Nutrition is an important element of health in the elderly population and affects the aging process.
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 the decrease in food intake and loss of motivation to eat.
Malnutrition indicates the existence of problems with the regulation of energy balance and control of food intake.
As a result of the Mini Nutrition Assessment (MNA) conducted among 201 patients over the age of 65 who were hospitalized in 2016, it was observed that 93% of the population was malnourished or at risk of malnutrition.
Body weight loss is thought to be caused by a low energy intake, social or physiological factors, or a combination of both.
Biological Changes in the Digestive System
• Gastrointestinal symptoms such as dysphagia (difficulty in swallowing), gastrointestinal reflux and constipation may occur due to neurodegeneration in the nervous system.
• Gastric motility deteriorates with aging.
• Stomach acid secretions decrease.
• Structural changes are seen in the pancreas. The concentration of pancreatic lipase, chymotrypsin, and bicarbonate in pancreatic juice has been shown to decrease with aging.
• Liver size and blood flow also decrease with age, 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 skeletal muscle loss.
• After the age of 50, up to 3 kg of lean body mass is lost per decade. This is equivalent to the average body fat of a 20-year-old.
• The cause of fat increase is multi-factorial and these are; It is a decrease in physical activity, a decrease in the secretion of growth hormone and sexual hormones, and a decrease in the 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) loss. It results from catabolism (breakdown) and causes changes in body consumption.
• Sarcopenia is a decrease in skeletal muscle mass. It is associated with decreased physical activity.
Anorexia of Aging
Appetite and food consumption decrease with increasing age. Healthy older people are less hungry and more full before meals. They consume smaller meals and eat more slowly. Average daily food intake decreases by 30% between the ages of 20 and 80.
In a study published in 2016, using the Simplified Nutritional Appetite Questionnaire (SNAQ), it was concluded that anorexia was common among 179 elderly women in a hospital in England and that poor healthcare had an impact on this.
Bad dentures and ill-fitting dentures can limit the type and amount of food they eat.
Changes in the olfactory epithelium, receptors and nerve pathways can affect the sense of smell. This reduces interest in food, food intake and can affect the type of food in older people
Older patients with reduced sense of taste have a less variable diet and consequently develop micronutrient deficiencies. Parkinson's medications and antidepressants can affect the sense of taste.
It has been shown that increased 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 maintain energy balance, in the elderly also causes a feeling of fullness and restricts food intake.
Insulin regulates glucose metabolism. Aging is associated with low glucose tolerance and high insulin levels.
Medical Causes
• 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, such as stroke, Parkinson's disease, motor neuron disease � �ı
• Infection (such as pneumonia, urinary tract infection)
• Physical disability (such as arthritis)
• Alcoholism
• Drugs
Psychological and Social Causes
• Delirium
• Dementia / Alzheimer's disease (Fifty percent of Alzheimer's patients feel sick 8 years after diagnosis) Olfactory changes that can affect food intake also occur in Alzheimer's.)
• Depression (It has been documented that 30% to 36% of the weight loss seen in outpatients and nursing homes is due to depression.)
• Anxiety
• Alcoholism
• Loss
• Poverty
• Isolation
• Food Not being able to shop, prepare or cook food
The nutrition of people in old age is planned taking such situations into consideration. It is also important to pay attention to these for those staying in hospitals or elderly care centres.
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