Department of Geriatric Nutrition

Many people’s first impression of the Department of Geriatric Nutrition is either “a leisure department that prescribes calcium supplement recipes and advises the elderly to eat less oil and meat”, or it is a “window to generate income by selling nutritional supplements.” However, in fact, the Department of Geriatric Nutrition is a clinical specialty that specializes in connecting the physiological degenerative changes, comorbidities, and daily behavioral habits of the elderly to reduce the risk of chronic disease complications, reduce the probability of hospitalization, and improve the quality of life in old age through personalized nutritional intervention. It is not an exaggeration to say that it is the “invisible line of defense” for many elderly people’s chronic disease management.

The 72-year-old Aunt Zhang who I treated last week is a typical example. She has a 12-year history of diabetes and is also complicated by COPD. She listened to the health-preserving guide and said, "Drink porridge to control sugar." She eats white porridge with pickles. She lost 12 pounds in half a year. When she came here for the first time, she was wrapped in a thick cotton-padded jacket. She couldn't breathe for three minutes even when she sat down. Her voice was as thin as a mosquito. The family had been monitoring the lung function and blood sugar indexes before, and they changed medicines three times but there was no improvement. Finally, the respiratory doctor referred him to our department. I didn't prescribe any expensive supplements to her. I just changed the white porridge every meal to thick multigrain porridge with brown rice and oats, added a spoonful of minced lean beef or steamed soft shrimps to each meal, half a box of sugar-free yogurt in the morning, and a small handful of steamed red dates in the afternoon to prevent her from being deliberately hungry. She walked slowly for 10 minutes half an hour after the meal. In three weeks, her weight has increased by 4 pounds, and her fasting blood sugar has stabilized at around 6.5. When she came for a follow-up visit last week, she wore a bright yellow floral sweater and stuffed her own dried sweet potatoes into the nurse's station as soon as she entered the door. She said that now she doesn't need to rest in the middle of climbing to the third floor.

When it comes to this, some people are definitely going to make excuses. Isn't it said that "a thousand pieces of gold can't buy you old age"? Aren’t you worried about high blood lipids after eating so much meat? Alas, this happens to be a controversial point that has been quarreling in the field of geriatric nutrition for almost ten years. The traditional concept of health care for the elderly does advocate a light diet and underweight. The reason is that high weight will increase the burden on the cardiovascular and cerebrovascular vessels and induce the three highs. This statement is not unreasonable. For the 60-year-old who has just retired, has good health and no underlying diseases, it is indeed appropriate to control the BMI between 20-24. But now more and more clinical data supports another point of view: elderly people over 75 years old, with comorbidities, and have begun to lose muscle mass, whose BMI remains slightly obese between 22 and 26, have an all-cause mortality rate 37% lower than that of thin elderly people - to put it bluntly, as you get older, you have a bit of "excess meat" on your body, which is resistant to colds, fractures, and surgeries.

Don’t underestimate the difference in weight. I have been in this department for 6 years and I have seen too many elderly people who were either defeated by cancer or myocardial infarction or other serious illnesses. They were unable to eat for two or three months in a row. They lost muscle mass quickly. They fell and fractured when walking. They also suffered from lung infections while lying in bed. They collapsed. Many people think that loose muscles and lack of energy in walking are normal symptoms of aging. In fact, this is called sarcopenia. Adjusting your diet and supplementing enough protein as early as six months can completely delay the progression and avoid suffering later.

The most common misunderstanding encountered in outpatient clinics is that children shout as soon as they enter the door, "The doctor prescribed two cans of the best protein powder for me, and my dad can't eat." Really, protein powder is not a miracle drug. I met an 81-year-old man before who had chronic renal insufficiency. His son was filial and I gave him two cups of imported protein powder every day. After half a month of supplementation, his creatinine spiked and he was hospitalized. Before we prescribe supplements to the elderly, we must first check the liver and kidney function, chewing ability, and daily diet structure. Many elderly people cannot eat because they lack nutrients, have bad teeth, or the cooking at home is too plain. Chop the lean meat and vegetables into small pieces, and simmer them with rice to make soft rice. This is much better than protein powder that costs hundreds of dollars per can.

Our department now provides dietary guidance, and we have long since stopped using notices full of professional terms. They are all in vernacular that the elderly can understand: instead of saying "daily intake of 1.2-1.5g of high-quality protein per kilogram of body weight", just write "1 egg per day, 1 cup of warm milk, a palm-sized piece of lean meat/fish and shrimp"”； Instead of saying "control the intake of refined sugar", just write "drink less milk tea, eat less candied fruit, and eat rice dumplings and mooncakes without sugar water." Even the amounts are clearly indicated, so the elderly can just follow the instructions when they go home, without having to use their brains to calculate. Of course, there are also elderly people who really can't eat, such as those who have just finished radiotherapy and chemotherapy, or have dysphagia. We will also prescribe corresponding enteral nutrition preparations according to the situation. These are all covered by medical insurance, and the price is not as exaggerated as everyone thinks.

Next time, if an elderly person at home loses more than 5 pounds for no apparent reason in six months, or is unable to eat or has chronic diseases that cannot be controlled, don't just focus on taking medicines and injections. Come to the geriatric nutrition department and ask, maybe adjusting two meals will solve the problem.