A physical examination can reveal signs of clinical nutritional deficiencies, including skin changes, fatigue, weakness, changes in ability to taste or smell, and gastrointestinal complaints (poor appetite, oral problems, nausea, vomiting, diarrhea, constipation). Changes in mental or emotional status may also be associated with an inadequate nutritional state (9). However, the single most important clinical measure of undernutrition in older adults is that of current body weight and any recent changes. The Long-Term Care Minimum Data Set considers a weight loss of 5% of usual body weight in 30 days or 10% in 180 days as a trigger for activating clinical assessment protocols (10). Unintentional recent weight loss is associated with increased mortality (11). Even with a stable body weight, older adults may have a marked reduction in fat-free mass or increases in fat mass (12).
TABLE 56.1 POTENTIAL PHYSIOLOGIC AND METABOLIC DETERMINANTS OF NUTRIENT NEEDS AND INTAKES IN OLDER ADULTS
higher for men compared with women, such as DRIs for protein, fiber, magnesium, zinc, vitamin B6, vitamin A, and vitamin K. DRI recommendations increase with age for vitamin D and decrease with age for sodium (16, 17).
TABLE 56.2 RECOMMENDATIONS AND INTAKES OF SELECTED NUTRIENTS FOR OLDER ADULTS (NHANES)a