Nutritional frailty : prevalence, screening and management

Abstract

Nutritional frailty refers to the downward spiral of increasing frailty that may occur in old age as a result of rapid, unintentional loss of body weight and sarcopenia. In the studies described in this thesis, the prevalence of under-nutrition was high and these undernourished older people were more likely to be hospitalized, spend longer in hospital, be admitted to facilities with increased level of care, fall and report weight loss. Also, medical and emotional well-being, good oral and dental health and access to nutritious food were all shown to be associated with better nutritional health. Screening for under-nutrition is important. The ‘DETERMINE Your Nutritional Health Checklist’ was found to be a simple awareness tool that could be easily used to increase knowledge in carers and older people. The rapid screen, in which an older person is classified as under-nourished if they have: 1) body mass index < 22 kg/m2 and/or 2) unintentional weight loss > 7.5% in the previous 3 months, was found to be simple and highly specific and suitable for use in facilities with financial, time and staffing constraints. The Mini Nutritional Assessment tool with its better sensitivity and specificity may be better in resource rich settings as results from this tool can guide management. In one of the studies, fasting plasma ghrelin levels in under-nourished older people were comparable to that in nourished older people, not higher as in previous studies (in other states of negative energy balance) and this may indicate a failure in energy homeostasis. Relatively reduced ghrelin levels in under-nourished older people may contribute to the development and/or progression of the anorexia of ageing and this requires further evaluation. Many frail older people are at risk of post-prandial hypotension and its many adverse health effects. Dietary carbohydrate manipulation by substituting sucrose with fructose may be beneficial in reducing the post-prandial blood pressure fall in older people. In conclusion, nutritional frailty is prevalent and has many adverse health consequences. Early detection and systematic intervention may help reduce morbidity.