Manual of Clinical Nutrition Management A- 22 Copyright © 2013 Compass Group, Inc.
NUTRITION AND THE OLDER ADULT
Health, physiologic, and functional changes associated with the process of aging can influence nutritional
needs and nutrient intake (1). The practice of nutrition for older adults is no longer limited to those who are
frail, malnourished, and ill (1). The promotion of healthy lifestyles, early detection of diseases,
immunizations, and injury prevention has proven to be effective in promoting the health and longevity of
older adults (1). One in every eight people in America is an older adult, defined by the Older Americans Act
(OAA) as an individual who is age 60 years and older (2). By 2030, predictions indicate that the older-than-
age- 65 years population will increase to approximately 72.1 million, or 19.3% of the population (3,4). Older
adults 85 years of age is the fastest growing segment of this population group (1,4,5).
Older adults display wide individual variations in aging processes and thus in nutritional needs and
concerns (1). Maximizing and maintaining functional status and quality of life becomes the priority healthcare
objective in this population group (1). The nutritional care goal is to provide health promotion and nutrition
education to achieve this objective, as decreased metabolic needs and activity levels, chronic disease
management and illness, economic challenges, loss of social support systems, and other variables impact food
and nutritional intake (1,4,5).
Each older adult should be viewed as a unique individual. Diet quality and quantity play major roles in
preventing, delaying onset, and managing chronic diseases associated with aging (5,6). About 87% of older
adults have diabetes, hypertension, dyslipidemia, or combination of these chronic diseases (5,6). Provision of
medical nutrition therapy requires the regular assessment of each older individuals nutritional status and
care plan. To optimize overall health and quality of life outcomes, the least restrictive regimen possible
should be tailored to each person’s medical condition, needs, desires, and rights (1,4).
Meal Planning Considerations for the Older Adult
When planning the diet for older adults, the Dietary Reference Intakes (DRIs) and Dietary Guidelines for
Americans (1, 7 - 9 ) provide population-specific guidelines. The DRIs divide the adult population older than 50
years into two life-stage groups: 51 through 70 years and older than 70 years ( 7 - 9 ). Overall nutrient
requirements are similar between these age groups with the exception of the vitamin D requirement, which
increases with age. To ensure adequate consumption of vitamin B 12 and vitamin D, the Dietary Guidelines for
Americans recommends consuming vitamin B 12 in its crystalline form, eg, fortified foods or supplements, and
consuming extra vitamin D from vitamin D–fortified foods and/or supplements ( 9 ).
Food intake typically declines with age, even in healthy older adults (4). Decreases in taste, olfaction, and
changes in levels of hormones that control satiety and food intake can diminish appetite and lead to lower
energy and overall nutrient intake (4). Food is an essential component of quality of life; an unpalatable or
restrictive diet can lead to poor food and fluid intake, resulting in undernutrition and related negative health
effects (4). When planning nutrient restrictions or therapeutic diets health care practitioners must assess
risk versus benefit to ensure overall adequate nutrition intake ( 4 ).
Energy and Nutrient Considerations
Total and resting energy requirements decrease progressively with age because of decreases in the basal
metabolic rate and in a large part decreases in physical activity level (1). The DRIs suggest that the daily
energy intake should be reduced by 10 kcal for men and 7 kcal for women for each year of age above 19
years. For a 51-year-old man, this would equate to a 320 kcal reduction from the baseline DRI (1 0 ). (Refer to
Section IA: Estimated Energy Requirement for Men and Women.) Meeting the nutritional needs of the older
adult is challenging because although energy needs decrease, the requirements for protein, vitamins, and
minerals remain the same or increase. The average daily energy intake for persons older than 51 years of
age is 2,400 kcal for men and 2,000 kcal for women ( 10 ). Nutrients consistently found to be deficient in diets
of older adults include antioxidants, calcium, zinc, iron, potassium, vitamin D, E, and K (1). In addition
nutrients for which the digestion, absorption, or metabolism declines with age, such as vitamin B- 12 and
other B vitamins are also found to be deficient in this population group ( 1 ). A large proportion of adults age >
51 years do not consume sufficient amounts of many nutrients from food (11). When dietary selection is
limited, nutrient supplementation with low-dose multivitamin and mineral supplements can be helpful for
older adults to meet recommended intake levels (1).
Energy requirements: The Academy of Nutrition and Dietetics has reviewed studies to determine the
energy needs of adults older than 65 years. The energy needs of healthy adults older than 65 years, as
measured by indirect calorimetry, were reported to be 18 to 22 kcal/kg per day for women and 20 to 24