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Protein-energy malnutrition (PEM), the primary focus of this chapter, is present when insufficient energy and/or protein is available to meet metabolic demands. PEM may develop because of poor dietary protein or calorie intake, increased metabolic demands as a result of illness or trauma, or increased nutrient losses.


Maintenance of nutrition is an essential component of comprehensive geriatric care, particularly in the acute care setting where the presence of malnutrition is clearly associated with increased complications and other adverse health outcomes. Prevalence data, relying on a variety of measures of nutritional adequacy, suggest that deficiencies in macronutrients (protein-energy intake) and micronutrients (vitamins and minerals) are very common among older adults. National survey data indicate that 40% to 50% of noninstitutionalized older adults are at moderate to high risk for nutritional problems, and that up to 40% have diets deficient in three or more nutrients. Prevalence estimates in selected populations over 65 years old indicate that 9% to 15% of older persons seen in outpatient clinics, 12% to 50% of hospitalized elderly persons, and 25% to 60% of older persons residing in institutional settings have one or more nutritional inadequacies—with PEM being the most common. Physical and psychosocial factors that may lead to inadequate nutrition are listed in Table 40-1.

Table 40-1 Factors Contributing to Inadequate Nutrition in Older Adults

Energy intake does decline significantly with age, attributable to the decrements in lean body mass and physical activity that often accompany aging. A still greater reduction in caloric intake to levels that may be below daily requirements has been a consistent finding of nutritional surveys conducted among community-dwelling elderly people. In the most recent National Health and Nutrition Examination Survey (NHANES III), the mean daily energy intake of persons aged 70 years and older was approximately 1800 kcal/d for men and 1400/d kcal for women, and more than 10% of elderly people reported consuming less than 1000 kcal/d. Even if this limited energy intake met the caloric needs of less-active older adults, it is unlikely that all noncaloric nutrient needs (vitamins and minerals) would be met unless the diet ...

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