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Nutrition Through The Ages: Older Adults

Although the body of an older adult is often characterized as when body systems begin to slow down - muscle mass, bone mass, and muscle strength can be linked to an individual's continued physical activity (both strength training and aerobic). In this series, we've discussed how growth and development is no longer a focus for our bodies once we are in young adulthood and subsequently, our bodies experience the onset of aging (where lifestyle choices, environment, genetics, and increasing age all merge together overshadowing the physical advantages of youth) in adulthood.


Just like with adults, aging and older adulthood doesn't automatically equal poor health, but achieving and sustaining health does require more effort. Degeneration of our bodies as we age can be attributed [in many instances] to low physical activity and poor nutrition. Additionally it must be mentioned, "social isolation and loneliness" not only impacts our mental health and cognitive abilities, research indicates the impact on our physical health as well (high blood pressure, heart disease, etc.). And while the older adult population is especially susceptible to social isolation, those "who engage in meaningful, productive activities with others tend to live longer, boost their mood, and generally maintain their well-being (simultaneously improving their cognitive function) (NIH.gov).


Connection and purpose is key - and it's not just true for older adults.


[For the purposes of this series, ages 65 and up fall into this stage of life.]


Lower Energy Needs & Nutritional Status

With basically every age group discussed in this series, it's been noted how caloric intake guidelines are just that, guidance. Actual intake should be based upon individualized need and this is especially true for this age group. Many older adults have lower energy needs (compared to their OWN previous energy needs as adults). This is mostly due to a decrease in physical activity, but it is also connected to muscle mass and lean tissue loss.


Physiological Changes - How The Body Functions

So what exactly is changing when it comes to consumption and digestion as we age, and how might those changes impact our nutrient needs? Food intake and nutritional status can decline when our taste, touch, vision, and smell receptors no longer function in the way we've used them.

  • Vision changes impact our ability to read food labels, set temperature and time settings when cooking, and decrease our access to foods if driving is no longer possible. AND, vision changes can decrease the visual appeal that comes with advertisements, restaurant menus, and product packaging that can influence our desire to eat.

  • Oral health changes (loss of teeth, ill fitting dentures) can make eating both difficult and unenjoyable.

  • Changes in gut bacteria can occur with age (and with certain medications), and this can mean less diversity of bacteria plus an increased prevalence of pathogenic bacteria (instead of beneficial bacteria). Read more about the importance of a healthy gut biome.

  • Changes in satiety/hunger hormones can make it difficult to WANT to eat.

  • Changes in digestive enzymes can decrease the body's ability to absorb nutrients.

  • Intestinal motility changes can decrease the body's ability to properly digest proteins, fats, and carbohydrates.


Here are some specific changes that can also impact the ability to consume foods as needed:


Anosmia

  • loss of smell, can occur with age (as early as 70)

  • may be related to loss of nerve endings and diminished mucus production

  • impacts how we taste foods

  • may not be able to detect when foods have gone bad

  • may be connected to a zinc deficiency (and is treatable in this case)

Dysgeusia

  • abnormal taste perception

  • often caused by medication side effects, oral health problems, and other sickness

  • may cause perception of food blandness and over-salting of foods

  • may cause diminished sweet and sour taste receptors

Xerostomia

  • dry mouth (excessive)

  • due to decreased salivary production

  • makes chewing and swallowing more difficult

  • moist foods, fruits & veggies, sauces and gravies can help with this

Dysphagia

  • difficulty swallowing

  • commonly caused by stroke, dementia, location dependent cancers, Parkinson's, and neurological disorders

  • can lead to malnutrition

  • avoid multi-textured foods and focus on smooth, thick foods like cream soups, milkshakes, etc.

Achlorhydria

  • reduction or inability to produce gastric acid

  • causes diminished absorption of minerals (calcium, iron, zinc) as well as Vitamin B12 and Folic Acid

  • creates an opportunity for bad bacteria to flourish (since the acid is not present enough to intercept)

  • can be caused by long-term medication use (proton pump inhibitors)

 

Macronutrients

Macronutrients are the nutrients the body requires in large amounts. They are what makes up our total caloric intake.


Carbohydrates

  • NEEDED FOR: Carbohydrates are the brain’s primary choice for energy.

  • NOTE: Zero-carb and very low-carb diets are NOT suggested for older adults.

  • AMOUNT: 45 to 65% of total intake

  • FOODS TO EAT: Complex carbs (whole grains, vegetables, lentils, peas and beans), but also nutrient-rich simple carbs like fruits and 100% fruit juice.

Fats

  • NEEDED FOR: Dietary fats support normal brain functions. Fat also helps cushion and insulate the body, and it supports many body processes.

  • NOTE: Fats are needed to absorb some vitamins (A, D, E, K).

  • AMOUNT: 20 to 35% of total intake

  • FOODS TO EAT: Unsaturated fats (avocados, peanut butter, almonds, walnuts, olive oils, peanut oils, canola oils, flax seed, and salmon). Limiting trans fats is suggested.

