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Senior Nutrition

Definition

Senior nutrition addresses the special dietary requirements of the elderly. Although wise food choices and a balanced diet are essential for older adults to maintain a healthy lifestyle and to promote longevity, there are various obstacles that prevent or limit seniors from practicing and benefiting from good eating habits. Such obstacles include loneliness, depression, economic concerns, lack of cooking skills or desire to cook, inadequate nutritional knowledge, reduced capacity to absorb and utilize nutrients, oral/dental problems and difficulty in chewing, loss of appetite, and eating/nutrient complications due to the use of various medications. In addition, older adults need certain vitamins and nutrients to aid in the maintenance of their health.

Description

Healthy eating and regular physical activity are necessary to maintain good health at any age. However, older persons, especially after the age of 50, often experience various obstacles that prevent them from following healthy diets. They experience reductions in metabolism (the rate at which the body burns energy) and changes in physiology that significantly affect their nutritional needs. The metabolic rate of an individual can decline as much as 30% over the lifetime, and lean muscle mass can decrease by as much as 25%, accompanied by an increase in body fat. These changes often require the use of lower calorie diets as well as changes in nutritional intake.

The United States population is rapidly aging. By 2030, the number of Americans aged 65 and older will more than double to 71 million, comprising roughly 20% of the U.S. population. In some states, fully a quarter of the population will be aged 65 and older. The cost of providing health care for an older American is three to five times greater than the cost for someone younger than 65. By 2030, the nation’s health care spending is projected to increase by 25% due to demographic shifts unless improving and preserving the health of older adults is more actively addressed.

Almost 90% of Americans over the age of 65 have one or more degenerative disorders, such as heart disease, cancer, arthritis, diabetes, macular degeneration, and osteoporosis. These conditions were once considered inevitable diseases of old age, but now are recognized as life-style diseases. Therefore, changes in habits, including diet, can significantly reduce the risks of developing these diseases as well as prevent

Senior nutrition

Health risks of underweight older adults

  • Constipation
  • Decreased immunity
  • Decreased muscle strength
  • Hypothermia (lowered body temperature)
  • Osteoporosis (bone loss)
  • Poor memory

Health risks of overweight or obese older adults

  • Coronary heart disease
  • High blood cholesterol
  • High blood pressure
  • Gallbladder disease
  • Some types of cancer
  • Stroke
  • Type 2 diabetes

SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services

(Illustration by GGS Information Services/Thomson Gale.)

premature aging. However, according to a report by the Merck Institute of Aging and Health and the Centers for Disease Control and Prevention, two-thirds of older adults fail to adhere to a healthy diet and one-third fail to exercise. Therefore, to ensure that the aging population takes necessary steps to stay healthy and independent and to reduce the risk of disabilities, it is necessary to educate the elderly about healthy behaviors and to help them translate that knowledge into action.

Energy decline in the elderly, as lean body mass, including muscle, decreases with age. Therefore seniors need to eat foods that are concentrated in nutrients but low in calories. It has been recommended that after the age of 50 that men reduce their daily calorie intake by 600 calories and that women reduce their daily calorie intake by 300 calories. However, calorie needs will vary with the level of exercise a person gets, as well as other health conditions. For example, the calorie needs of a wheelchair-bound 80-year-old will differ from an 85-year-old who plays tennis and swims every day.

Maintaining a healthy weight may reduce the risk of many chronic diseases, help with flexibility and mobility, and aid in mental alertness. The risks of being underweight include poor memory, decreased immunity, osteoporosis, decreased muscle strength, hypothermia (lowered body temperature), and constipation. The risks of being overweight or obese include type 2 diabetes, high blood pressure, high blood cholesterol, coronary heart disease, stroke, some types of cancer, and gallbladder disease.

KEY TERMS

Antioxidants— Compounds that protect against cell damage inflicted by molecules called oxygen-free radicals, which are a major cause of disease and aging.

Diverticulitis— A condition in which pouch-like bulges or pockets (diverticula) in the wall of the intestine—most commonly the large intestine— become inflamed or infected.

