Older Adult Nutrition &

Geriatric Failure to Thrive

Ericka Yiu
Sodexo Dietetic Intern
Objectives
Describe physiological changes associated with aging
Identify common problems/conditions that affect
nutritional status in older adults
Define geriatric failure to thrive, its causes and various
implications
Discuss the role of RDNs and MNT recommendations
for older adult malnutrition and weight loss
 Statistics
1 in 8 people in America is an older adult
Older Americans Act= individual aged 60 years and older
Percentage of Americans aged 65 years and older has
more than tripled since 1900
40.4 million older adults in 2010
72.1 million older adults by 2030, representing 19% of
the population
Statistics
5 out of 8 of the most common causes of death have a
nutritional influence
80% of older adults have one chronic condition and
50% have two or more
Health consequences of chronic illness are extensive
Changes with Aging
As people age, physiological factors alter eating and
appetite
Food intake decreases even in healthy older adults=
anorexia of aging
Physiological decrease in food intake that occurs to
counterbalance the declines in physical activity and
resting metabolic rate that is generally seen in older
adults
Changes with Aging
Taste and Smell
Dysgeusia (taste) and Hyposmia (smell)
Hearing and eyesight
Immunocompetence
Slower and less efficient immune response
Increased risk of infection
Oral
Dry mouth (xerostomia)
Changes with Aging
GI
Dysphagia
Achlorhydria
Neurologic
Cognition, sensation, reaction, balance, coordination, gait
Can affect eating, chewing, swallowing and malnutrition risk
Eye Disease
Creates difficulty with food preparation
Changes with Aging
Depression
Appetite loss
Weight loss
Fatigue
Can exacerbate other medical conditions
Pressure Ulcers
Heavily sedated, bed bound, poor mobility
Malnutrition and undernutrition contribute and delay healing
Common Problems
Common problems affecting nutritional status:
Poor appetite
Weight loss
Pressure ulcers
Chronic disease
Eating dependency
Sensory loss
Poor oral health
Polypharmacy
Common Problems cont.
Loss of appetite is a major cause of undernutrition and
may lead to debilitation from weight loss
As appetite diminishes intake of total energy,
protein, vitamins, minerals is reduced depleting
body of essential nutrients
Predisposes older adults to increased risk of illness and
infection
Weight Loss
Weight loss associated with
Frailty
Functional impairments
Immune disorders
Pressure ulcers
Hip fractures
Cognitive impairment
Low quality of life
Increased mortality
Undernutrition
Undernutrition adversely affects the quality and length
of life and, therefore, has aroused the concern of
geriatric health professionals
The prevalence of protein energy malnutrition for older
adults ranges from 23%-85%, making malnutrition one
of the most serious problems facing health
professionals
Contributes to geriatric failure to thrive
Geriatric Failure to Thrive: Definition
The National Institute on Aging defines geriatric failure to
thrive as a:

"syndrome of weight loss greater than 5%, decreased

appetite and poor nutrition, and inactivity, often
accompanied by dehydration, depressive symptoms,
impaired immune function, and low cholesterol"
Geriatric Failure to Thrive: Prevalence
Varies depending on setting:

5-35% community dwelling older adults

25-40% nursing home residents
50-60% hospitalized older adult patients
Geriatric Failure to Thrive: Causes
Not a normal part of the aging process, although occurrence
increases with age
Impossible to provide specific prognosis
Four factors known to be predictive of adverse outcomes and geriatric
failure to thrive include:
Malnutrition
Impaired physical functioning
Depression
Cognitive impairment
Geriatric Failure to Thrive: Effects
Increased risk of morbidity and mortality
Increased length of hospital stay and healthcare costs
Decreased quality of life
Unintentional Weight Loss
One of the most common symptoms of failure to thrive
May result in undernutrition or protein calorie malnutrition if left
untreated
Early intervention necessary to prevent progression
Validated tools to be used for screening: The Mini-Nutritional
Assessment, the Malnutrition Universal Screening Tool and the
Short Nutritional Assessment Questionnaire
Tools can help determine which patients should be referred to an
RDN for further nutrition assessment
Nutrition Care
Important factor in improving longevity and quality of
life
Good nutritional status benefits both the individual and
society health is improved, dependence is decreased,
time required to recuperate from illness is reduced,
and use of health care resources is contained
Assessing Energy & Nutrient Needs
Nutrient requirements of older population are not well
understood assessing needs can be difficult
Energy needs may decrease as a result of less activity
and lean body mass, but also increase with infection
and stress
Nutrient requirements may increase or remain the
same
Energy and Nutrient Needs
Protein RDA
0.8 g/kg body weight
Some research indicates a minimum of 1.0-1.25 g/kg of high-quality
protein
Fat
20-35% total energy
Less than 10% from saturated fat
Less than 300 mg cholesterol
Limit trans fat to a minimum
Energy and Nutrient Needs
Carbohydrates
45-65% total energy

Fluids
30 mL/kg body weight or a minimum of 1.5 L/d
AI: 2.7 L for women and 3.7 L for men
Nutrition Assessment
Should include:
Food/nutrition-related history
Biochemical data
Medical tests & procedures
Anthropometric measurements
Nutrition-focused physical findings
Nutrition Interventions
Goals
Maintain or replete lean body mass
Meet daily energy and protein needs

Increased energy intake essential to overcome

accelerated weight loss and protein catabolism from
hypermetabolism that occurs in malnourished adults
Nutrition Interventions
Involve the patient/client, caregiver/family
Encourage eating in social situations dining rooms
and congregate meals for those in long-term care and
assisted living facilities
Recommend oral supplements to increase
energy/protein intake
Liberalize the diet and modify textures as needed
to help encourage intake
Liberalizing the Diet
Stringent diet recommendations limiting familiar foods
and eliminating or modifying seasonings may
contribute to:
Poor appetite
Decreased food intake
Increased risk of illness
Infection
Weight loss
Liberalizing the Diet cont.
Does not represent a disregard for the persons health
but is an appropriate response to the shift in
healthcare priorities
Can enhance both quality of life and nutritional status
Increases patients satisfaction with meals, reducing the
risk of malnutrition and weight loss
RDNs must help the healthcare team assess risks vs.
benefits of therapeutic diets
Nutrition Interventions
Provide familiar foods at acceptable mealtimes
Depending on advanced directives, provide
appropriate enteral nutrition recommendations
Appetite stimulants/orexigenic drugs may be
considered if food intake doesnt improve after all
factors have been addressed
Nutrition Interventions
If an older adult is in the end stages of a terminal
disease, advanced interventions may not be
appropriate
Weight loss may not be preventable
Provide favorite foods or comfort foods
Allow patient to eat whatever he/she likes
Conclusion
Geriatric failure to thrive is a serious issue that needs
to be addressed by dietetic professionals
MNT for these patients is multifaceted and critical to
reducing the risks of malnutrition and weight loss
To meet these needs RDNs must consider each
person holistically, including personal goals, overall
prognosis, benefits and risks of treatment and quality
of life