Due to increase in life expectancy, the elderly patient became more stricken by acute and chronic diseases, and are hospitalized more frequently. Elderly people are more susceptible to changes in nutritional condition as result of changes compatible with aging. Inflammatory and nutritional condition, genetic predisposition, physical inactivity and frequently associated comorbidities are predominating factors. In fact, comorbidities can be the causes of nutritional impairment or, are even worsened by malnutrition. Thus, it is essential to identify and monitor the nutritional condition of the elderly patient (through subjective and objective anthropometric assessment), because this change is directly related to morbimortality, and from this to determine the optimal NT, whether oral or enteral (1,2).
Multiple mechanisms involve inadequate food intake in the elderly patient, especially (1,3):
-loss of appetite (particularly for fluids and fibers);
-decrease of taste, predominantly for acidic and bitter foods (atrophy of the taste buds, -mainly those with predominance of acidic and bitter flavors);
-changed olfactory sense;
-impaired oral health (which makes consumption of more fibrous and caloric foods difficult);
-difficulty in chewing and swallowing;
-reduction of salivary flow;
Psychosocial factors (social isolation, depression and dementia) and economic factors also interfere in the food intake (4).
The ESPEN guidelines bring as recommendation to this population for the diet to include at least 1.0 to 1.2 g protein/kg body weight/day, as well as the practice of daily physical activity and resistance training, when possible (5).
1. Projeto Diretrizes – DITEN. Terapia Nutricional para Pacientes na Senescência (Geriatria). 2001. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_para_pacientes_na_senescencia_geriatria.pdf)
[Guidelines Project - DITEN. Nutritional therapy for patients in Senescence (Geriatrics). 2001. (http://www.projetodiretrizes.org.br/9_volume/terapia_nutricional_para_pacientes_na_senescencia_geriatria.pdf)]
2. Gariballa SE. Nutrition and older people: special consideration for ageing. Clin Med 2004;4:411-3.
3. Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, et al. ESPEN Guidelines on enteral nutrition: geriatrics. Clin Nutr 2006;25:330-60. (http://espen.info/documents/ENGeriatrics.pdf)
4. Forster S, Gariballa S. Age as a determinant of nutritional status. A cross sectional study. Nutr J 2005;4:28.
5. Deutz et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition 33 (2014) 929e936. (http://www.espen.org/files/PIIS0261561414001113.pdf)