Protein-energy malnutrition in older subjects.

Abstract

The concept of old age is not a new one. Many of the ancient Greek philosophers lived long and full lives, e.g. Isocrates 98 years, Sophocles 91 years, Plat0 8 1 years. The bible refers to the extreme longevity of personages such as Methusaleh. What is new is the greying of populations as opposed to the successful ageing of a few individuals. By the year 2000, approximately two-thirds of the elderly in the world will live in developing countries, e.g. 300 million in China and 170 million in India. By the year 2030, the percentage of older individuals in the population of most developed nations will be approaching 20 %. Individuals over the age of 65 years are faced by a number of challenges that increase the chance of them developing protein-energy malnutrition. These challenges include difficulty in shopping (1 1 %), in preparing meals (7 %), inability to self-feed (27 %), poverty (15 %), social isolation (30 %), impaired mobility (87 %), visual deficits (8 %), dental problems (16 %), and difficulty in chewing (35 %). As will be further explored later in the present article (pp. 588-589), the development of protein-energy malnutrition is directly responsible for a number of disease processes and functional impairment in old age. Protein-nergy malnutrition is a major problem in older subjects. While estimates of its prevalence vary, it has been reported to be present to some degree in 15 % of community-dwelling older subjects (Morley et al. 1989). Severe protein-energy malnutrition occurs in 10-38 % of older outpatients (Miller et al. 1990; Wallace et al. 1995; Wilson et al. 1998), 5-12 % of homebound patients (Morley, 1997), 26-65 % of hospitalized patients (Linn & Jensen, 1984; Morley et aE. 1989) and 5-85 % of institutionalized older subjects (Sandman et al. 1987; Johnson et al. 1993; Silver et al. 1993; Morley & Silver, 1995). While proteinenergy malnutrition is extremely common in older subjects, its presence is rarely recognized by physicians, and even when recognized, it is even more rarely treated (Miller et al. 1990; Wilson et al. 1998). The physiological anorexia of ageing