Energy Needs and Weight Loss

Calories are a measure of energy, but are often negatively associated with, for example, the risk of obesity. Fat, protein, and carbohydrates are energy-yielding nutrients. Alcohol provides energy but is not a nutrient. Water, minerals, and vitamins do not provide energy.

Typically, energy needs decrease as we age. This means that many older people start to eat less. At the same time, the need for nutrients remains unchanged or even increases, partly because older people sometimes have a harder time absorbing nutrients.

The need for energy varies depending on what you do during the day. If you are bedridden, you burn 25 kilocalories per kilogram of body weight. If you are up and about or exercising, the need increases to 30 and 35 kilocalories respectively.

There are diseases that increase energy needs. COPD, heart failure, dementia, cancer, Parkinson's, and fractures. In the case of COPD, energy needs are estimated to rise to around 40 kilocalories per kilogram of body weight.

A lack of energy intake can lead to a weakened immune system, muscle breakdown, fatigue, depression, and impaired wound healing. For those who are sick, weight loss tends to result more in loss of muscle than fat. Muscle breakdown can mean that the elderly person no longer has the strength to stand and walk, and even the heart muscle loses strength. As blood cell formation deteriorates, the elderly become more susceptible to infections. Protein intake is essential to maintain muscle mass.

The energy requirement is 25–30 kcal/kg body weight and the fluid requirement is 30 ml/kg. This means that someone who weighs 60 kg needs approximately 1800 kcal and 1800 ml of fluid per day. This is knowledge that staff must have in order to be able to calculate whether a resident has received enough nutrition and fluid.
When fluid and nutrient intake is impaired, the cause should be investigated. Many times it is age and disease and it is then natural that the elderly eat poorly, but it may be malnutrition that is causing the deterioration. In the case of Alzheimer's disease, weight loss is common even before diagnosis and weight loss increases with the severity of the disease.

Other causes of weight loss in Alzheimer's disease may include difficulties interpreting visual impressions, difficulties performing volitional actions, and language difficulties. Likewise, some people with dementia suffer from energy-demanding wandering behavior.

Weight loss can be due to nausea and vomiting. Communication between the healthcare staff and the nurse is important to ensure that the right measures are taken. Weight loss can be linked to swallowing difficulties and is common among people with dementia and people who have had a stroke or have another neurological disease. Nutritional status should be assessed in the case of weight loss. What does the resident weigh, how great is the weight loss over time. BMI and appetite are investigated.

In case of swallowing difficulties, a speech therapist can be contacted to carry out an investigation and assessment of the severity and possible measures. Likewise, the dental hygienist can be consulted.

Examples of high-energy diets suitable for the elderly

Here are some examples of high-energy diets that may be suitable for sick elderly people:
- Avocado: Avocado is rich in calories and healthy fats. It can be used in smoothies, on sandwiches, or as part of a salad.
- High-fat dairy products: Milk, yogurt, and cheese with high fat content contain more calories and can be good for increasing energy intake.
- Nuts and seeds: Nuts and seeds are rich in calories and healthy fats. They can be eaten as snacks or added to various dishes and smoothies.
- Lean meat, such as chicken or turkey, can be energy-rich and contains a lot of protein that can aid recovery.
- Bread, pasta, and rice made from whole grains are nutritious and can help increase energy intake.
- There are fortified products on the market that can be good for increasing energy intake, such as fortified drinks or fortified bread.
Special diets should always be planned in consultation with a nurse, who if necessary consults a doctor or dietitian.

Other important nutrients for the elderly

There are several nutrients that are especially important for older people because they may be harder for them to get through their diet or to absorb properly. Some of the most common and important nutrients for older people include:
- Calcium: This is important for maintaining strong bones and preventing osteoporosis. Calcium supplements may be useful for the elderly who do not get enough calcium through their diet.
- Vitamin D: This helps the body absorb calcium and also promotes bone health. Older people may have a reduced ability to produce enough vitamin D through sun exposure, and thus supplements may be helpful.
- Vitamin B12: This vitamin is important for healthy nerve function and blood formation. The risk of deficiency increases with age as the elderly may have difficulty absorbing the vitamin properly from food. B12 supplements may be necessary to avoid deficiency.
- Iron: Soil levels and iron deficiency may be more common among the elderly, especially women. Iron supplements may be required in some cases to avoid anemia.

Herbal remedies and dietary supplements can in some cases affect other drug treatment. It is important to note that dietary supplements do not replace a balanced diet, so always consult a nurse or doctor before starting to use dietary supplements.

Vitamins

Diet matters. One example is the intake of vitamins. All vitamins are necessary even for the elderly. Vitamin D occupies a special position as it is linked to the risk of falling. We meet our vitamin D needs through sunlight and diet. For the elderly who move into a nursing home, the time spent in the sun usually decreases at the same time as the skin's ability to absorb vitamin D from sunlight deteriorates. Younger people need about 10 micrograms of vitamin D per day and those over 75 need 20 micrograms per day.

For those with a vitamin D deficiency, the skeleton becomes softer. This can be noticed through bone pain, difficulty walking, cramps and fractures as well as concentration difficulties, low mood, and irritability. Vitamin D is mainly found in fatty fish such as salmon. It is also found in dairy products and eggs but often in small quantities, which makes it difficult to meet the daily requirement.
Calcium is very important for the skeleton. The need is unchanged through aging. Here too, dairy products and fish are useful. 5 dl of dairy products covers most of the daily requirement.

