Nutrition for Older Adults

Author:  Frank W. Jackson, M.D.

Purpose

Some things you never outgrow–like your need for healthful eating. Good nutrition is important at every stage of life, from infancy through late adulthood. The basics of a balanced diet remain the same but individual nutritional needs change as you grow older. No matter what your age, it is never too late to start living a healthier life.

Whether you are 50 or 85, active or homebound, your food choices will affect your overall health in the years ahead. The risk for certain diseases associated with aging such as heart disease, osteoporosis and diabetes can be reduced with a lifestyle that includes healthy eating. Good nutrition also helps in the treatment and recovery from illness. While healthy living can’t turn back the clock, it can help you feel good longer.

Eating healthfully means consuming a variety of good foods each day. Food provides the energy, protein, vitamins, minerals, fiber and water you need for good health. For one reason or another your body may not be getting the right amounts of these nutrients.

There are several factors that indicate an increased risk for poor nutrition. If you have three or more of the risk factors listed below consult with a physician or registered dietitian:

  • ill health
  • poor eating habits
  • unexpected weight gain or loss
  • taking medications
  • poor dental health
  • economic hardship
  • loneliness and lack of social contacts
  • the inability to care for yourself

Nutrition Facts

Older adults need the same nutrients as younger people, but in differing amounts. As you get older, the number of calories needed is usually less than when you were younger. This is because basic body processes require less energy when there is a decline in physical activity and loss of muscles. However, contrary to popular belief, basic nutrient needs do not decrease with age. In fact, some nutrients are needed in increased amounts. The challenge is to develop an eating plan that supplies plenty of nutrients but not too many calories.

This can be done by choosing nutritious foods that are low in fat and high in fiber like whole grain breads and cereals, fruits and vegetables. Also be sure to include moderate amounts of low-fat dairy products and protein foods like meat, poultry, fish, beans and eggs. Sweets and other foods high in sugar, fat and calories can be enjoyed from time to time but the key is to eat them sparingly.

The Food Guide Pyramid is a great guide for your daily food choices. Calorie needs vary depending on age and activity level but for many older adults 1600 calories each day will meet energy needs. Chosen carefully those 1600 calories can supply a wealth of nutrients. The recommended number of daily servings from each group in the Food Guide Pyramid, with a few additions of fats, oils and sweets, will easily add up to 1600 healthful calories.

Calcium is important at any age and may need special emphasis as you grow older. Calcium is a mineral that builds strong bones and helps prevent osteoporosis. Many older adults don’t eat enough calcium rich foods and the aging body is less efficient in absorbing calcium from food. In addition, many adults don’t get enough weight bearing exercise like walking to help keep bones strong.

It is not too late to consume more calcium and reduce the risk of bone fractures. Eat at least 2-3 servings of calcium rich foods everyday. Low-fat milk, yogurt and cheese are good choices. Some dark green, leafy vegetables, canned salmon with edible bones, tofu made with calcium sulfate, and calcium fortified soy milk can add a significant amount of calcium to your diet. In addition, do some weight bearing exercise like walking for a total of 30 minutes each day.

The National Institutes of Health advise adults over 65 to consume 1500 mg of calcium daily. This amount may be difficult to achieve through food alone so for some people a calcium supplement is a wise choice. If you do take a supplement, take it between meals. Calcium can hinder the absorption of iron from other foods.

One Serving Equals
Grain Milk, Yogurt, and Cheese
1 slice of bread
1/2 bagel or hamburger bun
1 ounce ready-to-eat cereal
1/2 cup cooked pasta or rice
5-6 small crackers
1 cup milk or yogurt
1.5 ounces natural cheese|
2 ounces process cheese
Fruits and Vegetables Meat, Poultry, fish, Dry Beans, Eggs and Nuts
1 cup raw, leafy vegetables
1/2 cup cooked, chopped or canned
3/4 cup juice
1 medium
1-3 ounces cooked lean meat, poultry or fish
1 ounce of meat equivalents:
1/2 cup cooked cry beans
1 egg or 2 egg whites
2 tablespoons peanut butter
1/3 cup nuts
Can Food Do It ALL?
Yes, food can provide an adequate diet and the pleasures of eating too. But for those who are unable or unwilling to eat a healthy diet a multivitamin and mineral supplement is a good way to get all the needed vitamins and minerals. The guideline is to get enough without getting too much. Look for a supplement that provides about 100% of the RDA. Physicians regularly prescribe supplements for certain health conditions. It is not a good idea to take mega-doses without first discussing it with your physician. Beware of supplements that claim to be magic or promise miracle cures. Taking unproven remedies in place of well-proven treatments could make your health worse in the long run.

