundation for the design of strategies aimed at preventing or managing chronic malnutrition. However, modifying patient behaviour is an ambitious undertaking which may not be within the scope of existing clinical nutrition services. A number of non-traditional models of managing chronic malnutrition in children and the elderly are promising. Increasing recognition of the value of systematic review will also provide improved strategies for prevention and management of chronic malnutrition.     

Nutritional approaches to the management of sarcopenia

Sarcopenia is defined as a decline in muscle mass and/or function, which is a consequence of ageing. The consequences of a declining muscle mass become serious if functionally important thresholds for physical independence are crossed, and this will occur more readily in the presence of disease. Although sarcopenia is of complex aetiology, contributory factors likely include habitual sedentarism and/or deficits in the responsiveness of muscle protein synthesis to physical activity and nutrition, as well as impaired muscular regenerative capacity. Altered inflammatory, immune and endocrine functions are also associated with sarcopenia, in addition to phenomena such as a reduced response to oxidative stress, metabolic acidosis and nutritional (e.g. vitamin D) deficiencies. Sarcopenia is associated with malnutrition, which may contribute to the poor muscle function observed in many older adults, particularly in frail patient groups. The problem is that as a result of anabolic resistance, simply increasing dietary protein ‘chronically’ in older age may not be effective. When exercise and nutritional interventions are combined in the form of resistance exercise training plus protein/essential amino acid supplementation, there is evidence of some benefit for older adults in terms of improved muscle function, but further research is needed in adults aged over 75 years. In addition, there are as yet relatively under‐researched intervention strategies (timing and distribution of protein supplementation; novel nutriceuticals, vitamin D) bearing potential utility in improving responsiveness to physical activity and nutrition in old age.     

Malnutrition in elderly ambulatory medical patients.

Elderly ambulatory persons may be especially susceptible to malnutrition, particularly those who are poor and socially isolated or have comorbid chronic medical diseases. We found that 98 of 2,986 persons aged 60 years or older attending a hospital-based medical practice between 1979 and 1989 weighed less than 45.4 kg (100 lbs). All but 1 of these subjects met criteria for malnutrition as judged against age-specific norms for weight. Thus the prevalence of malnutrition in this sample was 3.25% (95% CI 2.61, 3.89%). Interviews and physical examinations of a subsample (n = 16) revealed that all 16 subjects either met anthropometric-based criteria for malnutrition or were being treated for malnutrition. Of the 98 subjects who weighed less than 45.4 kg, 62 (63.3%; 95% CI 53.8, 72.8%) had comorbid conditions that could have contributed to malnutrition. Physicians did not record a diagnosis of malnutrition or weight loss in 47.9% of subjects (95% CI 38.0, 57.8%) and did not prescribe a nutrition supplement for 76.5% of subjects (95% CI 68.1, 84.9%). Subjects treated with nutrition supplement were more likely to have cancer. These findings suggest that malnutrition, both with and without concomitant major comorbid disease, is relatively frequent among elderly ambulatory patients and that a specific nutritional diagnosis is not made in many cases. We suggest that weight under 45.4 kg in an elderly person is a useful criterion for identifying elderly patients at nutritional risk.     

Interleukin-2, its receptor and nutrition in older adults: a review

It is well recognized that malnutrition can impair immune function. Conversely, immune activity may influence measures of malnutrition, such as serum albumin and prealbumin. Interleukin-2 (lL-2) and its receptor are key components of immune function. Recent evidence has expanded our understanding of the interaction between nutrition and this cytokine system. particularly in older adults. (A cytokine is a protein that acts as a "hormone" regulator of the immune system.) This paper will summarize more recent findings regarding the relationship between nutrition and the IL-2/IL-2 receptor system.     

Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies

Objective

The association between frailty and malnutrition is widely noted, but the common and distinct aspects of this relationship are not well understood. We investigated the prevalence of prefrailty/frailty and malnutrition/nutritional risk; their overlapping prevalence; compared their sociodemographic, physical, and mental health risk factors; and assessed their association, independently of other risk factors.

Nutrition Risk Measured Online in Community-Living Older Australians

Abstract

Many community-living older adults experience the condition of malnutrition and the causes are complex and multi-factorial. This study examined nutrition risk in a sample of community-living older Australians (n?=?77, age ≥65 years) using an online, self-administered survey consisting of two validated questionnaires (SCREEN II and SF-12). We found a significant relationship between health status and nutrition risk; those with higher self-rated health status had lower nutrition risk. Forty percent of the participants were categorized at high nutritional risk, 26% at moderate nutritional risk and 34% not at nutritional risk. The most common nutrition risk factors were: (i) weight perception (perceiving weight to be more than it should); (ii) food avoidance; (iii) low intake of milk, milk products and alternatives; and (iv) finding meal preparation a chore. Many nutrition-risk factors were consistent with population survey data highlighting the need for greater awareness of nutritional requirements for healthy ageing.     

Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools

Protein-energy malnutrition is a prevalent problem in older persons. Its relation to increased morbidity and mortality has been well documented. Early recognition of malnutrition allows for a timely intervention. A large proportion of chronic diseases affecting older persons can be either prevented or significantly improved by improving nutrition, which underscores the importance of developing a screening system that can trigger a more comprehensive evaluation when indicated. Screening for malnutrition in older persons can be difficult because of the normal age-related changes in many of the commonly used parameters. A comprehensive nutritional evaluation includes a complete history and physical examination in addition to a more specific nutrition-oriented assessment. Specific nutritional assessment includes estimating food intake, anthropometric measurements, and evaluation of several biochemical parameters commonly affected by changes in nutritional status. In this article, we review the commonly used tools for nutritional assessment in older persons. The goal is to promote disease-free, active, and successful aging.