Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 353

In many older adults, the decrease in energy intake is greater than the decrease in energy expenditure, so body weight is lost. This physiological, age‐related reduction in energy intake has been termed anorexia of ageing.¹ Undernutrition is common in older adults, with a significant impact on outcomes including physical function, healthcare utilization, and length of hospital stays.^2–5 According to the World Health Organization, malnutrition refers to deficiencies, excesses, or imbalances in a person’s energy intake. Malnutrition encompasses both undernutrition and obesity⁶; in this chapter, malnutrition and undernutrition are used interchangeably. The Global Leadership Initiative on Malnutrition established that the diagnosis includes a phenotypic criteria (non‐volitional weight loss, low body mass index, or reduced muscle mass) and a etiologic criteria (reduced food intake or absorption, or underlying inflammation due to acute or chronic disease/injury).⁷ A key predictor of malnutrition in older adults is loss of appetite.⁸ The prevalence of malnutrition depends on the population, geography, and living situation. One study from 2010 reported a review of the Mini Nutritional Assessment across settings in Europe, the United States, and South Africa; the prevalence of malnutrition was 22.8% (n = 4507, mean age 82.3, 75.2% female), with the highest rates for patients in rehabilitation units (50.5%), less for hospitalized older adults (38.7%), and lower among community dwellers (5.8%).⁹ More recently, in 2016, a meta‐analysis on malnutrition in various European healthcare settings suggested the following malnutrition rates: 6.0% (95% CI 4.6–7.5); hospital, 22.0% (95% CI 18.9–22.5); nursing homes, 17.5% (95% CI 14.3–20.6); long‐term care, 28.7% (95% CI 21.4–36.0); rehabilitation/sub‐acute care, 29.4% (95% CI 21.7–36.9).¹⁰

As indicated in this chapter, (i) ideal weight ranges are almost certainly higher in older than younger adults; (ii) weight loss is often associated with adverse effects in the elderly, particularly if unintentional; and (iii) undernutrition manifesting as low body weight and weight loss is common in older adults and has significant adverse effects. Healthcare providers should maintain a high level of awareness to detect unintentional weight loss and undernutrition in this age group.