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13.6: Older Adults and Nutrition

  • Page ID
    21188
  • Learning Objectives

    • Summarize nutritional requirements and dietary recommendations for older adults.
    • Discuss the most important nutrition-related concerns for older adults.
    • Discuss the influence of diet on health and wellness for older adults.

    Beginning at age 51, requirements change once again and relate to the nutritional issues and health challenges that older people face. For example, immune function declines, short-term memory issues might arise, and slight reductions in height may occur. Other changes include a decline in hormone production (e.g., testosterone, estrogen, growth hormone), muscle mass, and strength. In addition, the heart has to work harder because each pump is not as efficient as it used to be; kidneys are not as effective in excreting metabolic products such as sodium, acid, and potassium, which can alter water balance and increase the risk for over- or underhydration; and there is lower efficiency in the absorption of vitamins and minerals. Many older adults suffer from serious health conditions, such as cardiovascular disease and cancer. Being either underweight or overweight is also a major concern for older adults. However, older adults can remain in relatively good health and continue to be active. Good nutrition is often the key to maintaining health later in life. In addition, the fitness and nutritional choices made earlier in life set the stage for continued health. Older adults should continue to consume nutrient-dense foods and remain physically active. However, deficiencies are more common after age sixty, primarily due to reduced intake or malabsorption. The loss of mobility among frail, homebound elderly adults also impacts their access to healthy, diverse foods.

    Energy

    Due to reductions in lean body mass and metabolic rate, older adults require less energy than younger adults. The decrease in physical activity that is typical of older adults also influences nutritional requirements.

    Macronutrients

    The AMDRs for carbohydrates, protein, and fat remain the same from middle age into old age (Table \(\PageIndex{1}\))1. Older adults should try to include unrefined carbohydrates, such as whole grains and brown rice, as fiber is especially important in preventing constipation and diverticulitis, and may also reduce the risk of colon cancer. Protein should be lean, and healthy fats, such as unsaturated and omega-3 fatty acids, are part of any good diet.

    Table \(\PageIndex{1}\): Acceptable Macronutrient Distribution Ranges (AMDRs) for Older Adults
    Macronutrient AMDR
    Carbohydrate 45-65% of total calories
    Protein 10-35% of total calories
    Fat 20-35% of total calories

    Micronutrients

    An increase in certain micronutrients can help maintain health during this life stage. The recommendations for calcium increase to 1,200 milligrams per day for men over the age of 70 and all older adult women to slow bone loss. Also to help protect bones, vitamin D recommendations increase to 20 micrograms per day for men and women over the age of 70. Vitamin B6 recommendations rise to 1.7 milligrams per day for older men and 1.5 milligrams per day for older women to help lower levels of homocysteine and protect against cardiovascular disease. As adults age, the production of stomach acid can decrease; stomach acid is critical for the absorption of vitamin B12; therefore, a decrease in stomach acid can lead to a vitamin B12 deficiency. Because 10-30% of older people may have difficulty absorbing vitamin B12 from food (because of low stomach acid production), it is advisable for those older than 50 years to meet their vitamin B12 recommended intake mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12.1 For older adult women, higher iron levels are no longer needed postmenopause and recommendations decrease to 8 milligrams per day.

    Table \(\PageIndex{2}\): Micronutrient Recommendations for Older Adults
    Nutrient Older Adult Males Older Adult Females
    Vitamin A (mcg) 900 700
    Vitamin B6 (mg) 1.7 1.5
    Vitamin B12 (mcg) 2.4 2.4
    Vitamin C (mg) 90 75
    Vitamin D (mcg) 15 (51-70 years old); 20 (over 70 years old) 15 (51-70 years old); 20 (over 70 years old)
    Vitamin E (mg) 15 15
    Vitamin K (mcg) 120 90
    Calcium (mg) 1,000 (51-70 years old); 1,200 (over 70 years old) 1,200
    Folate (mcg) 400 400
    Iron (mg) 8 8
    Magnesium (mg) 420 320
    Niacin (B3) (mg) 16 14
    Phosphorus (mg) 700 700
    Riboflavin (B2) (mg) 1.3 1.1
    Selenium (mcg) 55 55
    Thiamin (B1) (mg) 1.2 1.1
    Zinc (mg) 11 8

    Nutritional Concerns for Older Adults

    Dietary choices can help improve health during this life stage and address some of the nutritional concerns that many older adults face. In addition, there are specific concerns related to nutrition that affect adults in their later years. They include medical problems, such as disability and disease, which can impact diet and activity level. For example, dental problems can lead to difficulties with chewing and swallowing, which in turn can make it hard to maintain a healthy diet. The use of dentures or the preparation of pureed or chopped foods can help solve this problem. There also is a decreased thirst response in the elderly, and the kidneys have a decreased ability to concentrate urine, both of which can lead to dehydration.

    Sensory Issues

    Around age 60, taste buds begin to decrease in size and number. As a result, the taste threshold is higher in older adults, meaning that more of the same flavor must be present to detect the taste. Many older adults lose the ability to distinguish between salty, sour, sweet, and bitter flavors. This can make food seem less appealing and decrease the appetite. An intake of foods high in sugar and sodium can increase due to an inability to discern those tastes. The sense of smell also decreases, which impacts attitudes toward food. Sensory issues may also affect digestion because the taste and smell of food stimulates the secretion of digestive enzymes in the mouth, stomach, and pancreas.

    Gastrointestinal Problems

    A number of gastrointestinal issues can affect food intake and digestion among older adults. Saliva production decreases with age, which affects chewing, swallowing, and taste. Digestive secretions decline later in life as well, which can lead to atrophic gastritis (inflammation of the lining of the stomach). This interferes with the absorption of some vitamins and minerals (such as vitamin B12). Reduction of the digestive enzyme lactase results in a decreased tolerance for dairy products. Slower gastrointestinal motility can result in more constipation, gas, and bloating, and can also be tied to low fluid intake, decreased physical activity, and a diet low in fiber, fruits, and vegetables.

