Nutrition For Older Adults

Presented by Janice Hermann, PhD, RD/LD

OCES Adult and Older Adult Nutrition Specialist

Increase In Aging PopulationU.S. population growing older Ratio of older people to young is

increasingAge Categories

55 to 64: Approaching Old Age65 to 74: Young Old75 to 84: Old85 and older: Oldest Old

Increase In Aging Population65 used to define transition between

middle age and old ageNumber over 65 doubled since 1950Fastest growing age group is over 85 years

of age group

Importance of Nutrition In Aging Aging is an inevitable and natural processGood nutrition and physical activity can

improve the quality of lifeHealthy habits may lower disease risk

Nutrient Needs For Older AdultsDietary Reference Intakes (DRI’s) provide

dietary recommendations for people over 50 by two age groups51 to 70 years71 years and above

Nutrient Needs For Older AdultsBasic guidelines the same for older adultsThe USDA Daily Food Plan is the best tool to

get the variety and amount of nutrients needed

Older adults do need to pay special attention to the quality of foods eaten

USDA Daily Food PlanThe amount of food recommended from

each USDA Daily Food Plan food group is based on calories

Calorie recommendations for adults 56 years of age and older vary widely from 1,600 to 2,600 calories per day depending on gender, age and activity level

Personalized nutritional recommendations based on gender, age and activity can be found at www.choosemyplate.gov

USDA Daily Food PlanFor a typical 2,000 calorie diet the USDA Daily

Food Plan recommends:2 cups of fruit2 ½ cups of vegetables6, 1-ounce equivalents of grains5 ½ ounces of protein foods3 cups of dairy6 teaspoons of oilLimit calories from solid fats and added sugars to

260 calories per day

CaloriesCalorie needs decrease about 5% per decade

after age 50Decrease in physical activityDecrease in muscle massDecrease in metabolism

Need careful meal planning to get adequate nutrients in fewer calories

Calorie ImbalanceWeight gain

Risk for many health problemsEstimate calories: Multiply weight in pounds by

activity factor (10 sedentary or for weight loss; 12-13 moderately active; 15 active)

Don’t go below 1200 caloriesWeight loss

Risk for malnutrition

ProteinProtein is important for older adults

Maintain healthy cellsSustain immune systemPrevent muscle wastingFight infectionsWound healingEnzymesHormones

Protein needs may increase due to surgery, illness or disease

ProteinAdults need 0.8 g/kg Some studies report older adults may

need more protein 1.0 to 1.25 g/kgBecause calorie needs decrease make

lower fat choicesDon’t omit these food groups to lower fat

FatFat concentrated source of energyFat has some important roles

Helps form cell membranesCarries fat-soluble vitaminsProvides essential fatty acids

FatToo much fat increases disease riskLimit total fat to 20-35% or less of total

calories and saturated fat to 10% or less of total calories

Limit fat intake by choosing lean, cooking lean, and limiting added and hidden sources of fat

CarbohydrateCarbohydrate foods provide energy for body

cells and central nervous systemComplex carbohydrate foods also provide

vitamins, minerals and fiber50 to 60% of total calories should come from

carbohydrate

CarbohydrateMost carbohydrate should come from

complex carbohydrate foods Simple carbohydrates or sugar rich foods

should be limited

FiberTwo types of fiber

Soluble and insoluble fiberBoth types are beneficial

ConstipationDiarrheaDiverticulitisHeart DiseaseColon CancerDiabetes

Food is only one factor

FiberFood is the best source of fiber21g fiber daily for females and 30g fiber

daily for males based on 14g fiber per 1,000 calories

The USDA Daily Food Plan recommends ½ of all grains should be whole grains to help provide adequate fiber

