nutritional diseases in the elderly malnutrition

Malnutrition related to nutritional diseases in the elderly is by no means "normal for the elderly to eat less" as everyone thinks. It is a clinical syndrome caused by aging degeneration, chronic disease comorbidities, medication interference, and social and psychological factors. The prevalence rate of hospitalized elderly people over 65 years old in my country exceeds 60%, and community residents About 30% of the patients are elderly. The core intervention principle is always to “screen first, then customize, and prioritize energy intake instead of strictly adhering to chronic disease taboos.” This is the most practical conclusion I have come to after working in community nutrition intervention for the elderly for 5 years and reviewing thousands of dietary files for the elderly.

Last month, I met 72-year-old Aunt Zhang at a free clinic. She has type 2 diabetes and high blood pressure for 11 years. She heard from a health care account that "you can control sugar by eating a vegetarian diet." She has not dared to touch red meat for more than a year and only eats half a bowl of rice at each meal.

Previously, there were indeed two completely different voices in the domestic nutrition community regarding the nutritional management of elderly patients with chronic diseases. In the past few years, the dominant group was the "strict control group", which believed that as long as you have diabetes, hyperlipidemia, or high blood pressure, you must strictly follow the dietary standards for adults. Sugar is not allowed, oil is limited to 25g per day, salt does not exceed 5g, and even staple foods must be clearly calculated based on kilograms of body weight. However, more and more clinical data have come out in the past two years. Many elderly people who strictly follow the rules have stable blood sugar, but they lose weight quickly, have poor immunity, and are hospitalized for pneumonia if they are not careful in winter. The gains outweigh the losses. Therefore, the voice of "relaxation first" is getting louder and louder. The "China Elderly Diabetes Diagnosis and Treatment Guidelines" updated last year clearly mentioned that the glycated hemoglobin control target can be relaxed to 8.5% for elderly people with diabetes over the age of 80. Priority should be given to ensuring adequate protein and energy intake, and not starving for sugar control.

Oh, by the way, there are still many elderly people who have been deceived by the old saying that "nothing can buy you old age to lose weight." They think that being thin means being healthy. In fact, for the elderly, it is best to maintain a BMI between 22 and 26. Being a little fatter will lead to a lower mortality rate. This has been confirmed by many top journals. Why are the elderly so prone to this type of malnutrition? It’s really not that they are “picky eaters” or “reluctant to eat”, there are many things they can’t help but do. Most of the elderly people in their 70s and 80s have missing teeth. Even with removable dentures, they can't bite hard things. The stewed vegetables are too rotten and tasteless, and they gradually don't want to eat them. ； There is also digestive function. The gastric acid secretion of the elderly is only less than 40% of that of the young. The gastric emptying time is slow, and they feel bloated after just two mouthfuls. The next meal is not digested yet, so they naturally eat less. ； What many people ignore is the issue of medication. Many elderly people take five or six types of medicines all year round. For example, calcium channel blockers that lower blood pressure can cause gum hyperplasia and loss of taste. Metformin can easily cause abdominal distension and loss of appetite. Antidepressants can even directly inhibit the feeding center. These are all "nutrient thieves" hidden behind the scenes.

There is also a more invisible influencing factor, which is loneliness. I once met an 81-year-old man who lived alone. His children were out of town and he was paid a lot of money every month. The supplements at home were piled up in the cabinets, but he was still malnourished. After a follow-up visit, I found out that it was troublesome for him to cook alone. He cooked a pot of porridge every day and ate some fermented bean curd for the whole day. No matter how good the supplements you gave him, he would not bother to take them out. Nowadays, many communities are piloting "senior meal assistance points" and "companion dining groups", which are to find a few elderly people who live nearby to eat together, chat and laugh, and eat half a bowl less. Our community tried it for three months last year, and the average weight of the participating elderly people increased by 1.2 kilograms, and their grip strength increased by 0.8 kilograms. The effect is really obvious. However, some people say that the cost of this model is too high and cannot be promoted in small places. It is better to distribute pre-made nutritional packages to the elderly living alone, which can be eaten after heating. Each has its own reasons, and there is currently no unified optimal solution.

Many family members ask me what is the best way to supplement nutrition for the elderly. I generally do not directly recommend health products. Let me start with three practical tips: The first is to add a "bite of protein" to every meal. No matter what he eats, add a spoonful of minced lean meat to the porridge, or boil an egg custard. If you really can't eat it, add a spoonful of whey protein isolate powder. It has no sugar and will not raise blood sugar. It works better than anything else.； The second is to make the food "tasteful". You don't have to strictly limit the amount of salt. As long as the blood pressure is not particularly high, add a little more, or add some mushrooms and dried shrimps to make the food fresher. The elderly are willing to eat it first. ； The third is not to force the elderly to eat "healthy foods" they don't like. Some elderly people drink milk and have diarrhea, but if you insist on letting them drink it, it will make them unhappy. Just switch to sugar-free yogurt or Shuhua milk. If you really can't eat tofu or soy milk, they can still supplement protein.

In fact, the longer I work in this industry, the more I realize that there is no perfect formula for nutrition for the elderly. I once met a 90-year-old man who liked to drink two ounces of wine every day with some fried peanuts. His children insisted on telling him to stop, which made the old man unable to eat. Later, I told my children that he is 90 and has been drinking all his life. If you don't let him drink, life will be unhappy. It is better to drink less and eat two more mouthfuls of meat at each meal, which is worse than anything else. You see, there is no absolute right or wrong. For the elderly, eating happily and staying healthy are more effective than any rigid dietary guidelines.