Barry Goldlist, MD, FRCPC, FACP
There is more and more evidence accumulating in recent years that demonstrates the critical importance of nutrition in the elderly. The negative consequences of being overweight have long been known. Much of the modern 'pandemic' of type II diabetes mellitus is secondary to this. As well, hypertension and hyperlipoproteinemias are related to obesity. Recent evidence has confirmed the long suspected relationship between arthritis of the knee and excess weight. Despite this, the average weight of North Americans continues to rise. My personal belief is that this does not simply reflect a lack of personal self-discipline, but rather a societal structure that constrains physical activity in day-to-day existence. Irregular trips to the gym are no substitute for walking each day, even if only to the bus stop. Our cities in North America, with their sprawling suburbs, seem designed specifically to discourage walking and encourage driving. A rethinking of how we design our living spaces might help in controlling the occurence of obesity.
We understand even less about the causes of under-nutrition in old age. Is it a consequence of disease and decline, or is it a factor that causes functional decline? Certainly the causes of weight loss in old age are almost always multifactorial. The various factors range from poor dentition, loss of ability to smell, the effects of drugs, to specific disease processes, such as cancer. Eating is also an intensely social process, and isolated seniors are particularly at risk for under-nutrition. Regardless of whether under-nutrition is the 'chicken or the egg', once an elderly person becomes ill, careful attention to nutritional issues is often the key to ultimate functional recovery. Thus, in any geriatric service, the clinical dietitian is a key member of the team. For any physician following elderly patients in their own practice, the easiest way to detect problems at an early stage is to carefully record the patient's weight at regular intervals. This is particularly important in nursing homes, where weights should be recorded on a monthly basis. In the USA, intense research interest has been focused on this issue, particularly on the fact that protein loss seems to predominate in some patients. The resulting loss of muscle mass has been called 'sarcopenia', and is clearly a factor in functional decline.
It is ironic, that as a geriatrician, even though I have seen wonderful therapeutic advances in care of the elderly, the best strategy for maintaining quality of life in old age, continues to consist of regular exercise and good eating habits.
