The only difference in the nutritional needs of older adults was long thought to be the decrease in caloric needs, about a 2% to 5% decrease with each decade of life. The smaller decrease in caloric need (2%) is for those who exercise and the higher decrease (5%) is for those who do not exercise. Decrease in caloric need is complicated by the well-established phenomenon that weight gain tapers as humans age. Peak weights for men are at around 55 years, with weight loss after that age (slowly, because rapid weight loss has significant risks in the older adult). Peak weights for women are at around 65 years with decreases after that age. Rapid weight loss can identify critical problems; one of the first signs of dementia is often unintended weight loss. Additional changes in nutrient needs occur mainly because of the physiologic changes of aging (Box 37-2). The Tufts University USDA Human Nutrition Center on Aging has developed a food pyramid based on the different nutrient needs that are critical to older adults (Russell et al., 1999).

Because psychosocial components are so important in determining nutritional status in older adults, reliable nutrition assessment includes consideration of these elements for evaluation (Fig. 37-2). Functional status and mental status influence nutrition and well-being.

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