• Discuss the demographics of the aging population and the impact of malnutrition.
• Describe the physiological conditions associated with aging and their impact on nutrient requirements, absorption and metabolism.
• Identify risk factors for developing deficiencies.
• Identify the tools used to evaluate nutritional status.
• Formulate a multidisciplinary management plan.

Angela R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education Manager
Division of Gerontology, Geriatrics and Palliative Care

Erum Jadoon, MD
Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care

University of Alabama at Birmingham
Birmingham, Alabama

Dr. Jadoon has no commercial affiliations to disclose.

Because of the nature of preliminary studies, some products mentioned are unlabeled and investigational. Dosages, indications, and methods of use of drugs mentioned in this publication may reflect the experience of the authors, clinical literature, or other resources. Therefore, please see the full prescribing information before using any licensed product mentioned.

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

Nutrition plays a pivotal role in healthy aging, and malnutrition can have potentially devastating effects. The population segment comprising older adults is rapidly increasing and constitutes a diverse group. Eighty-seven percent of older adults have hypertension, diabetes, dyslipidemia or a combination of the above. Nutrition impacts all of these chronic diseases [1,2]. In addition, aging itself is associated with a number of factors that can affect nutrition. Effectively managing nutrition in the complex older patient with multiple chronic diseases is a team effort. In this module we will present an overview of the clinical approach regarding nutrition issues that commonly arise in the care of the older patient. We will revisit these in greater detail in subsequent modules.

CASE 1:

Let’s consider the case of Mr. Jones who is coming for an outpatient office visit after a recent hospitalization.

Chief Complaint: Fatigue

History of Present Illness: Mr. Jones is an 80-year-old African-American male in previously good health. He has been having some fatigue and lack of energy for the past 6 months. He developed flu like symptoms with high grade fever about three weeks ago. He felt weak and almost fell at home. His daughter took him to the local emergency room. He was subsequently admitted for pneumonia. He developed confusion the first day and fell trying to find the bathroom. The confusion cleared in the next few days, and he was discharged home after one week. He says that he is beginning to feel better, but still does not have any energy. His daughter reports that his clothes appear loose on him.

Past Medical History: Hypertension, Gastritis, Arthritis

Medications:

• Hydrochlorthiazide (Thiazide diuretic) 25mg once daily
• Diltiazem (Calcium channel blocker) 120 mg twice daily
• Protonix (Proton pump inhibitor) 40mg
• Acetaminophen 500 mg every 6 hours as needed for osteoarthritis

Social History: Mr. Jones completed high school and started his own hardware store. He was very active most of his life until his arthritis began to limit his physical activities. He had early retirement and started to drink regularly. He has been abstinent for the past three years. He lives with his wife in their two level house. He has a daughter in town and two sons who live out of state. He helps to take care of his wife who suffers from early cognitive impairment. He has no energy to “get up and go” anymore and falls asleep in front of the television. He also reports being constipated and feeling that his food does not have much taste. His daughter is very involved in his care, but has a full time job and children.

Physical Examination
Vital Signs
Temperature: 97.0◦F (36◦C)
Heart rate: 88 beats per minute (BPM)
Respiration: 18 BPM
Height: 5’11” (180 cm)
Current weight: 150 lb (68 kg)
Usual weight: 170 lb (77 kg)
BMI: 18 kg/m2
Percent weight change: 12% (170to 150/170 × 100)
General: Thin, older man who is appropriately conversant but withdrawn.
Skin: Warm to touch, patches of dryness and flaking to elbows and lower extremities
Head, ears, eyes, nose, throat (HEENT): Temporal muscle wasting, no enlargement of thyroid
Mouth: Ill-fitting dentures, cracks/fissures at corners of mouth (angular chelitis)
Cardiac: Regular rate at 88 BPM, soft systolic murmur
Abdomen: Well-healed appendectomy site scar, no enlargement of liver or spleen, diffusely diminished bowel sounds
Extremities: trace pretibial edema to both lower extremities
Rectal: Hard stool in vault, stool test for occult blood negative
Neurologic: Alert, good memory, no evidence of sensory loss
Gait: Slightly wide-based with decreased arm swing, antalgic and tentative but with safe, appropriate use of cane