Nutrition for older people
In developing countries children suffer most of the malnutrition. In developed countries it is the elderly who are most at risk of nutritional deficiency, though this is usually mild or subclinical and often associated with other disease(s). But it is very misleading to lump everyone over 65 together and expect them all to show the same problems and diseases.
Healthy older people who are socially integrated are no more likely to get into nutritional trouble than anyone else.
For the majority people most of their life after 65 should be healthy and enjoyable. This “third age” is a time when people want to look after their health. They can now give more attention, time and money to getting and keeping healthy. They can take plenty of gentle exercise, have none of the stress of the workplace, few deadlines, and plenty of rest, and have time to choose food carefully and prepare it nicely. The dietary guidelines for younger adults all apply after retirement.
A nutritious diet from a variety of foods is more important than when people are younger because the total energy intake is usually smaller than in young adults. The number of calories needed is less but not the requirements for most essential nutrients.
To be light in weight eases the load on osteoarthritic joints and ageing heart and lungs and reduces the risk of accidents. Judicious regular exercise is much better than food restriction.
Cut down on fat, especially saturated fat. Fat supplies more empty calories than any other dietary component. It predisposes to thrombosis, raised plasma cholesterol, and atherogenesis.
Eat plenty of bread and cereals (preferably wholegrain) and vegetables and fruits; older people are liable to constipation, and a good intake of fibre will help to control this.
Limit alcohol consumption. The smaller liver cannot metabolise as much alcohol as in young adults and the consequences of falls or accidents are more serious. No more than one or two drinks a day.
Cut down on salt and salty foods. They tend to raise blood pressure; salt sensitivity increases with age and hypertension predisposes to strokes.
Avoid too much sugar because of the empty calories, but dental caries is less troublesome in surviving mature teeth.
With ageing (from 20-30 to over 70 years)
Risk factors for impaired nutrition in older people
Social risk factors
- average body weight goes down after middle age (partly because of selective mortality of obese people)
- lean body mass declines from average 60 to 50 kg in men and 40 to 35 kg in women
- there is a loss of height and of mass of the skeleton
- muscle mass declines from about 450 g/kg to 300 g/kg
- body density goes down from 1.072 to 1.041 in men and from 1.040 to 1.016 in women
- body fat (as % of body weight) increases from about 20% to 30% in men and from 27% to 40% in women. It becomes more central and internal
- liver weight falls from about 25 g to 20 g/kg body weight
- basal metabolic rate goes down proportionally with lean body mass.
Immobility (no transport).
Medical risk factors
Cancer and radiotherapy.
Chronic bronchitis and emphysema.
Some common drugs that can lead to malnutrition
Aspirin and NSAIDs --> blood loss, so iron deficiency. NSAIDs - non-steroidal anti-inflammatory drugs
Digoxin --> lowers appetite.
Purgatives --> potassium loss
Cancer chemotherapy --> anorexia
Many diuretics --> potassium loss
Metformin --> vitamin B-12 malabsorption
Co-trimoxazole --> can antagonise folate.
Some suggested extra dietary guidelines for older people
Women especially should keep up a good intake of calcium from (low fat) milk or cheese, or both. This may help to delay osteoporosis.
Those who are housebound or do not get out regularly should take small prophylactic doses of vitamin D.
Elderly people should avoid big meals. On the other hand, they should not miss any of the three main daily meals.
Old men have little warmth and they need little food which produces warmth; too much only extinguishes the warmth they have.
Coffee or tea in the evening may contribute to insomnia.
There is a place for fatty fish or small amounts of fish oils containing fatty acids like eicosapentaenoic acid, which can reduce the risk of thrombosis.
Nutrients most likely to be deficient in old people are (roughly in order of importance)
total energy—thinness, wasting, under nutrition
potassium—deficiency can present with confusion, constipation, cardiac arrhythmias, muscle weakness, etc
folate—deficiency can present with anaemia or with confusion
vitamin B-12—because of gastric atrophy. Serum methylmalonate may be elevated before vitamin B-12 is low
vitamin D—deficiency can present with fractures or bone pains of osteomalacia
water—frail old people may not drink enough, which can lead to urinary tract infection or dehydration
dietary fibre—deficiency leads to constipation
vitamin C—low plasma concentration, haemorrhages
protein—low plasma albumin, oedema
calcium—low intake; decreased bone density
zinc—low plasma concentration
thiamin—biochemical features of deficiency (red cell transketolase)
magnesium—low plasma concentration
pyridoxine—biochemical features of deficiency.
Only rarely are low intakes of nutrients and abnormal laboratory findings associated with a disturbance of function that would support the diagnosis of clinical malnutrition. The usual finding can best be called subclinical deficiency, and we are often not sure of its clinical importance. It is prudent to attempt to raise the level of nutrients to make people with subclinical deficiency more resistant to the effects of stress caused by non-nutritional diseases, which become increasingly common with advancing years.
General practitioners, with the younger family members or a friend, district nurse, or social worker can improve an old person’s nutrition in several ways:
suggest cooking lessons for retired men
arrange help for partly disabled people to adapt cooking techniques
organise delivery of heavy shopping
suggest (where one is absent) buying a refrigerator or freezer
ensure that every elderly person or couple has an emergency food store
suggest that a younger relative helps with shopping and invites the elderly person for a regular good meal
arrange for him or her to attend a lunch club
arrange for meals on wheels
possibly prescribe micronutrient supplements, but some multivitamin tablets do not contain them all (some miss folic acid) and there may be more need for potassium
build on established eating patterns when advising about changing food consumption; drastic changes are likely to confuse
warn that reduced sense of smell and sight make it hard to detect food that is no longer wholesome.