Diverticulosis— A condition in which pouch-like bulges or pockets (diverticula) develop along the digestive tract. Normally, these pouches don’t cause any problems but may become inflamed or infected (diverticulitis).

Degenerative disorders— A condition leading to progressive loss of function.

Macular degeneration— A chronic disease of the eyes caused by the deterioration of the central portion of the retina, known as the macula, which is responsible for focusing central vision in the eye.

Osteoporosis— Thinning of the bones with reduction in bone mass due to depletion of calcium and bone protein. Osteoporosis predisposes a person to fractures, which are often slow to heal and heal poorly.

It is more common in older adults, particularly post-menopausal women; in patients on steroids; and in those who take steroidal drugs. Unchecked osteoporosis can lead to changes in posture, physical abnormality (particularly the form of hunched back known colloquially as "dowager’s hump"), and decreased mobility.

Triglycerides— The body’s storage form for fat. Most triglycerides are found in adipose (fat) tissue, while some triglycerides circulate in the blood to provide fuel for muscles. Triglycerides come from the food we eat as well as from being produced by the body.

Osteoporosis— Thinning of the bones with reduction in bone mass due to depletion of calcium and bone protein. Osteoporosis predisposes a person to fractures, which are often slow to heal and heal poorly. It is more common in older adults, particularly post-menopausal women; in patients on steroids; and in those who take steroidal drugs. Unchecked osteoporosis can lead to changes in posture, physical abnormality (particularly the form of hunched back known colloquially as "dowager’s hump"), and decreased mobility.

Generally, the daily recommended amount of calories for women over the age of 50 are:

  • 1,600 calories, if her physical activity level is low
  • 1,800 calories, if her physical activity level is moderate
  • 2,000 to 2,200 calories if her physical activity level is high.

The recommended daily amount of calories for men over the age of 50 are:

  • 2,000 calories, if his physical activity level is low
  • 2,200 to 2,400 calories, if his physical activity level is moderate
  • 2,400 to 2,800 calories if his physical activity level is high.

The dietary guidelines from the U.S. Department of Agriculture (USDA) suggest that persons select a suggested amount from five major food groups each day. Selecting the smallest amount will result in about 1,600 calories per day, while the largest number has about 2,800 calories. The USDA Daily Dietary Guidelines are:

  • Grains: 5-10 ounces (with at least three ounces from whole grains)
  • Vegetables: 2 to 3 1/2 cups, with a variety of colors and types
  • Fruits: 1 1/2 to 2 1/2 cups
  • Milk, yogurt, and cheese: 3 cups of milk (1 cup of yogurt, 1 1/2 to 2 ounces of cheese, or 2 cups of cottage cheese are equivalent to one cup of milk)
  • Meat, poultry, fish, dry beans, eggs, and nuts: 5-7 ounces of lean meat, poultry or fish (1/4 cup of cooked beans or tofu, 1 egg, 1/2 ounce of nuts or seeds, or 1 tablespoon of peanut butter are equivalent to one ounce of meat)

Elderly persons should ensure that there is adequate protein in their diets, for protein is necessary for a healthy immune system and for repair and maintenance of body tissues. In addition, only small amounts of fats, oils, and sweets should be eaten each day. Fats can provide energy and vitamins, but too much fat can lead to heart disease. fat is also high in calories. To lower fat in the diet, a person can:

  • Choose lean cuts of meat, fish, or skinless poultry
  • Trim off fat before cooking
  • Use non-stick cooking pans and pots and cook without added fat
  • If fat is used for cooking, use an unsaturated vegetable oil or nonfat cooking spray
  • Broil, roast, bake, stir-fry, steam, microwave, or boil foods rather than frying
  • Season foods with lemon juices, herbs, or spices instead of butter or margarine

Dietary fiber from fruits, vegetables, beans, nuts, seeds, brown rice, and whole grains can help an older person avoid intestinal problems such as constipation, diverticulosis, and diverticulitis. Fiber may also help lower cholesterol and blood sugar. If a person is not used to eating large amounts of fiber, additional fiber should be added to the diet slowly to avoid intestinal problems. Drinking fluids are necessary to help move the fiber through the intestines.

