Nutrition was a crucial aspect of health among the elderly patients in the recent past, but the recognition of nutritional importance has increased because of the rise of morbid conditions, such as dementia, cancer, and heart-related illnesses, among persons over the age of 65 years, who in this case are referred to as elderly (Wells & Dumbrell, 2006). Although one cannot categorically assign a precise definition of malnutrition among the elderly, the specific vitamin inadequacy and awkward body mass index form common indicators. The diagnosis of malnutrition among the elderly is rare, and many medical practitioners have raised concerns about a need of more educational sensitization about the nutritional wellbeing of the elderly. For instance, physicians may fail to associate the loss of body mass to the morbid signs of malnutrition since it is a common phenomenon for the loss of body mass among the elderly due to the age-related body weight reduction (Wells & Dumbrell, 2006). This essay seeks to explore the nutritional complexity of the earlier regarding malnutrition during hospitalization, weight loss, cognitive impairment, the physiology of aging, protein undernutrition, and elderly dietary recommendation.

The Physiology of Aging and Nutritional Status

Metabolic Rate and Energy Requirements

Body experiences a slight decline in mass with age, and this change becomes more noticeable among the persons of over 60 years of age as compared to the young people (Wells & Dumbrell, 2006). Their energy demand also diminishes by approximately 100kcal/day in a decade interval. To be able to curb this condition, the recommendation for the intake of multivitamin supplements is highly encouraged. Another scenario is whereby pulmonary, neurological, and cardiovascular diseases together with osteoporosis and osteoarthritis may vary the energy requirement by either reducing it due to an individual’s inactivity or increasing its expenditure. These conditions make it hard for the assessment of the nutritional status of the elderly given that their appetite is minuscule in such moments.

Age-related Changes to Gastrointestinal Tract

Smell and taste alteration are age-related changes, and it is unclear whether these changes are the reason for the loss of appetite among the elderly. Additionally, gastrointestinal changes alter the oral intake in older persons, especially in the cases of gastric emptying delays and greater satiation once they have taken a meal. After overnight fast, they usually experience a lower appetite (Wells & Dumbrell, 2006). Atrophic gastritis, dental, and oral aspects as well as esophageal motility can affect one’s nutritional status. The nutritional premise is the likely cause of dental problems, while atrophic gastritis may be the result of iron and vitamin B12 absorption impairment.

Age-related Renal Impairment

The functionality of the renal system deteriorates with age. This condition leads to the reduced response to an antidiuretic hormone that causes a high risk of dehydration among the elderly. Therefore, this situation makes it difficult to replete the lost fluid via oral intake only (Wells & Dumbrell, 2006). Vitamin D metabolism may also be affected by renal impairment, and this reduces the vitamin D that in turn contributes to the development of osteoporosis among the elderly.

Reduced Immunity

Nutrition is an important aspect of the immune system among the old, and the elderly are at a higher risk of dying from infections as compared to the young adults (Wells & Dumbrell, 2006). High risk of sepsis among the elderly is related to malnutrition. The functionality of macrophage, the alteration of phagocyte, and T-cell response impairment contribute to the general immune functionality among the elderly. All infections affect metabolic rate, in which the elderly are unable to eat enough to match the increased demand. According to Wells and Dumbrell, (2006), studies have shown that elderlies randomly put on mineral supplements and vitamin have shown lower nutritional deficiencies as the functionality of immune cells is improved in addition to the decreased usage of antibiotics. This issue indicates a reduction in the cost of the medical expenses among the elderly since the sick days significantly reduce.

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Protein under Nutrition

There is no individual description of the protein energy nutrition among the elderly. In one perspective, it can be termed as low intake of protein and calories, while in another context, it can be taken to be low-level albumin malnutrition (Wells & Dumbrell, 2006). In the marasmus condition, the body mass is significantly reduced due to the reduced muscle and body fat while keeping a constant serum albumin. This weight loss is common among the elderly, with low albumin malnutrition being a collective experience for the hospitalized patients. Metabolism complication due to inadequate protein intake and the effects of bowel disease, renal and hepatic failures contribute to the nutritional state of the elderly. Protein undernutrition accelerates the risk of adverse outcomes after an injury.

Weight Loss

Weight loss is a worrisome sign among the elderly from a clinical perspective. Voluntary or involuntary weight loss among the elderly has a connection to morbidity. Although weight loss can be the result of physiological changes, a greater loss of 4% of body mass annually forms an independent morbidity predictor (Wells & Dumbrell, 2006). A loss of more than 5% of body mass monthly is considered alarming and it needs an immediate physician’s evaluation (Wells & Dumbrell, 2006). It is possible to prevent morbid malnutrition sequelae via the timely identification as well as assessment followed by nutritional deficiencies and weight loss treatment. Concomitant complications as the result of economic, social, and psychological issues contribute to the weight loss among the fragile elderly patients (Wells & Dumbrell, 2006). Thus, there is a need for a comprehensive and efficient diagnosis of physiological, socioeconomic, and functional contributors of malnutrition among the persons aged over 65 years.

