Energy requirements in older adults
Basal metabolic rate declines with age, primarily due to loss of muscle mass. However, disease, infection, pressure sores, and elevated physical demands can substantially increase energy requirements above calculated TDEE. The Mifflin-St Jeor equation used here provides a reasonable estimate for older adults, with stress multipliers applied for pressure sores (×1.15) and acute illness (×1.10).
Protein requirements in older adults are higher than in younger adults due to anabolic resistance — the reduced efficiency of muscle protein synthesis. ESPEN guidelines recommend 1.0–1.2 g/kg/day for healthy older adults and 1.2–1.5 g/kg/day in the presence of illness, injury, or pressure sores. Meeting protein targets requires intentional dietary planning, especially when appetite is poor.