Aging and Nutrition

Aging Americans will make up an unprecedented proportion of the population as the 78 million baby boomers reach age 50. The baby boomers, those born between 1946 and 1964, will first reach age 65 in 2011, transforming the 35 million people over age 65 in 2000 to an estimated 69 million by 2030. With improved health care, socioeconomic status , and health behaviors, people 85 and over are expected to be the fastest-growing group of elderly persons, tripling from 4 million in 2000 to about 14 million by 2040. Growth in the elderly population has led to two subgroups: the young-old (55 to 74 years) and the old-old (75 and older). Still, elderly people remain the most diverse segment of American society.

A nutritious daily diet is one factor that can assist people who are 55 and older in maintaining optimal levels of health and preventing or delaying the onset of disease. The Dietary Reference Intakes (DRI) are the quantities of nutrients that form the basis for planning and assessing diets. The DRIs include the Recommended Dietary Allowances (RDA), the nutrient levels that meet the requirement for nearly all (97–98%) healthy people. Two sets of RDAs exist for elderly individuals, one for those 51 to 70 years of age, and one for those over 70 years of age.

According to the RDAs, elderly people have the same nutrient requirements as their younger counterparts, yet most need fewer calories . Vitamins D and B₆, and calcium , are exceptions and are needed in greater amounts for those 51 years old and older. Therefore, a nutrient-dense diet, with fewer calorie-laden foods, becomes more crucial at older ages of the life cycle. In general, women have nutrient requirements similar to men, though they require fewer calories. Therefore, elderly women must be especially careful to select nutrient-dense foods.

The best way to establish a nutrient-dense diet is to balance a variety of food choices (in moderation) that are adequate to meet nutritional and caloric needs. The Food Guide Pyramid (FGP) is helpful to guide food selection and daily serving totals. An FGP specifically for those over 70 years of age recommends 1,200–1,600 calories from whole-grain foods, a variety of colored fruits and vegetables, low-fat dairy products, lean meats, fish and poultry, and eight glasses of fluid daily. Food labels help put single servings of food into the FGP. Results of national dietary surveys have led some experts to recommend calcium supplements and a one-a-day type of multiple vitamin. Other health food supplements are not generally needed and can be very expensive for those on fixed incomes.

Nutrition Screening Initiative

Elderly individuals are at increased risk for problems that affect their nutritional status. The nationwide Nutrition Screening Initiative (NSI) categorizes these problems as those affecting functional, social, or financial status and access to food and drink. These problems can affect quality of life and the ability to perform activities of daily living, including eating. The DETERMINE checklist is the NSI tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

Disease

Eating poorly

Tooth loss/mouth pain

Economic hardship

Reduced social contact

Multiple medications

Involuntary weight loss/gain

Needs assistance in self care

Elder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

Dietary Problems

Some elderly individuals encounter dietary problems, making them less able to select, purchase, prepare, eat, digest, absorb, and use food. An inability to consume an adequate daily diet places the elderly person at increased risk for medical, physical, and functional problems. Therefore, it is important to intervene to correct any dietary problems that may exist. Examples of dietary problems, and interventions to improve the problems, are described below.

Difficulty Chewing or Swallowing.

Choose more fruit and vegetable juices, soft canned fruits, and creamed or mashed cooked vegetables; eggs, milk dishes (like creamed soups), cheese, and yogurt; and cooked cereals when chewing meat or fresh fruits and vegetables are difficult. Chop, stew, steam, or grate hard foods.

Difficulty Digesting.

Choose more fruit and vegetable juices, soft canned fruits, and non-gas-forming vegetables rather than gas-producing vegetables like cabbage or broccoli. If digesting milk is a problem, use cultured dairy products like yogurt or add lactaid to milk. If milk continues to be problematic, consider a daily calcium supplement.

Difficulty Shopping.

Shop by phone to find grocery stores that deliver in your area. Find volunteer or paid help in your area. Ask family or neighbors to help. See yellow pages under "Home Health Services" for assistance.

Difficulty Cooking.

Use a microwave. Cook and freeze in batches. Relocate to a facility where other's cook, such as a family member's home or an assisted-living home environment .

Appetite Difficulties.

Increase the flavor of food by adding spices and herbs, lemon juice, or meat sauces. Discuss medications with your physician, particularly if they are causing appetite or taste changes.

Financial Difficulty.

Use coupons, unit pricing, and shopping lists. Plan and prepare ahead, freezing several meals at once. Buy more generic or store-brand foods and foods on sale. Find food assistance programs or sources for free and reduced-price meals, such as churches, Meals On Wheels, Congregate Dining , and Food Stamps. Buy more low-cost foods, such as dried beans and peas, rice, pasta, canned tuna, and peanut butter.

Social Problems

Loneliness.

Invite a friend or neighbor over or have a standing date to eat out with friends or family. Buy smaller sizes to avoid the repetition of leftovers. Set the table attractively and play music softly. Participate in Congregate Dining in your area.

Living Alone.

Research has shown a correlation between living alone and having lower quality diets. Men may be at greater risk because they are less experienced with planning, shopping, and preparing meals. Women may feel less motivated to prepare meals when there is no one to share them with. Ways to improve social interaction during meals and improve the experience of dining alone include: participating with others, such as at churches or Congregate Dining sites, eating by a window, using good china, eating in a park or on one's porch, garnishing meals, and trying various frozen or prepared dinners.

When living alone challenges an elderly person's health, he or she can investigate the continuum of care, including adult day care, in-home care, retirement communities, residential care or assisted living, intermediate care, and nursing homes or convalescent hospitals.

Medical, Physical, and Functional Problems

Many chronic medical conditions, such as osteoporosis , arthritis , depression , and diabetes have nutritional consequences. Loss of body water, lean body mass, and bone mass; decline of the immune response; over- and underweight; malnutrition ; and declining taste, smell, and thirst are among the problems that affect physical strength, functional ability, and vitality. At times, specialized diets or medical nutrition therapy are needed; these are best planned with a registered dietitian. In addition, medications can affect the absorption and use of nutrients. Lists of food and drug interactions are available from a pharmacist or from a registered dietitian who can coordinate advice about medications with specialized dietary information.

see also Dietary Reference Intakes; Meals On Wheels; Menopause; Nutrient-Drug Interactions; Osteoporosis; Recommended Dietary Allowances.

Sally Weerts

Bibliography

Davis, M. (2000). "Living Arrangements Affect Dietary Quality for U.S. Adults Aged 50 Years and Older: NHANES III 1988–1994." The Journal of Nutrition 130(9): 2256–2264.

Fletcher, R. H. (2002). "Vitamins for Chronic Disease Prevention in Adults: Clinical Applications." Journal of the American Medical Association 287(23): 3127–3129.