Clinical consequences of undernutrition in the elderly

A common problem: Undernutrition occurs when nutrient intake does not meet nutritional needs. Selective food intake induced micronutrient deficits (mo derate undernutrition) and can later lead to protein calorie malnutrition ( PCM). PCM is often discovered during acute illness (increased nutritional n eeds). PCM is observed in 30 to 50% of the institutionalized population and in 2 - 4% of the elderly living at home. Micronutrient deficits are far mo re frequent and concern 4 million elderly persons in France. Age-related changes: Decreased smell and taste capacities and the inability to modify eating habits in stress conditions are mainly responsible for lo w food intake. Low intake leads to immunodeficiency, and subsequent frailty . Any intercurrent illness aggravates both undernutrition and immunodeficie ncy, creating a disease-to-disease spiral (undernutrition-immunodeficiency) that is difficult to inverse. Signs of PCM: Early signs of protein-calorie malnutrition are nonspecific: fatigue, apathy, decline in muscle strength. It is important to diagnose un dernutrition at this stage before more specific symptoms develop: anorexia, weight loss, infection. Metabolic disorders occur at a later stage, genera lly during an acute illness, leading to overt PCM with perturbed glucose me tabolism, recurrent infection, dehydratation, impaired wound healing, and c alcium bone loss. The length of refeeding therapy depends on the intensity of the clinical signs, weight loss, dehydratation, glucose metabolism disor der and/or on the severity of clinical complications such as infection or b one fractures. Practical attitude: Under nutrition must be recognized early at the stage o f nonspecific clinical expression. Practitioners must be constantly aware o f the risk of undernutrition and search for nonspecific signs in the elderl y.