Although a person’s diet is the preferred source of nutrition, evidence suggests that the use of a single daily multivitamin-mineral supplement may be an effective way to address nutritional gaps that exist among the elderly population, especially the elderly poor. Low dietary intakes are a problem for almost all micronutrients because older people do not eat as much as younger people. Less food means fewer calories but also fewer vitamins and minerals. It is appropriate for an elderly person to take in fewer calories than younger people, for they burn fewer calories through exercise; however, the body’s need for some vitamins and minerals may actually increase with age.

For example, vitamin D and calcium are especially important for the elderly, to strengthen bones and to prevent bone loss, but intake through dietary sources may be low. All elderly people are prone to vitamin D depletion, but this is a particular concern for those who are in a nursing home or a hospital, partly because of poor diet and partly because of insufficient exposure to sunlight. Calcium sources include low- and non-fat yogurt, cottage and ricotta cheeses, milk, tofu processed with calcium, broccoli, kale, Asian greens such as bok choy, orange juice fortified with calcium, and legumes and fortified bread and cereal products. Soy or rice milk fortified with calcium and vitamin D may be used by lactose-intolerant seniors. Calcium supplements are also recommended, especially for women. In addition, seniors may secrete less hydrochloric acid, which is involved in food digestion, resulting in less absorption of calcium.

Many health care professionals advise seniors to add antioxidants, such as vitamin C and selenium, to their supplementation routine. Antioxidants may have several positive effects, such as slowing the aging process, reducing the risks of cancer and heart disease, and reducing the risks of illness and infection by strengthening the immune system. Coenzyme Q10 is another antioxidant that some health care professionals recommend, especially with regards to protection of heart health. The supplement glucosamine and chondroitin may be useful for seniors with joint problems and pain.

Sodium, which is contained in salt, is necessary for healthy blood, muscles, and nerves. However too much sodium can result in high blood pressure. Person over the age of 50 should consume only about 1,500 mg of sodium daily from all their food sources, which is about 2/3 of a teaspoon of table salt. Spices, herbs, and lemon juice can be used in place of table salt to add flavoring to food. Canned vegetables and beans can be washed under cold water to lower their salt content. Potassium can counter the effects of salt on blood pressure. Sources of potassium include leafy green vegetables, fruit from vines, such as tomatoes, bananas, and root vegetables such as potatoes.

Seniors are at high risk for becoming dehydrated because they tend to feel less thirsty. Dehydration can result in disorientation, confusion, and changes in blood pressure. It can also lead to kidney and cardiac abnormalities. In addition to water, seniors can drink fruit and vegetable juices, sparkling waters, chilled and flavored soy and rice milk, and hot or cold herbal teas. Caffeine and alcohol containing beverages do not replenish but deplete the body of fluids.

There are also other obstacles to seniors receiving necessary nutrition. Factors such as dexterity (for example, being able to use a knife with ease), flavor preferences and personal tastes (for example, preferences for spicy or bland foods) and the ability of seniors to chew and swallow (for example, missing teeth or poorly adjusted dentures) can affect nutrition. Problems with chewing can often be addressed through eating canned fruits, creamed or mashed vegetables, ground meat, or foods made with milk or drinking fruit and vegetable juices.

The sense of taste and smell commonly diminish with age, often adversely affecting the appetite. In addition, medications can also alter the sense of taste. A switch in medications may help with this problem.

Food safety is also important with regards to taste and smell. Older persons may not be able to tell if foods have gone bad. To counter this problem, foods can be dated when placed in the refrigerator. If there is any doubt on whether a food item is spoiled, it should be thrown out.

Older people should also be careful when preparing foods that need to be cooked thoroughly to prevent disease. Examples of these types of food include eggs, pork, shellfish, poultry, and hot dogs. Raw sprouts, some deli meats, and foods that are not pasteurized (heated sufficiently to destroy disease-causing organisms) may also be unsafe.

Diseases such as arthritis and dementia can affect the nutritional status of elderly persons. A person may not to able to shop, cook, or even use utensils. Persons with Alzheimer’s Disease or other types of dementia may eat poorly or even forget to eat at all.

