Nutrition For Older Adults

Nutrition For Older Adults
Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

Increase In Aging Population
U.S. population growing older Ratio of older people to young is increasing Age Categories 55 to 64: Approaching Old Age 65 to 74: Young Old 75 to 84: Old 85 and older: Oldest Old Increase in Aging Population The U.S. population is growing older. The majority is now middle-aged, and the ratio of older people to young is increasing. Definitions of old age include the following categories. Persons approaching old age: 55 to 64 years Young old: 65 to 74 years Old: 75 to 84 years Oldest old: 85 years and older

Increase In Aging Population
65 used to define transition between middle age and old age Number over 65 doubled since 1950 Fastest growing age group is over 85 years of age group Our society uses the arbitrary age of 65 to define the transition between middle age and old age. Since 1950 the number of people over 65 years has more than doubled. In fact, the fastest growing age group is people over 85 years.

Importance of Nutrition In Aging
Aging is an inevitable and natural process Good nutrition and physical activity can improve the quality of life Healthy habits may lower disease risk Importance of Nutrition in Aging Aging is an inevitable and natural process. However, people can improve the quality of their life in later years, within limits, by adopting healthy lifestyle habits such as healthy eating and being physically active. Good nutrition and physical activity can help keep the body healthy, and may lower the risk of some conditions that can occur in later years.

Nutrient Needs For Older Adults
Dietary Reference Intakes (DRI’s) provide dietary recommendations for people over 50 by two age groups 51 to 70 years 71 years and above Nutrient Needs of Older Adults The Dietary Reference Intakes (DRI) provide dietary recommendations for people over 50 years of age by two age groups, 51 to 70 years and 71 years and older.

Nutrient Needs For Older Adults
Basic guidelines the same for older adults The USDA Daily Food Plan is the best tool to get the variety and amount of nutrients needed Older adults do need to pay special attention to the quality of foods eaten The basic guidelines for a nutritious diet are about the same for most healthy older adults as most healthy younger adults. The USDA Daily Food Plan is the best dietary tool to help older adults get the variety and amount of nutrients they need every day. However, older adults do need to pay special attention to the quality of foods they eat. There are some changes in nutrient needs with aging.

USDA Daily Food Plan The amount of food recommended from each USDA Daily Food Plan food group is based on calories Calorie recommendations for adults 56 years of age and older vary widely from 1,600 to 2,600 calories per day depending on gender, age and activity level Personalized nutritional recommendations based on gender, age and activity can be found at The amount of food recommended from each USDA Daily Food Plann food group is based on estimated calorie need. Calorie intake recommendations for adults 56 years of age and older vary from 1,600 to 2,600 calories per day depending on gender, age and activity level. Personalized nutritional recommendations based on gender, age and activity can be found at

USDA Daily Food Plan For a typical 2,000 calorie diet the USDA Daily Food Plan recommends: 2 cups of fruit 2 ½ cups of vegetables 6, 1-ounce equivalents of grains 5 ½ ounces of protein foods 3 cups of dairy 6 teaspoons of oil Limit calories from solid fats and added sugars to 260 calories per day For a typical 2,000 calorie diet the USDA Daily Food Plan recommends: 2 cups of fruit 2 ½ cups of vegetables 6, 1-ounce equivalents of grains 5 ½ ounces of protein foods 3 cups of dairy 6 teaspoons of oil Limit calories from solid fats and added sugars to 260 calories per day

Calories Calorie needs decrease about 5% per decade after age 50
Decrease in physical activity Decrease in muscle mass Decrease in metabolism Need careful meal planning to get adequate nutrients in fewer calories Calories: Calorie needs decrease with age as physical activity, muscle mass and the body's metabolism slows down. Calorie needs tend to decrease about 5% per decade. As a result, the RDA for calories for adults decreases slightly after age 50. Careful meal planning is important for older adults in order to get all the nutrients they need in fewer calories.

