Dr. Matthew Knight

An apple a day keeps the doctor away

In contrast to the picture seen in developing countries, under-nutrition in the developed world is seen predominantly in the elderly. Up to 10% of residents in nursing homes and 50% of older patients discharged from hospital suffer from frank under-nutrition. (1)

When older people lose weight, they double their risk of death even when they are overweight (2,3). The main causes of weight loss are insufficient intake, cachexia, malabsorption and metabolic problems (eg Thyroid diseases). Weight loss puts the elderly at increased risk of falls and fractures, due to weaker bones and also reduced muscle mass. Drug toxicity increases as body fat composition reduces below safe levels (1)

A recent clinical trial (single blind randomised) by Beck et al (4) demonstrated improved outcome over a 6 month period in elderly patients who received home visits from a dietician following discharge from hospital for an acute event. Patients’ mobility and general functional status were improved significantly in the group that received dietician input, versus controls, and utilisation of ‘meal on wheels’ services were reduced. In this short small trial there was not a statistically significant benefit with regards to reduced hospital admissions, although there was a trend towards this.

Good nutrition in the post hospital patient leads to improved mobility and quality of life, and is an important need to be addressed. In this trial each patient in the intervention group received 3 visits to their home from a dietician over three months and outcomes assessed at 6 months. Nutrition is one domain that is heavily neglected in many elderly people. Unfortunately at the current time a comprehensive nutritional service is not available via the social healthcare system here in the UK, however this simple intervention has a demonstrable improvement in quality of life.

If you are losing weight then an assessment by your GP is advised and if no obvious cause found a referral to your local dietician is recommended.


(1) Morley, JE, Undernutrition in older adults: April 2012 (Fam Pract. 2012), 29 Suppl 1: i89-i93.
(2) Bales CW, Buhr G, Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life: Jun 2008 (J Am Med Dir Assoc, 2008), 9(5):302-12.
(3) Morley JE, Nutrition and the aging male: May 2010 (Clin Geriatr Med, 2010), 26(2):287-99.
(4) Beck AM, Kjær S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C, Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial: 20 Dec 2012 (Clin Rehabil, 2012), Epub ahead of print.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

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