Are Your Elderly Wasting Away?
Are Your Elderly Wasting Away? by Elaine Young
(Reproduced from Mind Your Body, June 22 issue, with permission)
Grey Matters
Old people risk being malnourished even if they don't look thin, as Elaine Young finds out.
At dinner tonight, take note of what the elderly members of your family are eating - or not. Geriatric malnutrition is a growing problem, especially as the population ages.
Geriatric malnutrition is a complex condition, says Dr Chan Kin Ming, a consultant in geriatric medicine and internal medicine at Gleneagles Medical Centre because 'there is no single definition as such. We have to look at various measurements - height, body weight, skin fat, calcium levels, bone structure, protein levels, vitamin levels, hemoglobin levels and from there we look at the overall clinical picture. '
And being on the heavy side does not mean they are okay - experts say People who are overweight are likely to be consuming empty calories in unhealthy foods.
One of the critical indicators, however, is weight loss - more than 4kg in a month. 'You can catch it if you don't see them that often. If you live with them, you may not notice it,' says Ms Anna Jacob, consultant nutritionist and dietitian in private practice.
Also look out for complaints about the food - saying it doesn't taste the same - and selective eating - whether they are avoiding meat and vegetables they can't chew. Ms Jacob suggests getting creative with the way you present nutrients to them and that could mean making a soup base for vegetables so that they are softer and easier to digest.
The descent into malnutrition comes, she says, from either cost savings, which can lead to only one meal per day, denture problems, not wanting to eat alone or not having the inclination to prepare a meal for one.
A good safeguard would be multivitamins or a nutrition drink like Ensure. If you supplement their diet this way, Ms Jacobs says, they will be more alert and more receptive to what you are trying to do to prevent malnutrition.
The symptoms of geriatric malnutrition don't show up right away. Says Dr Chan: 'Sometimes we need such minute amounts of vitamins and minerals that it will take a long time before we deplete those stores.
'For example, most of us have three years supply of vitamin B12, so it won't be till after this time that you start feeling weak and looking pale.' Adds Professor Jane White from the department of family medicine at the University of Tennessee: 'We know that malnutrition isn't prevalent just in hospitals and nursing homes but occur, although to a lower degree, in the community.'
Dr White was in Singapore to share the screening tool used by her and a million professionals in the United States because, as she says, 'there is no universal tool that everybody is using'. She goes on to say that 'malnutrition increases morbidity, length of stay in hospital, mortality and cost but we can manage nutrition and improve quality of life'.
So the screening tool that was developed was the DETERMINE checklist. It's an acronym based on the warning signs to look out for: Disease, Eating poorly, Tooth loss, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss/gain, Needs assistance in self care, Elder years above 80. The checklist asks for yes or no answers to questions based on these signs: for example, 'I eat fewer than two meals a day', 'I eat alone most of the time'.
Once you use the screening tool, and depending on the overall nutrition score, you'll know whether to take your elderly person to the geriatric specialist, dietitian or, if they are nutritionally sound, make sure they carry on that way.
'The older the person, the higher the risk,' says Dr Chan, who thinks the elderly should be screened for malnutrition.
In a 2001 study done at Tan Tock Seng Hospital, 25 per cent of those 61 years and over were identified as being malnourished. It's not just a public-sector issue either.
As Dr Chan says: 'Even the group of elderly who come and see me at Gleneagles has protein calorie malnutrition. The patients come with swollen feet and muscle wastage, and when you check with them, you find they don't eat meat, and that accounts for 40 per cent of patients I see.'
The reason? They think that because they are older, their digestive systems aren't so good - and they may not have many teeth - so they chew the meat, sucking out the juice, but leaving the meat itself uneaten.
Dr Chan's prescription for this: eat an egg white a day, some liver and easier-to-digest meat.
Basic nutritional screening is done in hospitals here as part of admissions, says Ms Jacob but while she acknowledges that there is an abundance of health screenings, few of them look at nutrition.
But watching what old folks eat pays off, she says. 'It's not hard to do and we should work at it. If you catch it early, you keep them well for longer.'
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