"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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The Extremes of Life - The Elderly

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Both the elderly and infants are at increased risk of deficiency due to:

  • limitations in food intake
  • reduced tissue stores compared with younger adults
  • the effects of disease and sometimes drugs

The main manifestations of nutritional deficiency in the elderly are:

  • Anaemia
  • Apathy, weakness and loss of self-care
  • Loss of appetite
  • Fragile skin, bruising and poor wound healing
  • Muscle wasting which may be evidenced by loose fitting clothes
  • Change in mental state or mood
  • Recurrent or severe infection
  • Osteoporosis and low-impact fracture
  • Heart failure
  • Neurological problems

Any elderly person with the above problems should have an assessment of their nutritional state.

Common Deficiencies in the Elderly

According to the National Diet and Nutrition Survey: British people 65 years and over, the commonest deficiencies are:

  • Anaemia was found in 10% of the free-living and in 40% of the institutionalised
  • Iron deficiency was observed in 8% of the free-living and 10% of the institutionalised and the prevalence of a poor intake was approximately half of these figures with occult blood loss, often from the gastrointestinal tract, being a prominent cause of the remainder
  • Vitamin B12 deficiency (<118 pmol/l) was found in 6% of the free-living and 9% of those in institutions
  • Folate deficiency (red cell folate < 230 nmol/l) was found in 8% of the free-living and 16% of the institutionalised with a further 21% and 19% respectively having mild deficiency (230 to <345 nmol/l)
  • Vitamin B1, thiamine, deficiency, as defined by an increased Erythrocyte Transketolase Activation Coefficient (>1.25) was observed in 8% of the free-living and 14% of those in institutions
  • Vitamin C intakes were below the Lower Reference Nutrient Intake in only 1% of those surveyed in both the free-living and the institutionalised but low plasma levels (<11.0 umol/l) were found in 14% and 41% respectively
  • Vitamin D deficiency as defined by a plasma level < 25 nmol/l was seen in 8% of the free-living and 37% of the institutionalised
  • Calcium intakes were poor, below the Lower Reference Intakes, in 5% of free-living men and 9% of free-living women but in only 1% of the institutionalised due to their usually generous intake of dairy foods
  • Potassium intakes were worryingly low with 17% of free-living men and 39% of free-living women having intakes below the Lower Reference Intake and 37% of those in institutions being below this level
  • Zinc intakes were below the Lower Reference Nutrient Intake level in 8% of free-living men and 4% of free-living women and 5% of those in institution care.  Plasma levels were low (<10.0 umol/l) in 2% of the free-living and 9% of the institutionalised.

In the elderly the risk of deficiency rises with increasing age especially in those aged over 85 years of age and is greatly influenced by the presence of additional risk factors especially feeding difficulties or chronic illness.

Other Risk Factors for Nutritional Deficiency in the Elderly

In one detailed nutritional survey of acutely ill patients in Yorkshire that required hospital admission in the 1970s all were found to have laboratory evidence of deficiency of at least one nutrient.  It would seem therefore that nutritional deficiencies will be a part of the normal aging and pre-disease process for many of us.

In the early 1970s the Department of Health published the findings of the first nutrition survey of old people.  Though the sample was not necessarily representative of the British population as a whole its findings lead to the realisation that nutritional deficiencies were commonplace in the elderly and that there were characteristic risk factors for their development.  They included:

  • Elderly men
  • Those living alone
  • Those with chronic disease especially chest disease
  • The socio-economically deprived.

For more detail see A Nutrition Survey of the Elderly, 1979.

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Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
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