Calorie Imbalance Weight gain Weight loss
Risk for many health problems Estimate calories: Multiply weight in pounds by activity factor (10 sedentary or for weight loss; moderately active; 15 active) Don’t go below 1200 calories Weight loss Risk for malnutrition Consuming more calories than what the body needs can result in weight gain. Excess weight is linked to many health problems. These include high blood pressure, heart disease, stroke, diabetes and certain cancers. An easy method to use to estimate calorie needs for older adults is to multiply current weight in pounds by an activity factor. Multiply 10 calories per pound if sedentary or desiring weight loss. Multiply 12 – 13 calories per pound if moderately active. Multiply 15 calories per pound if active. Consuming less than 1200 calories is not recommended because it’s difficult to get all the nutrients needed in less than 1200 calories. Limiting intake of fatty foods, sweets, high-calorie snacks and alcohol can lower calorie intake and help with weight control. These foods contain lots of calories but few nutrients. Eating them in place of more nutritious foods can lead to weight gain without meeting nutritional needs. Some older adults do not eat enough food, particularly foods that supply necessary nutrients. As a result they may not get enough calories and nutrients to maintain health and well-being.

Protein Protein is important for older adults
Maintain healthy cells Sustain immune system Prevent muscle wasting Fight infections Wound healing Enzymes Hormones Protein needs may increase due to surgery, illness or disease Protein: Adequate protein is especially important for older adults in order to maintain healthy cells, sustain the immune system to help the body fight infections, and prevent muscle wasting. Protein is also needed for wound healing and to make enzymes and hormones. As a result, protein needs may actually increase due to surgery, illness or disease.

Protein Adults need 0.8 g/kg
Some studies report older adults may need more protein 1.0 to 1.25 g/kg Because calorie needs decrease make lower fat choices Don’t omit these food groups to lower fat The Dietary Reference Intake (DRI) for protein for adults 18 years of age and older is 0.8 g/kg body weight. However, some research indicates that older adults may need slightly more protein (1.0 to 1.25 vs. 0.8 g/kg body weight, respectively). Because calorie needs decrease, protein must be obtain from lower fat sources of high-quality protein such as lean meats, poultry, fish and eggs; nonfat and low-fat milk products; and legumes. Many older adults limit meat and dairy foods to lower fat for weight loss. However, lowering fat in the diet doesn’t mean omitting meat and dairy products. These foods are part of a well balanced diet, and there are many low-fat choices available.

Fat Fat concentrated source of energy Fat has some important roles
Helps form cell membranes Carries fat-soluble vitamins Provides essential fatty acids Fat: Fat is the most concentrated source of food energy. Fat helps form cell membranes and carries the fat-soluble vitamins A, D, E, and K. Fat also provides the essential fatty acids the body cannot make.

Fat Too much fat increases disease risk
Limit total fat to 20-35% or less of total calories and saturated fat to 10% or less of total calories Limit fat intake by choosing lean, cooking lean, and limiting added and hidden sources of fat Although fat is important in the diet, many adults eat more fat than they should. High fat diets are a risk factor for heart disease, cancer, and overweight. By increasing the risk of overweight, high fat diets may indirectly increase the risk of diabetes and high blood pressure. The Dietary Guidelines for Americans recommend adults consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and to keep trans fatty acid consumption as low as possible. The Dietary Guidelines for Americans also recommend adults keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Fat intake can be lowered by choosing lean meats and low-fat dairy products, using low-fat preparation methods, and limiting the use of added or hidden sources of fat.

Carbohydrate Carbohydrate foods provide energy for body cells and central nervous system Complex carbohydrate foods also provide vitamins, minerals and fiber 50 to 60% of total calories should come from carbohydrate Carbohydrate: Carbohydrate provides energy for body cells and the central nervous system. Adequate carbohydrate is needed to protect protein from being used for energy. Recommendations are that 50 to 60 percent of calories should come from carbohydrate rich foods.

Carbohydrate Most carbohydrate should come from complex carbohydrate foods Simple carbohydrates or sugar rich foods should be limited Most should come from complex carbohydrate foods: cereals, grains, legumes, vegetables and fruits. These foods not only provide carbohydrate but they also supply vitamins, minerals and fiber. Simple carbohydrates or sugar-rich foods should be limited.

