The role and significance of geriatric nutrition

The core role of geriatric nutrition is to help the elderly reduce the risk of chronic disease progression, reduce the probability of disability, and improve the quality of life in their later years through personalized dietary nutrition intervention. Its ultimate significance is never to force the elderly to "live longer," but to allow them to "live more comfortably and with more dignity."

Last week, when I was doing a free clinic in the community, I met 72-year-old Aunt Zhang. She has a history of diabetes for 8 years. I heard from popular science on the Internet that she should strictly control her staple food. She only eats less than half a bowl of white rice every day and only cooks vegetables. She lost 12 pounds in three months. I adjusted her diet plan: replacing white rice with multi-grain rice that is half multi-grain and half rice, eating a flat bowl at each meal, adding a boiled egg and 20 taels of lean pork every day, and a small cup of unsweetened yogurt in the afternoon. After communicating with the endocrinologist, she adjusted the dosage of the sugar-controlling medicine a little. Half a month later, she came for a follow-up consultation. She had gained 3 pounds, and she could already walk two stops carrying a vegetable basket.

Speaking of which, the academic community’s intervention standards for elderly nutrition are not yet completely unified, and the two groups have been arguing for several years. One group holds the view that "indicators come first" and believes that blood sugar, blood lipids, and blood pressure must be strictly controlled to normal standards for young and middle-aged people. The diet must be absolutely low in oil, salt, and sugar. Many children also follow this approach. They don't even dare to add more soy sauce when cooking for the elderly. I used to I met a 76-year-old man who ate "healthy meals" with no oil or salt for half a year with his children. In the end, his appetite completely disappeared. He secretly ate soybean curd for three days before he recovered. His indicators were all within the normal range. But when he went out for a walk of 500 meters, he had to squat down and rest for ten minutes.

The other school of thought is the "quality of life first" view, which believes that the metabolic level and willingness to eat of the elderly are inherently lower than those of young people. Instead of starving due to stuck indicators, it is better to satisfy the appetite as much as possible while keeping the basic risks under control. An 88-year-old professor I met had high blood pressure for 30 years. He had to drink a small cup of Shaoxing rice wine with two pieces of soy pork elbow at noon every day. We adjusted his fat and salt intake in the morning and evening meals, and paired them with vegetables with high potassium content. Now his blood pressure has been stable at around 140/90mmHg, and he can still write calligraphy for two hours a day. Last year, he climbed Mount Taishan with his children and grandchildren.

Most of us who do practical work on the front line tend to find a balance between the two. After all, every elderly person’s physical condition, living habits, and even life pursuits are different. How can there be any nutritional plan that is universally applicable?

Many people have misunderstandings about nutrition for the elderly, thinking that they only buy protein powder and health products for the elderly. In fact, this is not the case at all. Nearly 60% of the elderly people I interact with over the age of 80 have varying degrees of dysphagia. There used to be an 82-year-old grandmother who always choked and coughed. Her family members thought it was something growing in her throat. They checked laryngoscopes and found nothing wrong. In the end, they found out that the tongue muscles were not strong enough. We gave She made solid food into a thick paste, and added whey protein and B vitamins to her diet. She basically stopped choking in half a month, and she no longer needed a gastric tube. Think about it, for the elderly, being able to sit at the table and eat a hot meal is better than any nutritional supplements.

Survey data from the Chinese Nutrition Society last year also supports this point: the malnutrition rate among people over 65 years old in my country exceeds 25%, of which nearly 40% are caused by wrong dietary concepts - it is not that they cannot afford to eat, but they do not know how to eat. Many people think that the elderly have poor digestion, so they feed them porridge and pickles. In fact, the glycemic index of porridge is high and the nutrient density is low. The salt content of pickles exceeds the standard, and long-term consumption may cause problems. As long as the cooking method is adjusted, an 80-year-old man can still eat steak and seafood as long as his teeth are good, and it will not put any burden on the body at all.

I have been doing geriatric nutrition for almost 10 years, and my deepest feeling is that this subject has never been about shackles on the elderly, but about loosening them. You don’t have to dare to take a bite of sweet food all your life because of a fasting blood sugar value, and you don’t have to give up your favorite braised pork to lower blood lipids. Find the right way to eat it that suits you. It’s comfortable and better than anything else.

When Aunt Zhang came for a follow-up visit last time, she specially gave me a handful of green vegetables she had grown on the balcony, with water droplets still on the leaves. She said that now she could finally go downstairs for a walk and dance square dances with her old sisters. You see, this is the most practical meaning of geriatric nutrition - it is never beautiful data written in a paper, but a steady step under the old man's feet, a hot rice bowl that can be held in his hand, and a solid life where he can eat whatever he wants.