FiberIncrease dietary fiber slowlyDrink plenty of fluidsCheck with physician before increasing

dietary fiberSome older adults may need to limit dietary

fiber if they have chewing, swallowing or other medical problems

Vitamins and MineralsVitamin and mineral needs are similar to

younger adults, with some differencesVitamin AIronVitamin DVitamin B12Calcium

Vitamin AVitamin A needs decrease and vitamin A is

stored more readily with ageThis makes over-dosing with vitamin A

supplements more common among older adults

Beta-carotene, vitamin A precursor, not a problem for over-dosing

Vitamin ADRI for adults 51 years and older is 900

micrograms for males and 700 micrograms for females

The Tolerable Upper Intake Level (UL) for Vitamin A is 3,000 micrograms/day

Leading food sources are carrots, ready-to-eat cereal, and milk

IronIron needs for women decrease after

menopauseLike vitamin A, iron is stored more readily in

older adultsExcess iron can increase oxidative stress

Iron DRI for adults 51 years and older is 8

milligrams per dayUL for iron is 45 milligrams per dayLeading food sources of iron are ready-to-eat

cereals, yeast bread and beef

Vitamin DVitamin D needed to absorb calciumVitamin D needs increase with ageAbility of the body to synthesize vitamin D

precursor in skin decreases with ageOlder adults also tend to have less sunlight

exposure

Vitamin DDRI for vitamin D is 600 IU for people aged 51

to 70DRI for vitamin D is 800 IU for people 71

years of age and older UL for vitamin D is 4,000 IU.

Vitamin DLeading food sources of vitamin D are

fortified cereals, milk, eggs, liver, salmon, tuna, catfish and herring

Vitamin B1215% of older adults are deficient in vitamin

B12People with atrophic gastritis are particularly

vulnerable to vitamin B12 deficiencyB12 deficiency can result in irreversible nerve

damage

Vitamin B12Older adults lose to ability to absorb the

naturally occurring form of B12 in foodTo absorb naturally occurring B12 from food

must split it from a protein carrierOlder adults may absorb vitamin B12 better

in synthetic form, which is not bound to a protein carrier

Vitamin B12Synthetic vitamin B12 is found in fortified

foods such as cerealsProtein-bound B12 is found in all animal

products

Vitamin B12DRI for vitamin B12 for adults 51 years of age

is 2.4 micrograms per dayLeading food sources of vitamin B12 are beef,

milk, fish and shellfish

CalciumCalcium requirements increase with ageMany older adults do not consume enough

calciumAn adequate calcium intake is one way to

help protect against osteoporosis

CalciumDRI for calcium for men

51 to 70 years of age is 1,000 milligrams per day.71 years of age and older is 1,200 milligrams per

dayDRI for calcium for women 51 years of age

and older is 1,200 milligrams per day. The UL for calcium is for adults 51 years of

age and older is 2,000 milligrams per day

CalciumLeading food sources of calcium are milk,

yogurt, cheese and other dairy products, dark green leafy vegetables, such as broccoli and canned salmon

Vitamins and MineralsOlder adults tend to have low dietary intakes

of some vitamins and mineralsVitamin EFolateMagnesiumZinc

Vitamin EVitamin E plays an important role in the

health of older adult due to its antioxidant functions, such as decreasing the development of cataracts and heart disease

Vitamin E is also associated with increased immune function

Vitamin EThe DRI for vitamin E for adults age 51 years

of age and older is 15 milligrams or 15 IU alpha-tocopherol equivalents (TE)

The UL for vitamin E is 1,000 mg or IU

Vitamin ELeading food sources of vitamin E are salad

dressings/mayonnaise, margarine, and ready-to-eat cereals

Other good sources of vitamin E are oils, especially sunflower and safflower oils, fats, whole grains, wheat germ, leafy green vegetables, tomatoes, nuts, seeds and eggs

FolateAdequate folate can decrease blood

homocysteine levels, which are a risk factor for heart disease

DRI for folate for people 51 years of age and older is 400 micrograms per day

The UL for folate is 1,000 micrograms from supplements and fortified foods

FolateLeading food sources of folate are ready-to-

eat cereals, yeast bread, orange juice and grapefruit juice

MagnesiumMagnesium is needed for bone and tooth

formation, nerve activity, and metabolism of carbohydrates, protein and fat

DRI for magnesium for adults 51 years of age and older is 420 milligrams for males and 320 milligrams for females per day

