Geriatric Nutritional Analysis
Subject Profile: RS
I conducted an interview with my 91 year old female neighbor, RS, followed by a 24 hour
nutritional analysis of her diet using the Cronometer app. RS is 5’8 and weighs 152 pounds with
a BMI of 24 which is in the healthy range of 23-28. A MUST score of 0 indicates that she is at
low risk of malnutrition which is important since the elderly often suffer from malnutrition due
to limited cognition, resources, appetite, and malabsorption (Volkert et al, 2019). RS lives alone
and is in relatively good health. She currently takes medication for high blood pressure and
cholesterol but was not able to tell me the medication names. Aside from hypertension and
hypertriglyceridemia, she has a history of breast cancer which went into remission approximately
20 years ago. RS suffers from short term memory issues and confusion which sometimes cause
her anxiety and sadness. RS is aware of these mental deficits. A present concern is that she now
occasionally suffers bouts of dizziness. Her son is aware of these dizzy spells and believes that
they are from dehydration. Additionally, anxiety can also be caused by dehydration (Benton et
al., 2016). This occasional dizziness places her at risk of a serious fall. RS suffered from one of
these dizzy spells last week as we chatted at the mailboxes and I asked another neighbor to help
me escort her up the concrete stairs to her apartment. I could not convince her to sit down on her
couch, reluctantly leaving her alone, and our neighbor checked on her one hour later to make
sure that she was okay and brought her a bottle of water. RS lives alone in a large three bedroom
apartment which has a long staircase from the main living level to the bedrooms and, in addition,
her apartment is on the second floor, accessed only by another long staircase.
RS stopped driving four years ago because she recognized that she was becoming less
coordinated and unable to drive safely. This makes her reliant on her son and neighbors for food
NUTRITIONAL ANALYSIS
2
and other supplies. RS owns a cane but rarely uses it. Her mobility, and thus her independence
and freedom, are compromised as she has lost muscle, particularly in the last year, and suffers
from a knee issue that makes one of her legs weak. Her ability to exercise is limited due to these
constraints and she no longer feels safe going for walks although she will occasionally walk to
the dumpster which is approximately 300 feet from the ground level of our building. RS does get
some exercise by virtue of her large apartment and the necessity of navigating the stairs multiple
times daily. In addition, she comes to the ground level of the building once or twice daily to
check her mail. RS has one son who lives three hours away and visits her twice per month. In
addition, she has a step-granddaughter who visits her twice per month. RS prepares some simple
meals and relies heavily on pre-made foods from the store which her son orders for home
delivery. Recently, a hired caregiver has started to come help her once weekly. It is unclear how
that will work out as RS declares “I think I help her more than she helps me.”
RS is extremely independent, intelligent, and stubborn. She keeps herself busy at home but
does suffer from loneliness as most of her friends have died. Her mood has declined over the last
year telling me that she is tired of being alive. To this, I nod my head and do my best to
empathize with her feelings but also try to encourage her and remind her or her relatively good
health. RS is cognizant of her health although she hates going to the doctor. She eats three meals
daily plus a snack or two and eats healthfully aside from her occasional indulgence in vanilla ice
cream or some chocolate treat. RS does minimally cooking and relies on frozen vegetables,
peanut butter and jelly sandwiches, yogurt, granola bars, oatmeal, a cranberry-walnut trail mix
that she makes herself, and pasta. Other than those items, her food is prepackaged frozen meals.
Given her physical and somewhat deteriorating mental condition, she lacks both the interest and
ability to cook more diverse meals. RS is financially stable with a generous pension from her job
NUTRITIONAL ANALYSIS
3
and benefits from the Coast Guard with which her deceased husband served. RS was widowed
young, in her 30’s, and is accustomed to living alone.
