Nutrition and the Older Adult
Manual of Clinical Nutrition Management A- 24 Copyright © 2013 Compass Group, Inc.
Vitamin D and Calcium: Among their numerous benefits, adequate vitamin D and calcium are best known
for their crucial role in the prevention and delay of progression of osteoporosis (1). Vitamin D levels may be
reduced in the elderly even with adequate exposure to sunlight. This deficiency may be exacerbated by
homebound status, use of sun block, poor dietary intake, decreased capabilities to synthesize cholecalciferol
in the skin, and a decreased number of gastrointestinal receptors (1,12,23). For adults aged 51 to 70 years, the
DRI for vitamin D is 600 IU (15 μg) and increases to 800 IU (20 μg) for older individuals. The recommended
intake of calcium for adults older than 50 years is 1,200 mg/day ( 24 ). Because of inadequacy of intake and
absorption issues, older adults and those with dark skin are in need of oversight for adequacy of these
nutrients in order to maintain bone integrity and maintain serum 25 - hydroxy - vitamin D [25(OH)D] levels
at 80 nmol/L ( 23 ). Other nutrients, including protein, vitamins A and K, magnesium, and phytoestrogens, are
also involved in maintaining bone health and should be evaluated for adequate intake ( 1 ). The Surgeon
General’s report on bone health and osteoporosis recommendations include consuming recommended
amounts of calcium and vitamin D, maintaining a healthful body weight, and being physically active, along
with minimizing the risk of falls (25).
Sodium: The 2010 Dietary Guidelines for adults > 51 years of age are recommended to reduce sodium in
their diets to 1,500 mg daily in an effort to lower their risk of high blood pressure and associated chronic
diseases such as heart disease, stroke, and kidney disease (1,9). This recommendation is also supported by
The Academy of Nutrition and Dietetics and the Food and Nutrition Board of the Institute of Medicine (1).
Older adults should be guided to consume a wide variety of fresh foods including fruits and vegetables, use
of low sodium season alternatives and less processed foods in accordance with the DASH meal planning
guidelines (1).
Nutrition Assessment Considerations for Older Adults
Weight is a vital sign that should be routinely evaluated in the older adult population. Evidence-based
nutrition practice guidelines recommend a baseline weight measurement, regardless of setting, upon initial
visit, admission, or readmission, followed by weekly weight measurements for older adults ( 12 ). There is
strong evidence in support of an association between unintended weight loss and increased mortality (Grade
II) ( 12 ). The registered dietitian should use clinical judgment in interpreting nutrition assessment data to
diagnose unintended weight loss and underweight in the older adult ( 12 ). Studies support an association
between increased mortality and underweight (BMI <20 kg/m^2 or current weight compared with usual or
desired body weight) or unintended weight 5% or more in 30 days (Grade II) ( 12 ). Studies also show an
association between reduced appetite and poor protein and energy intake, resulting in weight loss and poor
nutritional status (Grade I) ( 12 ). Medical nutrition therapy that includes a thorough nutrition assessment of
biochemical data, medical tests and procedures, client history (see Table A- 2 below) and food and nutrition-
related history is needed to effectively determine the nutrition diagnosis and plan for nutrition interventions
(1, 12 ).
On the other side of the spectrum, there is increasing prevalence of sarcopenic obesity in the older adult
population (1). Sarcopenic obesity, the coexistence of age-related loss of skeletal mass and strength and
excess body fat, puts older adults at special risk for adverse outcomes including cardiovascular disease and
functional impairment (1). Excess energy intake, physical inactivity, low grade inflammation, insulin
resistance, and hormonal changes associated with aging have all been implicated in the etiology (1).
Sarcopenic obesity presents treatment challenges requiring the clinician to weigh the risks associated with
weight maintenance versus treatment to promote weight loss to optimize health, cardiovascular risk, and
functional status (1). Older adults presenting with risk factors for sarcopenic obesity should have a
comprehensive nutritional assessment considering existing comorbidities, weight history, and potential
adverse health effects of excess body weight (1).
Dehydration, a form of malnutrition, is a major problem for the elderly, especially persons aged <85 years
and institutionalized older adults (1). Fluid intake needs are the same for the young and the old, but the
elderly are prone to inadequate fluid intake. Frequently, diseases will reduce the ability to recognize thirst,
create an inability to express thirst, or decrease access to fluids ( 1 ,2 6 ). Even healthy elderly persons have
reduced thirst in response to fluid deprivation. Fear of incontinence and difficulty making trips to the toilet,
due to arthritic pain or other immobility, may also interfere with adequate fluid consumption ( 1 ). An
important part of the nutrition assessment in older adults is an assessment of hydration status based on
physical signs and symptoms including dry tongue, longitudinal tongue furrows, dry mucous membranes of
the nose and mouth, eyes that appear recessed in their sockets, upper body muscle weakness, speech