Malnutrition in the elderly

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Under-nutrition is a significant issue in geriatric patients, contributing to increased morbidity and mortality. It impairs immune function, heightens the risk of falls and fractures, delays recovery from acute illness, and leads to frequent complications. Both acute and chronic illnesses can trigger a catabolic metabolism, exacerbating malnutrition symptoms. Inflammatory cytokines hinder albumin synthesis and redirect protein production towards acute phase proteins. This process activates the ubiquitin-proteasome pathway, resulting in muscle protein degradation and further muscle mass loss, which is compounded by age-related sarcopenia and frailty. Distinguishing whether metabolic changes stem from malnutrition or concurrent illness can be challenging. Psychological factors also play a critical role in anorexia, significantly worsening the condition and contributing to failure to thrive in older adults. Effective management requires not only addressing the underlying illness but also ensuring adequate calorie and nutrient intake over an extended period, typically showing clear improvements after six weeks or more. While overt malnutrition is identifiable, selective nutrient deficiencies are more common, driven by various mechanisms leading to inadequate micronutrient supply.