Fiber Two types of fiber Both types are beneficial
Soluble and insoluble fiber Both types are beneficial Constipation Diarrhea Diverticulitis Heart Disease Colon Cancer Diabetes Food is only one factor Fiber: Most older adults do not consume adequate fiber. Fiber comes in two basic types, soluble fiber and insoluble fiber. Both types of fiber are important for good health. Dietary fiber is beneficial for many health conditions, such as constipation, diarrhea, diverticulitis, cardiovascular disease, colon cancer, and diabetes. However, one should remember that dietary fiber is only one factor involved in these conditions.

Fiber Food is the best source of fiber
21g fiber daily for females and 30g fiber daily for males based on 14g fiber per 1,000 calories The USDA Daily Food Plan recommends ½ of all grains should be whole grains to help provide adequate fiber Foods are the best way to increase fiber intake. Food sources of fiber include fruits, vegetables, whole grains, dried peas and beans, nuts and seeds. The USDA Daily Food Plan recommends that at least one-half of grains should be whole grains. Cooking, processing, and removing peels can lower the fiber in foods. The DRI for fiber for adults 51 years of age and older is 21 grams of fiber per day for females and 30 grams of fiber per day for males, based on 14 grams fiber per 1,000 calories each day.

Fiber Increase dietary fiber slowly Drink plenty of fluids
Check with physician before increasing dietary fiber Some older adults may need to limit dietary fiber if they have chewing, swallowing or other medical problems It is important to increase fiber in the diet slowly. Increasing fiber too fast may cause bloating and gas. Since fiber absorbs water it also is important to drink plenty of fluids when increasing dietary fiber. Older adults should check with their physician before increasing dietary fiber. Fiber intake may need to be limited for older adults who have chewing, swallowing or other medical problems.

Vitamins and Minerals Vitamin and mineral needs are similar to younger adults, with some differences Vitamin A Iron Vitamin D Vitamin B12 Calcium Vitamin and Mineral needs for older adults are about the same as for younger adults. However, some differences in nutrient needs do occur with age.

Vitamin A Vitamin A needs decrease and vitamin A is stored more readily with age This makes over-dosing with vitamin A supplements more common among older adults Beta-carotene, vitamin A precursor, not a problem for over-dosing Vitamin A. Vitamin A needs decrease with age. In addition vitamin A is more readily stored in older adults than younger adults. This makes over-dosing with vitamin A supplements more common among older adults.

Vitamin A DRI for adults 51 years and older is 900 micrograms for males and 700 micrograms for females The Tolerable Upper Intake Level (UL) for Vitamin A is 3,000 micrograms/day Leading food sources are carrots, ready-to-eat cereal, and milk The DRI for adults 51 years of age and older is 900 micrograms for males and 700 micrograms for females. The Tolerable Upper Level of Intake (UL) for vitamin A is 3,000 micrograms (3 milligrams) per day. Beta-carotene is a plant precursor of vitamin A and will does not cause a problem with over-dosing. Leading food sources of vitamin A and beta-carotene are carrots, ready-to-eat cereals and milk.

Iron Iron needs for women decrease after menopause
Like vitamin A, iron is stored more readily in older adults Excess iron can increase oxidative stress Iron. Iron needs for women decrease after menopause. Like vitamin A, iron is stored more readily in older adults than in younger adults. Excess iron can increase oxidative stress.

Iron DRI for adults 51 years and older is 8 milligrams per day
UL for iron is 45 milligrams per day Leading food sources of iron are ready-to-eat cereals, yeast bread and beef The DRI for adults 51 years of age and older is 8 milligrams per day. The UL for iron is 45 milligrams per day. Leading food sources of iron are ready-to-eat cereals, yeast bread and beef.

Vitamin D Vitamin D needed to absorb calcium
Vitamin D needs increase with age Ability of the body to synthesize vitamin D precursor in skin decreases with age Older adults also tend to have less sunlight exposure Vitamin D. Vitamin D is needed to absorb calcium. Vitamin D needs increase with age. The ability of the body to synthesize the vitamin D precursor in the skin decreases with age. Older adults also tend to have less sunlight exposure either due to limited time in the sun, being homebound or use of sun blocks.

Vitamin D DRI for vitamin D is 600 IU for people aged 51 to 70
DRI for vitamin D is 800 IU for people 71 years of age and older UL for vitamin D is 4,000 IU. The DRI for vitamin D is 600 IU for people aged 51 to 70; and 800 IU for people 71 years of age and older. The UL for vitamin D is 4,000 IU.

