Nutritional Considerations for Older Adults

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Image: “Albert Anker: Old Man Drinking Tea.” by Albert Anker – 1. Christie’s via ARCADJA auction results 2. Christie’s, LotFinder: entry 5678697 (sale 2001, lot 41, Zürich, 27 May 2013, page no longer available). License: Public Domain

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Definition

Malnutrition refers to inability of the body to absorb enough nutrients from foods.

Importance of Nutrition

Malnutrition leads to many problems such as:

1. Unintentional weight loss
2. Muscle weakness and fatigue
3. Depression, memory loss and other mental problems
4. Immunosuppression
5. Anemia

Etiology of Malnutrition

There are different causes of malnutrition in older people.

Non-physiological causes of suboptimal nutrition

Convivial factors

• Low socioeconomic status
• Inability to prepare and cook food
• Not able to feed oneself
• Failure to cater to ethnic food preferences
• Living a life of isolation (social isolation can lead to a decreased nutrient intake and also depression)

Psychological factors

• Cholesterol
• Alcoholism
• Dementia or Alzheimer disease
• Bereavement
• Depression
• Phobia

Medical factors

• Anorexia (anorexia of aging describes the physiological decrease in appetite and food intake that accompanies normal aging, which may result in undesirable weight loss.)
• Early satiation
• Malabsorption
• Increased metabolism
• Cytokine-mediated
• Impaired functional status
• Cancer
• Alcoholism
• Cardiac failure
• Chronic obstructive airways disease
• Infection
• Dysphagia
• Rheumatoid arthritis
• Parkinson disease
• Hypermetabolism (e.g., hyperthyroidism)
• Malabsorption syndromes
• Gastrointestinal symptoms: dyspepsia, atrophic gastritis, vomiting, diarrhea, constipation
• Poor dentition

Medications

• Nausea/vomiting: Antibiotics, opiates, digoxin, theophylline, nonsteroidal anti-inflammatory agents (NSAIDs)
• Anorexia: Antibiotics, digoxin
• Decreased sense of taste: Metronidazole, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACE), metformin
• Early satiety; Anticholinergic drugs, sympathomimetic agents
• Reduced feeding ability: Sedatives, opiates, psychotropic agents
•  Dysphagia: Potassium supplements, NSAIDs, biphosphonates, prednisolone
•  Constipation: Opiates, iron supplements, diuretics
•  Diarrhea: Laxatives, antibiotics
•  Hypermetabolism: Thyroxine, ephedrine

Nutritional frailty and sarcopenia are common among older adults.

Good Nutrition for Seniors

Nutrient needs must be met on fewer calories by:

• Eating more dietary fiber
• Having a variety of nutritious foods
• Consuming enough fluids
• Maintaining health and nutritional status
• Addressing any barriers to healthy eating
• Staying physically active, if possible
• Preventing or treating chronic diseases
• Minimizing food–drug interactions

Aging and dehydration

Fluid intake recommendations:

• ~ 3.7 l/day for men
• ~ 2.7 l/day for women

However, older adults find it difficult to maintain the fluid balance. This is because of the following factors:

• A reduced sense of thirst in older people leads to drinking lesser fluids.
• Poor mobility, poor bladder control and illnesses can cause them to drink less fluid.
• Water loss as a result of diarrhea and poor absorption from the intestines.
• Use of diuretics and laxatives increase the risk for dehydration.
• Use of medications that increase the fluid needs of the body.

Estimated calorie needs for adults 51 years and older

Estimated protein needs for individuals 51 years and older

The recommended daily allowance for protein in adults who are 51 to 70 years or > 70 years of age is 1.0–1.6 g/kg/day.

As the caloric needs are decreased in older people, the need for some nutrients increases, such as vitamin B6, calcium and vitamin D. This is why older people face the nutritional needs challenge and, therefore, they need to consume a variety of nutrient-dense food on a daily basis. These types of food contain more vitamins and minerals and have low calories. Examples of nutrient-dense food are:

• Fruits and vegetables
• Wholegrain bread
• Lean meats
• Low-fat dairy products
• Fortified cereals

Foods to take with precaution

• Refined grains
• Cholesterol
• Saturated fats
• Trans fats
• Food containing added sugars and high salt

How to improve one’s wellness

Intake of healthier foods

Foods rich in nutrients include fruits, vegetables, and whole grains. This is also coupled with limitation of solid fats, sugars and alcohol.

Frequent intake of snacks

This gives extra nutrients and calories in between meals. It is more helpful in older adults who get full easily before intake of enough food.

Intake of supplements in diet

They maximize the amount of absorbed nutrients and flavor of some foods thus encourage more intake.