Vitamin D protects against bone disease by helping deposit calcium into bones. Known as the sunshine vitamin, it is made within the skin by exposure to the sun’s ultraviolet rays. Only 20 to 30 minutes of sunlight on the hands or face two to three times per week will provide enough vitamin D. However, dark skinned people do not make vitamin D from sunlight so they must get it from food sources. Food sources of vitamin D include fortified milk and cereals. Look for it on food labels.

Vitamin C helps your body absorb iron from plant sources of food. Most people who follow the guidelines of the Food Guide Pyramid consume enough vitamin C. Poor eating habits or smoking can contribute to low levels of vitamin C. A lack of vitamin C can cause bleeding gums, delay wound healing and contribute to low levels of iron. The most effective way to increase vitamin C is to eat citrus fruits, melons, tomatoes, green peppers and berries.

Sodium is found naturally in foods such as milk, seafood and eggs. Processed foods such as tomato juice, frozen dinners, canned soups, canned fruits and canned vegetables are high in added sodium. People with high blood pressure and certain types of heart disease may be advised by their physicians to reduce the amount of sodium in their diets. For healthy adults, the American Heart Association recommends not more than three grams (3000 mg) of sodium each day. One and a half teaspoons of salt is equal to 3000 mg of sodium, so go lightly with the salt shaker.

Special Considerations

The ability to smell and taste may decline gradually with age. When the sense of smell becomes dulled, it affects the sense of taste and makes food less appetizing. Also, some medications may leave a bitter taste, which affects saliva, giving foods a bad flavor. Smoking reduces the ability to enjoy flavors too. Poor eating habits can result when food just doesn’t taste as good as it used to.

To compensate for the loss of smell and taste, create meals that appeal to all the senses. Intensify the taste, smell, sight, sound and feel of foods. Perk up flavors with herbs, spices and lemon juice rather than relying solely on salt or sugar. Choose foods that look good and have a variety of textures and temperatures. Try new ideas. Use garlic and seasoning on foods, add a new texture like crushing crackers in soup, or change the temperature like serving applesauce warm with cinnamon.

Safety in the Kitchen
With age may come a variety of physical difficulties that can interfere with food preparation and eating. Older adults may experience a decrease in stamina and physical strength or deal with the challenges of arthritis, deafness or failing vision. Following are some suggestions to make food preparation and eating less of a challenge or risk to safety.

  • Wear flat, rubber soled shoes in the kitchen and wipe up spills immediately so you don’t slip.
  • Remove throw rugs from the kitchen to prevent falls.
  • Sit while working at the kitchen table, or use a stable stool when working at the stove or counter.
  • Organize the kitchen so everything is within easy reach. Keep appliances out on the counter and store heavy pans on lower shelves. Use a rolling tea cart to move food and dishes from kitchen to table.
  • Use a loud timer to avoid overcooking and potential fires, especially if you have trouble hearing or tend to be forgetful.
  • Keep a magnifying glass handy to read the small print on packages or recipes.
  • Keep the cordless phone nearby while you cook for safety and convenience. If you do fall or have an emergency you can call for help.
  • Check with your physician or a medical supply store for adaptive kitchen devices. Utensils with specially designed handles, an all-in-one fork and spoon and cutting boards with spikes to hold foods in place can make food preparation and eating easier for people with arthritis or other physical limitations.

Dry mouth is another problem faced by many older adults. When it feels like your mouth is filled with cotton balls and your lips are parched and cracked, food just doesn’t taste good. It can be difficult to chew and swallow because of a lack of saliva. Dry mouth is a potential side effect of many medications such as drugs to lower blood pressure or treat depression. It may also be a symptom of cancer or kidney failure.
To relieve dry mouth discomfort, watch out for spicy foods that irritate the lips and tongue. Eat soft foods that have been moistened with sauces or gravies. Try sucking on hard candies or popsicles and drink plenty of fluids. A room humidifier may help by moistening the air. It will also help to breathe through your nose–not your mouth.

Tooth loss or mouth pain can be an obstacle to good eating. Generally, people who wear poorly fitting dentures chew 75% to 85% less efficiently than those with natural teeth. Dentures should be adjusted for a proper fit. Softer foods are easier to chew. Drinking plenty of water or other fluids with meals may make swallowing easier. Good dental care (brushing, flossing, regular check-ups) will help keep teeth and gums healthy.

