What can a geriatric nutrition specialist do?

The geriatric nutrition department is essentially a department that customizes personalized nutrition intervention plans for the elderly. It ranges from adjusting daily diet to providing nutritional support in conjunction with clinical treatment. It covers the nutritional needs of the entire stage from the prevention of chronic diseases for healthy elderly people to the postoperative rehabilitation of sick elderly people. It is not as simple as "prescribing a nutritious meal recipe" as everyone thinks.

In the past two months, we treated 82-year-old Aunt Zhang. She has a history of diabetes for more than 20 years and has high blood pressure. She listened to various health advice at home and dared not eat or touch anything. She lost 12 kilograms in half a year and was down to only 68 kilograms. She fainted and was sent to the emergency room twice. When she came here, her muscle mass test was only 60% of that of her peers. We first performed a comprehensive nutritional screening on her, and then checked the metabolic effects of several antihypertensive and antidiabetic drugs she usually took. We found that she had been deficient in B12 after taking metformin for a long time. In the past, she rarely ate staple food to control her sugar, which often triggered hypoglycemic reactions. Later, in the adjusted plan for her, the staple food was specifically changed to a low-GI rice mixed with mixed beans, and she only ate half a bowl at each meal. Instead, she was asked to increase the amount of meat, eggs, and milk, and also supplemented with some basic B vitamins. In less than two months, she gained 4 pounds and never fainted again. Last time she came for a follow-up, she said that she finally dared to eat braised pork, and there was nothing wrong with eating two pieces at a time.

Many people's understanding of nutrition for the elderly is still based on the general advice of "drink more milk and supplement calcium", ignoring that the elderly's metabolic level, underlying diseases, and even chewing ability and medication use will all affect the absorption and utilization of nutrients. For example, if elderly people with chronic obstructive pulmonary disease follow the general advice of "eating more staple foods to replenish energy", they will produce too much carbon dioxide due to carbohydrate metabolism, which will increase the burden on breathing. We generally advise them to appropriately increase the proportion of high-quality fats, eat more slowly, and eat small and frequent meals, which will help them breathe less. There are also many elderly people who have been discharged from the hospital after surgery. At home, they cook white porridge and stew bone soup every day to "replenish the body." On the contrary, the more they supplement, the more deficient they become. The protein cannot keep up with the slow healing of wounds. In fact, they do not know that the nutritional density of the seemingly light porridge and soup is extremely low. Instead, it is better to break up lean meat and eggs and mix them with soft food to eat.

Of course, we are often questioned. An old man comes in and says, "I've been eating for my whole life and I still need you to teach me?" ”There are also family members of patients who think that we prescribe nutritional supplements just to earn commission. To be honest, this misunderstanding is not without reason. In the early years when the industry was not standardized, some institutions did over-promote high-priced supplements. Now the geriatric nutrition specialists in regular hospitals recommend on-demand supplements. It is absolutely not recommended to take dietary supplements. If you really want to prescribe them, you will give priority to affordable preparations covered by medical insurance. There is no need to waste money. Some people think that nutritional intervention is the "icing on the cake" and cannot cure the disease. This is right or wrong. Nutrition is not a substitute for drug treatment. For example, for the elderly with severe dysphagia, we can only give them a nutritional plan of tube feeding. They still need to cooperate with the training of the rehabilitation department to slowly return to independent eating. It is impossible to solve the problem just by adjusting the diet. But if the nutrition cannot keep up, whether it is taking medicine or undergoing rehabilitation, the effect will be greatly reduced.

To put it bluntly, what we do is to break down the simple-sounding thing of "eating well" into specific methods suitable for each elderly person, such as how to make the food soft without losing nutrients for those with bad teeth, how to avoid the conflict between diet and medicine for those who take multiple medicines, and how to eat for those who are bedridden for a long time to reduce constipation and reduce muscle loss. In essence, it is to make every bite of the elderly people really replenish their body, and avoid being blamed for eating incorrectly.