MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTHHANOI MEDICAL UNIVERSITY BIT Till CAM TRA NUTRITIONAL STATUS AND DIGESTIVE SYMPTOMS OF THE ELDERLY AT HANOI MEDICAL UNIVERSITY HOSPIT
LITERATURE REVIEW
1.1 An overview of elderly individuals Ị.Ỉ.L The concept
Over the past three decades, Vietnam's population has experienced significant changes in both scale and age structure, reflecting broader economic and social development trends As life expectancy continues to rise, the definition of "elderly" varies globally; for instance, most European nations classify individuals aged 65 and older as elderly, while some African countries consider those around 50 to 55 as such In Vietnam, both the United Nations and national legislation define the elderly as individuals aged 60 years and older, encompassing both men and women.
Life expectancy varies significantly between developed and developing countries, influenced by population characteristics In developed nations, most elderly individuals reside in urban areas, while in developing countries, such as Vietnam, nearly 80% of the elderly population lives in rural regions The General Statistics Office categorizes the elderly into groups: young elderly (ages 60-69), middle-aged elderly (ages 70-79), and old elderly (ages 80 and above) However, these age divisions do not accurately reflect the biological processes of aging, highlighting that such classifications are conventional and have relative significance.
Aging is an inevitable biological process that affects all humans, resulting in various molecular changes throughout the body This process impacts cells, tissues, and organs, leading to a decline in functional activities and a reduced capacity for self-regulation and adaptive mechanisms Consequently, the body struggles to meet the essential demands of life.
Aging is not merely a mechanical accumulation of changes; it involves the emergence of new compensatory mechanisms that help maintain homeostasis The rate of aging is influenced by the interaction between these processes For elderly individuals, adhering to a proper nutritional regimen and engaging in age-appropriate physical activity can slow down the manifestations of aging The aging process affects various levels of biological organization—molecular, cellular, organ systems, and the entire body—unequally, with some parts aging faster than others By understanding these inevitable changes and the underlying principles of aging, it is possible to implement strategies that promote health, balance the aging process, and enhance longevity.
Aging is not a disease, but it creates conditions that increase susceptibility to various illnesses as health declines and immune system functions weaken Older adults often face multiple comorbidities, with about 95% suffering from at least one chronic disease This decline in self-regulation and adaptability can lead to unmet life activity needs, and inadequate nutrition can further accelerate the aging process and heighten disease risk Common causes of improper nutritional status in the elderly must be addressed to improve their overall health and well-being.
* The functional capacity of the body decreases decreased acidity of gastric juice, concentration and activity of enzymes
* Due to poor chewing musculature atrophy gradual tooth loss leading to impaired chewing function atrophy of the gastric mucosa reduced intestinal motility causing, digestive disorders w ôt> CM/ HJC V M ằy
Many elderly individuals live independently, often lacking the care and support of their families This situation frequently results in monotonous and unbalanced diets, which can lead to nutritional deficiencies Such deficiencies may accelerate the aging process, highlighting the importance of proper nutrition for seniors.
* The elderly people with a lifestyle of less physical activity, often tend to sit in one place, so energy needs are low 14
1.1.3 The epidemiology of the elderly
By 2029, Vietnam's elderly population aged 60 and above is projected to reach 17.28 million, making up 16.53% of the total population This figure is expected to rise to 25.61 million (24.88%) by 2049 and 31.69 million (27.11%) by 2069 Notably, Vietnam will officially enter the 'aging population' stage in 2036, with elderly individuals comprising 14.17% of the total population, which equates to nearly 15.46 million people.
Population aging is occurring globally, but the rates differ significantly across regions and countries, with developing nations experiencing the most rapid increase, even among those with predominantly young populations Between 2010 and 2015, the average life expectancy was 78 years in developed countries compared to 68 years in developing nations Projections for 2045-2050 indicate that life expectancy will rise to 83 years in developed countries and 74 years in developing countries, highlighting the considerable variations in life expectancy based on population characteristics between these two categories.
1.2 The nutritional status of the elderly
❖ The concept of nutritional status
Nutritional status encompasses the functional, structural, and biochemical characteristics that indicate how well the body meets its nutritional requirements It is influenced by an individual's diet and how effectively their body utilizes the nutrients consumed The process of nutrient utilization involves not just digestion but also various metabolic functions essential for overall health.
Nutrient absorption is influenced by various factors, including biochemical and physiological aspects of metabolism, as well as individual health status Conditions like swallowing disorders can impair the ability to eat or drink safely, highlighting the importance of good nutritional status A balanced intake of food relative to health conditions is crucial, as deficiencies or excesses in nutrients can indicate underlying health or nutritional issues.
