38
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The Challenge of Managing Undernutrition in Older People with Frailty

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.

          Related collections

          Most cited references151

          • Record: found
          • Abstract: found
          • Article: found

          Frailty in elderly people

          Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Prevalence of frailty in community-dwelling older persons: a systematic review.

            To systematically compare and pool the prevalence of frailty, including prefrailty, reported in community-dwelling older people overall and according to sex, age, and definition of frailty used. Systematic review of the literature using the key words elderly, aged, frailty, prevalence, and epidemiology. Cross-sectional data from community-based cohorts. Community-dwelling adults aged 65 and older. In the studies that were found, frailty and prefrailty were measured according to physical phenotype and broad phenotype, the first defining frailty as a purely physical condition and the second also including psychosocial aspects. Reported prevalence in the community varies enormously (range 4.0-59.1%). The overall weighted prevalence of frailty was 10.7% (95% confidence interval (CI) = 10.5-10.9; 21 studies; 61,500 participants). The weighted prevalence was 9.9% for physical frailty (95% CI = 9.6-10.2; 15 studies; 44,894 participants) and 13.6% for the broad phenotype of frailty (95% CI = 13.2-14.0; 8 studies; 24,072 participants) (chi-square (χ(2) ) = 217.7, degrees of freedom (df)=1, P < .001). Prevalence increased with age (χ(2) = 6067, df = 1, P < .001) and was higher in women (9.6%, 95% CI = 9.2-10.0%) than in men (5.2%, 95% CI = 4.9-5.5%; χ(2) = 298.9 df = 1, P < .001). Frailty is common in later life, but different operationalization of frailty status results in widely differing prevalence between studies. Improving the comparability of epidemiological and clinical studies constitutes an important step forward. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found
              Is Open Access

              Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group.

              New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance- and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, ≥ 1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73 m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
                Bookmark

                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                10 April 2019
                April 2019
                : 11
                : 4
                : 808
                Affiliations
                [1 ]Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; S.E.Lim@ 123456soton.ac.uk (S.E.R.L.); N.Cox@ 123456soton.ac.uk (N.J.C.); K.Ibrahim@ 123456soton.ac.uk (K.I.)
                [2 ]NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
                [3 ]NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton SO16 7NP, UK
                Author notes
                [* ]Correspondence: hcr@ 123456soton.ac.uk ; Tel.: +44-2381-204-354
                Author information
                https://orcid.org/0000-0002-5291-1880
                https://orcid.org/0000-0002-4297-1206
                Article
                nutrients-11-00808
                10.3390/nu11040808
                6521101
                30974825
                6bb39e81-0fdd-4d1d-81e8-163100d3f5f4
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 March 2019
                : 08 April 2019
                Categories
                Communication

                Nutrition & Dietetics
                malnutrition,older,frail,screening,appetite,mealtime,food fortification,nutritional supplement

                Comments

                Comment on this article