Vitamin D Leading food sources of vitamin D are fortified cereals, milk, eggs, liver, salmon, tuna, catfish and herring Leading food sources of vitamin D are fortified cereals, milk, eggs, liver, salmon, tuna, catfish and herring.

Vitamin B12 15% of older adults are deficient in vitamin B12
People with atrophic gastritis are particularly vulnerable to vitamin B12 deficiency B12 deficiency can result in irreversible nerve damage Vitamin B12. An estimated 15% of older adults are deficient in vitamin B12. People with atrophic gastritis are particularly vulnerable to vitamin B12 deficiency. B12 deficiency can result in irreversible nerve damage.

Vitamin B12 Older adults lose to ability to absorb the naturally occurring form of B12 in food To absorb naturally occurring B12 from food must split it from a protein carrier Older adults may absorb vitamin B12 better in synthetic form, which is not bound to a protein carrier Many older adults lose their ability to adequately absorb the naturally occurring form of B12 found in food. In order to absorb naturally occurring B12 from food the body must split it from a protein carrier.

Vitamin B12 Synthetic vitamin B12 is found in fortified foods such as cereals Protein-bound B12 is found in all animal products Older adults may absorb vitamin B12 better in synthetic form, which is not bound to a protein carrier, than from food.

Vitamin B12 DRI for vitamin B12 for adults 51 years of age is 2.4 micrograms per day Leading food sources of vitamin B12 are beef, milk, fish and shellfish The DRI for vitamin B12 for adults 51 years of age is 2.4 micrograms per day. Synthetic vitamin B12 is found in fortified foods such as cereals. Protein-bound B12 is found in all animal products. Leading food sources of vitamin B12 are beef, milk, fish and shellfish.

Calcium Calcium requirements increase with age
Many older adults do not consume enough calcium An adequate calcium intake is one way to help protect against osteoporosis Calcium. Older adults should pay particular attention to their need for calcium as reflected by the higher calcium DRI for older adults. Many older adults do not consume enough calcium. An adequate calcium intake is one way to help protect against osteoporosis. Osteoporosis is a condition, which thins the bones and can lead to painful fractures.

Calcium DRI for calcium for men
51 to 70 years of age is 1,000 milligrams per day. 71 years of age and older is 1,200 milligrams per day DRI for calcium for women 51 years of age and older is 1,200 milligrams per day. The UL for calcium is for adults 51 years of age and older is 2,000 milligrams per day The DRI for calcium for men 51 to 70 years of age is 1,000 milligrams per day. The DRI for calcium for men 71 years of age and older is 1,200 milligrams per day. The DRI for calcium for women 51 years of age and older is 1,200 milligrams per day. The UL for calcium for adults 51 years of age and older is 2,000 milligrams per day.

Calcium Leading food sources of calcium are milk, yogurt, cheese and other dairy products, dark green leafy vegetables, such as broccoli and canned salmon Leading food sources of calcium are milk, yogurt, cheese and other dairy products, dark green leafy vegetables, such as broccoli and canned salmon.

Vitamins and Minerals Older adults tend to have low dietary intakes of some vitamins and minerals Vitamin E Folate Magnesium Zinc In addition to some changes in vitamin and mineral requirements with age, older adults tend to have low dietary intakes of some vitamins and minerals.

Vitamin E Vitamin E plays an important role in the health of older adult due to its antioxidant functions, such as decreasing the development of cataracts and heart disease Vitamin E is also associated with increased immune function Vitamin E. Vitamin E is an antioxidant. Vitamin E plays an important role in the health of older adult due to its antioxidant functions, such as decreasing the development of cataracts and heart disease. Vitamin E is also associated with increased immune function.

Vitamin E The DRI for vitamin E for adults age 51 years of age and older is 15 milligrams or 15 IU alpha-tocopherol equivalents (TE) The UL for vitamin E is 1,000 mg or IU The DRI for vitamin E for adults age 51 years of age and older is 15 milligrams or 15 IU alpha-tocopherol equivalents (TE). The UL for vitamin E is 1,000 mg or IU.

