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 SIGNS EASY TO DETECT
The problems of nutrition of the elders can be prepared, controlled or treated, but the signs of alarm of the malnutrition are, often, they spent for high. The not treated malnutrition can lead to a spiral of infections, major undernourishment and death. There are simple instruments of evaluation that can be used during the consultation to identify the factors of risk of the bad nutritional state.
These factors comprise advanced age, depression, social isolation, physical or cognitive deterioration (memory) and low income level. The identified patients since of high risk they need an immediate intervention that includes the medical and psychological evaluation. Often, an elder without cognitive deterioration can assume an independent activity when a support is provided adapted to correct the causes of malnutrition.
NUTRITIONAL EVALUATION
Questionnaire
- I have had an illness or complaint that there has made me change the type and/or food quantity than like (2)
- I do less than two meals to the day (3)
- As few fruit, vegetables or dairy products (2)
- I take more than three glasses of beer, liquor or wine, almost every day (2)
- I have dental problems that are difficult to me to eat (2)
- Not always I have enough money to buy the meal that I need (4)
- Like only most of the times (1)
- I take every day three or more prescribed medicines or for my account (1)
- Without wanting it, I have lost or gained 5 kg in weight in the last six months (2)
- Not always I can buy, cook and/or eat for myself for physical problems (2)
If the entire punctuation is:
- 0 to 2: Good. To re-evaluate the nutritional punctuation in six months.
- 3 to 5: Moderate nutritional risk. To take measures to improve the food habits and the life style. To re-evaluate in three months.
- 6 or more: High nutritional risk. Take the questionnaire to his qualified doctor, specialist in dietetics or other professionals of social services or of health and ask for help to improve his nutritional state.
Normal values, used to value the nutritional state
MEN
Centile 55-65 years 65-75 years
Average circumference of the arm (cm)
10 27,3 26,3
50 31,7 30,7
95 36,9 35,5
Average muscular circumference of the arm (cm)
10 24,5 23,5
50 27,8 26,8
95 32,0 10,6
Cutaneous crease tricipital (mm)
10 6 6
50 11 11
95 22 22
WOMEN
Centile 55-65 years 65-75 years
Average circumference of the arm (cm)
10 25,7 25,2
50 31,7 29,9
95 38,5 37,3
Average muscular circumference of the arm (cm)
10 19,6 19,5
50 22,5 22,5
95 28,0 27,9
Cutaneous crease tricipital (mm)
10 16 14
50 25 24
95 38 36
INDICATORS OF MALNUTRITION
Major indicators
- Loss of weight of more than 5 kg.
- Under weight / excess weight.
- Albumin sérica minor than 3,5 g/dl.
- I change in the functional state.
- Inadequate food ingestion.
- Muscular circumference of the minor arm of 10 ° centile.
- Cutaneous crease minor tricipital of 10 ° centile or major of 95 ° centile.
- Obesity.
- Illnesses related to the nutrition:
- Osteoporosis.
- Osteomalacia.
- Folato deficit.
- Deficit of vitamin B12.
Minor indicators
- Alcoholism
- Cognitive deterioration.
- Chronic renal insufficiency.
- Polymedication.
- Malabsorción syndromes.
- Anorexia, morning sickness, disfagia.
- Changes in the intestinal habit.
- Fatigue, apathy, loss of memory.
- The bad oral or dental state.
- Dehydration.
- Bad healing of the wounds.
- Loss of subcutaneous fat or of muscular mass.
- Liquids retention.
- Decrease of iron, ascorbic acid or zinc.
ORIGIN AND CONSEQUENCES
The cognitive deterioration can be caused by so many not nutritional factors that it is easy to spend for high potential nutritional causes, like dehydration, imbalance of the potassium, ferropénica anemia and deficit of many of the vitamins hidrosolubles.
The depression can lead in the elder to the anorexia, causing a spiral of malnutrition and major cognitive deterioration. The deficits of folato, vitamin B12, tiamina and vitamin C have been all of them related to the loss of the cognitive functional capacity that happens in the aging.
The diminished levels of vitamin B12 in the very aged persons are often secondary to the malabsorción provoked by a pernicious anemia or an atrophic gastritis, frequent both in this age group. Also, for lack of ingestion of fruits and vegetables in the diet of the elder, it is possible to produce a vitamin deficit C, because the reservations of this nutrient are very limited.
TREATMENT
It usually advise a rule with supplements of minerals and vitamins, in addition to a high diet in proteins and nutrients, including three captures between meals of commercial food supplements. It is possible to evaluate the improvement both for the analyses and for the progress in the memory and motive functions altered previously.
PLAN OF HIGH
The in charge person of high will contact with the social work services, if it is necessary. Periodic contacts will be established to provide to the patient a help to part-time domicile. By means of this attention it is possible to control and to direct a meals program with the daily dietetic recommendations instructed by the doctor. The contributions vitamínicos and minerals are available in the drugstores.
TO SEE ALSO
WHAT DOCTOR CAN TREAT ME?
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