Frequent exercises

This helps to improve one’s appetite as well as maintaining strength and energy.

Social activities

Encourage exercises among partners and encourages physical exercises.

Hypertension in the Elderly

Hypertension is more prevalent in older adults. Keeping blood pressure in the normal range is important.

Guidelines to help prevent high blood pressure

• Maintaining a healthy weight
• Including fruits, vegetables and low-fat dairy foods
• Choosing foods with less salt and sodium. Older Americans are encouraged to keep sodium intake to 1,500 mg a day
• Limited alcohol intake
• Physical activity
• Greater quantities of sodium are often added to processed and prepared foods. These foods should be avoided.

Diabetes and Older Adults

It is imperative for older adults with diabetes to get their blood glucose levels checked and prevent the disease.

Preventing type 2 diabetes

• Maintaining a healthy weight
• Consuming plenty of fiber
• Eating appropriate portion sizes
• Being physically active, if possible

Goals for old people with diabetes

• Following a special dietary plan designed by GP
• Taking prescribed medicines
• Being physically active
• Maintaining a healthy weight
• Aiming for blood glucose levels within the recommended range

Osteoporosis in the Elderly

The risk of osteoporosis increases with old age. It is an important cause of bone fractures in older age groups.

Prevention of osteoporosis

• Regular intake of milk
• Intake of vitamin D (source: fatty fish and fortified milk)
• 1,200 mg of calcium each day (sources: low-fat milk, cheese, and yogurt)
• Regular physical activity

Vitamin and mineral supplements

It is challenging for the older age groups to meet the nutritional demands through food, especially during illness; therefore, multivitamin supplements can be used, based on the GP’s prescription. However, they are not a substitute to natural eating.

Medicines and Older Adults

Due to a higher incidence of chronic illnesses among older people, they consume a higher proportion of medications. Due to decreased liver and renal functions in old age, these medicines have more adverse effects on old age group as compared to the rest of the population.

Common side effects of medicines:

• Diarrhea or constipation
• Dizziness
• Decreased appetite
• Mood changes
• Blurred vision
• Skin rashes

The risk of overmedication

There are more risks of overmedication in older adults. Risk factors are:

• Old age
• Female
• Failure to follow the physician’s prescriptions
• Reduced blood flow to kidneys
• Less effective kidney functions resulting in medicines remaining in the body for a longer time
• Adverse drug reactions history
• The use of multiple medicines

To prevent overmedication, the caretaker of older people should keep the information of all the medicines that are prescribed.

Poor Appetite in Old Age Groups

A poor appetite is a common complaint of older adults. The following are the causes of poor appetite:

• Grief and anguish
• No social gathering for lunch
• Acute or chronic illness
• Sensory changes in vision, taste and smell
• Medicines that affect the appetite

Helping older adults with a poor appetite

• Providing foods that are high in calories or nutrition, such as milk, soup or hot chocolate, rather than tea or coffee
• Use of herbs and spices to enhance the flavor of food
• Adding a variety and color to the food
• Encouraging older adults to eat smaller and frequent meals, instead of large meals at one time

Cognitive Impairments

Cognitive impairment in older adults is very common, and it can range from minor memory loss to dementia. Causes may include:

• Stroke
• Alzheimer’s disease
• Neurological disorders
• Nutritional deficiencies
• Side effects of taking medicines

As a result of such impairment, these individuals have:

• A diminished attention span
• An increased risk of choking
• Inability to recognize thirst
• Inability to recognize hunger
• Confusion about meal times
• Confusion about how to use utensils

Dental Issues

Problems regarding chewing of food cause older adults to take fewer quantities of foods that are essential for proper health.

Fresh fruits and vegetables are important sources of vitamins, minerals and fiber. Ill-fitting dentures and missing teeth prevent older people from taking these foods.

The following are the considerations for promoting dental health of older age groups:

• Daily brushing and flossing of teeth
• Brushing or rinsing of the mouth after every meal
• Increased intake of calcium- and phosphorus-rich foods should be encouraged
• Stimulating the release of saliva by serving a variety of firm and fibrous foods
• Making sure that older adults have regular visits to their dentist

Addressing the chewing difficulties in older adults

• Providing water or other fluids with foods to allow for easy swallowing
• A soft diet should be given if more teeth are missing
• Tender meat cuts
• Soft foods rich in proteins, such as eggs, yogurt, milk and cheese
• Vegetables and fruits with removed peels
• Cooked vegetables and fruit juices
• Rice, pasta and cooked cereals
• Pureed food, if required

Based on all these factors, older people are a sensitive group. They need more care with proper diet administration plans.