Vitamin E Leading food sources of vitamin E are salad dressings/mayonnaise, margarine, and ready- to-eat cereals Other good sources of vitamin E are oils, especially sunflower and safflower oils, fats, whole grains, wheat germ, leafy green vegetables, tomatoes, nuts, seeds and eggs Leading food sources of vitamin E are salad dressings/mayonnaise, margarine, and ready-to-eat cereals. Other good sources of vitamin E are oils, especially sunflower and safflower oils, fats, whole grains, wheat germ, leafy green vegetables, tomatoes, nuts, seeds and eggs.

Folate Adequate folate can decrease blood homocysteine levels, which are a risk factor for heart disease DRI for folate for people 51 years of age and older is 400 micrograms per day The UL for folate is 1,000 micrograms from supplements and fortified foods Folate. Adequate folate can decrease blood homocysteine levels, which are a risk factor for heart disease. The DRI for folate for male and females, 51 years of age and older is 400 micrograms per day. The UL for folate is 1,000 micrograms from supplements and fortified foods.

Folate Leading food sources of folate are ready-to- eat cereals, yeast bread, orange juice and grapefruit juice Leading food sources of folate are ready-to-eat cereals, yeast bread, orange juice and grapefruit juice.

Magnesium Magnesium is needed for bone and tooth formation, nerve activity, and metabolism of carbohydrates, protein and fat DRI for magnesium for adults 51 years of age and older is 420 milligrams for males and 320 milligrams for females per day UL for magnesium is 350 milligrams from supplements and medications Magnesium. Adequate magnesium is needed for bone and tooth formation, nerve activity, and metabolism of carbohydrates, protein and fat. The DRI for magnesium for adults 51 years of age and older is 420 milligrams for males and 320 milligrams for females per day. The UL for magnesium is 350 milligrams from supplements and medications.

Magnesium Leading food sources of magnesium are milk, yeast bread, coffee, ready-to-eat cereal, beef and potatoes Leading food sources of magnesium are milk, yeast bread, coffee, ready-to-eat cereal, beef and potatoes.

Zinc Zinc deficiency is related to delayed wound healing, decreased taste acuity and immune response, and increases risk of dermatitis DRI for zinc for adults 51 years of age and older is 8 milligrams for females and 11 milligrams for males per day The UL for zinc is 40 milligrams per day Zinc. Zinc deficiency is related to delayed wound healing, decreased taste acuity and immune response, and increases risk of dermatitis. The DRI for zinc for adults 51 years of age and older is 8 milligrams for females and 11 milligrams for males per day. The UL for zinc is 40 milligrams per day.

Zinc Leading food sources of zinc are beef, ready- to-eat cereals, milk and poultry Leading food sources of zinc are beef, ready-to-eat cereals, milk and poultry.

Water Water is more critical to life than food
Older adults need 6-8 cups water daily Easy guide is 1 ml water/calorie with a minimum of 1500 ml or 6 cups Water can be in many forms Caffeine containing beverages can increase water loss Water: Water is more critical to life than food. Lack of water can result in death sooner than will lack of food. Older adults need at least six to eight cups of water each day. An easy guide to water intake is 1 milliliter of fluid per calorie eaten, with a minimum of 1500 milliliters (6 cups). Thus for a 2,000 calorie diet, this would be 2,000 milliliters fluid or 8 cups. Water can be taken in many forms such as water, fruit juice, milk, soups, coffee, tea or soft drinks. Because caffeine can cause water loss, decaffeinated fluids are recommended instead of caffeinated fluids.

Water Older adults are at increased risk for dehydration
Body water decreases with age Many medications increase water loss Thirst mechanism not as effective Self limit fluid intake Decreased mobility to reach fluids However, despite fluids being available, many older adults become dehydrated. Dehydrated older adults are more susceptible to urinary tract infections, pneumonia, pressure ulcers, confusion and disorientation. Older adults are at higher risk for dehydration. Body water decreases with age, leaving a smaller margin of safety for older adults. Many medications older adults use also increase in water loss. In addition, the thirst mechanism is not as effective in older adults. As a result, older adults do not seem to notice thirst and consume water in response. Fear of incontinence and increased arthritic pain resulting from numerous trips to the toilet may also interfere with consumption of adequate fluid intake. As a result, many older adults limit their fluid intake. Decreased mobility may also limit fluid intake. If an older adult is bed-ridden or wheelchair bound it may be difficult for them to reach fluids. Keep fluids close at hand in a pitcher or glass to encourage increase fluid intake. Decreased strength can make lifting a full glass or pouring water from a pitcher difficult. If a person is very weak or frail using a small glass, or using a straw may make fluid intake easier.

