Clinical manifestations of malnutrition in the elderly

The core clinical manifestations of malnutrition in the elderly can be divided into Visible symptoms that are visible to the naked eye and Easily mistaken for hidden symptoms caused by aging/chronic disease Two categories, among which more than 60% of hidden symptoms are often ignored by family members and even primary care, missing the best window for intervention.

The first thing that can be noticed is mostly weight changes. If you don't deliberately lose weight and lose more than 5% of your weight in half a year, for example, an elderly person who weighs 100 pounds and loses less than 95 pounds in half a year, you should basically be wary of malnutrition. But don’t take it lightly if you haven’t lost weight. I met 68-year-old Aunt Zhang at a community free clinic before. Her diabetes has been controlled for ten years. She only dares to eat boiled vegetables and brown rice every day. Her weight has been stable at 92 pounds for more than half a year. She still thinks that "it is a blessing to be thin as she grows old." As a result, the flesh on her upper arms is as loose as a deflated balloon, and two centimeters can be pulled out when she pulls it. rice, and my grip strength is not as strong as that of a 100-pound woman like me. After checking my body fat, I found that my muscle mass is 12% lower than the standard for my age, which is a typical "sarcopenic malnutrition". Later, within two months, I fell into a small puddle and fractured. My blood albumin was only 32g/L, which was almost 10 units lower than the normal value.

To be honest, it is not poverty that causes malnutrition. Many elderly people who live in big houses and whose children have bought a cabinet of health care products are still suffering from malnutrition. Either he is afraid of high blood sugar and blood fat and dares not touch anything, or he has lost his teeth and has not replaced them in time, so he cannot chew meat and vegetables so he eats porridge with pickles, or he lives alone and is too lazy to turn on the stove and reheats a meal several times to make ends meet. If you look closely, you can see that their skin is dry and wrinkled, like orange peels that have lost moisture, their hair is falling out in handfuls, and their fingernails are so thin that they break easily. These are all very intuitive and obvious manifestations.

Oh, by the way, there is another symptom that is particularly easy to misdiagnose: edema. Many elderly people have swollen feet and faces. Their first reaction is that they have kidney problems or heart problems. They check their organs and ignore them. In fact, nutritional edema caused by hypoalbuminemia is too common - less albumin in blood vessels cannot hold water, and water seeps into the interstitial spaces and causes swelling. There was a 76-year-old man before. Grandma’s feet were so swollen that she couldn’t wear men’s size 42 slippers. Her son took her to several hospitals to check her heart and kidney function, and her heart and kidney functions were normal. Finally, she came to the nutrition department and took supplements of steamed eggs, skim milk and lean tenderloin for three weeks. The swelling disappeared and she lost two pounds. This was because the swelling was all water and not solid meat at all.

Nowadays, the industry often quarrels over the weight standards for the elderly: most nutrition departments advocate that the BMI of the elderly over 75 years old can be relaxed to 22-26. If they have a little meat and sufficient muscle mass, they have strong risk resistance and can recover quickly from the flu or minor surgery. Some data say that the hospitalization period of this type of elderly is nearly 40% shorter than that of those with a BMI below 20.； However, for the sake of controlling blood sugar and reducing cardiovascular burden, colleagues in the endocrinology department still recommend that the elderly with diabetes and coronary heart disease try to control their BMI below 24. In fact, both sides are right. The core is never the number on the scale, but the biochemical indicators related to muscle proportion and nutrition, such as albumin, prealbumin, and hemoglobin, which are much more reliable than simply looking at fatness and thinness.

As for the hidden manifestations that are easy to be ignored, everyone may agree with you: Do the elderly at home always complain that they are tired, dozing off three or four times when sitting on the sofa watching TV, or out of breath after walking 500 meters to the vegetable market? Do you catch a cold every now and then, then get it again within two weeks of getting better, and have a small cut on your body that doesn’t heal in ten days and a half? There are also elderly people who take chronic disease medicine regularly, but their blood pressure and blood sugar fluctuate up and down. Many family members and even doctors think this is "normal for old age". In fact, in at least one-third of the cases, it is due to insufficient energy supply, reduced immune function, and poor metabolic regulation ability caused by malnutrition. I once met a 72-year-old man who had half a cupboard filled with fish oil and protein powder bought by his son. However, the man found the protein powder fishy and refused to touch it. His teeth were not good and he couldn't chew meat. He drank white porridge with soft bread every day. He was hospitalized for pneumonia every winter. Later, he was made to drink two cups of Shuhua milk every day, eat two steamed eggs, chop the meat into meatballs and cook it in the noodles. Last winter, he didn't even catch a cold.

There is also a vicious cycle to mention: many elderly people cannot eat, have no taste in their mouths, and feel full after eating even a little. Everyone thinks that this is the degradation of digestive function caused by aging. In fact, on the other hand, long-term insufficient nutritional intake will also cause the digestive glands to atrophy. The less they eat, the worse their digestive function will be. The worse they are, the less they want to eat, and there are too many examples of severe malnutrition in the end.

Anyway, every time I go to a community free clinic, I have to tell the old men and women: Don’t be afraid of eating meat or drinking milk. As long as the food is cooked lightly and contains less salt, it will be better than any health care product that costs thousands of dollars. Really, the saying "A thousand dollars can't buy weight loss with old age" has harmed many people. Being able to eat and sleep, clenching fists with strength, and walking without shaking are the most reliable health standards for the elderly.