Nutritional intervention for prevention of falls in older adults with neurological diseases

Abstract

Patients with neurological diseases such as cerebrovascular disease and Parkinson disease are required appropriate nutritional assessment and intervention because of high frequency of falls. We focus on the following three key points of nutrition to prevent falls : (1) malnutrition, (2) sarcopenia, and (3) osteoporosis. In older adults, malnutrition is one of the risk factors of falls. Nutritional screening tools such as MNA^®–SF and SGA takes account of weight loss, body mass index, and changes in dietary intake, but the GLIM criteria for the diagnosis of malnutrition published in 2018 allows assessment that also considers inflammation associated with the diseases. In order to prevent malnutrition, it is essential to ensure that the diet provides sufficient energy. Many patients with neurological diseases have dysphagia and may not be able to intake their energy requirements with texture–modified diets. We recommend that avoiding skipping meals, using nutritional supplements appropriate for their swallowing ability. Additionally, adequate intake of protein is also important for older patients, as they have less skeletal muscle and are more susceptible to sarcopenia. Branched–chain amino acids (BCAAs) have been reported to promote synthesis and inhibit catabolism of muscle proteins. In older adults with low blood vitamin D levels, vitamin D supplementation may be useful in preventing falls. Because some patients who fall suffer from fractures, it is important to prevent of osteoporosis. The osteoporosis guidelines recommend to intake not only calcium, the main component of bone tissue, but also vitamin D and vitamin K. Our hospital provides nutritional counseling consecutively at the time of discharge and during outpatient visits to prevent falls at home.