Dietary restrictions of fat and cholesterol are recommended in order to lower blood cholesterol levels and the associated cardiovascular disease risks. However, there have not been any long-term drug or dietary cholesterol-lowering intervention trials in healthy persons older than 65 years. Some studies have shown that although total cholesterol levels may be good predictors of cardiovascular disease in middle-aged persons, they are not good predictors for elderly persons. Research has also shown that levels of high density lipoproteins (HDL, or the ‘good cholesterol) are a better predictor of risk in the elderly than low density lipoproteins (LDL, known as the ‘bad‘ cholesterol). When seniors reduce fat in their diets with carbohydrates, blood triglyceride levels can increase, which in turn results in lowering the HDL (the ‘good‘) cholesterol levels and in increasing the levels of LDL (the ‘bad‘) cholesterol levels. Often these simple carbohydrates that are used to replace higher fat food choices contain less nutrients and may have more calories, thus leading to obesity and its associated risks. Overall it is recommended that dietary restrictions for the elderly not be overly restrictive and that any dietary changes be addressed to specific health problems, such as diabetes, food allergies, and kidney problems.

Elderly people may require special diets because of chronic medical problems. These special diets could include a low-fat, low-cholesterol diet for heart disease, a low-sodium diet for high blood pressure, or a low-calorie diet for weight reduction. However, often it takes extra effort to adhere to these dietary needs, and the elderly may settle for easy to prepare meals that may not be appropriate for the specific diet required.

Social isolation is also an obstacle to good nutrition. Older persons who find themselves single after many years of living with another person may find it difficult to be alone at mealtimes. Depression may lead to a lack of desire to prepare or eat meals. A study of newly widowed people found that nearly 85% reported a weight change during the two years following the death of a spouse, as compared to 30% of married subjects. The widowed group reported an average weight loss of 7.6 pounds. Widowed women reported that cooking was a ‘chore,‘ especially since there was no one to appreciate their cooking efforts. Widowed men may not know how to cook and may become dependent on snacks and fast foods, thus not getting sufficient nutrients and vitamins. Microwave ovens can be useful by providing an easy means for cooking nutritious frozen foods or foods already prepared by grocery stores.

Family members and friends can provide assistance to help seniors with nutritional needs. They can help elderly persons take advantage of food programs by aiding them in contacting agencies and organizations that can provide assistance and by helping them fill out forms and paperwork. They can stop by and make sure the person is eating, they can prepare foods for the person, and they can join the person for meals. An explanation of proper nutrition and how to read food labels may also be helpful. In some cases, family members and friends may need to help the person move to an assisted living facility or nursing home to ensure that the older person gets adequate nutrition.

Many elderly persons in the United States depend only on Social Security for their income. In the United States, the number living in poverty increased for seniors 65 and older 3.6 million in 2005, up from 3.5 million in 2004, which is about 10% of the senior population. An older person with limited financial resources can minimize food costs by:

  • Purchasing generic or store brands of food
  • Purchasing low-cost foods such as dried beans and peas, rice, and pasta, or processed foods that contain such items
  • Planning menus by incorporating food items that are on sale or use money-saving coupons
  • Sharing meal shopping, preparation and costs with a friend
  • Planning potluck dinners where everyone brings a prepared dish
  • Taking part in group meal programs at senior citizen’s centers or at churches or synagogues
  • Utilizing food stamps

In the United States, food stamps are also an option that seniors can utilize to purchase food. In many areas, there is grocery-shopping assistance available to help the home-bound purchase food items -sometimes a service fee may be required, in addition to the cost of the groceries.

The Elderly Nutrition Program, authorized under Title III of the U.S. Older Americans Act, provides grants to state community agencies on aging and federally recognized tribal governments to support congregate and home-delivered meals to persons 60 years and older. Additional funds for the program are provided by state and local agencies. The program is designed to address problems of dietary inadequacy and social isolation among older persons, especially low-income minorities and rural populations. Although these programs target the poor, they are available at no cost to all elderly persons, regardless of income. Many seniors participate in these programs while confidentially and voluntarily donating money in order to keep active and socially engaged.

