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Chapter 18
Nutrition and Older Adults

“Nutrition is one of the major determinates of successful aging.”

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  • Generalizations relative to health status changes with aging are unwise because “older adults” are a heterogeneous population

  • Diseases and disabilities are not inevitable consequences of aging

  • Functional status is more indicative of health in older adults than chronological age

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Introduction

  • In “normal” aging, inevitable & irreversible physical changes occur over time
  • We will look at
  • nutrient requirements
  • dietary recommendations
  • food & nutrition programs designed to support healthy aging

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What Counts as Old?

There is no one age that defines “old”

  • 50—Eligibility for AARP
  • 60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program
  • 65—Eligibility for full Social Security
  • U.S. Census Bureau uses:
  • 65 to 74—“young old”
  • 75 to 84—“aged”
  • 85 & older—“oldest old”

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Food Matters: Nutrition Contributes to a Long and Healthy Life

  • Cumulative effects of lifelong dietary habits determine nutritional status in old age
  • CDC suggest that longevity depends on:
  • 10% access to health care
  • 19% genetics
  • 20% environment (pollution, etc.)
  • **51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)

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A Picture of the Aging
Population: Vital Statistics

  • More Americans are living longer
  • Currently, ~12.4% are >65 yrs
  • By 2050, ~20% will be >65 yrs

  • Persons ≥85 are the fastest growing population group

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Global Population Trends: Life Expectancy and Life Span

Life expectancy

Average number of yrs of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth

Life span

Maximum number of yrs someone might live; human life span is projected to range from 110 to 120 yrs

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Range of Life Expectancy for 15 of 37 Countries Reported in Health, United States 2005, for 2001, According to Gender

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Three Groups of Aging Theories

1) Programmed aging

  • Hayflick’s theory of limited cell replication
  • Modular clock theory

2) Wear and tear theories of aging

  • Oxidative stress theory
  • Rate of living theory

3) Calorie restriction & longevity

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Physiological Changes

  • Body composition changes
  • Lean body mass (LBM) & fat
  • Muscles: use it or lose it
  • Weight gain
  • Changing sensual awareness
  • Taste & smell
  • Oral health: chewing & swallowing
  • Appetite & thirst

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Body Composition Changes

  • Lean body mass (LBM)
  • Sum of fat-free tissues, mineral as bone, & water
  • Sarcopenia
  • Term used for loss of LBM associated with aging

  • Fat-free mass decreases ~15% from age 20 to 70
  • Older people have lower mineral, muscle, & water reserves

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Muscles: Use It or Lose It

  • In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density
  • Regular physical activity helps maintain functional status

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Weight Gain

  • Weight gain accompanies aging, but is not inevitable
  • Mean body weight gradually increases with aging, peaking between 50 & 59 yrs
  • Physical activity moderates weight gain & increases in body fat
  • Lack of estrogen promotes fat accumulation

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Changing Sensual Awareness:
Taste and Smell

  • Taste & smell senses decline with age
  • Decline in ability to identify smells varies by gender
  • In men, decline begins ~age 55
  • In women, decline is >age 60
  • Disease & medications affect taste & smell more than aging

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Changing Sensual Awareness:
Oral Health—Chew and Swallow

  • Oral health depends on:
  • GI secretions
  • Skeletal systems
  • Mucus membrane
  • Muscles
  • Taste buds
  • Olfactory nerves (smell & taste)
  • Healthy People 2010 Objective:
  • Reduce % of people aged 65-74 who have lost all their teeth from 26% to 20%

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Changing Sensual Awareness:
Appetite and Thirst

Appetite

  • Hunger & satiety cues weaken with age
  • Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted

Thirst

  • Thirst-regulating mechanisms decrease with age
  • Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective with advancing age

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Nutritional Risk Factors

Risk factors for older adults are:

  • Hunger, poverty, low food & nutrient intake
  • Functional disability
  • Social isolation or living alone
  • Urban & rural demographic areas
  • Depression, dementia, dependency
  • Poor dentition & oral health
  • Diet-related acute or chronic diseases
  • Polypharmacy
  • Minority, advanced age

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Tufts University’s Modified Food Pyramid for 70+ Adults

Note supplements at the top & water at the base

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Illustration 18.2 Tufts University modified food pyramid for 70+ adults.