UL for magnesium is 350 milligrams from supplements and medications

MagnesiumLeading food sources of magnesium are milk,

yeast bread, coffee, ready-to-eat cereal, beef and potatoes

ZincZinc deficiency is related to delayed wound

healing, decreased taste acuity and immune response, and increases risk of dermatitis

DRI for zinc for adults 51 years of age and older is 8 milligrams for females and 11 milligrams for males per day

The UL for zinc is 40 milligrams per day

ZincLeading food sources of zinc are beef, ready-

to-eat cereals, milk and poultry

WaterWater is more critical to life than foodOlder adults need 6-8 cups water dailyEasy guide is 1 ml water/calorie with a

minimum of 1500 ml or 6 cups Water can be in many formsCaffeine containing beverages can increase

water loss

WaterOlder adults are at increased risk for

dehydrationBody water decreases with ageMany medications increase water lossThirst mechanism not as effectiveSelf limit fluid intakeDecreased mobility to reach fluids

Dehydration Signs

0-1% Thirst

2-5% Dry Mouth, Flushed Skin, Fatigue, Headache

6% Increased Body Temperature, Breathing, Pulse Rate

8% Dizziness, Increased Weakness, Labored Breathing

10% Muscle Spasms, Swollen Tongue, Delirium

11% Poor Blood Circulation, Failing Kidney Function

Vitamin/Mineral SupplementsOlder adults can get the nutrients they need

by eating a wide variety of foods following the USDA Daily Food Plan

Variety is the key

Vitamin/Mineral SupplementsWhile it is possible to get all the nutrients

needed from food, many older adults do not do so

Many factors can interfere with consuming a well-balanced diet

Some older adults may benefit from a multi-vitamin/multi-mineral supplement

Vitamin/Mineral SupplementsDon’t take isolated nutrients unless

recommended by a physicianDon’t take large dosesOverdoses easier with supplementsSupplements can’t make up for a poor diet“Supplements” not “Replacements”

MedicationsIt is important to follow recommendations

regarding medications and eatingSome medications need to be consumed with

food, some need to be consumed on an empty stomach

Medications

Some medications can interact with certain foods, or can affect appetite

Some foods can interact with medicationsSome medications can cause water lossSome medications can cause depression

Factors That Affect IntakeMany factors can affect food intake among

older adultsPhysicalSocialEmotionalMental StatusEconomic

Physical ChangesPhysical changes can affect food intake

Body compositionSalivaTeethDigestion

Stomach acidFat intoleranceLactose intolerance

Physical ChangesPhysical changes can affect food intake

(cont.)ConstipationThirstTaste and smellEyesightStrength, energy and coordination

Body CompositionMany adults lose muscle, bone mineral and

body water with agingAt the same time, many older adults gain

body fatMuscle loss can cause people to lose their

ability to move and maintain balance, making falls likely

Body CompositionA loss of muscle is not inevitableGood nutrition and regular physical activity

can help maintain muscle mass and strength

Body CompositionStrength training can increase muscle and

decrease body fat Weight bearing and resistance activities also

increase muscle and bone densitySince muscle contains more water than fat,

building muscle also helps increase body water

SalivaProduction of saliva may decrease with ageSaliva moistens food and makes swallowing

easierFoods may be dry and more difficult to

swallow

TeethLoss of teeth makes eating and chewing some

foods difficultMany older adults unable to adjust to

dentures or have dentures that do not fitVery hot or very cold foods may be painful for

people with dental problems

TeethPeople with tooth loss, gum disease, or poor

fitting dentures tend to eat softer foods or limit food intake which can lead to a poor diet

Poor chewing can also increase the risk of choking

DigestionMany older adults do not digest foods as well

as when they were youngerIntestinal secretions change with ageServing four to six smaller meals may be

more acceptableMany older adults do not tolerance of high

fat or dairy foods

DigestionAtrophic gastritis affects almost 1/3 of people

over 60; characterized by inflamed stomach, bacterial overgrowth, and lack of hydrochloric acid and intrinsic factor. This results in impaired digestion and absorption of vitamin B12, biotin, folate, calcium, iron and zinc

