Part II. common nutritional issues in older adults

Abstract

Nutritional issues frequently affect older adults. Increased prevalence of chronic diseases, declining physical function, and diminished social support place older adults at risk for nutritional compromise. Physiologic changes such as augmented feelings of satiety, increased leptin levels, and decline in feeding drive occur with aging and lead to reduced volitional intake. 1 In considering poor nutrition in the older adult, one often envisions the person with nutritional frailty. The older adult may have marked diminution of lean body mass, ie, sarcopenia, which may or may not be accompanied by rapid unintentional weight loss. Weight loss may be due to poor intake alone (wasting) or to a cytokine-mediated response (cachexia). 2 In addition to macronutrient deficiencies characterized by sarcopenia and weight loss, an increasing number of older adults exhibit macronutrient excess, or obesity. 3,4 Obesity is associated with functional decline and risk for osteoarthritis, hypertension, hyperlipidemia, coronary artery disease, insulin resistance, and non-insulin-dependent (type II) diabetes mellitus. 5-7 Malnutrition in older adults may also be characterized by deficiencies in micronutrients such as vitamin B 12 , vitamin D, and folate. Given the multiple dimensions of malnutrition in the older adult, a high index of suspicion and careful monitoring are mandatory to prevent further complications associated with poor nutritional status. Nutritional Assessment