Nestle Supplement 2

NUTRIENTS AND FRAILTY John E. Morley, MB, BCh From the Division of Geriatric Medicine, Saint Louis University School of Medicine and GRECC, VA Medical Center, Saint Louis, Missouri Correspondence: John E. Morley, MB, BCh, Geriatric Medicine, Saint Louis University School of Medicine 1402 S Grand Blvd, M238 Saint Louis, MO 63104 “The trouble is, old age is not interesting until one gets there. It is a foreign country with an unknown language to the young and even the middle-aged.” — May Sarton, As We Are Now T he concept that nutrition can alter quality of life and lifespan is not a new one. Seneca said, “Man does not die; he kills himself.” Benjamin Franklin pointed out that “against diseases known the strongest fence is the defensive virtue of abstinence.” In contrast, the Austrian physician Arnold Lorand in 1910 lamented,“We occasionally witness the peculiar fact that persons who live very moderately and eat very sparingly, and who totally abstain from alcohol nevertheless become old before their time, while there are those…addicted to the pleasures of the bounteous table and unstinted wine and spirits enjoy a green old age.” Frailty exists when an older person is at high risk of becoming disabled when exposed to a stressful event, such as influenza. Recently, Fried and colleagues1 developed an operational definition of frailty that allows the identification of persons at increased risk to outcomes of adverse events (Table 1).Women are more likely to be frail, and approximately 6% of the population are frail by this definition.The International Academy of Aging and Nutrition has developed the following simplified definition of frailty: Fatigue Resistance (walk up 1 flight of stairs) Aerobic (walk 1 block) Illness (greater than 5 illnesses) Loss of weight (greater than 5%). Bartali et al2 have shown that frailty is strongly related to a low daily energy intake ( 10 lb weight loss in 1 year Lowest 20% of population Self report Lowest 20% of population Men < 383 kcal/week Women < 270 kcal/week *Frailty is defined as having 3 or more of the above criteria WEIGHT LOSS AND AGING In middle age, those who are overweight and have an increased waist circumference are at increased risk for disease, whereas with aging, weight loss is the key factor associated with disease. Numerous studies have demonstrated that in persons over 60 years of age weight loss is highly predictive of death.4 This has been shown to be true in patients in nursing homes5 and even in older persons with diabetes mellitus.6 Voluntary weight loss in older women leads to osteopenia and hip fracture.7 Persons with heart failure and weight loss of over 7.5% have markedly increased mortality.8 Finally, weight loss is associated with increased likelihood of institutionalization.9 FAT: THE WICKED WITCH OF MODERN MEDICINE Body fat plays a key role in revival. It is essential to store calories, which is a key need for older persons when they enter hospitals and often receive a paucity of calories. It plays a role in thermoregulation, protecting individuals from DECEMBER 2007 • 23

Table of Contents Feed for the Digital Edition of Nestle Supplement 2

Nestle Supplement Table of Contents Introduction to Weight Loss in Older Persons Diagnosis and Management of Oropharyngeal Dysphagia in the Elderly The Danger of Weight Loss in the Elderly Nutrients and Frailty

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