Nutrition for older people Energy (calories) The major nutrients Protein – dispelling the ‘protein myth’ Fat – omega-3 for vegetarians/vegans Fibre Vitamins and minerals to take care about in a care setting

Protein A comparison of the protein content of meat and vegetarian foods Meat productProtein content in grams Vegetarian food Protein content in grams Small beef burger10.2Baked beans, ½ can 11.5 Three fish sticks12.1Pasta, average serving 8.5 Kidney beans, average serving 12.4 Peanuts, small packet 6.1

Fat: omega-3 Older people of all ages need omega-3 fat in their diet. Of course vegetarians don’t eat fish or fish oils so they can’t get omega-3 from them.

Omega-3 fat – why? Protection against heart disease (important for people who’ve had a heart attack). Can relieve rheumatoid arthritis (swollen and tender joints, grip strength and mobility).

Omega-3 fat – why? Eye health Preventing mental decline Immune function

Omega-3 fat – where? Omega-3 fats1 daily portion is... Flaxseed (linseed) oil1 teaspoon Ground flaxseeds (linseeds)1½ tablespoons Hempseed oil1 tablespoon Rapeseed (vegetable) oil1½ tablespoons Walnuts8 halves/28g/1oz Hempseed5 tablespoons

Fibre Can help to prevent: -constipation- heart disease -diabetes- some cancers But if people have a poor appetite, bulky foods can stop them getting all the nutrients they need.

Fibre Good sources are wholegrain foods: wholemeal bread, pasta and cereals, brown rice, peas, beans and lentils, and fruits and vegetables. Shouldn’t need extra bran.

Vitamins and minerals Older people are less able to digest, absorb, use and excrete vitamins and minerals. According to a national survey, older people living in institutions may have low intakes or low blood levels of certain vitamins and minerals.

National Diet and Nutrition Survey Nutrient deficiency (or excess)% of older people in institutions affected Iron deficiency40% Vitamin C deficiency41% Vitamin B1 (thiamin) deficiency14% Folate deficiency10% Vitamin B12 deficiency9% Vitamin D deficiency37% Vitamin A (retinol) EXCESS2 to 3%

National Diet and Nutrition Survey

Iron-rich foods Good sources for vegetarians/vegans Fortified breakfast cereals, especially bran flakes (contain 3 times more iron than anything else on this list – see chart that follows)

Iron-rich foods Good sources for vegetarians/vegans Grains: wholemeal bread, spaghetti Pulses (peas, beans – including tofu, and lentils) Figs – just 3 dried figs supply 29% of daily iron Eggs (not for vegans) Green veg, especially curly kale

Vitamin C rich foods Vitamin C is the most common deficiency seen in institutionalised adults (41%). Also, vitamin C helps the body absorb iron. Fresh fruit juice or a starter containing citrus fruits is a good way to ensure iron from foods is absorbed well.

Vitamin C rich foods Good sources of vitamin C are: Citrus fruits Green vegetables Peppers Tomatoes Potatoes (just under the skin)

B vitamins: B1 (thiamin) and folate B vitamins are water soluble which means they are not stored for long in the body. So try to include some of these foods every day. Diets containing too little B vitamins can lead to multiple deficiencies within a few months.

B vitamins: thiamin & folate B1 Found in wholegrain cereals, nuts, seeds and pulses (peas, all types of beans, including soya, and lentils) Folate Found in green vegetables, especially broccoli, oranges, nuts, wholegrain cereals

B vitamins: vitamin B12 Vitamin B12 is needed every day. Vegetarians get B12 from free-range eggs and dairy. Vegans get it from B12-fortified foods, such as breakfast cereals, margarines, nutritional yeast (e.g. Marmite) and soya milk. B12 from fortified foods is better absorbed than the B12 from meat, poultry and fish.

Vitamin A Comes in two forms Pre-formed (retinol) – from animal foods. So-called ‘pro-vitamin’ form (carotenoids). Over 700 of these, including beta-carotene and lycopene (the protective pigment in tomato ketchup!)

Vitamin A Carotenoids are found in red, yellow and orange fruits and vegetables (carrots, tomatoes, peaches and apricots). And also in green leafy veg: watercress, rocket, spinach and cabbage.

Vitamin A Hazards of excess As we’ve seen in the survey, 2-3% of older people living in institutions get too much pre-formed vitamin A (retinol) – found in animal products. Egg yolks, butter, milk, liver and fish oils are rich sources. Deficiency is rare. But too much can increase risk of osteoporosis and hip fractures.

Calcium rich foods Calcium is the most abundant mineral in the body and essential to keep bones and teeth strong.

Calcium rich foods Good sources for vegetarians are: Milk, cheese, yoghurt Fortified non-dairy versions of the above (for vegans) Almonds and sesame seed paste (tahini) Green leafy vegetables (not spinach) Broccoli Soya beans (edamame) Tofu (made with soya beans)

Vitamin D Like calcium, vitamin D is important for good bone health. We get most of our vitamin D from summer sunlight on our skin which is converted into vitamin D.

Vitamin D But good dietary sources for vegetarians are milk, free-range eggs and fortified cereals and margarines. Dairy-free milks and margarines (such as the ‘Pure’ brand) are fortified with vitamin D and are suitable for vegans. Older people who do not get outside much are advised to take a vitamin D supplement.