Stomach AcidProduction and secretion of stomach acid

tends to decrease with ageThis causes decreased digestion and a feeling

of indigestion

Fat ToleranceMany older adults do not tolerate high fatty

foodsFat intolerance can result in abdominal pain

and diarrheaDecrease the amount of fat added to foods,

choose low-fat foods and use low-fat preparation methods

Lactose ToleranceMany older adults do not tolerate milk and

milk products due to lactose intoleranceSome can tolerate small amounts of milk, or

fermented milk products such as buttermilk, yogurt and cheese

Lactaid or Dairy Ease can help with digestion of milk or milk products

ConstipationConstipation is a common problem among

older adultsThe intestinal wall tends to lose strength and

elasticity with age which results in slower intestinal motility

Many medications can also cause constipation

ConstipationSufficient fiber and fluids are important to

combat constipationPhysical activity is also important in

reducing constipationFiber supplements may be needed as a last

resort

ThirstThe combined effects of decreased thirst

sensation, decreased body water, increased water loss, incontinence and decreased mobility put older adults at greater risk for dehydration

Keep fluids close at hand to encourage increase fluid intake

Taste and SmellTaste and smell tend to decline with ageThe number of taste buds and olfactory cells

decrease with ageMedicines can also interfere with taste and

smellChanges in taste and smell may decrease

appetite and food intake

EyesightEyesight tends to decline with ageThis can make shopping, cooking, and

possibly eating become more difficultProblems reading small print recipes or

seeing oven temperatures may result in less meal preparation

Strength, Energy and CoordinationStrength and energy often decline with

increasing ageFood shopping, carrying heavy groceries,

choosing from a wide variety of foods and preparing meals may become difficult

Strength, Energy and CoordinationDecreased strength and coordination can

affect ability to eatKeep a reserve food supply on hand for sick

days or when the weather is bad

Social ChangesLoneliness is a major problem for may older

adults who live and eat aloneCan decrease appetite and motivation to

cook or eatMonotonous meals, snacking, and eating

easily prepared and softer foods, which can result in a poor diet

Social Changes

Doesn’t necessarily relate to living alonePhysical isolation may be far less important

than the frequency of communication

Emotional ChangesFeelings or worthlessness can cause a loss of

interest in foodAs people age they continually give up parts

of their lives; jobs, home, spouse and peers.May suffer overwhelming grief with the loss

of a spouse, friend or family member

Emotional ChangesDepression is common among older adults,

which can decrease appetite and decrease motivation to cook or eat

Some medications and nutritional deficiencies including B6, B12, folate, and iron can cause symptoms of depressions

Mental Status ChangesDementia is a leading cause of weight loss

and nutritional problems for older adultsMemory loss, disorientation, impaired

judgment, apathy, combative feeding behavior, and appetite disturbances are factors identified with weight loss

Mental Status ChangesIn beginning stages impaired memory and

judgment can lead toNot completing mealsForgetting to eatEating the same meal twice

Mental Status ChangesIn intermediate stages agitation can result in

increased calorie needsIndividuals seldom consume sufficient

calories to meet increased needs and often begin to lose weight

Individuals may require assistance with eating such as cutting food

Mental Status ChangesDuring final stages individuals may be unable

to swallow and may require tube feedingsOthers may simply refuse to eatNutritional supplements are very important

in meeting the needs of individuals with advanced dementia

Economic ChangesMany older adults have limited incomes

which can decrease diet qualityLess money for foodHousing facilities for storing and preparing foodTransportation to shop

Tips For A Healthy DietInclude a variety of food following the USDA

Daily Food Plan food groupsAvoid empty calorie foodsUse fresh fruits for dessertsEncourage snacks if food intake is lowEncourage adequate water, fiber and physical

activity to prevent constipation

Tips For A Healthy DietInclude a variety of foods and spices, unless

specific foods or spices aren’t toleratedCurrent recommendations suggest limited

benefits of special diets for people over 75 years of age. Therapeutic benefits need to be weighed against affect on dietary intake