RS still enjoys eating, particularly sweets, although her sense of taste has diminished greatly
as she has aged. RS grew up in Manhattan, New York and formerly enjoyed foods from diverse
cultures although she primarily consumed a standard American diet. Since she is mostly
homebound, she can no longer venture downtown for a good taco or other food, but she
remembers these foods fondly and tries to make up for it by requesting items such as the
Mexican chicken bowls that Trader Joes sells. RS does not have any food allergies. In the last
year she has lost approximately ten pounds, the reason undetermined. Covid, coupled with her
physical decline, has left RS more isolated and prone to sadness, perhaps contributing to her
weight loss. In the eight years that I have known her, RS has not had even a cold. Whether that
be due to a strong constitution or her limited exposure to the public and assiduous use of masks
during Covid 19 in her ventures to the mailbox and dumpster, sanitizing the stair’s handrails
down the way, is unclear.
I do not think that her blood pressure or cholesterol medication affect her food intake. RS
does not attempt to eat a low sodium diet which is recommended for high blood pressure. RS has
good dentition and does not have issues with chewing, swallowing, or digestion other than
constipation which she treats with Miralax. She still has enough manual dexterity for it to not be
a limiting factor in eating her meals. Her energy level is good given her advanced age and she is
not a particularly slow walker. RS’s fluid intake is significantly lower than 2000-3000 mL per
day. She drinks half decaf coffee, milk, and inadequate amounts of water.
Results and Discussion
NUTRITIONAL ANALYSIS
4
A 24 hour tabulation of Cronometer results showed that RS consumed 1584 calories which is
16% higher than the level of 1367 calories recommended to maintain her weight. I do not think
that this is a problem given that she has lost ten pounds over the last year and she is already in
the lower part of the healthy BMI range for her height and weight. Also, I had Cronometer set to
“sedentary” to calculate her target calories but this is not completely accurate as she does climb
stairs and walk around her 1250 square feet apartment. Protein only accounted for 15% of her
calories consumed while her target level was 25%. This is problematic given that she is losing
more muscle as she ages and she needs good protein levels to maintain and rebuild lost muscle.
Low protein consumption is my biggest concert for RS. The amino acids represented within her
protein ranged from 41 to 113% of recommended levels with most falling approximately
midrange. RS’s carbohydrate consumption was 57%, 12% higher than Cronometer’s
recommendation of 45%. RS had a target fat level of 30% for calories consumed and was just
2% short of the recommended target. This deficit can easily be made up with the addition of a
healthy fat such as avocado or olive oil.
RS was high in iron with 111% and copper with 132% of the recommended daily allowance.
Iron is important to prevent anemia which can cause fatigue and tachycardia
(hopkinsmedicine.org). Copper is an essential element aiding the body in regulating gene
expression, immunological processes, angiogenesis, and neurohormone homeostasis (Collins,
2014). Excess copper is excreted through bile and urine and RS’s consumption is nowhere near
toxic levels (hopkinsmedicine.org).
A surprising finding for me was that RS’s calcium, extremely important for bone health, only
met 74% of the RDA. This can be compensated for by eating sardines with the bones, almonds,
or kidney beans. RS’s vitamin A level was only 24% of the RDA. Vitamin A is important in
NUTRITIONAL ANALYSIS
5
maintaining normal immune function, vision, and in regulating the production of new cells in the
body. This deficiency could be mitigated by consuming sweet potatoes, carrots, spinach, or eggs
(https://lpi.oregonstate.edu/mic/vitamins/vitamin-A). RS’s vitamin B12 was of concern as she
did not consume any at all. Vitamin B12 deficiency can easily lead to pernicious anemia to
which the elderly are even more susceptible and can be avoided by increasing consumption of
chicken, beef, or eggs (https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12). Indeed, RS’s diet
was low in all of the B vitamins and this could be helped by increasing her meat consumption as
just specified, salmon, and foods made with fortified flour. RS’s folate levels were only 41% of
the RDA and this can lead to megaloblastic anemia; it can be resolved by consuming 6 ounces of
orange juice, enriched white rice, or lentils (https://lpi.oregonstate.edu/mic/vitamins/folate). This
orange juice would also address RS’s vitamin C deficiency meeting only 68% of the RDA. RS’s
vitamin D was only 11% and could be rectified by drinking fortified orange juice, consuming
trout, or sunning herself on her balcony for 15-30 minutes daily. Vitamin E was only 51% and
this can be rectified by eating leafy greens.