The congregate meal program allows seniors to gather at a local site, such as a senior citizen’s center, school, or restaurant for a meal. Often additional services are available, such as health and nutrition screenings and education, counseling, fitness programs, or recreational activities. This program assures that for five to seven days each week, seniors eat at least one nutritious meal that provides at least one-third of the recommended dietary allowances for an older person. Often meals are available that meet the requirements for special diets, such as low-sodium for high blood pressure or soft foods for those who have trouble chewing.

Meals on Wheels Association of America (MOWAA) is an organization whose membership is comprised mostly of senior nutrition programs in the United States. MOWAA member programs throughout the country provide nutritious meals and other nutrition services to men and women who are elderly, homebound, disabled, frail, or at risk. These services significantly improve the quality of life and health of the individuals they serve and postpone early institutionalization. Many participants are people who do not require hospitalization, but who need a helping hand in order to maintain their independence. As a national organization, MOWAA focuses on those issues that can best assist its members in achieving their individual missions of providing quality meals and nutrition services to as many vulnerable people as possible in the most efficient and effective manner ‘so no senior goes hungry‘.

Volunteers who deliver meals to older persons who are homebound through MOWAA are encouraged to spend time with their clients. The volunteers also check on the welfare of the homebound so that they can report any health or other problems that they note during their visits.

The Senior Farmers’ Market Nutrition Program (SFMNP) awards grants to states, United States territories, and federally-recognized tribal governments to provide low-income seniors with coupons that can be exchanged for eligible foods at farmers’ markets, roadside stands, and community support agriculture programs. In addition to providing fresh, nutritious locally grown fruits, vegetables, and herbs to low-income seniors, the program also increases and expanding domestic consumption of local agricultural commodities. Persons eligible for SFMNP benefits are individuals who are at least 60 years old and who have household incomes of not more than 185% of the federal poverty guidelines. In 2004, 802,000 low-income seniors purchased food from 14,500 farmers at 2,500 farmers’ markets as well as at 2,500 roadside stands and 215 community-supported agriculture programs.

You Can! - Steps to Healthier Aging is part of the U.S. Department of Health and Human Services’ Steps to a Healthier US initiative, which encourages Americans of every age to make healthier choices. The You Can! campaign is designed to increase the number of older adults who are active and healthy by using a partnership approach to mobilize communities. Information about this community program is available on the web site of the United States Administration of Aging: [www.aoa.gov/youcan/]. By September 30, 2006, atotalof more than 2,800 community organizations had made a commitment to reach 4.2 million older adults with information and 436,000 with programs.

Complications

Without adequate nutrition, the health of senior citizens will suffer.

BOOKS

Bales, Connie Watkins (ed.), and Ritchie, Christine Seel. Handbook of Clinical Nutrition and Aging Totowa, NJ: Humana Press, 2003.

Dangour, Alan (ed.), Grundy, Emily (ed.), and Fletcher, Asrtrid. Ageing Well: Nutrition, Health, and Social Interventions. Boca Raton, FL: CRC Press, 2007.

Lam, Pat. Nutrition: The Healthy Aging Solution. Carol Stream, IL: Allured Publishing Corporation, 2004.

Watson, Ronald R. Handbook of Nutrition in the Aged, Third Edition. Boca Raton, FL: CRC Press, 2000.

ORGANIZATIONS

Meals on Wheels Association of America, 203 South Union, Alexandria, VA 22314. Telephone: 703-548-5558. Website: [www.mowaa.org]

National Institute on Aging, Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD 20892. Telephone: 301-496-1752. Website: [www.nia.nih.gov]

United States Administration on Aging, 330 Independence Avenue, SW, Washington, DC 20201. Telpehone: 202-619-0724. Website: [www.aoa.gov]

United States Department of Agriculture Food and Nutrition Information Center, 10301 Baltimore Avenue, Department of Agriculture, Beltsville, MD 20705-2351. Telephone: 301-504-5719. Website: [www.nal.usda.gov/fnic/]

Judith L. Sims


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