Tips If Appetite DeclinesEat meals at regular timesHave the main meal earlier in the dayPlan 5-6 smaller mealsHave special event mealsAsk people what are some food they enjoy

Tips If Appetite DeclinesKeep the physical surroundings pleasant and

calmAllow enough time for mealsEncourage daily physical activity to increase

appetiteRemember medications can affect appetite

Tips If Smell and Taste DeclineUse herbs and spicesUse a variety of flavorsUse a variety of visual clues

ColorsShapesTemperatureTextures

Tips If Chewing and Swallowing DeclineUse gravies and sauces to moisten foodServe a beverage with the mealEat slowly and chew thoroughlyBe sure dentures fit properlyMaintain as normal of a diet as possibleGround meats are dry and difficult to

swallow, try soft high protein foods

Tips If Chewing and Swallowing DeclinePrecut foods and use in casseroles, soups or

gelatinMash foods if it is an acceptable formShred raw vegetables or fruits for salads,

gelatins or stir-fryWatch for signs of choking

Tips If Emotional & Social Factors Decrease Food IntakeServe food attractivelyUse a variety of flavors, colors, temperature,

shapes and textureDon’t serve same foods every dayMake the surroundings pleasantInvite friends or relatives overEat Out Occasionally

Tips If Emotional & Social Factors Decrease Food IntakeEncourage other activities to increase feelings

of self-worth and self-esteemSeek individuals participation in meal

planning and preparationStart a garden and use produce in saladsWatch for signs of depression

Tips if Strength, Energyor Coordination DeclineSpecial eating utensils, cups and plate guards

are availableSome foods take a lot of effort to eat if

coordination is a problem such as peas, rice, salads, soup

Some foods need something to help them stick together

Tips if Strength, Energyor Coordination DeclineFinger foods are ideal because they require

less effort to eatSome modifications can help such as soup in

a mug or spaghetti pre-mixed with sauce and melted cheese on top to help hold together

Tips if Strength, Energyor Coordination DeclineProvide assistance with tasks requiring hand

and finger dexterity, such as opening packages of crackers or cartons of milk, and cutting meat

Plan the dining room for safety, allowing space to accommodate wheelchairs, walkers, and canes

Tips If Mental Status Declines Make mealtime a routine that occurs at the

same time and place to avoid confusionServe familiar foods in familiar waysHave the main meal at noon when appetite is

larger and mental abilities are at their peak

Tips If Mental Status Declines

May help to offer fewer choices and smaller portions with snacks as needed

Serving one food at a time may be less confusing

Make physical surrounds pleasant and calm and avoid unnecessary distractions

Tips If Mental Status DeclinesSet aside enough time for mealsCheck food temperature to prevent burnsFood consistency may need to be modified to

prevent chokingIndividual may not know what should and

should not be eaten

Tips If Mental Status DeclinesBe aware that messiness and spills may occur

due to loss of coordinationIf disruptive behavior occurs, try

discontinuing mealtime for a few minutes or have someone else try feeding

Tips If Mental Status DeclinesIndividual may spit out food not because they

are being difficult, but because they are having a difficult time eating

Don’t continue feeding if person is chokingConsult with a physician if the individual

refuses to eat or is not eating enough

Tips For The CaregiverPreserve the dignity of the person being fedAllow sufficient time for feedingPosition the person being feed Offer small amounts of food at a time

Feeding food too rapidly can increase the risk of choking and food aspiration

Tips For The Caregiver

Don’t use straws that supply liquid more rapidly than it can be swallowed

Infant rice cereal is an inexpensive and effective thickener for thin liquid

Foods should be nutrient dense because individuals may tire quickly and consume only limited amounts of food

Nutritional Support is “Mealtimes”M - Maintain a routine E - Eat well-balanced mealsA - Alertness to any nutritional problemsL - Light and frequent mealsT - Teach the caregiver how to deal with the older adultI - Interactions between drugs and nutrientsM - Minimize confusion for the older adultE - Encourage older adult to eatS - Supplement the diet when necessary