Page 343 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 3 Nutrition for Older Adults 331

Vitamin and Mineral Supplements

In theory, older adults should be able to obtain adequate amounts of all essential nutrients
through well-chosen foods. In practice, a large percentage of older adults do not obtain rec-
ommended amounts of many nutrients from food alone (Sebastian, Cleveland, Goldman,
and Moshfegh, 2007). According to 2003–2006 survey data, 70% of adults older than 70
years reported taking at least one supplement in the previous month, with 33% taking a
multivitamin/multimineral supplement (Albright et al., 2012). A study by Fabian, Bogner,
Kickinger, Wagner, and Elmadfa (2012) showed that the use of supplements significantly
improved the status of several vitamins in elderly people, particularly for vitamins B1, B2,
and B12, folate, and vitamin D. While food is the preferred vehicle for providing nutrients,
low-dose multivitamin and mineral supplements can be valuable in helping older adults
achieve nutritional adequacy (Sebastian et al., 2007). Interestingly, supplement users gener-
ally tend to eat more nutrient-dense diets than nonsupplement users.

Undernutrition and Malnutrition

Older adults represent the largest demographic group at disproportionate risk for inad-
equate intake and protein–calorie malnutrition (PCM) (Skates and Anthony, 2012). Cross-
sectional and longitudinal studies indicate that the quantity of food and calorie intake
decreases substantially with age (Bernstein and Munoz, 2012). As calorie intake decreases,
so does micronutrient intake. Numerous physiologic, psychosocial, cultural, and medical
factors may contribute to a decrease in intake and appetite in older adults (Wernette, White,
and Zizza, 2011). Weight loss, functional dependence, cognitive impairment, loneliness,
living without a partner, history of lung or heart disease, and the presence of acute vomiting
are among the risk factors for malnutrition in older adults (Jurschik et al., 2010).

The exact prevalence of undernutrition and malnutrition is unknown because there is
currently no gold standard for diagnosis. Recent data show an overall prevalence of malnu-
trition at 23% of older adults, and an additional 43% of older adults are at risk for malnutri-
tion (Kaiser et al., 2010). These figures translate to nearly two-thirds of older adults with
malnutrition or risk for malnutrition. Malnutrition is reported to affect 91% of older adults
in rehabilitation facilities, 86% in hospitals, 67% in nursing homes, and 38% living in the
community (Kaiser et al., 2010).

Malnutrition impairs quality of life and increases morbidity and mortality. It is linked
to diminished cognitive function, physical weakness, and muscle wasting, which increase
the risk of falls, fractures, and infections (Skates and Anthony, 2012). Among hospitalized
older adults, malnutrition is associated with longer hospitalizations (Pichard et al., 2004)
and higher rates of complications and death (Thomas et al., 2002). In nursing homes,
malnutrition increases the risk of pressure ulcers, cognitive deficits, and infections (Barrett-
Connor, Edelstein, Corey-Bloom, and Wiederhold, 1996; Horn et al., 2004; Hudgens,
Langkam-Henken, Stechmiller, Herrlinger-Garcia, and Nieves, 2004). Selected factors that
may contribute to malnutrition are discussed in the following sections.

Anorexia of Aging

“Anorexia of aging” is a term used to describe the natural decrease in food intake that occurs
even in healthy older adults in response to a decrease in physical activity and metabolic rate.
Older adults exhibit less hunger and earlier satiety than younger adults (Bernstein and
Munoz, 2012). Diminished appetite contributes to undernutrition in both community and
institutional settings and can lead to unintentional weight loss, which is often associated
with poor health outcomes and is a marker for deteriorating well-being in older adults