Table 1.

Risk Factors for Reduced Protein Intake in Older Adults

Risk Factors	Causes and Impact
Reduced energy needs	The majority of older persons consume the same proportion of their energy intake from protein as do young adults. Thus, the quantity of dietary protein progressively declines with advancing age due to reduced energy needs and intake (1).
Physical dependence	Difficulty acquiring and preparing food. About 20% of homebound older adults had protein intakes less than the Recommended Dietary Allowance (2).
Anorexia	Overall reduction in energy and protein intake, mainly due to underlying disease, neurosensorial changes in appetite and food preference, as well as poor dentition (3,4).
Change in food preference	Preferential consumption of protein-rich foods may decrease with aging, potentially reducing protein intake in favor of carbohydrate and fat-rich foods (5,6). Thus, reduced protein intake may coexist with normal or relatively high energy intake.
Food insecurity	Limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire foods in socially acceptable ways, which is associated with inadequate nutrition and poor health. Approximately 4 million adults aged 60 and older and about 8% of households with older adults had experienced food insecurity (7). The prevalence is high among older adults receiving or requesting congregate meals, home-delivered meals, and other community-based services (8). It is paradoxically associated with both obesity (9) and poor-quality diets low in protein and other nutrients (7). It is also associated with poorer self-reported health, depression, limitations in activities of daily living, and diabetes.