nutritional diseases in the elderly malnutrition

Malnutrition related to nutritional diseases in the elderly is essentially a specific problem caused by the superposition of physiological degenerative changes, chronic disease constraints, and dietary behavioral deviations. It is by no means a normal phenomenon in the public perception that "thinner people are healthier". Domestic nutrition clinical data shows that early detection and early intervention can reduce the incidence of elderly complications by 32% and shorten the average hospitalization time by 38%. This is a solid conclusion that I have come to through five years of related work in clinical and community screening.

I was particularly impressed by Aunt Zhang, who I met at the outpatient clinic last week. She is 72 years old and has been suffering from type 2 diabetes for 11 years. She heard from a health care account that "the less staple food you eat, the more stable your blood sugar will be."

Believe it or not, the family members of more than half of the elderly people who come to the outpatient clinic think that the elderly people just have "poor appetite due to old age" and do not realize that they are already in a pathological state. In the past two months, I was doing nutrition screening for the elderly in a community. Among the 200 elderly people over the age of 65, nearly 40% had varying degrees of malnutrition, and 80% of them had at least one chronic underlying disease.

Currently, the industry has always had two different tendencies in nutrition intervention for the elderly with underlying diseases: one is "disease priority". For example, patients with diabetes strictly control sugar and patients with kidney disease strictly limit protein. The disease indicators should be stabilized first to avoid further organ damage. This is also the first suggestion given by many physicians.； The other type is "nutrition first", especially for the elderly over 80 years old. It is believed that there is no need to set the indicators too tightly, and priority is given to ensuring energy and protein intake to avoid more dangerous acute events such as falls, infections, and multiple organ failure.

When I intervene on a case-by-case basis, I usually look at a compromise: elderly people who are under 75 years old, whose underlying diseases are under stable control, and who are usually quite active, can have no problem controlling their diet according to the requirements of the disease.； If you are over 80 years old, wobbly when you walk, and are still losing weight, there is really no need to dare not even drink a sip of milk in order to lower your fasting blood sugar by 0.5mmol/L. Last month, there was an 83-year-old man who has been diabetic for 20 years. His family didn't even let him drink porridge. He ate less than half a bowl of multi-grain rice every day. When he came here, his BMI was only 16, and his albumin was 29g/L. He got pneumonia if there was a slight breeze. Later, we relaxed his diet and added 200ml of whole milk every day. He was allowed to eat a small piece of soda cracker in the afternoon. He gained 4 pounds in one month. He didn't even catch a cold in the past two months, and his blood sugar didn't drift anywhere.

Many people think that the elderly are poor because they are malnourished, or they are reluctant to eat. This is not true. I have met many elderly people with pensions of tens of thousands, but they are still malnourished. Some have lost teeth that were not replaced in time and cannot bite meat or vegetables. They drink porridge or pickles every day. ； Some live alone and find it troublesome to cook. They cook noodles once for two meals and don’t even bother to add eggs. ； Others were frightened by the various health-preserving articles on the Internet, which were supposed to increase blood pressure, and in the end they did not dare to eat anything.

Many people say that knowing how to judge malnutrition is too technical and ordinary people cannot learn it. It is really not difficult. Just keep an eye on three signs: have you lost more than 5 pounds for no reason in the past three months? Have you eaten half as much recently as you did half a year ago? Do you always feel weak and weak in your legs when walking? If any one of them occurs, go to the community hospital to check for albumin. Don’t wait until you fall, break a bone, or get hospitalized due to infection.

When it comes to supplements, the first reaction of many children is to buy protein powder, bird's nest, and various imported nutritional solutions. There is also a lot of controversy in this. Many nutritionists believe that as long as you can eat normally and take supplements, supplements will earn you IQ tax. ； There is also a view that the elderly's digestive and absorption functions have deteriorated, and they cannot absorb much even if they eat. It is more efficient to supplement medical nutritional supplements. My own experience is that if the elderly eat normally and can eat less than half a bowl of rice, one or two pieces of meat, and a cup of milk at each meal, there is really no need to buy those extremely expensive supplements. Stewing soft beef brisket twice a week and steaming egg custard twice a week are better than anything else. If you can no longer eat anything, or you have just undergone surgery or are recovering from a serious illness, then regular medical nutritional supplements are really useful. Don’t be too expensive, they will always cost less than hospitalization.

To be honest, in the past few years of doing nutrition for the elderly, my biggest feeling is that the diet of the elderly should not be made like an experiment. One day they will be stuck in oil and the next day they will be stuck in salt. They are not even allowed to eat their favorite foods. Ask the old man more about what he wants to eat. If his teeth are not good, cook it softer. Eat more meals if the amount is small. Compared with the fluctuating numbers on the test sheet, the most important thing is that the old man can eat and sleep, and go out for a walk without falling.