Protein

  • NEEDED FOR: Protein is necessary to repair cells and make new ones.

  • NOTE: Older adults process protein less efficiently, and thus may require more of it (spread throughout the day).

  • AMOUNT: 10 to 35% of total intake

  • FOODS TO EAT: Lentils, nut butter, hummus, oatmeal, whole wheat products, salmon, fish sticks, eggs, turkey lunch meat, yogurt, mozzarella string cheese, and even veggies like peas, broccoli, and potatoes.

  • NUTRITION TIP: Spread out protein intake throughout the day. Consuming a large amount at one time does NOT provide extra benefits.

Calories

*Not a macronutrient, but worth including here.

  • NEEDED BECAUSE: Calories are the fuel our bodies require to survive.

  • NOTE: Caloric need is LARGELY dependent on activity level.

  • NUTRITION TIP: Caloric need can typically be determined by your body's needs by listening to hunger and fullness cues; HOWEVER older adults may need to set a schedule and/or calorie count to meet their needs due to physiological changes (described above).


 

Micronutrients

Micronutrients are the nutrients the body requires in small amounts. Although they are recommended in smaller amounts compared to macronutrients, they are equally essential. The following are a few notable needs for this age group:


B Vitamins (B6, B12, Folate)

  • NEEDED FOR: B12 is needed to convert food into energy, red blood cell formation and nervous system function. Folate is needed for red blood cell formation and metabolizing protein. B6 is needed to maintain blood levels.

  • NOTE: There is an increased susceptibility for B6, B12, and folate deficiencies in older adults as they become harder to be absorbed

  • NUTRITION TIP: B12 is found in animal products (dairy, eggs, meat, poultry, seafood) or FORTIFIED products. Folate is found in green stuff (leafy greens, asparagus, avocado, peas, broccoli, brussels sprouts, etc.). In general though, beans, ENRICHED grains, fruits, and veggies are decent sources too. B6 is found in fish, organ meats, and starchy veggies.

Calcium

  • NEEDED FOR: Calcium promotes bone structure. Can help reduce the onset of bone loss in upper ages.

  • NOTE: Bone density is nutritionally connected to calcium and vitamin D intake. Read more about bone density below.

  • NOTE: Amount needed for women increases earlier than it does for mem.

  • NUTRITION TIP: Dark green veggies are a good source of calcium. Some 70% of calcium needs are met through dairy products. Calcium-fortified orange juice, milk alternatives, supplements, etc. can replace dairy.

Vitamin D

  • NEEDED FOR: An increased need of vitamin D is important to reduce Osteoporosis risk and because there is a decreased ability to synthesize vitamin D as we age.

  • NOTE: Bone density is nutritionally connected to calcium and vitamin D intake. Read more about bone density in Nutrition Through The Ages: Adolescence.

  • NUTRITION TIP: Vitamin D is a fat soluble vitamin which means fat is required to enable absorption of the vitamin through the diet.

Iron

  • NEEDED FOR: Iron is needed for energy production, muscle development, and wound healing.

  • NOTE, WOMEN: Iron needs DECREASE during this stage of life due to reduced muscle mass and cessation of menstruation.

  • NUTRITION TIP: Good sources of heme iron (animal proteins) are lean meats, fish, and poultry. Non-heme iron sources are primarily plant based (peanuts, lentils, peas, and beans, greens and fortified foods), but also include some animal proteins like egg yolks.

  • NUTRITION TIP: Vitamin C is suggested at the same meals when consuming non-heme iron sources as this will help increase absorption.

Vitamin C

  • NEEDED FOR: Vitamin C is needed for immunity and may lower risk of hypertension and other age-related macular degeneration

  • NOTE: Vitamin C is a well-known antioxidant that enhances immune functions.

  • NUTRITION TIP: Vitamin C is highly unstable. It is impacted by both oxygen exposure and heat. If the goal is retain as much Vitamin C as possible, avoid cooking veggies at high heat for long periods of time. Similarly, when exposed to oxygen, Vitamin C loses its potency. Avoid pre-peeling oranges and pre-cutting strawberries. Don't let fruit juices sit out uncovered for long periods of time,

Vitamin E

  • NEEDED FOR: Vitamin E, like Vitamin C, is an integral antioxidant that is essential for immune functionality.

  • NOTE: Vitamin E deficiencies are rare (thanks largely to fortified foods), and typically only show in extreme cases of malnutrition.

  • NUTRITION TIP: Greens, peanut butter, and fortified foods are great sources.

Fiber

*Not a micronutrient, but worth including here.

  • NEEDED FOR: At a minimum, fiber is needed for digestive health. Looking at the big picture, fiber efficiently assists in the removal of waste from our body and provides nourishment for the gut microbiome, both of which greatly impact our overall health.

  • NOTE: Over half of all adults do not meet fiber recommendations. Fiber recommendations for older adults are 21grams/day for women and 30grams/day for men.