Caloric Intake Comparison of Younger and Older Adults by Gender

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Eating Occasions

Eating Out

  • Older adults eat out less than younger persons

Snacking

  • Older adults snack less than other groups

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Nutrient Recommendations

  • Nutrient recommendations change as scientists learn more about effects of foods on human functions
  • Specific DRI for those >51 yrs were 1st established in 1997

Estimating Energy Needs

  • Decrease in physical activity & BMR from early to late adulthood results in ~20% fewer calories needed

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Protein

  • Inactive, older adults living alone may have low protein intakes
  • Several researchers report protein needs for older adults are 1 to 1.25 g/kg body wt (higher than the DRI of 0.8 g)
  • Nitrogen balance is easier to achieve when:
  • Protein is a high quality
  • Adequate calories are consumed
  • Elders participate in resistance training

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Considerations for Protein Adequacy of Older Adults

  • Based on ht & wt, how much protein will meet individual’s needs?
  • Are enough calories eaten so that protein does not have to be used for energy?
  • If marginal amounts of protein are eaten, is the protein of high quality?
  • Are there additional needs: wound healing, tissue repair, surgery, fracture, infection?
  • Is the individual exercising? (Nitrogen balance is harder to achieve while sedentary.)

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Fats and Cholesterol

  • Minimize saturated fat & keep total fat between 20 to 35% of calories----same as young & middle-aged adult

  • Even though eggs are high in cholesterol, they are a nutrient-dense, convenient, & safe food for older adults that do not have lipid disorders

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Recommendations for Fluid

  • The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated
  • ≥6 glasses of fluid/day will prevent dehydration in most older adults
  • To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL

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Age-associated Changes in Metabolism: Vitamin D, Calciferol

  • Factors that put older adults at risk for deficiency:

1. Limited exposure to sunlight

2. Institutionalization or homebound

3. Certain medications (barbiturates, cholestyramine, Dylantin, laxatives)

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Age-associated Changes in Metabolism: Iron

  • Iron needs  after menopause
  • Most older adults consume more iron than needed
  • Excess iron contributes to oxidative stress
  • Reasons that some older adults may have iron deficiency include
  • Iron loss from disease or medications
  •  acid secretion
  •  calorie intake

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Low Dietary Intake:
Nutrients of Concern

Vitamin E

Folate, folic acid

Calcium

Magnesium

Zinc

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Nutrient Supplements: When ?

  • May be useful with those who:
  • Lack appetite resulting from illness, loss of taste or smell, or depression
  • Have diseases in GI tract
  • Have a poor diet due to food insecurity, loss of function, or disinterest
  • Avoid specific food groups
  • Take medication or other substances that affect absorption or metabolism

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Dietary Supplements Potentially Used by Older Adults for Health Conditions

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Nutrient Recommendations: Using the Food Label

  • In nutrition labeling & dietary guidance, “one size does not fit all”
  • Nutrient amounts for older adults are slightly different than those for younger
  • Main differences:
  • Need more calcium & vitamins D & C
  • Need less iron & zinc

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Food Safety Recommendations

  • Older adults are vulnerable to foodborne illness because they have compromised immune systems
  • Leading hazardous practices:
  • Improper holding temperatures
  • Poor personal hygiene
  • Contaminated food preparation equipment
  • Inadequate cooking time

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Physical Activity Recommendations

  • Exercise: the “true fountain of youth”
  • Exercise guidelines
  • Keep Moving—Fitness after 50 screening tool
  • Resistance or weight-bearing activities
  • Aerobic exercise

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Nutrition Policy and Intervention for Risk Reduction

Nutrition Education

4 C’s:

-Commitment

-Cognitive processing

-Capability

-Confidence

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Considerations for Educational Materials for Older Adults

  • Larger type size
  • Serif lettering (such as Times Roman)
  • Bold Type
  • High contrasts (black on white)
  • Non-glossy paper
  • Avoid blue, green & violent
  • Reading level of 5th to 8th grade

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Community Food and Nutrition Programs

Elderly Nutrition Programs

  • Government programs include:
  • USDA’s food stamp & extension programs
  • Adult Day Services Food Programs
  • Nutrition Assistance Programs for Seniors
  • Meals-on-Wheels
  • Senior Nutrition Program of the Older Americans Act

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The Promise of Prevention: Health Promotion

  • Good nutrition habits make a greater impact when started early in life
  • Many not motivated to make changes until later in life or when health problems occur
  • The belief that an 80 y/o is too old to learn and practice health promotion strategies is an outdated myth

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