Are older people starving to death in a world of plenty?

The indictment by Nightingale has persisted for over a century, aided by the inadequate attention paid by physicians to nutritional status. Dietary restrictions, improper dietary prescriptions, and keeping patients non per ora for considerable lengths of time have contributed to nutritional problems in the healthcare system [1, 2]. The nutritional status of older adults living at home is poor. On average, persons over the age of 70 years consume one third less calories compared to younger persons. Energy intakes of older men (40–74 years old) range from 2,100 to 2,300 cal/day compared to younger men (24–34 years old) who consume 2,700 cal/day [3]. Ten percent of older men and 20% of older women have intakes of protein below the US recommended daily allowance (RDA), and one third consume fewer calories than the RDA. Fifty percent of older adults have intakes of minerals and vitamins less than the RDA and 10–30% have subnormal levels of minerals and vitamins [4]. Sixteen to eighteen percent of community-dwelling elderly persons consume less than 1,000 kcal daily [5]. The drive to find food, designated by the term ‘hunger’, is essential in all species. Hunger is controlled by chemical mediators, signaling when to stop eating (‘satiation’), and when to resume searching for food (‘satiety’) which Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 15–29, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.