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Food Fortification and Frail Elderly Nursing Home Residents

  • Kristina Norman
  • Matthias PirlichEmail author
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

In higher age, several factors may lead to decreased intake of food. Physiological age-related changes such as decrease in taste and smell and reduced sensation of thirst may reduce the drive to eat, while physical disability on the other hand may impair the capacity of providing, cooking, or eating meals. Besides, high morbidity and multiple medication which are frequently present in the elderly, as well as sociopsychological factors such as depression, isolation, poverty, or mental disorders may further contribute to insufficient nutritional intake (see Table 14.1). Recently, several studies have furthermore demonstrated an altered, decreased muscle protein synthesis following protein ingestion in the elderly [1, 2], placing them at high risk of developing sarcopenia, an age-associated phenomenon, where muscle mass and functional capacity are reduced [3]. The functional consequences of malnutrition very often lead to increasing isolation and a greater dependency that ultimately impair quality of life [4]. And vice versa, elderly nursing residents who exhibit various degrees of dependence are therefore at increased risk of malnutrition. An analysis combining data from 12 countries revealed a prevalence of malnutrition of 22.8 % in elderly subjects, with the highest occurrence in rehabilitation units, followed by hospitals and nursing homes, where nearly 14 % of residents were moderately or severely malnourished [5]. The prevalence of malnutrition in nursing homes can be considered an indicator of the quality of nutritional care, although it still remains unclear to what extent malnutrition is preventable in elderly nursing home residents.

Keywords

Malnutrition Elderly Nursing homes Food fortification Feeding assistance Micronutrients 

Abbreviations

ADL

Activities of daily living

BMI

Body mass index

ONS

Oral nutritional supplements

References

  1. 1.
    Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am J Clin Nutr. 2005;82:1065–73.PubMedGoogle Scholar
  2. 2.
    Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly. Am J Physiol Endocrinol Metab. 2006;291:E381–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12:403–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008; 27:5–15.PubMedCrossRefGoogle Scholar
  5. 5.
    Kaiser MJ, Bauer JM, Ramsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58:1734–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Isaksson B. How to avoid malnutrition during hospitalization? Hum Nutr Appl Nutr. 1982;36:367–73.PubMedGoogle Scholar
  7. 7.
    Andersson J, Nydahl M, Gustafsson K, Sidenvall B, Fjellstrom C. Meals and snacks among elderly self-managing and disabled women. Appetite. 2003;41:149–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Engelheart S, Lammes E, Akner G. Elderly peoples’ meals. A comparative study between elderly living in a nursing home and frail, self-managing elderly. J Nutr Health Aging. 2006;10:96–102.PubMedGoogle Scholar
  9. 9.
    Taylor KA, Barr SI. Provision of small, frequent meals does not improve energy intake of elderly residents with dysphagia who live in an extended-care facility. J Am Diet Assoc. 2006;106:1115–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Odlund OA, Koochek A, Cederholm T, Ljungqvist O. Minimal effect on energy intake by additional evening meal for frail elderly service flat residents—a pilot study. J Nutr Health Aging. 2008;12:295–301.CrossRefGoogle Scholar
  11. 11.
    Tannen A, Schutz T, Smoliner C, Dassen T, Lahmann N. Care problems and nursing interventions related to oral intake in German nursing homes and hospitals: a descriptive multicentre study. Int J Nurs Stud. 2012;49(4):378–85.PubMedCrossRefGoogle Scholar
  12. 12.
    Simmons SF, Osterweil D, Schnelle JF. Improving food intake in nursing home residents with feeding assistance: a staffing analysis. J Gerontol A Biol Sci Med Sci. 2001;56:M790–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Walton K, Williams P, Bracks J, et al. A volunteer feeding assistance program can improve dietary intakes of elderly patients—a pilot study. Appetite. 2008;51:244–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Barton AD, Beigg CL, Macdonald IA, Allison SP. A recipe for improving food intakes in elderly hospitalized patients. Clin Nutr. 2000;19:451–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Lorefalt B, Wissing U, Unosson M. Smaller but energy and protein-enriched meals improve energy and nutrient intakes in elderly patients. J Nutr Health Aging. 2005;9:243–7.PubMedGoogle Scholar
  16. 16.
    Gall MJ, Grimble GK, Reeve NJ, Thomas SJ. Effect of providing fortified meals and between-meal snacks on energy and protein intake of hospital patients. Clin Nutr. 1998;17:259–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Odlund OA, Armyr I, Soop M, et al. Energy-dense meals improve energy intake in elderly residents in a nursing home. Clin Nutr. 2003;22:125–31.CrossRefGoogle Scholar
  18. 18.
    Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition. 2008;24:1139–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Bischoff-Ferrari H. Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract Res Clin Rheumatol. 2009;23:789–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Stover PJ. Physiology of folate and vitamin B12 in health and disease. Nutr Rev. 2004;62:S3–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Dunne JL, Dahl WJ. A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutr Rev. 2007;65:135–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Silver HJ. Oral strategies to supplement older adults’ dietary intakes: comparing the evidence. Nutr Rev. 2009; 67:21–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Radimer K, Bindewald B, Hughes J, Ervin B, Swanson C, Picciano MF. Dietary supplement use by US adults: data from the National Health and Nutrition Examination Survey, 1999–2000. Am J Epidemiol. 2004;160:339–49.PubMedCrossRefGoogle Scholar
  24. 24.
    Sebastian RS, Cleveland LE, Goldman JD, Moshfegh AJ. Older adults who use vitamin/mineral supplements differ from nonusers in nutrient intake adequacy and dietary attitudes. J Am Diet Assoc. 2007;107:1322–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Manders M, De Groot LC, Hoefnagels WH, et al. The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people. J Nutr Health Aging. 2009;13:760–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Manders M, de Groot CP, Blauw YH, et al. Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly. Eur J Clin Nutr. 2009;63:1241–50.PubMedCrossRefGoogle Scholar
  27. 27.
    Adolphe JL, Whiting SJ, Dahl WJ. Vitamin fortification of pureed foods for long-term care residents. Can J Diet Pract Res. 2009;70:143–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Keane EM, Rochfort A, Cox J, McGovern D, Coakley D, Walsh JB. Vitamin-D-fortified liquid milk—a highly effective method of vitamin D administration for house-bound and institutionalised elderly. Gerontology. 1992;38:280–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Gastroenterology, Infectiology and Rheumatology (incl. Nutritional Medicine)Charite University Medicine Berline—CCMBerlinGermany
  2. 2.Innere Medizin, Evangelische Elisabeth KlinikBerlinGermany

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