If the appetite decreases, you must try to eat more often and smaller portions. There are nursing homes that always have some kind of snack available for those who are hungry. Weight loss can be a warning signal that the body is not getting enough nutrition. The recommendation is that those living in nursing homes should be offered to eat six times per day. Meals eaten together reduce feelings of loneliness and increase quality of life.

Fluid Needs and Dehydration

When it comes to fluid needs, an ambulatory person is estimated to consume 30 ml of fluid per kilogram of body weight per day. All fluids count and normally the food during the day contains between half and one liter. Any alcohol is deducted. In the case of diarrhea, vomiting, or fever, there is a risk of dehydration.

In case of reduced fluid and nutrient intake, food and fluid registration are needed to check the intake. Fluid registration may be relevant if the resident has severe heart failure and is at risk of accumulating fluid. The intake of fluid is then usually limited to a maximum of 1500 ml per day. Many of the heart failure patient's medications are diuretic and cause increased thirst

Good routines for giving the residents fluids are an essential part of good care. Many elderly people have reduced mobility and therefore cannot provide themselves with fluids. In addition, thirst may become less acute with age.

On hot days, staff should offer extra fluids. It is not always possible to reach the recommended levels and the assessment must be made on a case-by-case basis. You can't force residents to eat and drink.

Why do we need to hydrate

When it's hot outside, it's essential that the elderly drink enough so as not to become dehydrated. Dehydration is all too common in the summer and sometimes leads to unnecessary hospitalizations. Dehydration can occur for several reasons. Diarrhea is one and another is that many elderly people drink poorly. The kidneys take what is needed for them to function. With well-functioning kidneys, the need is about 0.5 l per day. With poorly functioning kidneys, up to 2.5 l of urine may be required to cleanse the blood of waste products.

We get hydrated in many ways. The most important thing is what we drink, but even food contains water. In addition, water is formed when the body converts carbohydrates, fat, and proteins into energy. As we age, we often have an increased need for fluids, partly due to deteriorating kidney function. In addition, the water content of the body decreases as muscle mass decreases. Many elderly people do not feel thirsty in the same way or may avoid drinking due to incontinence problems. In addition, medication side effects can contribute to decreased thirst and appetite. Many elderly people have more difficulty swallowing due to various disease conditions.

Symptoms of fluid deficiency are dry mouth, fatigue, small amounts of urine, and dark-colored urine. In severe dehydration, the pulse increases, the person can become confused and eventually lose consciousness. Those who constantly drink too little easily become constipated. Dry skin is also a sign of dehydration.

Nutritional drinks for the elderly

Aging involves changes in the body's nutritional needs and ability to absorb and utilize nutrients. When older adults face challenges such as loss of appetite, chewing and swallowing difficulties, or medication that affects nutrient intake, nutritional drinks can be a valuable supplement to ensure they get the necessary nutrients. Nutritional drinks are a valuable resource for older adults who may need extra support to meet their nutritional needs. They can play a key role in ensuring that older people continue to enjoy a healthy and active lifestyle as they age. Consult with a nurse or dietitian to design the best diet plan for each individual.

What are nutritional drinks?
Nutritional drinks, sometimes called meal replacements or dietary supplements, are drinks that are specially formulated to contain a balanced amount of macronutrients (proteins, carbohydrates, and fats), vitamins, minerals, and sometimes even fibers. These drinks can be liquid or in powder form that is mixed with water or milk.

Why are nutritional drinks important for the elderly?
Nutritional needs: Older adults may have difficulty eating enough food to meet their nutritional needs. Nutritional drinks provide a concentrated source of necessary nutrients.
Weight control: Some older adults may struggle with unintentional weight loss. Nutritional drinks can help increase calorie intake and maintain a healthy weight.
Maintaining muscle function The protein in nutritional drinks is important for preserving and building muscle mass, which is especially relevant for the elderly who are at risk of muscle wasting.
Part of treatment Nutritional drinks can also be adapted to meet specific needs, such as diabetes, cardiovascular diseases, or malnutrition.
Easy to consume: Liquid sources of nutrition can be easier to swallow and digest than solid foods, which is especially important for the elderly with swallowing or chewing difficulties.

There is a wide range of flavors and consistencies to choose from. It is important to find products that suit the taste of the elderly. Nutritional drinks should not completely replace real food. They are best as a complement to a varied diet.

Reflection - nutritional needs and the impact of diet on the body
Care staff:
• Do you have training on the elderly's need for energy, protein, and nutrition?
• Do you contact licensed personnel when you see someone losing weight?
• Do you have any thoughts on how you set up special diets so that they look appetizing?
• Are there snacks readily available for those living in the residence?
• Do you have good conditions to detect dehydration?

Manager, nurse, occupational therapist, and physiotherapist:
• Do you follow up on how you succeed in maintaining good nutrition at the group level in the residence?
• Do you have a well-functioning team collaboration to help them get enough nutrition?
• Is there a culture where meals are served in an appetizing way?
• Do you have functioning routines for weight checks?
• Do the residents get enough dietary fiber and fluid?
• Do you live up to the guideline of offering meals six times per day?

Residents and relatives:
• Does your relative drink and eat properly?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day