    Dysphagia

    Some older adults have difficulty getting adequate nutrition because of the disorder dysphagia, which impairs the ability to swallow. Any damage to the parts of the brain that control swallowing can result in dysphagia. Therefore, stroke and dementia are two common causes. To assist older adults suffering from dysphagia, it can be helpful to alter food consistency. For example, solid foods can be pureed, ground, or chopped to allow for a more successful and safe swallowing process. This decreases the risk of aspiration, which occurs when food flows into the respiratory tract and can result in pneumonia. Typically, speech therapists, physicians, and dietitians work together to determine the appropriate diet for dysphagia patients.

    Dysphagia

    This video provides information about the symptoms and complications of dysphagia.

    Obesity in Old Age

    Similar to other life stages, obesity is a concern for older adults. Adults over age 60 are more likely to be obese than young or middle-aged adults. As explained throughout this chapter, excess body weight has severe consequences. Being overweight or obese increases the risk for potentially fatal conditions that can afflict the elderly. They include cardiovascular disease, which is the leading cause of death in the United States, and Type 2 diabetes, which causes over 83,000 deaths in the United States annually.2 Obesity is also a contributing factor for a number of other conditions, including arthritis.

    For older adults who are overweight or obese, dietary changes to promote weight loss should be combined with an exercise program to protect muscle mass. This is because dieting reduces muscle as well as fat, which can exacerbate the loss of muscle mass due to aging. Although weight loss among the elderly can be beneficial, it is best to be cautious and consult with a health-care professional before beginning a weight-loss program.

    The Anorexia of Aging

    In addition to concerns about obesity among senior citizens, being underweight can be a major problem. A condition known as the anorexia of aging is characterized by poor food intake, which results in dangerous weight loss. This major health problem among the elderly leads to a higher risk for immune deficiency, frequent falls, muscle loss, and cognitive deficits. Reduced muscle mass and physical activity mean that older adults need fewer calories per day to maintain a normal weight. It is important for health care providers to examine the causes for anorexia of aging among their patients, which can vary from one individual to another. Understanding why some elderly people eat less as they age can help health-care professionals assess the risk factors associated with this condition. Decreased intake may be due to disability or the lack of a motivation to eat. Also, many older adults skip at least one meal each day. As a result, some elderly people are unable to meet even reduced energy needs.

    Nutritional interventions should focus primarily on a healthy diet. Remedies can include increasing the frequency of meals and adding healthy, high-calorie foods (such as nuts and dried fruits) to the diet. Liquid supplements between meals may help to improve caloric intake. Health care professionals should consider a patient’s habits and preferences when developing a nutritional treatment plan. After a plan is in place, patients should be weighed on a weekly basis until they show improvement.

    Vision Problems

    Many older people suffer from vision problems and a loss of vision. Age-related macular degeneration is an eye disease that can blur the sharp, central vision you need for activities like reading, driving, and cooking; it is the leading cause of vision loss in Americans over age 50.3 This disorder can make food planning and preparation extremely difficult and people who suffer from it often must depend on caregivers for their meals. Self-feeding also may be difficult if an older adult cannot see his or her food clearly. Friends and family members can help older adults with shopping and cooking. Food-assistance programs for older adults (such as Meals on Wheels) can also be helpful.

    Diet may help to prevent macular degeneration. Consuming colorful fruits and vegetables increases the intake of lutein and zeaxanthin. Several studies have shown that these antioxidants provide protection for the eyes.4 Lutein and zeaxanthin are found in green, leafy vegetables such as spinach, kale, and collard greens.

    Neurological Conditions

    Older adults who suffer from dementia may experience memory loss, agitation, and delusions. Experts suggest that more than 5.5 million Americans, most of them age 65 or older, suffer from Alzheimer’s, which is the most common form of dementia.5 These conditions can have serious effects on diet and nutrition as a person increasingly becomes incapable of caring for himself or herself, which includes the inability to buy and prepare food, and to self-feed.

    Longevity and Nutrition

    The foods you consume in your younger years influence your health as you age. Good nutrition and regular physical activity can help you live longer and healthier. Conversely, poor nutrition and a lack of exercise can shorten your life and lead to medical problems. The right foods provide numerous benefits at every stage of life. They help an infant grow, an adolescent develop mentally and physically, a young adult achieve his or her physical peak, and an older adult cope with aging. Nutritious foods form the foundation of a healthy life at every age.

    Key Takeaways

    • As adults age, physical changes impact nutrient needs and can result in deficiencies.
    • Older adults are more susceptible to medical problems, such as disability and disease, which can impact appetite, the ability to plan and prepare food, chewing and swallowing, self-feeding, and general nutrient intake.
    • A nutrient-dense diet can help prevent or support the healing of a number of disorders that impact older adults.

    References

    1. Summary Report of the Dietary Reference Intakes. nationalacademies.org. www.nationalacademies.org/our-work/summary-report-of-the-dietary-reference-intakes. Accessed July 14, 2020.
    2. FastStats - Deaths and Mortality. cdc.gov. https://www.cdc.gov/nchs/fastats/deaths.htm. Accessed July 15, 2020.
    3. Age-Related Macular Degeneration. nei.nih.gov. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/age-related-macular-degeneration. Accessed July 15, 2020.
    4. Carotenoids. lpi.oregonstate.edu. https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/carotenoids#age-related-macular-degeneration-prevention. Accessed July 15, 2020.
    5. Alzheimer's Disease Fact Sheet. nia.nih.gov. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet. Accessed July 15, 2020.
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