Geriatric (Elderly) Care and Nutrition
The Stamford Medical Centre has specialists in Internal Medicine. Internal Medicine physicians are those who deal with Adult care, and that also includes seeing Elderly patients, a field known as Geriatircs. As we age Nutrition becomes more and more important. I have seen many cases in Viet Nam where a major change in an elderly person’s life that appeared to be expalined away as “getting old” was actually due to a simple Dietary or Nutritional Deficiency. For example, Vitamin B12 deficiency takes years to occur, but when an elderly person becomes Vitamin B12-deficient, they can have major behavioral and neurological problems, and become demented. Recognizing these symtpoms is very important as they can occur slowly over time such that some family members may believe it is a natural part of “Grandma is just getting old”, when in truth this kind of Vitamin B 12 deficinecy can be corrected and suddenly Grandma is her old healthy self again. The same kind of thing I have seen happen many times with Thyroid Disease in that a condition of too low activity of the Thyroid gland called Hypothyroidism, or too high activity of the Thyroid gland, called Hyperthyroidsm, can lead to a slow, almost unrecognized decline in an elderly person’s health and capabilities. There are many other examples too that can be noted where many elderly patients would benefit from a good initial medical evaluation and regular follow up at 3-6 month intervals.
Changes associated with normal aging increase nutritional risk for older adults. Aging is characterized by diminished capacity of our organs in what is called “organ system reserves”—most organs (for example liver and kidneys) in our body have more than adequate function or amount of tissue to serve our daily needs, but as we age, we begin to lose those reserves. Then, any stress on our body or organs can lead to problems. Aging also leads to weakened regulatory organ controls, and as we age there is an increase in the variation among individuals in how our organ systems function, influenced by genetic and environmental factors.
Nutritional needs of the older individual are determined by multiple factors, including specific health problems, an elderly person’s level of activity, energy expenditure, and calorie requirements; the ability to access, prepare, ingest, and digest food; and personal food preferences.
Serial or repeated measurements of body weight offer the simplest method for screening for nutritional adequacy or a change in nutritional status in older adults. Studies suggest that weight loss in older adults, especially if it is not voluntary, is predictive of health problems or nutritional deficiency.
Getting regular body weights can be challenging in frail patients, who might not be able to stand or maintain an upright position. Low body weight is defined as less than 80 percent of the recommended body weight. Loss of as little as 5 percent of weight over a three year period is associated with increased health problems among older adults.
Weight loss is considered to be clinically significant if these changes occur:
Compared to younger adults, undernutrition in older individuals is both more common and has a greater impact as the elderly are less able to adapt to undernutrition or malnutrition. Older adults can experience less frequent hunger than younger adults when they are not eating enough. Eldery adults also have more difficulty in regaining the total amount of weight they have lost, even when allowed to eat food freely for six months. In contrast, younger adults on average can easily regain all their lost weight that has taken place.
The lack of ability to compensate for periods of low food intake due to an illness or other difficulties can result in long-term, persistent weight changes. Poor nutrition can be made especially worse when weight loss is combined with social, medical, or psychological factors that can negatively impact body weight.
Involuntary weight loss is driven by the following factors:
or a combination of all of these factors.
Cancer can be identified as the cause for weight loss in 9 percent of elderly patients, and was second only to depression as the most frequent identifiable cause of undernutrition. Depression and dysphoria (depressed mood) are common in older adults and often remain unrecognized and undertreated. Depression is an important cause of weight loss in older patients in the community. In one medical study, depression was the cause of weight loss in 30 percent of the older patients, compared to only 15 percent in younger patients.
Other important medical etiologies to consider include:
The initial evaluation of an elderly person who is noted to have lost weight, or for whom concern is raised about weight loss or nutritional status by the patient, family members, or caregivers should follow certain steps.
This discussion of the importance of Nutrition in Elderly patients to prevent nutritional disease is only one aspect of taking care of the elderly patient. There are many more aspects to making the Golden Years of life in our elderly loved ones as comfortable as possible.
The physicians at Stamford Medical Centre are expereinced and have expertise in the care of Elderly individuals and patients. We routinely evaluate elderly patients for these kinds of conditions and many others that could be of great benefit to our elderly patients.
Dr. Mark L. Siefring M.D.
Dr. Tom Nguyen M.D.
Dr. Doanh Lu M.D.
