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clinical focus
Muscle
up
The importance of restoring and
preserving these tissues in ageing
people cannot be overstated.
ByMelissaBarnes
L
osing weight is a positive thing for many people, but as
we age it can be a reason for concern. A change in weight
in aged care is a rough measure of whether a resident is
receiving adequate nutrition.
Sarcopenia is a relatively new medical term and refers to the
loss of muscle with ageing, which affects strength and the ability
to perform a range of functions normally taken for granted. Any
weight loss includes a loss of muscle. Losing muscle affects the
ability to sit, stand, move, swallow and even breathe. It increases
frailtyandreducesqualityoflife.Preventionofmuscleloss
preserves strength, function and overall integrity of the body.
But muscle also has a role in health not as well understood. It
is our reservoir of protein, which the body needs to regenerate its
tissues. It also provides a source of energy when we are not able
to eat adequately to meet our needs. Each time we experience
a serious illness, we break down muscle that requires effort to
rebuild, with appropriate nutrition and activity. The less muscle
we have, the less able we are to survive a critical illness. If our
lean mass falls to 60 per cent of baseline levels, it is likely fatal.
In contrast, the greater our muscle mass, the greater our protein
36 agedcareinsite.com.au
stores and ability to survive illness or a period of poor nutrition.
Clearly, maintaining muscle as we age is linked to longevity and
ability to cope with illness.
Obese patients can also have low levels of muscle, therefore
any weight loss is reason for concern. In fact, sarcopenia in an
obese individual is even more dramatic, with the loss of strength
making it even more difficult to move a large frame. Even the
muscles of the respiratory system in obese individuals have
increased work, as fat tissue around the rib cage and abdomen
resistsmovement.Whilewecanreasonthatweightlosswillhelp
improve the mobility of the patient and the ease of staff handling,
if too much muscle is lost the reverse is true.
It is reasonable to assume that all aged-care residents are
at high risk of sarcopenia, with age, inactivity, illness and poor
nutritionincreasingthelikelihood.Whilewecannotinfluence
some factors such as age and illness, it is important to identify
what we can do for each resident to optimise their physical state.
By far the greatest factor in preventing weight loss, and therefore
muscle loss, is achieving an adequate intake of energy (calories or
kilojoules) and protein.
In general, appetites are poor and standard menus in
aged-care facilities should be energy dense and high in protein
to help achieve adequate intakes. Low-calorie food requires
the residents to eat more to reach their energy requirements
and prevent weight loss. Gravies, cream and cheese are great
waystomakeadishmoreenergydenseandpalatable.Protein
powders, or other sources of protein, such as skim milk powder,
canbeaddedtodrinksandsoupstoenrichthem.Manypeople
constantly look for hidden calories to lose weight. In aged care,
we focus on adding them back in.
Dietary restrictions should be kept to a minimum to enhance
the palatability of meals and to encourage a decent dietary intake.
Medicalstaffshouldensure,forexample,thatbloodsugartargets
are not overzealous and consider that it is often more appropriate
to alter medications than to restrict a diet that is already limited by
factors such as poor appetite.
Constipation can also affect appetite. Dehydration is a
common reason for it and fluids should be encouraged,
preferably nutritional fluids (for example, dairy based) to make
every bit count. Inactivity and a poor intake compound the
problem and there are often effects from medications. Aperients
may be necessary.
Other common factors affecting how much a resident will eat
include pain, depression, poor dentition, declining cognition,
impaired or altered tastes, dysphagia or fatigue. Knowing each
resident’s needs is essential in combating their barriers to eating.
Texture-modified meals, smaller, more-frequent meals, finger
foods, encouragement or assisted feeding may be appropriate
solutions. Changes in medications may also be helpful.
Remember, weight loss in elderly patients indicates inadequate
nutrition and loss of muscle. Loss of muscle increases frailty and
mortality. Aged care menus should be energy and protein dense
tooptimiseresidents’intake.However,evenwiththebestefforts,
some residents will require additional support.
An accredited practising dietitian can assess a resident’s needs
and existing management, and prescribe nutritional supplements
to achieve an adequate intake if necessary. ■
Dr Melissa Barnes is an accredited practising clinical dietitian.
To find an accredited practising dietitian in your area, visit the
‘find an APD’ section of the DAA website at daa.asn.au or call
1800 812 942.