Malnutrition is a condition characterized by an imbalance in energy, protein, and other nutrients, leading to adverse effects on organ structure and function, as well as increased risks of disease, complications, mortality, and extended hospital stays According to the European Society for Clinical Nutrition and Metabolic Nutrition (ESPEN), malnutrition is defined as an undersupply or disorder of nutrient absorption that results in changes in body composition, including a reduction in free fat mass and body cell mass, ultimately impairing physical and mental functions and negatively affecting disease treatment outcomes.
Malnutrition refers to a condition characterized by both under-nutrition and over-nutrition, resulting from acute or chronic nutritional disorders It involves a combination of deficiencies and inflammatory states, which can vary in severity and lead to changes in body composition and a decline in overall function.
Malnutrition is a widespread issue impacting millions globally each year, particularly among ill individuals It often arises from inadequate food intake or heightened nutrient needs, resulting in reduced nutrient absorption, as well as changes in nutrient transport and utilization.
Signs and symptoms of malnutrition include
• Loss of appetite or lack of interest 111 food or drink
Frequent feelines of sadness, anxiety, fatigue or irritability
Reduced muscle mass, fat loss (adipose tissue)
• Always feeling cold, abnormal decrease in body temperature
• Higher risk of disease and longer time to recover
High risk of complications after surgery
• Thin dry, non-elastic, pale and cold skin
• Emaciated cheeks and sunken eyes from loss of subcutaneous fat
• Hair gradually becomes dne and thinner, prone to falling
• The fatal duration of starvation occurs within 8-12 weeks
❖ Screening and assessment of nutritional status
The European Society of Parenteral and Enteral Nutrition (ESPEN) emphasizes that the initial step in addressing nutritional risk is to screen patients for malnutrition risk This screening is essential for categorizing patients accordingly and should be followed by a comprehensive nutritional assessment within 24 hours of admission This timely evaluation is crucial for creating a personalized nutritional care plan that meets the specific needs of each patient group.
Most screening tools focus on four key factors: recent weight loss, dietary intake, anthropometric measurements, and current body mass index (BMI), or other predictive indices for assessing malnutrition risk The advantages of these recommended screening methods stem from their predictive accuracy, content validity, reliability, and practicality.
RESEARCH SUBJECTS AND METHODS
RESULTS
Digestive symptoms of older patients treated at Hanoi Medical University Hospital
Chart 3.4 Incidence of digestive gastrointestinal symptoms among participants (11 264) Regarding the rate of gastrointestinal symptoms among older patient people receiving inpatient treatment: the results of chart 3.5 show that up to 60 2% of older patients have symptoms of functional dyspepsia 33 7% have symptoms of belching disorder Nausea and vomiting disorders account for the lowest rate (16 4%)
Chart 3.5 The l ate of Simplified Nutritional Appetite Questionnaire
SNAỘ: Simplified Nutritional Appetite Questionnaire
The SNAQ tool results indicate that 61.4% of participants had a total SNAQ score greater than 14, signifying a well-nourished status, in contrast to those with a score below 14, who were categorized as having a poor appetite.
Table 3.9 The association between SNAQ and age gender and comorbidities of participants (n 264)
In participants over 75 years old, 45.0% had a total SNAQ score of less than 14, which is higher than the 36% observed in those under 75 Among female participants, 45.3% scored below 14, surpassing the 33.3% of male participants Additionally, older patients with more than three comorbidities had a total SNAQ score of 44.2%, indicating a higher prevalence compared to those with fewer than three comorbidities.
Table3.10 ĩbe association between general information and some gastrointestinal disorders Or264)
Functional Dyspepsia Belching disorder Nausea and vomiting disorders
Variable Yes No OR Yes No OR Yes No OR
The study reveals that patients under 75 years old experience a higher prevalence of digestive disorders compared to those aged 75 and older, with indigestion rates at 61.8% for the younger group versus 55.0% for the older group Additionally, the rates of beta disorders and nausea and vomiting are 17.6% higher in the under 75 group compared to the over 75 group Female participants reported a higher incidence of functional dyspepsia at 61.1%, surpassing the 57.1% in males Furthermore, the rate of belching disorders in females was 38.5% higher than in males (29.9%), and nausea and vomiting disorders were 216% more prevalent in females (12.2%) than in males, indicating a significant difference (OR 2.05, 95% CI 1.05-3.98, p