22 Nutrition Through the Lifecycle – Older Adults

Learn

  • Nutrient needs for older adults
  • How aging impacts your body
  • Special nutrient concerns in older adults

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.

Older Adults

The older adult or senior years are the periods from age fifty-one until the end of life. Elderly typically refers to adults between the ages of 65-74 years. Several physiological and emotional changes take place during this life stage. For example, many older adults face serious health challenges, such as cancer, heart disease, diabetes, or dementia. Both men and women experience a loss of hormone production, muscle mass, and strength and change body composition. Fat deposits build up in the abdominal area, which increases the risk of Type 2 diabetes and cardiovascular disease. The skin becomes thinner and may take longer to heal after an injury. Around age seventy, men begin to experience bone loss when estrogen and testosterone levels begin to decline. In the later years, the heart has to work harder because it does not pump as efficiently. Kidneys are not effective in excreting metabolic products such as sodium, acid, and potassium, altering water balance and increasing the risk for over-or underhydration. Besides, immune function decreases, and there is lower efficiency in the absorption of vitamins and minerals. Also, disorders of the nervous system can have profound effects. Dementia is the umbrella term for changes in the normal activity of the brain. Elderly adults who have dementia may experience memory loss, agitation, and delusions. One in eight people over age sixty-four, and almost half of all people over eighty-five, suffer from brain disorder Alzheimer’s disease, which is the most common form of dementia. Neurological disorders and psychological conditions, such as depression, can influence attitudes toward food, along with the ability to prepare or ingest food. They might lead some adults to overindulge to compensate for stress or emotions that are difficult to handle. Other adults might eat less or pay less attention to their diet and nutritional needs. Older adults may also need guidance from dietitians and health-care professionals to make the best dietary choices for this stage of life.
 
At age fifty-one, requirements change once again and relate to the nutritional issues and health challenges that older people face. After age sixty, blood pressure rises, and the immune system may have more difficulty battling invaders and infections. The skin becomes more wrinkled, and hair has turned gray or white or fallen out, resulting in hair thinning. Older adults may gradually lose an inch or two in height. Also, short-term memory might not be as keen as it once was. Being either underweight or overweight is also a major concern for the elderly. However, many older adults remain in relatively good health and continue to be active in their golden years. Good nutrition is often the key to maintaining health later in life. Besides, the fitness and nutritional choices made earlier in life set the stage for continued health and happiness.  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 and Macronutrients

Due to reductions in lean body mass and metabolic rate, older adults require less energy than younger adults. The energy requirements for people ages fifty-one and over are 1,600 to 2,200 calories for women and 2,000 to 2,800 calories for men, depending on activity level. The decrease in physical activity that is typical of older adults also influences nutritional requirements. The AMDRs for carbohydrates, protein, and fat remain the same from middle age into old age. Older adults should substitute more unrefined carbohydrates for refined ones, such as whole grains and brown rice. Fiber is essential in preventing constipation and diverticulitis and may also reduce the risk of colon cancer. Protein should be lean, and healthy fats, such as omega-3 fatty acids, are part of any good diet.

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 both men and women to slow bone loss. Also, to help protect bones, vitamin D recommendations increase to 10–15 micrograms per day for men and women. 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 homocysteine levels and protect against cardiovascular disease. As adults age, stomach acid production can decrease and lead to an overgrowth of bacteria in the small intestine. This can affect the absorption of vitamin B12 and cause a deficiency. As a result, older adults need more B12 than younger adults and require an intake of 2.4 micrograms per day, promoting healthy brain functioning. For older women, higher iron levels are no longer needed postmenopause, and recommendations decrease to 8 milligrams per day. People over age fifty should eat foods rich in all of these micronutrients.

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. Also, 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. Decreased intake may be due to disability like arthritis where the person cannot stand at the stove, open a jar/can, or use a knife to chop foods.  Also, many older adults skip at least one meal each day. As a result, some older adults are unable to meet even reduced energy needs. Additionally, older adults have a decreased thirst response, and the kidneys have a decreased ability to concentrate urine, both of which can lead to dehydration.

