Medihub - Medical Information - Geriatric and healthcare of the elderly

Diet of the Elderly person- 3 Main Energy Sources (Fats, Proteins and Carbohydrates)

Fats

Substituting polyunsaturated for saturated fats has been shown to decrease serum cholesterol levels and deaths from coronary artery disease.

There is some degree of evidence of a correlation between fat intake and cancers of the colon, breast and prostate although dietary intervention to reduce this risk has not yet been tried.

Hence, there is a suggestion, but no proof that limiting fat intake in the elderly is useful. An acceptable recommendation is to limit fat in the diet to 30% of the total calories. Some simple and practical ways to achieve this are:

1. Avoiding fried and fatty foods

2. Removing visible fat from meat and the skin of poultry

3. Using skimmed or low fat milk and

4. Consuming only modest amounts of butter

Proteins

Understanding Protein requirements

Total energy must come from proteins, fats and carbohydrates. It is common to calculate using the calories: nitrogen ratio which formulates the amount the calories provided by fats and carbohydrates (calories) as one group and proteins (measured in grames of nitrogen) as a separate group.

A calories:nitrogen ratio of 200:1 may be adequate for the normal individual but a 150:1 ratio would be required for moderately stressed patients.

In critically ill patients under severe stress, a ratio of 100:1 is recommended.

Total daily nitrogen requirement (g) = total energy (kilocalories) (200 or 150 or 100

1g nitrogen = 6.25 g protein

Total daily protein requirement (g) = total daily nitrogen requirement x 6.25

As a rough guide, protein needs can be calculated as:

Normal requirement: 1 g/kg/day

Moderate stress: 1.5 - 2 g/kg/day

Severe stress: 2 - 3 g/kg/day

Special circumstances

i. Patients with Renal failure (RF):

Chronic RF 0.6 to 0.8 g /kg/day

CRF on haemodialysis 1 - 1.2 g/kg/day

CRF on peritonal dialysis 1 - 1.5 g/kg/day

Nephrotic syndrome 0.8 - 1.0 g/kg/day

ii. Patients with SLE:

Acute hepatic encephalopathy: 0 gm initially

Systemic Lupus Erytheromatosus chronic encephalopathy - 0.5 g/kg/day of proteins.

The current recommendation for protein intake is 0.8 g/kg body weight. This represented about 12 to 14% of the total calories taken in during later life. Elderly persons should be encouraged to eat foods with substantial protein content, if they do not suffer from renal or hepatic failure.

Protein Calorie Malnutrition

Protein calorie malnutrition (PCM) is perhaps the most underdiagnosed nutritional disorders world-wide. Elderly persons are especially prone to develop this problem, particularly those hospitalised for periods of greater than 2 weeks.

Poor dietary intake due to low socio-economic status, loss of dentition, other functional impairments, and gastrointestinal malabsorption are some of the causes of PCM.

PCM may be characterised by inadequate intake of both calories and protein or sufficient caloric intake at the expense of a high carbohydrate, low protein diet.

Problems associated with PCM include:

· weight loss

· pallor

· anaemia

· skin problems such as flaky, dry skin, dermatitis,

· loss of muscle mass (including temporal wasting).

· Hypoproteinaemia, low albumin states causing oedema

· Cutaneous anergy, a depressed cell-mediated immunity condition which could predispose the elderly malnourished patient to infections.

As a result of all this, there are possibilities of wrong diagnoses that Anaemia and weight loss could be caused by occult malignancy or that Oedema is caused by Congestive Cardiac Failure or Deep Vein Thrombosis. It is thus important to recognize the symptoms carefully.

Carbohydrates

Foods containing a high content of simple carbohydrates such as sugar, honey, syrups, jam and cakes provide energy with no other nutritive value. They do not need to be restricted unless they displace the desire to eat other foods with essential nutrients.

Chronic alcoholics, who derive a large percentage of their caloric intake through alcohol, are an example of a group who may consume adequate calories but inadequate protein.

Fruits and vegetables should be encouraged as they contain vitamins, minerals and fibre, in addition to carbohydrates.

Lack of fibre has been linked with a number of problems including carcinoma of the colon and constipation. Fibre might affect blood sugar control.

If for no other reason, food with fibre content should be taken to reduce the problem of constipation in the elderly. The best food sources include bran, legumes, fruits and vegetables.