The Stamford Medical Centre has specialists in Internal Medicine. Internal Medicine physicians are those who deal with Adult care, and that also includes seeing Elderly patients, a field known as Geriatircs. As we age Nutrition becomes more and more important. I have seen many cases in Viet Nam where a major change in an elderly person’s life that appeared to be expalined away as “getting old” was actually due to a simple Dietary or Nutritional Deficiency. For example, Vitamin B12 deficiency takes years to occur, but when an elderly person becomes Vitamin B12-deficient, they can have major behavioral and neurological problems, and become demented. Recognizing these symtpoms is very important as they can occur slowly over time such that some family members may believe it is a natural part of “Grandma is just getting old”, when in truth this kind of Vitamin B 12 deficinecy can be corrected and suddenly Grandma is her old healthy self again. The same kind of thing I have seen happen many times with Thyroid Disease in that a condition of too low activity of the Thyroid gland called Hypothyroidism, or too high activity of the Thyroid gland, called Hyperthyroidsm, can lead to a slow, almost unrecognized decline in an elderly person’s health and capabilities. There are many other examples too that can be noted where many elderly patients would benefit from a good initial medical evaluation and regular follow up at 3-6 month intervals.
Changes associated with normal aging increase nutritional risk for older adults. Aging is characterized by diminished capacity of our organs in what is called “organ system reserves”—most organs (for example liver and kidneys) in our body have more than adequate function or amount of tissue to serve our daily needs, but as we age, we begin to lose those reserves. Then, any stress on our body or organs can lead to problems. Aging also leads to weakened regulatory organ controls, and as we age there is an increase in the variation among individuals in how our organ systems function, influenced by genetic and environmental factors.
Nutritional needs of the older individual are determined by multiple factors, including specific health problems, an elderly person’s level of activity, energy expenditure, and calorie requirements; the ability to access, prepare, ingest, and digest food; and personal food preferences.
Serial or repeated measurements of body weight offer the simplest method for screening for nutritional adequacy or a change in nutritional status in older adults. Studies suggest that weight loss in older adults, especially if it is not voluntary, is predictive of health problems or nutritional deficiency.
Getting regular body weights can be challenging in frail patients, who might not be able to stand or maintain an upright position. Low body weight is defined as less than 80 percent of the recommended body weight. Loss of as little as 5 percent of weight over a three year period is associated with increased health problems among older adults.
Weight loss is considered to be clinically significant if these changes occur:
≥2 percent decrease of baseline body weight in one month
≥5 percent decrease in three months, or
≥10 percent in six months
The lack of ability to compensate for periods of low food intake due to an illness or other difficulties can result in long-term, persistent weight changes. Poor nutrition can be made especially worse when weight loss is combined with social, medical, or psychological factors that can negatively impact body weight.
Involuntary weight loss is driven by the following factors:
Inadequate dietary or nutrition intake
Appetite loss
Immobility, lack of use of muscles (no exercise) leading to muscle wasting
Inflammatory effects of disease
Cancer can be identified as the cause for weight loss in 9 percent of elderly patients, and was second only to depression as the most frequent identifiable cause of undernutrition. Depression and dysphoria (depressed mood) are common in older adults and often remain unrecognized and undertreated. Depression is an important cause of weight loss in older patients in the community. In one medical study, depression was the cause of weight loss in 30 percent of the older patients, compared to only 15 percent in younger patients.
Other important medical etiologies to consider include:
Diseases like Low or High Thyroid States (Hypothyroidism, Hyperthyroidism) and Diabetes
Diseases involving the Heart like Heart Failure, Kidney diseases, chronic Lung disease from smoking damage or damage from past infections like Tuberculosis, and Liver diseases.
Gastrointestinal Diseases can certainly lead to poor nutrition and nutitional deficiencies as it is in the stomach and intestines, and colon where nutrients are absorbed.
Infections like Tuberculosis
Joint and/or some arthritic (Rheumatologic) conditions
Neurological conditions (Prior Stroke, Parkinson disease, chronic pain)
Drug or alcohol dependence/abuse.
Medication side effects
The weight loss needs to be documented. It is important to note objective evidence of weight loss from recorded serial weights over time, this information is often not available from family members or from the patient themselves.
An evaluation of appetite and dietary intake must be performed. Determining if there has been a change in hunger may provide more revealing information than performing a formal dietary recall. The eledrly individual will be asked about their appetite, their dietary intake in relation to their usual pattern, the number of meals they consume per day, portion size, snacks between meals, if and when they feel full during their meal, and whether the patient likes what he or she is eating.
Perform a complete history and physical examination, and order appropriate laboratory studies. This cannot be overstated in importance. It is critically important to have any elderly patient receive a good history and physical examination. Some blood tests can suggest the presence for metabolic or inflammatory diseases, thyroid function problems, and malnutrition and/or deficiency of certain vitamins. A plain Chest-X-Ray and/or plain abdominal X-rays can also be considered.
This discussion of the importance of Nutrition in Elderly patients to prevent nutritional disease is only one aspect of taking care of the elderly patient. There are many more aspects to making the Golden Years of life in our elderly loved ones as comfortable as possible.
The physicians at Stamford Medical Centre are expereinced and have expertise in the care of Elderly individuals and patients. We routinely evaluate elderly patients for these kinds of conditions and many others that could be of great benefit to our elderly patients.
Dr. Mark L. Siefring M.D.
Dr. Tom Nguyen M.D.
Dr. Doanh Lu M.D.