Sensory Issues

At about age sixty, 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 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 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 stimulate digestive enzymes’ secretion in the mouth, stomach, and pancreas.

Loss of Teeth

Dental problems can lead to chewing and swallowing difficulties, making it hard to maintain a healthy diet. The use of dentures or the preparation of pureed or chopped foods can help solve this problem.

Difficulty Swallowing Foods

Some older adults have difficulty getting adequate nutrition because of the disorder dysphagia, which impairs swallowing. Any damage to the brain’s parts that control swallowing can result in dysphagia; therefore, stroke is a common cause. Dysphagia is also associated with advanced dementia because of overall brain function impairment. 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 a more successful and safe swallow. 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.

Vision Problems

Many older people suffer from vision problems and a loss of vision. Age-related macular degeneration is the leading cause of blindness in Americans over age sixty. 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 protect the eyes. Lutein and zeaxanthin are found in green, leafy vegetables such as spinach, kale, collard greens, corn, peaches, squash, broccoli, and Brussels sprouts, orange juice, and honeydew melon.

Anemia

Iron poor diets and chronic disease can lead to anemia in older adults. Other health issues like ulcers, decreased stomach acid, or intrinsic factors to properly absorb vitamin B12 can also contribute.

Signs and Symptoms of Anemia

  • Fatigue
  • Shortness of breath
  • Feeling cold
  • Confusion
  • Depression
  • Dizziness or weakness
  • Brittle or spoon-shaped nails
  • Experience a change in how foods taste
  • Headache
  • Sore tongue
  • Pale colored skin
  • Dry and easily bruised skin
  • Restless legs syndrome
  • Fast heartbeat

Eating iron-rich foods like red meat, pork, poultry, seafood, beans, dark leafy green vegetables can help maintain iron stores in the body.

Constipation

According to the National Institute of Health, in people aged 65, about 26% of women and 16% of men suffer from constipation. The rate continues to increase as we age. For 84 years and older, rates rise to 34% for women and 26% for men.  Constipation can be a side effect of medication, low fluid intake, low activity, or a low fiber diet, and many times it is a mix of some or all of these issues. If not properly addressed, these issues can lead to an intestinal blockage.

Osteoporosis

The importance of having adequate calcium stores early in life impacts our risk of fractures later in our elderly years. Many elderly with osteoporosis who fall and break a hip never recover fully. Approximately 15% die within one year due to complications as their health further declines due to the injury.  The elderly need to continue to participate in strength bearing exercises and get adequate amounts of Vitamin D and calcium to help support bone health.

Polypharmacy

The use of five or more prescription drugs per day is referred to as polypharmacy. Most older adults average 2-9 medications per day. With each medication comes side effects such as decreased appetite, dizziness, fatigue, taste alterations, excretion of certain vitamins and minerals. Additionally, the elderly are at a higher risk for drug interactions due to their body’s ability to metabolize and clear the drugs from their body.

Obesity

Obesity is a concern for the elderly. Adults over age sixty are more likely to be obese than young or middle-aged adults. Being overweight or obese increases the risk of cardiovascular disease, which is the leading cause of death in the United States. Type 2 diabetes causes about seventy thousand deaths in the United States annually. Obesity is also a contributing factor for many 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 and fat, which can exacerbate muscle mass loss due to aging. Although weight loss among the elderly can be beneficial, it is best to be cautious and consult with a healthcare professional before beginning a weight-loss program.

 

Learning Objectives

  • Identify key nutrients for older adults. (MCCCD Competency 4)
  • Explain age-related changes within the body that could negatively impact health. (MCCCD Competency 4)
  • Discuss special nutritional concerns associated with older adults. (MCCCD Competency 3)

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Nutrition Essentials by Stephanie Green and Kelli Shallal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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