Cognitive Impairment and Vascular Risk Factor

A compromised cognitive ability among the elderly contributes to their hunger. Their inability to prepare meals may hinder their sufficient nourishment, and this has been pointed out as a significant early sign of cognitive impairment. According to Haute Autorité de Santé, (2007), some people suffer from severe Alzheimer’s disease. As this condition is associated with the inability to get food, forgetting food, and the failure to wash utensils, it may hinder their oral intake. The inadequate vitamin intake, especially such vitamins as B6 and B12 as well as folate, contributes to the cognitive impairment. They also have an association with the vascular risk factor called hyperhomocysteinemia. Treatment with these vitamins has shown a decrease in the level of homocysteine and improved working of the vascular in hyperhomocysteinemic patients suffering from coronary artery illness, which creates a regression in cholesterol plaque (Wells & Dumbrell, 2006). Polly-pill cardiovascular disease treatment can prevent primary and secondary cognitive impairment among the elderly patients. The incidences of Alzheimer’s can be reduced substantially by the intake of nutritional antioxidant supplements that inhibit the free radial cellular as well as damage to the DNA. Foods rich in flavonoids and phytochemicals, such as blueberries, citruses, and tomatoes, have been associated with the reduction of cognitive impairment and oxidative stress.

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Hospitalized Elderly Patients Nutritional Issues

Despite the fact that the incidence of malnutrition among the elderly is approximately 2% to 16%, over 55% of the hospitalized individuals experienced hunger before (Wells & Dumbrell, 2006). An estimate of 57% of protein undernutrition is evident among the patients of a geriatric rehabilitation setting (Wells & Dumbrell, 2006). Besides the pre-existing malnutrition reported amongst the hospitalized elderlies, they also suffer from malnutrition during their hospital stay. Some activities, such as vomiting or the positioning of food at a distance the patient may not reach, as well as religious or ethnic preference of food may contribute to nutritional deficiencies among the elderly during their stay in the hospital. Malnutrition is linked with impaired respiratory, immunity delay in the healing of wounds and muscle function, although zinc and vitamin C have shown ability to improve results associated with pressure sores.

Screening and Detecting Nutritional Deficit among the Elderly

Wells and Dumbrell (2006) assert that it is essential to conduct screening in the elderly to detect the level of risk they might face while living in an institution as well as those living alone since they are more vulnerable. The informal measures, such as self-administered diaries and the questionnaires, may be ineffective specifically among the cognitive impaired patients. This issue necessitates the need for the health practitioners to conduct nutritional screening among the elderly regularly. The physical exam may not aid in the early malnutrition detection among the elderly since excessive muscles loss may be same as age-related processes (Haute Autorité de Santé, 2007). Laboratory tests and other biochemical examinations give the most positive nutritional status and they can help in the determination of specific deficiencies such as changes in tongue, nails, hair, and mouth angle. Regarding nursing home setting, patients with more than 25% food remains on the plate mostly suffer from protein undernutrition, in which 84% of these patients have been estimated to have less daily caloric expenditure (Wells & Dumbrell, 2006). Only 5% of these patients receive nutritional supplements, and this is an alarming statistic given the fact that most of the elderly are isolated.

Dietary Recommendations

Preference of vegetables, fruits, and complex carbohydrates that include whole grains foods rich in fibers are necessary to everyone since everyone lucky enough to live long will reach this fragile age. In a total caloric intake, the only proportion of less than 30% should be fat, with the patients with nutrition shortage encouraged to take more of nutrient-rich food. Counseling should be an effective way of improving the habit of eating standard dietary food amongst the malnourished elderly patients. Thus, a clinical referral of these patients to a nurse educator or dietician is highly recommended since the advice given by these experts can help to improve the nutritional conditions of these elderly patients (Haute Autorité de Santé, 2007). Because of age-related body weaknesses, it becomes difficult to absorb foods rich in low nutrients; therefore, people need to increase such nutrients in their diet. There is a suggestion of a positive outcome of the increased allowances of magnesium, calcium, folate, vitamin B12, and niacin among the elderly. Furthermore, I should also recommend the intake of foods rich in these nutrients. With the proper adherence to the professionals' guidelines, the nutritional status of the elderly ought to improve, and this will help in the lowering of their mortality rate. 

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It is evident that the elderly are vulnerable due to the alteration in their body functionality. Thus, there is a greater need to ensure the best nutritional care for them. They are adversely affected by the nature of their body condition, and it would be crucial to consider their body condition. Immunity and physiology are an age-related alteration that requires high supplements of minerals and vitamins. Regardless of weight loss, it is common for the elderly to suffer from protein undernutrition. Cognitive impairment can be improved by the high intake of antioxidants and low fat intake, while those, who are hospitalized, need care as they do suffer from malnutrition. Screening is also an important aspect, in which biochemical tests should be encouraged to know the specific nutrient deficiency. Finally, medical dietary recommendations ought to be emphasized so that they could help in improving the health condition of the elderly.

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