The role and significance of geriatric nutrition

The core role of geriatric nutrition is to tailor nutrition to the declining physiological functions and chronic disease characteristics of the elderly, to delay physiological degeneration to the greatest extent, reduce the risk of acute onset of chronic diseases, and improve the quality of life in old age. Its significance is not only related to the quality of life of an individual elderly person, but also can directly reduce the medical and care costs of families and society as a whole.

I have been a community nutrition guide for the elderly for almost 7 years, and I have met too many elderly people and their family members who have misunderstandings about "elderly nutrition". Last week at the free clinic, I met 68-year-old Aunt Zhang. In order to control blood lipids, she followed the advice of the health regiment and ate a vegetarian diet for half a year. She rarely touched eggs or milk. The last time she squatted down to pick something up, she fell and fractured her radius. The serum albumin was only 32g/L, which is almost 8 units lower than the lower limit of normal. The essence is muscle attenuation caused by long-term insufficient protein intake, and her balance cannot keep up.

Speaking of which, we have to mention two different views on the scale of nutritional intervention for the elderly in the industry. In the past few years, the mainstream voice was the "restrictive school", which believed that the elderly have a slow metabolism and should strictly limit salt, oil, and protein intake, and keep blood pressure, blood lipids, and blood sugar indicators to the same standards as young people to be considered healthy. However, in the past two years, more and more clinical data have supported the "sufficiency" view. In particular, the guidelines updated in 2023 by the Geriatrics Branch of the Chinese Medical Association clearly mentioned that elderly people over 75 years old do not need to excessively restrict dietary fat and red meat intake. Compared with slightly higher blood lipids, the risk of falls, infection, and multi-organ decline caused by rapid decline in muscle mass is much higher. Both views are actually supported by clinical data. The core still depends on the age and underlying diseases of the elderly. There is no unified standard answer. My own follow-up data can also prove that 27 elderly people over 80 years old who adhered to a high-protein adapted diet last year had 60% fewer respiratory infections throughout the year than before.

Many people think that geriatric nutrition is about teaching the elderly how to take supplements, but this is not the case at all. Last month, a family member brought his 72-year-old father to see me, saying that his son was filial and bought her 20,000 yuan worth of Cordyceps sinensis and sea cucumber protein powder. It turned out that the old man himself had hyperuricemia. He suffered from gout three times after taking the medicine for three months, and his walking was difficult. To be honest, a large part of the role of nutrition for the elderly is to "remove falsehoods and retain the true": the more expensive ingredients are not more suitable for the elderly, eating porridge every day is not only good for the stomach, nor being completely vegetarian can reduce the three highs, many of these misunderstandings that have been passed down for more than ten years have been corrected after stepping on the health pitfalls of countless elderly people.

There is another point that is still being debated in the industry: Should the elderly take nutritional supplements regularly? One school of thought believes that as long as the dietary structure is reasonable, sufficient nutrients can be obtained from food, and supplements are a waste. ； The other group believes that the digestion and absorption function of the elderly generally declines. Even if they eat enough, the absorption rate of nutrients is only 60%-70% of that of young people, especially vitamin D, vitamin B12, and calcium. The benefits of regular supplementation outweigh the disadvantages. My own practical experience is not to apply a one-size-fits-all approach. First, do a serum nutritional marker test for the elderly. Make up for whatever is missing. If the indicators are normal, dietary adjustments are enough. There is no need to spend more money.

From a larger perspective, the social value of geriatric nutrition is actually much greater than everyone thinks. Last year, I conducted a set of comparative statistics with the community health service center in the jurisdiction. It was found that the hospitalization rate of 120 elderly people who received individualized nutrition guidance for six consecutive months was 32% lower than that of the control group without intervention, and the per capita annual medical expenditure was more than 4,200 yuan less. If this range is expanded to the elderly population across the country, the saved medical insurance funds and reduced care pressure are not a small amount.

In fact, after working in this field for a long time, I feel that the science of nutrition for the elderly does not have so many high-level things. It is to help each elderly person find the most suitable way of eating for him or her. There is no need to go hungry in order to control the target, and there is no need to waste money on nutritional supplements. The greatest significance of this subject is to be able to eat well, be able to walk around, and run less to the hospital.