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GENERAL PRINCIPLES

Adequate nutrition is an important part of older adult health. However, nutritional needs may change with aging, and both obesity and malnutrition are prevalent in later life. Previous studies have reported that 35% to 65% of hospitalized geriatric patients and up to 60% of geriatric residents in institutions suffered from malnutrition. Although there has been an increase in the prevalence of obesity in older adults over the past 20 years, obese older adults experiencing involuntary weight loss lose lean mass and are similarly at risk for functional decline and other medical complications compared to nonobese older adults.

In general, body weight in men tends to increase from age 30 to 60 years, plateaus for the next 10 to 15 years, and then slowly declines. In women, the pattern of weight change is similar, except that changes occur approximately 10 years later in life. Lean body mass (primarily skeletal muscle) begins to decline by middle age as a result of many factors, including decreasing exercise and age-related declines in hormone levels (eg, testosterone, estrogen, and growth factors), metabolism, and muscle protein synthesis. Even during healthy aging, daily energy requirements decline with age. This is a result of decreases in muscle mass and decreases in physical activity.

CALORIC NEEDS AND RECOMMENDED DIETARY ALLOWANCES FOR OLDER ADULTS

There are many formulas to estimate resting caloric needs of older adults (Table 13–1). All of these estimations should take into account activity levels and underlying illness severity.

Table 13–1.Estimation of daily resting caloric (kcal) requirements.

Recommended dietary allowances (RDAs) of vitamins and minerals for geriatric patients are similar to those for middle-age adults, although older adults are recommended to have higher calcium and vitamin D intake. (Table 13–2). For men and women older than age 70 years, recommended calcium intake is 1200 mg/day, and recommended daily dosage of vitamin D (cholecalciferol) is 800 IU. Micronutrient deficiencies of vitamin B12 and vitamin D and inadequate calcium intake are common in older adults. However, unless it is clear an older adult is not meeting his or her micronutrient needs due to low overall intake, routine multivitamin supplementation is controversial. ...

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