Are our Elderly Clients Malnourished or at Risk for Developing Malnutrition? Protection Status

by Mary Ellen Posthauer, RDN, CD, LD, FAND

The past few months my blog has been devoted to illustrating the value of using an etiology-based approach to diagnosing adult malnutrition in clinical settings. This approach is detailed in The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.): Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition).

Identifying Characteristics of Nutritional Risk

The first step in the process is to define nutritional risk by identification of two or more of these characteristics:

  • Insufficient energy intake
  • Weight loss
  • Loss of muscle mass
  • Loss of subcutaneous fat
  • Localized or generalized fluid accumulation, which masks weight loss
  • Diminished functional status as measured by hand grip strength

The typical elderly client, defined as an individual over the age of 65, doesn't consume the recommended calories or protein as defined by the Institute of Medicine which suggests adult male consume 2,080 calories and females 1,762 calories. Elderly men decrease their daily intake by 1,000–1,200 calories per day and women by 600-800. Frequently, this concept is termed anorexia of aging, which is a physiological response to the decline in resting metabolic rate, coupled with a decline in physical activity.

The 3rd National Health and Nutrition Examination Study reported this reduction in caloric intake results in a decrease in protein consumption leading to declining physical function and frailty. Loss of muscle mass and function or sarcopenia occurs as part of the aging process. From ages 30-60 for every pound gained, a half pound of muscle is lost. After age 40, muscle mass declines 8% per decade and accelerates to 15% per decade after age 70.

Preserving lean muscle mass is critical to wound healing, immunity, organ function and muscle strength. Multiple studies support the need for increasing protein to 1.0-1.5 grams/kg of body weight for the elderly vs. the 8 grams/kg per day for healthy younger adults. This places the estimated needs for elderly females at 50-86 grams daily vs. 46 grams and 70-105 grams daily for men vs. 56 grams. Using the above characteristics, many elderly meet two of the criteria for defining nutritional risk.

Unintended weight loss often occurs with the decline in energy intake and is often the best indicator for undernutrition. Unplanned weight loss of 10% in six months or 5% in 30 days is a strong predictor of mortality. Once again, if our clients have two or more of these characteristics, they are at risk of or perhaps are malnourished.

A recent study noted that 30% of elderly adult outpatients suffered from depression that can also lead to declining appetite and weight loss. The evidence for improving the nutritional status of our elderly clients continues to climb.

Poor Nutrition Slows Wound Healing: Know Your Clients' Risk

If you are working in a wound clinic, how well do you really know your elderly clients? Learning the answers to these questions will help you learn important information about their risk for malnutrition:

  • Do they have access to food?
  • Can they prepare an adequate diet?
  • Do they have signs/symptoms of depression?
  • How many meals do they eat daily?
  • Can they afford the supplements you suggest?
  • Do you recommend and/or write an order for a nutrition consult by a registered dietitian?

Poor nutrition delays wound healing, so make the assessment of your elderly clients' nutritional risk a priority!

Coming next month: Practical Solutions for Meeting Energy and Protein Requirements for Our Elderly Clients

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association's Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.


My 46 year old husband is consuming all of his nutrients through a feeding tube in his stomach and for nearly four months his diet consisted of Very High Calorie Boost. His health began to decline and his weight continued to drop. We switched to blending whole foods and his digestive system has responded positively. I am looking forward to the information about meeting energy and protein requirements in addition to calories. It is challenging to prepare a variety of meals that contain fat, fiber and protein that equal 400+ calories and do not exceed two cups after blended. I have recently added whey protein but I am trying to stay with real foods more than adding supplements. Any suggestions would be greatly appreciated.

While I admire your dedication to preparing blended foods for your husband, the company that produces Boost High Nutrition makes Compleat®. This tube-feeding product is formulated with real food, chicken, peas, carrots, etc. and contains soluble fiber for good bowel function. There is always a safety concern when blending real foods due to the amount of steps required to produce a blended product in the correct amount, consistency, temperature to go though the tube plus making certain no food residue remains in the tube. Since I don’t know the details of your husband’s diagnosis, height, weight etc., my recommendation would be to consult a registered dietitian. The dietitian can recommended the appropriate calories etc. if you decide to try this product. There are liquid protein supplements that are formulated for either oral or tube feedings. Most contain 15 grams or more protein in an ounce and don’t require mixing with water, which the whey product does. Thank you for your inquiry. Good luck.

Mary Ellen Posthauer RDN,CD,LD

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