Dietary Optimization and Conclusion
According to Myplate.gov, RS should be consuming approximately 1.5 cups of fruit, 2 cups
of vegetables, 5 ounces of grains, 5 ounces of protein, and 3 cups of dairy daily. RS has a fair
diet, especially compared to her peers. I would only make a few minor tweaks given that she is
limited in both her cooking and shopping abilities. I would advise her to add berries to her
oatmeal for breakfast and suggest that she eat a different fruit each day as her snack instead of
relying solely on apples and bananas. I would recommend that instead of a peanut butter and
jelly sandwich for lunch, she have salmon sauteed in olive oil (which can be purchased pre
cooked so that she could easily microwave it, taking no longer than making a sandwich) and a
NUTRITIONAL ANALYSIS
6
fortified grain, either white rice (which can also be purchased precooked), and a colorful
vegetable like sweet potato or spinach. Or, if she really wanted a sandwich, she could spread
hummus (made with chickpeas and olive oil) topped with a few tomato slices on her favorite
fortified bread. I would leave her dinners alone as I know that she really enjoys her chicken
burrito bowls (and other similar protein bowls) from Trader Joes because they are flavorful and
well balanced nutritionally. Although it was not reflected in the particular 24 hours that I
recorded for Cronometer, I know that she regularly consumes fortified orange juice which helps
meet many of her deficient RDA’s. Fortunately, RS has always been rather attuned to nutrition
and eating healthy, simple foods. I have not had the opportunity yet to present her with my
suggestions. I know RS well and I know that she will likely be resistant to change and the truth is
that I do not know if she likes fish like salmon or trout which would be great additions to her
diet. She might be more receptive to taking a multivitamin. One last issue that I would address
with her and strongly encourage to change is her water consumption. RS drinks about five cups
daily which is much lower than the recommended amount of 2000-3000 mL. Water is essential
to every function of the body and could help her with her constipation. RS already consumes
more than the recommended amounts of fiber so perhaps it is the water that she is lacking to help
her with her elimination issues. Proper nutrition and hydration is important for any living being
but is even more essential for an elderly person. RS’s personality is more akin to that of a
middle-aged woman, but her body is definitely one of a 91 year old so the better that she can fuel
it, the better that she will feel.
NUTRITIONAL ANALYSIS
7
References
Benton, D., Jenkins, K. T., Watkins, H. T., & Young, H. A. (2016). Minor degree of
hypohydration adversely influences cognition: a mediator analysis. The American journal
of clinical nutrition, 104(3), 603–612. https://doi.org/10.3945/ajcn.116.132605
Blumberg JB, Frei B, Fulgoni VL, Weaver CM, Zeisel SH. Contribution of Dietary Supplements
to Nutritional Adequacy in Various Adult Age Groups. Nutrients 2017;9. [PubMed
abstract]
Copper - Health Professional Fact Sheet (nih.gov)
Copper's Previously Unknown Exit Strategy - 07/12/2012 (hopkinsmedicine.org)
https://Cronometer.com
Iron-Deficiency Anemia | Johns Hopkins Medicine
Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin,
Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and
Choline. Washington, DC: National Academy Press; 1998.
https://lpi.oregonstate.edu/mic/vitamins
https://Myplate.gov. US Department of Agriculture.
NUTRITIONAL ANALYSIS
8
Volkert, D., Beck, A. M., Cederholm, T., Cereda, E., Cruz-Jentoft, A., Goisser, S., de Groot, L.,
et al. (2019). Management of Malnutrition in Older Patients—Current Approaches,
Evidence and Open Questions. Journal of Clinical Medicine, 8(7), 974. MDPI AG.
Retrieved from http://dx.doi.org/10.3390/jcm8070974