  • NOTE: Soluble fiber absorbs water as it moves through the digestive tract. It slows digestion which helps us absorb nutrients. Soluble fiber helps reduce cholesterol, lower heart disease risk, and maintain appropriate blood sugar levels. Insoluble fiber is not digested. It helps food move through our system faster by "adding bulk" and it scrubs our intestines as it moves through.

  • NUTRITION TIP: Fruits, veggies, and whole grains are excellent sources of both kinds of fiber.

 

Additional Nutrition Related Considerations

Supplementation

What & Why

  • Reaching RDA (Recommended Dietary Allowance) for some nutrients through food alone may become more difficult due to above mentioned physiological changes.

  • Single nutrient supplementation (B12, Vitamin C, Calcium, Vitamin D) may be prescribed at this age

Tips

  • Take care to avoid megadosing. Too much Vitamin C can cause diarrhea. Too much Vitamin D is toxic. Iron accumulates in the liver.

  • Vitamin A potency is impacted by alcohol consumption.

Drug/Nutrient Interactions & Polypharmacy

What & Why

  • Numerous medications are known to alter nutrient digestion and absorption.

  • Polypharmacy - the simultaneous use of multiple drugs (more than five) to treat the same condition OR multiple conditions. Polypharmacy is often associated with a decrease in nutritional status. This may be due to medication side effects reducing appetite and leading to malnutrition or it could be associated with how the medications impact the body. Read more about polypharmacy.

Tips

  • Long-term antibiotic use can cause diarrhea and nutrient malabsorption (Calcium specifically impacted)

  • Warfarin/Coumadin is impacted by excess Vitamin A

  • Ibuprofen and Tylenol are both prescribed for headache and muscle and joint aches. They should not be combined with alcohol.

  • Follow guidance on medications to be taken with meals or in between meals so as not to disrupt nutrient absorption.

  • Grapefruit is notorious for impacting medication absorption and effectiveness.

Food Insecurity

What & Why

  • Not having access to sufficient food, or food of an adequate quality, to meet one's basic needs.

  • Inability to rely on adequate food intake to lead a healthy and active life.

  • Food insecurity does NOT only impact those who are low income. Decreased mobility, functional impairment, health problems, purpose and a minimal social network all contribute to food insecurity.

Food Access Resources for Older Adults

Watch Companion Video Here!



Other Nutrition Through The Ages Posts!


Resources

“Dietary Supplements: Vitamins and Minerals – 9.338.” Extension, https://extension.colostate.edu/topic-areas/nutrition-food-safety-health/dietary-supplements-vitamins-and-minerals-9-338/. Accessed 26 Oct. 2022.


“Food Insecurity in Older Adults: Much More than Food - Understanding It before Taking Action.” MOJ Gerontology & Geriatrics, vol. Volume 6, no. Issue 2, Mar. 2021. medcraveonline.com, https://doi.org/10.15406/mojgg.2021.06.00264.


Graham, Judith. “Why Older Adults Should Eat More Protein (And Not Overdo Protein Shakes).” KFF Health News, 17 Jan. 2019, https://kffhealthnews.org/news/why-older-adults-should-eat-more-protein-and-not-overdo-protein-shakes/.


Healthy Eating for Adults | MyPlate. https://www.myplate.gov/tip-sheet/healthy-eating-adults#:~:text=Fruits%2C%20vegetables%2C%20whole%20grains%2C,lentils%2C%20nuts%2C%20and%20eggs. Accessed 3 May 2023.


“How to Keep Your Bones Healthy.” Mayo Clinic, https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060. Accessed 9 July 2022.


How You Can Prevent Chronic Diseases | CDC. 23 May 2022, https://www.cdc.gov/chronicdisease/about/prevent/index.htm.


Interactive Nutrition Facts Label.

https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/vitamins.cfm. Accessed 29 Mar. 2022.



“Social Isolation, Loneliness in Older People Pose Health Risks.” National Institute on Aging, 23 Apr. 2019, https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks.


Soluble vs. Insoluble Fiber: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/002136.htm. Accessed 24 Oct. 2022.


The National Council on Aging. https://ncoa.org/article/navigating-social-isolation-and-loneliness-as-an-older-adult. Accessed 17 May 2023.


The National Council on Aging. https://ncoa.org/article/what-is-food-insecurity-get-the-facts. Accessed 17 May 2023.

Thompson, Janice, et al. The Science of Nutrition. 2nd ed., Student ed, Pearson Benjamin Cummings, 2011.


Vitamins and Supplements – The Benefits of Food First - Dana-Farber Cancer Institute | Boston, MA. https://www.dana-farber.org/health-library/videos/vitamins-and-supplements-%E2%80%93-the-benefits-of-food-first/. Accessed 26 Oct. 2022.


Why It Matters | Nutrition | CDC. 25 Jan. 2021, https://www.cdc.gov/nutrition/about-nutrition/why-it-matters.html.



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