In community surveys, however, the prevalence of nutrient-specific malnutrition is greater in people older than 65 years. In the National Health and Nutrition Examination Survey III, median energy intake for elderly adults was below the recommended levels, with higher intakes for whites than for African Americans. Minorities tended to have lower median energy, dietary, and mineral intakes than whites.
Malnutrition is an independent predictor of mortality in excess of the primary diagnosis.
In long-term care, malnutrition has been identified in 50 percent of residents and is also an independent predictor of subsequent mortality. Identification of elders at risk for malnutrition has been stimulated by the consensus guidelines of the Nutrition Screening Initiative. The most common medical problems contributing to PCM are congestive heart failure, chronic obstructive pulmonary disease, and neoplastic diseases. The pathophysiology of PCM involves both deficiencies of dietary protein and calories or the catabolic effects of hypermetabolism. Cytokines, particularly interleukins and tumor necrosis factor, may also contribute to the hypoalbuminemia that rapidly occurs in these patients.