Nutrition and the Older Adult
Manual of Clinical Nutrition Management A- 26 Copyright © 2013 Compass Group, Inc.
the food is hard to chew or dry. As we age, the amount of saliva we produce diminishes, affecting our
ability to soften food and swallow it appropriately. Modification of food and fluid consistency can help
with chewing and swallowing problems (2 7 ). Collaboration with a speech-language pathologist and other
healthcare professionals can ensure that older adults with dysphagia receive appropriate and
individualized modified-texture diets. Older adults consuming modified-texture diets report an
increased need for assistance with eating, dissatisfaction with foods, and decreased enjoyment of eating,
resulting in reduced food intake and weight loss (Grade I) ( 12 ).
Provide medical food supplements for older adults who are undernourished or at risk for malnutrition.
Studies support medical food supplementation as a method to provide energy and nutrient intake,
promote weight gain, and maintain or improve nutritional status or prevent undernutrition (Grade I) ( 12 ).
Consider enteral nutrition for older adults who are undernourished or at risk of undernutrition,
especially in patients with dysphagia ( 12 ). Studies support enteral nutrition as a method to provide
energy and nutrient intake, promote weight gain, and maintain or improve nutritional status or prevent
undernutrition ( 12 ).
Encourage adequate intake of high-fiber foods. The 2002 DRI for adequate intake of total fiber for adults
older than 50 years is 14 g of fiber per 1,000 kcal or 30 g/day for men and 21 g/day for women ( 28 ).
Include foods that can be easily chewed and not cause gastrointestinal discomfort. Frail older adults and
those with poor appetite and anorexia need to be evaluated carefully so that a high-fiber diet does not
lead to excess satiety leading to decreased food consumption and limiting nutrient intake (1). When
making recommendations regarding fiber content in the diet of an older adult, fluid intake must be
appropriately assessed and guidelines for fluid intake should accompany those for dietary fiber (1).
Ensure that all older adults who need assistance to eat receive it by collaborating with other healthcare
professionals. A review of research by the Academy of Nutrition and Dietetics (formerly American
Dietetic Association) has found a positive association between eating dependency and poor nutritional
status, especially in older adults with dysphagia who receive modified-texture diets ( 12 ). Also, the
evidence indicates an association between poor nutritional status, frailty, underweight, and/or weight
loss with cognitive impairment and a decrease in the activities of daily living, including the decreased
ability to eat independently ( 12 ).
*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.
References
- Position of the Academy of Nutrition and Dietetics: Food and nutrition for older adults: promoting health and wellness. J Acad Nutr
Diet. 2012; 112:1255-1277. - Older Americans Act. US Department of Health and Human Services Administration on Aging website.
http://www.aoa.gov/AoARoot/AoA_Programs/OAA/index.aspx. Accessed December 1, 2010. - Profile of older Americans. US Department of Health and Human Services, Administration on Aging web site.
http://www.aoa.gov/aoaroot/aging_statistics/Profile/index.aspx. Accessed May 5, 2010. - Position of the American Dietetic Association: Individualized nutrition approaches for older adults in health care communities. J
Am Diet Assoc. 2010;110:1549-1553. - Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: Food and
Nutrition programs for community-residing older adults. J Am Diet Assoc. 2010; 110:463-472. - Institute of Medicine Committee on Nutrition Services for Medicare Beneficiaries. The Role of Nutrition in Maintaining Health in the
Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population. Washington, DC: National Academies Press;
2000. - Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and
Fluoride. Washington, DC: National Academy Press; 1997. - Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B 6 , Folate, Vitamin
B 12 , Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998. - Dietary Guidelines for Americans 2010. Available at:
http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf. Accessed Jan 31, 2011. - Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids. National Academy of Sciences, 2002: 265 - 334; preprint at:
http://www.nap.edu.books/0309085373/html/index.html. Accessed September 16, 2002. - Sebastian R, Cleveland L, Goldman J, Moshfegh A. Older adults who use vitamin/mineral supplements differ from nonusers in
nutrient intake adequacy and dietary attitudes. J Am Diet Assoc. 2007;107(8):1322-1332. - Unintended Weight Loss in Older Adults Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence
Analysis Library. Academy of Nutrition and Dietetics; 2009. Available at: http://www.andevidencelibrary.com. Accessed October 24,
2012. - Paddon-Jones D, Short KR, Campbell WW, et al. The role of dietary protein in sarcopenia and aging. Am J Clin Nutr. 2008;87(suppl):
1562s-1566s. - American Dietetic Association Standards of Practice and Standards of Professional Performance for registered dietitians
(generalists, specialty, advanced) in: sports dietetics. J Am Diet Assoc. 2009;109(3):544-552. E30. - Houston DK, Nicklas BJ, Ding J, et al. Dietary protein intake is associated with lean body mass in older community-dwelling adults: