At its Simplest, Nutrition Among Elderly Is Access to Food, Expert Notes

   According to a presentation at Internal Medicine 2011, the annual meeting of the American College of Physicians in San Diego, the problem of patients losing weight may be simple: not appetite, but access. “Do they have the money? Do they have the transportation?” And once they get it, are dental problems or difficulty swallowing hindering a patient’s ability to eat?

   Those questions were posed by Dennis H. Sullivan, MD, a geriatrician at the University of Arkansas for Medical Sciences in a session, “Nutritional Issues in Older Adults.”

   As noted, there may be an inadequate quantity of nutrients. Reduced intake may also be a result of reduced appetite, which can be caused by depression. Drug regimens, infection, gastrointestinal disorders, metabolic problems, social isolation, or inactivity can also be responsible. “As I see a patient who is losing weight, I walk through this list to see if I can identify factors that I might be able to change,” Dr. Sullivan said.

   Elderly patients may also need to time their eating more like teenagers, which is far from the way most hospital and nursing home meals are scheduled. “We tend to want to feed patients on a rigid schedule -- give them very large meals at breakfast, lunch, and dinner,” said Dr. Sullivan. “And a lot of older patients, particularly when they don't feel well, don't want to do that. A lot of these individuals become grazers.”

   Eating a teen diet of junk food may reduce the risk of weight loss, but elderly patients also need the appropriate nutrients. “With advancing age, protein requirements increase,” said Dr. Sullivan. Current recommendations are that older adults to intake 1 to 1.2 grams of protein per kilogram of body weight daily.

   Physicians should make every effort to have patients eat real food. “Writing an order for Ensure, that’s the last thing you want to do,” he said.

   Data show that weight loss among the elderly is common, with most people hitting their peak weight in their sixties, Dr. Sullivan reported. Nonetheless, there’s “a very strong relationship between the history of weight loss in the prior year and mortality in the current year. Even weight loss of five percent to ten percent is associated with a risk of mortality.”