Malnutrition is both a cause and a consequence of ill health. Many older adults with long-term medical or psycho-social problems are underweight, and thus vulnerable to acute illness. This may even happen to well-nourished people if they are ill or injured for a short time, and do not eat well during this phase.
The consequence of malnutrition is vulnerability to infection, delayed wound healing, impaired function of the heart and lungs, decreased muscle strength, and depression.
Medical patients who have prolonged malnutrition have higher complication and mortality rates.
Surgical patients who are malnourished have three times as many post-operative complications and four times greater risk of death than well-nourished patients having the similar operation.
If older adults have poor dietary intake which persists, malnutrition can be life-threatening in itself. When the provision of normal food and drinks, along with physical help, becomes difficult or impractical, then nutrition support is indicated.
What is nutrition support?
Nutrition support includes taking extra oral food (pureed) or special drinks: feeding via a tube into the gastro-intestinal tract (enteral tube feeding) or giving nutrients intravenously, which is known as parenteral nutrition.
Nutrition support will prevent starvation in older adults, thus preventing malnutrition, and is a safe and simple route if the correct techniques are adhered to.
The need for nutrition support is absolute if older adults are unable to meet the majority of nutrient requirements for prolonged periods of time (eg post-stroke leading to swallowing difficulty or intestinal failure.) In these cases, nutrition support is provided via tubes into the gastro-intestinal tract.
Oral supplementation may not be the choice as they can cause pneumonia in dysphagic (swallowing difficulties) patients. Likewise, patients who are unconscious and unable to communicate will benefit from nutrition support.
Patients with severe acute pancreatitis or inability to gain enteral access, who suffer from intractable vomiting or diarrhoea, and with high output proximal fistula, cannot be given enteral nutrition support.
How to select the right formula
Selection of formulas
There are many types of formula available for enteral nutrition support. They are generally grouped into three main categories: polymeric, hydrolysed, and modular.
Selection of an appropriate formula is based on several factors, including digestive and absorptive capacity, volume status, and overall disease state.
A qualified dietitian will recommend the appropriate formula for the patient after nutrition assessment and diagnosis has been carried out. She will also calculate the calories, protein and other nutrients for the patient to prevent weight loss and malnutrition.
Polymeric formulas are nutritionally complete, predominantly lactose-free, and casein or soya protein isolate-based. Normal digestion and absorption is required in patients as the nutrients are in an intact molecular form.
Polymeric formulas supply all the necessary nutrients for complete nutrition. There are different types of polymeric formulae, such as standard, high nitrogen, fiber supplemented, concentrated, and disease specific.
Hydrolysed formulas aids in minimal digestion. The carbohydrate and protein sources are easily digested. These formulas are usually low in fat and provide a portion of fat in the form of medium chain triglycerides.
Due to hydrolysation, theses formulas tend to have a higher osmolality.
Modular formulas are composed of carbohydrates, protein and fat that may be used to alter the energy or protein content of a base formula or to create a new feeding formula.
Nutrition support, once featured predominantly in hospital settings, is becoming common in nursing facilities and in home care. Therefore, it is important that nutrition support is provided in a safe and efficacious manner, with the assistance of the doctor, dietitian, nurses, and pharmacist.
Mary Easaw is senior manager of dietetics & food services at the Institut Jantung Negara. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.