Diagnosing the nutritional status of patients aged 65 and above

To determine if the patients were malnourished, and if they were, whether they were mildly or moderately malnourished, the researchers used a standard tool to gauge their nutritional status. Known as the Subjective Global Assessment, the tool looked at factors such as the patients’ weight, oral intake, gastrointestinal symptoms, physical signs of malnutrition, and whether they had lost significant amounts of weight recently.

Only about 44 per cent of the patients were found to be well-nourished. This finding was supported by the results of a second, similar tool known as the Mini Nutritional Assessment. This tool was only used on patients who were at least 65 years of age. Of the 71 patients in this age group, 68 per cent were malnourished or at risk of malnourishment.

Each patient’s functional independence measure was rated weekly by the rehab team. The researchers found statistically significant differences between the score improvements of the well-nourished and severely malnourished patients. This means that severely malnourished patients fared worse in performing daily tasks ranging from eating to walking.

In fact, the severely malnourished patients remained in hospital for an average of 51 days, while the well-nourished ones went home on average about 20 days earlier. Ms Yang, Dietitian, Department of Dietetics, Department of Rehabilitation Medicine, Singapore General Hospital (SGH), a member of the SingHealth​ group said that there are many possible reasons for the patients’ malnourished state, which does not happen “overnight”. For example, suffering a stroke can mean that a patient has difficulty eating.

Tips to cope with malnourishment ​​in the elderly

As more than half the patients were already malnourished when they started rehab, one recommendation is to screen them earlier so that their nutrition levels can be improved at an earlier stage.

“We would like to be able to see the patients once they show that they are not eating well and have lost their appetite. We can assess if what they are eating is nutritionally enough, and then recommend a suitable diet and/or nutritional supplements to help them recover faster,” she said.

Family members can also do their part by watching the eating habits of the elderly, who​ may not have a balanced diet or eat enough of the food placed before them. Ms Yang said: “As people age, their sense of taste and smell can become impaired. If they feel the food is not tasty, they may not eat as well. Loss of vision and hearing can affect their ability to prepare and buy food. Dentures can make it hard for a wearer to chew food.

“Family members need to be able to recognise signs that the patient is not eating well, losing muscle, or losing weight. And they should take action to help them to maintain their weight. Otherwise, if disease attacks, they will be sicker.”

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