Aspects of nutrition in geriatric patients - Especially dietary assessment, intake and requirements

Abstract: The aim of this thesis was to develop and test the feasibility of a dietary record routine, where nursing staff assess the patient’s food and fluid intake based on standardised portion sizes and household measurements. The energy intake (EI) was studied with a dietary record in 61 geriatric patients. During the 6-month follow-up 11 patients died and an EI below median (1378 kcal) was associated with an age adjusted increased 6-month mortality risk, odds ratio 12.5. In the reproducibility study the dietary intake of 81 geriatric patients was recorded for two periods of 7 consecutive days. The mean difference in EI between the two periods was 4%. In the validity study total energy expenditure (TEE) was measured with the doubly labelled water (DLW) method concurrently using the dietary record routine in a 7-day recording in 31 body weight stable geriatric patients. The dietary record routine overestimated EI by 8% compared to DLW-measured TEE. In order to explore the accuracy of different equations to predict the TEE, 13 equations developed for the elderly were tested against DLW-measured TEE in 31 geriatric patients. The mean estimated physical activity level was 1.2. Three out of 13 equations could best predict TEE. Out of 81 patients 28% were classified as having a protein-energy malnutrition. Out of 220 patients 62% had an EI below the calculated energy requirements. Almost the entire EI took place within 9 hours during daytime. CONCLUSIONS: The 7-day dietary record routine seems to have a good reproducibility and validity in assessing the intake of energy and fluids in geriatric patients. However, the nursing staff seemed unable to ensure that the patients’ individual dietary needs were met. The low dietary intake indicates a need for general daily dietary supplementation to all geriatric patients.