Elderly people: the costs of malnutrition

Current data demonstrates that malnutrition increases the cost of elderly patient care, as well as the number of medical consultations and hospital stays (1,2). In 2000, annual costs of malnutrition were estimated at:

• 18.5 billion dollars in the USA (13.6 billion euros) and
• 7.3 billion pounds in 2003 in UK (8 billion euros),

approximately 10% of health expenses. 

Half of the costs attributable to malnutrition among elderly over 65 are due to long stays in hospitals and nursing homes (3-5).

The specific case of Alzheimer patients

In 2005, dementia affected 5.4% of elderly over 65 and its prevalence increases with age. Alzheimer disease is responsible for the majority of cases: in 2008, Alzheimer disease affected 860,000 people in France with 220,000 annual new cases and 8.45 million people in Europe (6). Dementia causes a significant financial burden to society, estimated at 141 billion euros per year in Europe, 56%  of which are informal care costs (7).

In institutions, medico-economic aspects of malnutrition among residents suffering from Alzheimer disease need further evaluation. Evaluations must include a more detailed study of the cost of time dedicated by nurse's aides to feed patients individually, as well as food waste and hygiene problems linked to finger food.

Anorexia and malnutrition: fight against the food waste

In regard to meals, a one-day multi-center European study including 16,290 hospitalized adults showed that more than half of these patients did not finish their meals served in hospitals (8).

In regard to protein-rich oral nutritional supplements (ONSs), another study was realized by dietitians in Nice University Hospital. This study including 51 patients hospitalized in geriatric wards showed that 23 % of the patients refused to consume protein-rich ONSs in the form of drinks or of creams, 8 % did not take them systematically and 24 % did not finish them. The main causes of refusal were the milky taste, too sweet taste, the liquid texture and/or the ballooning effect which reduced the appetite at the following meal (9).

To diversify the food of the anorexic persons, Protibis cookies present several advantages. With their aspect of small butter cookies, they please the malnourished elderly, including Alzheimer patients (10-13). They do not require a cold chain and can therefore be distributed in the morning to autonomous patients, without risk of microbial growth. The patients without cognitive problems enjoy their semi-independence and taking cookies at scheduled times suits them. 

For the care staff, the composition of 10,7 g of protein in 8 small cookies facilitates the observance and allows to avoid the wasting (9). The nursing team can distribute cookies one by one as necessary, and therefore easily control the quantity of cookies actually consumed.  Furthermore, with anorexic persons it is difficult to increase the volume of the intakes of protein and energy, and protein-rich dishes (meat, fish, eggs) are often thrown away without having been finished.  Protibis cookies allow to offer a concentrated amount of protein and energy in a small volume.

References

1. HAS : Haute Autorité de Santé. Recommandations professionnelles. Stratégie de prise en charge en cas de dénutrition protéino-énergétique chez la personne âgée. Avril 2007.

2. Rolland Y, Benetos A, Gentric A et al. Frailty in older population: a brief position paper from the French society of geriatrics and gerontology. Geriatr Psychol Neuropsychiatr Vieil 2001;9:387-390.

3. Arvanitakis M, Beck A, Coppens P et al. Nutrition in care homes and home care: how to implement adequate strategies (report of the Brussels Forum (22-23 November 2007)). Clin Nutr 2008;27:481-488.

4. Volkert D, Bernenr YN, Cederholm T et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutr 2006;25:330-360.

5. Pritchard C, Duffy S, Edington J et al. Enteral nutrition and oral nutrition supplements: a review of the economics literature. J Patenter Enteral Nutr 2006;30:52-59.

6. Helmer C, Pasquier F, Dartigues JF. Epidemiology of Alzheimer disease and related disorders. Med Sci 2006;22:288-296.

7. Hort J, O’Brien JT, Gainotti G et al. European Federation of the Neurological Societies. EFNS Panel on Dementia. EFNS guidelines for the diagnosis and management of Alzheimer disease. Eur J Neurol 2010;17:1236-1248.

8. Lafont C, Gérard S, Voisin T, Pahor M, Vellas B ; Members of I.A.A.G./A.M.P.A. Task Force. Reducing « iatrogenic disability » in the hospitalized frail elderly. J Nutr Health Aging 2011;15:640-55.

9. Grégoire J. Prise en charge de la dénutrition en milieu hospitalier : de la théorie à la pratique. Mémoire diététique. Département génie biologique, IUT Montpellier. Avril 2008.

10. Prêcheur I, Brocker P, Schneider S. Development of hyperproteic and hyperenergetic cookies: a solid nutritional supplement for patients with masticatory disabilities. European Society for Clinical Nutrition and Metabolism ESPEN2010-LB-014 2010, Nice France.

11. Prêcheur I, Brocker P, Schneider SM, Barthélémi C, Pesci-Bardon C. Compléments nutritionnels solides pour les personnes ayant des difficultés à mastiquer : enquête de satisfaction sur 30 seniors hospitalisés. Congrès International Francophone de Gériatrie et Gérontologie (CIFGG), P3.3-107, Nice 2010.

12. Solere JP, Brocker P, Schneider SM, Prêcheur I, Reichert E, Breugnon F et al. Distribution de galettes hyperprotidiques hyperénergétiques. Etude multicentrique auprès de seniors dénutris institutionnalisés : résultats intermédiaires sur 63 sujets. Journées Annuelles Francophones de la Société Française de Gériatrie et Gérontologie (JASFGG), P4-12.52, Paris 2011.

13. Philip JL. Lutter contre la dénutrition des malades d’Alzheimer, un exemple. Revue Geriatr 2012 ;37 :141-2.