Many older adults say they just aren’t hungry. There are many factors that influence appetite including digestive problems, certain medications, depression or loneliness. To encourage eating and appetite, keep portions small, allow plenty of time to dine, eat smaller meals more often, prepare attractive meals, play dinner music, eat meals with friends, and increase physical activity where possible. Consult a physician if the lack of appetite results in unwanted weight loss.

Constipation can be a chronic problem for many older adults. It can be caused by not getting enough fiber or fluids and by being physically inactive. To stay regular and avoid the strain of constipation engage in physical activity, drink plenty of fluids and eat fiber rich foods such as whole grain breads and cereals, legumes, vegetables and fruit. Fiber gives bulk to stools and fluids help keep stools softer making them easier to eliminate.

Some older adults have trouble digesting milk, even if it wasn’t a problem in their younger years. The small intestine may no longer be producing the enzyme lactase which breaks down the natural sugar, called lactose, in milk. When the lactase enzyme is missing you may experience bloating, abdominal cramps and diarrhea. Tolerance to lactose is variable. Try eating smaller amounts of these foods, eating them during a meal instead of alone or having them less often (perhaps every other day). Lactose-reduced and -free products are now available. Look for them in your supermarket. Also, the lactase enzyme is available in tablets or drops that can be added to milk before drinking. Follow the specific directions found on the packages.

Quick and Easy Eating
Here are some suggestions if you don’t have the time or inclination to cook good meals:

  • Plan meals in advance.
  • Stock up on ready to eat cereals and instant oatmeal for a quick breakfast.
  • Fill the refrigerator with ready to eat foods such as baby carrots, fresh fruits and vegetables, prewashed and cut salad ingredients in a bag, cheese and low-fat yogurt or pudding.
  • Cook ahead. Prepare stews, soups, casseroles or roasts in large quantities. Package in small containers and freeze the leftovers for reheating later.
  • Bring snacks with you as you dash around town. Take a bagel with a favorite spread. Try low-fat crackers, ginger snaps, vanilla wafers, juice boxes, crisp vegetables and dried or fresh fruits.
  • Keep a few frozen dinners and entrees on hand for quick cooking. A microwave oven can lessen the cooking time. While some pre-packaged foods are high in fat, salt and sugar, there are many good choices available. Read the food label.

Medications and older age often go together. Medications improve health and quality of life but some can profoundly affect nutritional needs. Be sure to consult with the physician or pharmacist as to specific instructions concerning food-drug interactions and directions on when and how to take medications.

Part of the pleasure of eating is in socializing with others. Many older adults who live alone may find mealtimes boring or depressing. Put some fun back into eating by getting together with friends for weekly or monthly potluck dinners. Look for a senior center in your community. This is a great way to meet old and new friends and many have programs that offer a midday meal on weekdays. Take advantage of early bird specials or senior discounts at restaurants and don’t hesitate to take home a ‘doggie bag’. Invite a friend to lunch at your home. Join a community service club or organization. Many of these groups plan social activities which often include getting together for meals. When home alone, make eating a special event with candles, tablecloth, music and something delicious to eat.

Look to local agencies for help for older adults who find it hard to cook their own meals or get out of the house. Meals-On-Wheels programs provide food for people who are homebound. Home health care organizations can provide aides who will shop and prepare meals for older disabled adults. Some local churches or community groups have volunteers who will help older adults with shopping and food preparation.

A Day of Good Nutrition Sample Menu
Breakfast

Bread

Vegetables

Fruit

Milk

Meat

Fluids

1 oz. whole grain cereal

1

1 cup 1% milk 1 1
1 banana

1

coffee or tea

1

Mid Morning
6 oz. tomato juice

1

3/4

1/2 raisin bagel

1

Lunch
Sandwich
2 oz. lean ham

1

on whole wheat

2

lettuce and tomato

1

1/4 cantaloupe

1

2 graham crackers

1

iced tea

1

Mid Afternoon
8 oz low fat yogurt 1
1 glass water 1
Dinner
3 oz broiled chicken breast 1
1/2 cup rice

1

1/2 cup cooked carrots

1

1/2 cup cranberry sauce

1

1/2 cup vanilla pudding (low fat milk)

1

1 glass water

1

cup of tea

1


Totals

6

3

3

3

2

6-7

© Frank W. Jackson, M.D.