Manual of Clinical Nutrition

Nutrition and the Older Adult

Manual of Clinical Nutrition Management A- 25 Copyright © 2013 Compass Group, Inc.

difficulty, and confusion (Grade III) ( 26 ). The elderly should be encouraged to ingest about 2 liters of fluid per day
or 30 mL/kg of body weight.

The use of quantitative methods to assess the intake of food, fluids, nutrients, and energy over several days
is recommended and supported by research (Grade II) ( 12 ). A multiday intake analysis based on the percentage
of food eaten and individual plate waste studies is suggested over single interviews (Grade II) ( 12 ).

Contributors to Poor Nutritional Status in Older Adults
Studies indicate older adults, particularly those 85 years and older who are institutionalized are at increased
risk of malnutrition, declining nutritional status, and adverse health effects (1,4,12). These unfavorable
nutrition outcomes are associated with the female gender, cognitive decline, loss of appetite, swallowing
problems, low activity level, eating dependency, recent hospitalization, and admission to healthcare
communities (Grade I) (12). A variety of factors may contribute to poor nutritional status as individuals age (1,12).
The factors listed in Table A-2 should be considered when evaluating nutritional status and developing a care
plan to prevent, delay, or correct nutritional problems. Although a cure is not possible for some conditions,
ameliorative or palliative nutritional interventions are often indicated and can improve the older individual’s
quality of life (1).

Table A-2: Contributors to Unintended Weight Loss ( 12 ) and Malnutrition in Older Adults (1,12)

Nutritional Psychological

Alcohol and addictive substances

Decreased appetite (Grade I) (1, 12 )

Drug-nutrient interactions (prescription/over-the-counter

drugs)

Inappropriate food intake

Increased nutrient requirements

Overly restrictive dietary prescriptions (1,4,5)

Bereavement

Change in body habits

Confusion

Depression (Grade II) ( 12 )

Fear

Withdrawal

Physical Social

Acute or chronic disease

Prevalence of infection (Grade I) ( 12 )

Changes in body composition

Changes in organ system structure/function

Changes in sensory perception

Dependence or disability

Cognitive impairment (eg, dementia disorders) (Grade I)( 12 )

Decreases in activities of daily living (Grade I)( 12 )

Infirmity or immobility

Poor dentition or poorly fitting dentures

Swallowing problems

Fixed income or poverty

Ignorance

Isolation

Limited food procurement, preparation, or

storage capabilities

Reliance on economic assistance programs

Nutrition Interventions to Improve Outcomes in Older Adults (1,4,12)

 Minimize dietary restrictions to encourage greater food intake. Liberalized diets and individualized meal
planning are associated with increased food and beverage intake (Grade I) (1, 4,12). Maintaining the desire to
eat and the enjoyment of food minimizes the risks of weight loss and undernutrition, especially in elders
in long-term care (1,12). For these people, a more liberalized nutrition intervention, rather than a
therapeutic diet, may be warranted to maintain quality of life (1,4). Research has not demonstrated
benefits of restricting sodium, cholesterol, fat, and carbohydrate in older adults (Grade I) ( 12 ). Refer to
Section IC: Medical Nutrition Therapy for Diabetes Mellitus for specific recommendations for older adults
with diabetes mellitus.
 Involve older adults in planning menus and establishing meal patterns (4). The involvement of long-term
care residents in menu planning and flexibility of the meal pattern and composition may result in
improved intake of food and fluid (Grade I) ( 12 ).
 Encourage dining with others and creative dining programs. Research indicates that older adults who eat
in a socially stimulating common dining area have improved food intake and nutritional status (4,12).
 Older adults are more prone to chewing and swallowing problems. Many older adults experience bone
loss around their teeth, resulting in tooth loss and reduced bone mass. Some older adults have poorly
fitting dentures that cause chewing problems or mouth pain. Dry mouth can cause problems, especially if