nutritional diseases in the elderly malnutrition

Malnutrition related to nutritional diseases in the elderly is by no means as simple as "eating less" or "reluctant to eat". It is an intervenable health problem caused by the combination of physiological decline, chronic disease status, and dietary cognition. According to a survey on the nutritional status of the elderly released by the Chinese Nutrition Society in 2023, the incidence of malnutrition among community-dwelling elderly people over 65 years old in my country is 31.5%, and the rate among hospitalized elderly people is more than 60%. Early nutritional intervention can reduce the incidence of chronic disease complications by 42% and reduce the risk of accidental falls by 30%.

I have been working in chronic disease management at a community health service center for almost 6 years. The most unfortunate case I have ever encountered is 72-year-old Aunt Zhang. She has been suffering from type 2 diabetes for 14 years. In order to control her sugar, she usually cooks vegetables with half a bowl of multi-grain rice. She even dares not eat more eggs. She always says "if you eat too much, your blood sugar will rise quickly." Last month, she stepped on a peel at home and fractured her femoral neck. The preoperative blood albumin test was only 28g/L, indicating severe malnutrition. Even the surgery required a week of nutritional supplements before surgery. She was lying in the hospital bed confused: "I eat on time every day, how can I still be malnourished?" ”

Regarding this kind of elderly malnutrition related to chronic diseases, there are actually two voices in the academic circles. Most colleagues who work in clinical nutrition prefer "disease first": after all, nearly 60% of malnutrition is secondary to chronic diseases - diabetic patients go too far in their sugar control and cut off high-quality protein. Elderly people with COPD consume twice as much energy in light breathing as ordinary people, and what they eat is not enough for breathing. The cachexia of tumor patients will directly disrupt the metabolic rhythm. If these elderly people do not stabilize the original disease first, they will not be able to absorb more nutrients no matter how much they supplement. But when we work in community public health, we see many elderly people who have no underlying diseases but are still undernourished, and we prefer "cognition first": We previously conducted nutrition screenings for 1,200 elderly people over 65 years old in our jurisdiction, and 42% of them were mildly malnourished. All chronic disease indicators were well controlled. All problems are caused by old ideas: either they believe that "money can't buy you old age", and you are so hungry that you think it is a good thing to lose ten pounds. ； Or they think that a “light diet” means plain porridge with pickles, and they are reluctant to open the protein powder they bought for their children after it has expired. ； Some people find it troublesome to wear dentures after their teeth have fallen out, so they eat steamed buns and drink porridge, but the nutritional density cannot keep up with their consumption.

In the past two years, our community has not been obsessed with which party to intervene in. It just works. Let’s take Uncle Li, who lives in Building 3, with COPD for 8 years. He had to stay in the hospital for half a month every winter before. He was given no other advice except antiasthmatic medicine. Last year, he was screened for moderate malnutrition. We calculated for him. He must eat at least 1,800 calories a day, and his protein cannot be less than 60 grams. We did not prescribe him any expensive nutritional supplements. , I told him to add a cup of whole milk and a boiled egg in the morning, eat a palm-sized piece of lean pork or fish at noon, and drink less gruel. If he felt he couldn’t eat it, mix in two small spoons of medical nutritional powder. It took more than three months of adjustment, and he had gained 4 pounds in weight. He didn’t even catch a cold this winter. When he came to dispense medicine last week, he said that he was no longer out of breath when climbing the third floor.

It’s interesting to say that many people have misunderstandings about nutritional supplements for the elderly. They always think that sea cucumbers, bird’s nests, and cordyceps are needed to supplement them. Last time, a family member brought two boxes of sea cucumbers and asked me how to feed them to the elderly. I did the math and found that one pound of dried sea cucumbers can be eaten 10 times after soaking. The total protein is not as good as 10 eggs and two chicken breasts. The price difference is almost 20 times. There is really no need to spend this wasted money. Some children are afraid that the elderly will have bad teeth, so they cook white porridge every day. Drinking a bowl of white porridge is almost like drinking a bowl of sugar water. There is almost no protein and vitamins. The more they drink, the thinner they become. In fact, they buy a food processor worth tens of yuan to smash meat, vegetables, yams, etc. into a thick soup. , soft and easy to swallow, and the nutritional density is more than ten times higher than that of white porridge. There used to be a 90-year-old man who lost all his teeth. His children drank white porridge every day and lost weight until they were only 72 kilograms. After a month of adjusting according to this method, their weight increased to 78 kilograms.

In fact, after working in this industry for a long time, I feel that there is really not so much profound knowledge about malnutrition in the elderly. Don’t focus on the various nutritional indicators. Pay more attention to it. If the elderly at home have lost more than 5% of their weight for no reason in half a year, or they don’t even want to touch their usual favorite foods, don’t take it seriously. Go to the community health service center to get a blood test to check for albumin. It costs more than ten yuan. Early detection and adjustment are much better than waiting for a fall or hospitalization to strengthen. By the way, if you have an elderly person living alone at home, you should pay more attention. Many elderly people are fooled by eating alone. They eat three meals of one dish and only one bowl of noodles. Even if they are not sick, they are prone to nutritional deficiencies. Go over and cook two hot meals when you have time, which will be more effective than buying many expensive health products.