Anorexia and Malnutrition Conditions in the Elderly

Nutrition is an important element of health in the elderly population and affects the aging process.

The rates of malnutrition in the elderly are increasing day by day. Although the prevalence of overweight is high in the elderly, the main concern is a decrease in food intake and loss of motivation to eat.

Malnutrition indicates the presence of problems with the regulation of energy balance and control of food intake.

As a result of the Mini Nutritional Assessment (MNA) conducted among 201 patients over 65 years of age who were hospitalized in 2016, the population 93% risk of malnutrition or malnutritionwas found to be.

A low energy intake that causes body weight loss is thought to be due to social or physiological factors, or a combination of both.

Biological Changes in the Digestive System

• Gastrointestinal symptoms such as dysphagia (difficulty swallowing), gastrointestinal reflux and constipation may occur due to neurodegeneration in the nervous system.

• Stomach mobility is impaired by aging.

• There is a decrease in gastric acid secretions.

• Structural changes are seen in the pancreas. It has been shown that the concentration of pancreatic lipase, chymotrypsin, and bicarbonate in pancreatic juice decrease with aging.

• Liver size and blood flow also decrease with age. It is known to be caused by inflammation, cellular stress and fibrosis.

Physiological Changes in the Digestive System

• With age, the amount of body fat increases and there is a decrease in lean mass due to loss of skeletal muscle.

• After the age of 50, up to 3 kg of lean body mass is lost every ten years. This is equivalent to the average body fat of a 20-year-old child.

• The reason for the increase in fat is multifactorial and these are; decrease in physical activity, decrease in the secretion of growth hormone and sex hormones, decrease in basal metabolic rate.

• Cachexia is seen in many chronic diseases such as heart failure and rheumatoid arthritis. Cachexia is an involuntary loss of lean mass (muscle, organ, tissue, skin and bone). It results from catabolism (destruction) and causes changes in body consumption.

• Sarcopenia is a decrease in skeletal muscle mass. It is associated with decreased physical activity.

Aging Anorexia

With increasing age, appetite and food consumption decrease. Healthy older people are less hungry and more satiated before meals. They eat smaller meals and eat more slowly. Average daily food intake decreases by 30% between the ages of 20 and 80.

A 2016 published study using the Simplified Nutritional Appetite Questionnaire (SNAQ) concluded that anorexia was common among 179 elderly women in a UK hospital, and poor health care had an impact on it.

Bad dentures and unsuitable dentures can limit the type and amount of food they eat.

Changes in the olfactory epithelium, receptors, and neural pathways can affect the sense of smell. This reduces interest in food in older people, food intake, and may affect the type of food.

Elderly patients with reduced sense of taste have a less variable diet and consequently develop micronutrient deficiencies. Parkinson’s drugs and antidepressants can affect the sense of taste.

It has been shown that the increase in cholecystokinin (CCK) hormone in the elderly is associated with high satiety and low hunger.

The high level of leptin hormone produced by fat cells, whose main role is to provide energy balance, also causes a feeling of satiety and restricts food intake.

Insulin regulates glucose metabolism. Aging is associated with lower glucose tolerance and higher insulin levels.

Medical Reasons

• Cardiac problems (such as heart failure)

• Respiratory system disease (such as chronic obstructive pulmonary disease)

• Gastrointestinal Disorders (such as malabsorption syndromes, dysphagia)

• Endocrine disorders (such as diabetes)

• Neurological, eg stroke, Parkinson’s disease, motor neuron disease

• Infection (such as pneumonia, urinary tract infection)

• Physical disability (such as arthritis)

• Alcoholism

• Medicines

Psychological and Social Causes

• delirium

• Dementia / Alzheimer’s disease (Fifty percent of Alzheimer’s patients cannot feed themselves 8 years after diagnosis. In Alzheimer’s, olfactory changes also occur that may affect food intake.)

• Depression (30% to 36% of weight loss in outpatients and nursing homes has been documented to be due to depression.)

• Anxiety

• Alcoholism

• Loss

• Poverty

• Insulation

• Not being able to shop, prepare and cook food

The nutrition of people in the old age period is planned taking into account such situations. It is also important to pay attention to these in those staying in hospital or aged care centers.

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