Nutrition for the Elderly

If one were asked to list those topics usually covered inadequately in medical school and in clinical residencies, "nutrition" and "geriatrics" would certainly be ranked high. It is significant, therefore, to have available one book which may help to remedy two of these deficiencies. The author, a Ph.D., is director of nutritional research at a rehabilitation center and a geriatric nutrition laboratory. The book includes chapters on: (1) geriatric medical problems; (2) geriatric physiologic needs; (3) water requirements; (4) protein needs; (5) carbohydrate requirements, with special reference to diabetes; (6) fats and their relation to cardiovascular disease; (7) calories and body weight; (8) vitamins; (9) phosphorus, magnesium, calcium, and bone health; (10) electrolyte and fluid balance; (11) iron needs and anemia; (12) trace minerals; and (13) drug and nutrient interactions. In addition, the appendix provides 17 reference tables on such topics as recommended dietary allowances, the nutritive values of various foods, good sources of various nutrients, several diet plans, and normal blood values of nutritionally relevant items. The book has occasional gems that were unknown to this reviewer, such as evidence that fructose has a greater protein-sparing capacity than glucose. It also discusses a number of well known but often forgotten items relevant to geriatric care, such as the fact that a high fiber diet will decrease calcium and phosphorus absorption; the elderly tend to have little exposure to sunlight and therefore may need dietary supplement of vitamin D; the need for phosphorus supplementation during hyperalimentation; the importance of the calcium/phosphorus ratio in the diet (although how to insure an approximately 1:1 ratio is not clarified); and the need for B12 supplementation for vegetarians (which the elderly often are, in effect, because of poor dentition, appetites, or buying power). The final chapter is one of the best. It concerns drug-nutrient interactions and focuses on salicylates, antacids, iron, corticosteroids, antibiotics, laxatives, alcohol, anorexic agents, and anticonvulsant drugs. Caution regarding drug use in the elderly is indicated for a number of reasons, including changes in the drug distribution space with age, which may decrease (alcohol) or increase (diazepam), or because excretion by the kidney or liver usually is slower than in a younger person. Particularly relevant is the author's emphasis on the potential dangers of over-the-counter drugs frequently obtained by the elderly, such as the salicylates, iron supplements, antacids, and laxatives. Nutritional adjustments or supplements may be needed with all of these. But even with prescription drugs such as antibiotics, how often do physicians order the appropriate dietary adjustments, such as eliminating iron supplements during the taking of tetracyclines? There is much useful information in this densely packed book. The problem with it, from my perspective, is that the book seems unsure whether it is a textbook of physiology from the nutritional point of view or an aid to practicing clinicians. It is more adequate from the former than from the latter perspective, probably because of the background of the author. It is a rewarding review for those willing to take the time to read it all, but it was disappointing to me in that it lacked the degree of