Recommendations for optimal nutrition care in the elderly

During the 40th European Society for Clinical Nutrition and Metabolism (ESPEN) conference held on 1-4 September 2018 in Madrid, there was much attention on the importance of good nutrition for elderly persons and geriatric patients. A group of scientists presented recommendations for the best nutritional care in the elderly to prevent undesired weight loss and reduced fluid balance.

Auto Draft 8During the 40th ESPEN congress, scientists under the guidance of Prof. dr. Volkert (Germany) presented an overview of recommendations for the best nutritional care in frail elderly and geriatric patients. In this article, we will list recommendations for energy and nutrient intake for the management of malnutrition. These are the first 4 recommendations mentioned in the original publication by Volkert et al (2018).

1. Energy

In both healthy and sick elderly, energy consumption at rest (REE: Resting Energy Expenditure) is 20 kcal / kg body weight / day. Assuming normal physical activity levels of 1.2-1.8 (PAL values), the total energy consumption in this group is 24-36 kcal / kg body weight / day. For underweight (BMI <21 kg / m²)  elderly, energy recommendations of 32-38 kcal / kg body weight / day is advised. Based on this variable in energy needs among the elderly, Volkert et al (2018) mentions the following recommendation:

Recommendation: Guiding value for energy intake in the elderly is 30 kcal / kg body weight / day.

This value should be adjusted according to individual nutritional status, level of physical activity and disease status of the elderly person.

2. Protein

The current protein recommendation for healthy adults is 0.8 g / kg body weight / day. With increasing insights from clinical and epidemiological research, it is suggested that this amount of protein is insufficient for the elderly. Volkert et al (2018) refers to recommendations from expert groups of 1.0-1.2 g protein / kg body weight / day for the elderly. For older patients with acute or chronic diseases, daily amounts between 1.2-1.5 g protein / kg body weight are advised. Volkert et al (2018) therefore gives the following recommendation:

Recommendation: Protein intake in the elderly should be at least 1 gram protein / kg body weight / day.

This value should be adjusted according to individual nutritional status, level of physical activity and disease status of the elderly person.

3. Fibers

A sufficient intake of fiber is important for the elderly. However, as Volkert et al (2018) states, the intake of fiber is often on the low side in this age group. In the case of enteral nutrition, Volkert et al (2018) recommends fiber-containing food products, as long as bowel function is not compromised. The following recommendation is therefore given by the scientists:

Recommendation: For enteral nutrition, fiber-containing products should be used.

4. Micronutrients

The same micronutrient recommendations apply to both elderly people and adults. However, according to Volkert et al (2018), less is known about the amount of nutrients needed when it comes to elderly people at very old age or older people who are frail or ill. As more gastrointestinal complaints occur in the elderly, the absorption of vitamin B12, calcium and iron as a result of a lower bioavailability can be reduced (Volkert et al 2018). This is mentioned as a point of attention, but no specific micronutrient recommendations are available for healthy elderly people.

Role of the professional

The recommendations underline the role of the nutrition professional as the expert who provides the best possible nutritional care. In geriatric institutions providing acute care, the dietitian must be part of the geriatric team to ensure that the nutrition component is integrated into the patient’s treatment.

In the original publication a total of 82 recommendations are given, including the scientific background how Volkert et al (2018) had come to these recommendations. Read the original publication here.

Change body composition

The body composition changes with age. The lean body mass, especially muscle mass, decreases and the fat mass gradually increases. This is a natural process, but in some situations it can lead to a higher degree of vulnerability. This is especially true with older people aged 80 years or older where increased vulnerability, in combination with comorbidity, can lead to limitations in physical or mental functions. The ability to independently carry out basic activities is at risk or lost. In addition, these frail elderly people are less able to cope with critical situations such as hospital admissions and the course and recovery from diseases.

What is ESPEN?

The abbreviation ESPEN stands for “European Society for Clinical Nutrition and Metabolism”. ESPEN aims to investigate the role of nutrition, and translates the knowledge and findings into practical applications in the field of clinical nutrition and nutrition for frail older persons. More information here.

References

Volkert, D. et al (2018). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 2018. https://doi.org/10.1016/j.clnu.2018.05.024