Nestle Supplement 2

NUTRITION AND THE OLDER PERSON TABLE 3. Adverse effects of protein energy malnutrition Anemia Hip fracture Decubitus ulcers Cognitive impairment Immune impairment – Decreased CD4+ T-cells – Decreased response to immunization – Decreased neutrophil function – Decreased mitogen lymphocyte proliferation – Decline in delayed hypersensitivity – Thymic atrophy Infections Fatigue Muscle loss and weakness Edema Mortality albumin seen in older persons is due to cytokine excess and not due to nutritional factors.10 In older hospitalized patients, low cholesterol is associated with increased mortality.11 Low total cholesterol predicts death in advanced heart failure.12 In the Honolulu Heart Program, low total cholesterol had a significant predictive effect on mortality in 71 to 93 year olds.13 TABLE 4. MEALS-ON-WHEELS mnemonic for treatable causes of weight loss Medications (eg, digoxin, theophylline, cimetidine) Emotional (eg, depression) Alcoholism, elder abuse, anorexia tardive Late-life paranoia Swallowing problems Oral factors Nosocomial infections (eg, tuberculosis) Wandering and other dementia-related factors Hyperthyroidism, hypercalcemia, hypoadrenalism Enteral problems (eg, gluten enteropathy) Eating problems Low-salt, low-cholesterol, and other therapeutic diets Stones (cholecystitis) ing or vomiting. In these cases, there is almost always a metabolic alkalosis, and the BUN to creatinine ratio also may be elevated. For hypernatremic dehydration, the treatment is water, whereas for hyponatremic hypoosmolar dehydration, the treatment is replacement with isotonic saline. This can be done either intravenously or by hypodermoclysis (subcutaneous fluid infusion utilizing recombinant hyaluronidase). CAUSES OF WEIGHT LOSS There are 6 major causes of weight loss: 1. Anorexia/decreased food intake 2. Sarcopenia 3. Cachexia 4. Dehydration 5. Malabsorption 6. Hypermetabolism. Hypermetabolism is usually due to excess hormone production, such as occurs with hyperthyroidism or pheochromocytoma. Malabsorption can be due to pancreatic insufficiency or gluten enteropathy. Demonstration of low circulating levels of vitamin A and beta-carotene are the best indicators of malabsorption. Dehydration is often forgotten as a cause of weight loss. Classically, dehydration presents with intravascular volume contraction, hypernatremia, and an elevated blood urea nitrogen (BUN) to creatinine ratio. Hyponatremia with intracellular dehydration can occur. This is best recognized in association with hyperglycemia and a metabolic acidosis. Hyponatremia also can occur with excess salt loss, eg, sweat- ANOREXIA A physiological anorexia of aging has been identified.14 This is due to a variety of factors including an increase in taste threshold and a reduction in olfaction, altered adaptive relaxation of fundus of the stomach, increased levels of the satiation hormone, cholecystokinin, increased circulating cytokines, and a decreased testosterone level. This anorexia of aging results in older persons failing to recognize when they are not eating sufficient calories to maintain their body weight. Food intake declines by 1,400 calories over the lifespan in men and 600 calories in women. Caloric supplements need to be given between meals to have a maximum effect.15 The Cochrane Database found that calorie supplements produce weight gain, decrease mortality, and reduce length of hospitalization in older persons. There are numerous pathological causes of anorexia in older persons. The reversible causes are easily remembered by the mnemonic MEALS-ON-WHEELS (Table 4). Depression is the most common cause of weight loss in older persons, DECEMBER 2007 • 25

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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