Advice line: don’t overlook the role of nutrition

Older people might need extra protein and calories, says dietitian Louise Nash.

Unintentional weight loss (malnutrition) causes losses in muscle mass, strength and function (sarcopenia), increasing risk for falls, fractures and long hospital admissions. Until recently, we thought the over-65s and under-65s had the same protein needs. We now know that the over 65s need more protein. In fact, some need up to twice as much, because we become less efficient at using protein as we age and some inflammatory diseases, such as chronic obstructive pulmonary disease, use up more protein.  
Sufficient protein can improve muscle mass, strength and function, especially when combined with resistance exercises. This enhances protein synthesis by sensitising the muscle to insulin and amino acid-mediated anabolic actions, peaking within three hours or so of exercise. Twenty grams of protein is recommended after exercise and 25 to 30g protein in meals for older adults. 
Protein can be found in meat, chicken, fish, milk, cheese, yogurts, eggs, pulses (such as beans, lentils, chickpeas) and nuts. Preventing weight loss through sufficient calories in the diet is also important to prevent or treat sarcopenia. 
I recently analysed admission rates and length of stay in the frail older patients I have worked with in their own homes, who were at high risk for falls and readmissions due to malnutrition and sarcopenia. I found a 67 per cent reduction in admissions six months after my intervention and that length of stay fell by 61 per cent
Unfortunately, this was often not the case for those patients who continued to lose weight and/or had a body mass index under 18.5 kg/m2. Patients who gained handgrip strength fared better; the extent of strength gain did not matter.  
What can you do? Encourage a high calorie high protein diet in patients who are malnourished and/or sarcopenic. A glass of milk after exercise is a good source of protein, as is fluid, which also plays a role in falls and admissions prevention. Ask your local dietitians about referrals and patient information sheets. 
  • Louise Nash is a frail elderly pathway dietitian, Airedale NHS Foundation Trust
Louise Nash Frail elderly pathway dietitian, Airedale NHS Foundation Trust

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