Dehydration Signs 0-1% 2-5% 6% 8% 10% 11% Thirst
Dry Mouth, Flushed Skin, Fatigue, Headache 6% Increased Body Temperature, Breathing, Pulse Rate 8% Dizziness, Increased Weakness, Labored Breathing 10% Muscle Spasms, Swollen Tongue, Delirium 11% Poor Blood Circulation, Failing Kidney Function The following table shows some common signs of dehydration. Percent Loss of Body Water Common Signs of Dehydration 0-1% Thirst 2-5% Dry mouth, flushed skin, fatigue, headache, impaired physical performance 6% Increased body temperature, breathing rate, and pulse rate 8% Dizziness, increased weakness, labored breathing with exercise 10% Muscle spasms, swollen tongue, delirium 11% Poor blood circulation, failing kidney function

Vitamin/Mineral Supplements
Older adults can get the nutrients they need by eating a wide variety of foods following the USDA Daily Food Plan Variety is the key Vitamin and Mineral Supplements: Many older adults can get the nutrients they need by eating a wide variety of nutritious foods each day following the USDA Daily Food Plan. The greater the variety the less likely one is to develop either a deficiency or an excess of any single nutrient and the more likely one is to stay healthy. There are a large number of nutrients that are essential to health, but vitamin and mineral supplements only contain some of them. A well-balanced diet one that contains a variety of foods will provide all the necessary nutrients. Foods may also contain some essential nutrients that have not yet been identified.

While it is possible to get all the nutrients needed from food, many older adults do not do so Many factors can interfere with consuming a well-balanced diet Some older adults may benefit from a multivitamin/multi-mineral supplement However, some older adults do not always get all the vitamins and minerals they need from their daily diet. Digestive problems, chewing difficulties, and the use of certain drugs can all interfere with good nutrition. Therefore, while it is possible for older adults to get all the nutrients for good health from food, they many not do so. Older adults with these problems may benefit from a multivitamin and/or multi-mineral supplement.

Don’t take isolated nutrients unless recommended by a physician Don’t take large doses Overdoses easier with supplements Supplements can’t make up for a poor diet “Supplements” not “Replacements” However, older adults should not take isolated vitamin and/or mineral supplements unless recommended by a physician. In addition, older adults should not take large doses (amounts far greater than the Dietary Reference Intakes) without specific medical recommendations. One might think that more is better when taking vitamin or mineral supplements. However, a vitamin or mineral taken in large amounts can be dangerous. Overdoses happen easier with supplements than with food. Minerals and in large amounts can be dangerous as can vitamins. Our bodies store excess minerals and fat-soluble vitamins (vitamins A, D, E, and K). Excessive amounts of these nutrients can accumulate and be harmful. Dangerous levels can produce such symptoms as nausea, vomiting, and other serious side effects. Toxicity from water-soluble vitamins, such as vitamin C, is unlikely since excess amounts are flushed from the body in the urine. However, serious side effects can occur even with water-soluble vitamins. Because nutrients interact with each other, a balance of all nutrients is important. If the body has too much or too little of any nutrient it can affect how the body uses other nutrients. Some guidelines to consider before selecting a vitamin or mineral supplement are: Does the supplement contain a balance of vitamins and minerals? When all supplements and fortified foods are combined, is the dose still safe? Does the supplement carry a USP or NF code to assure potency and purity? Is the supplement safe? The term “natural” does not mean safe. Vitamin or mineral supplements cannot make up for a poor diet. No supplement contains all the essential nutrients the body needs. The basis for good health depends on a well balanced diet from a variety of foods. The keys to good nutrition are variety and moderation. The greater the variety of foods, the less likely a deficiency or excess of any one vitamin or mineral will occur. Following the USDA Daily Food Plan is the best guide for getting the right foods in the right amounts for good health.

Medications It is important to follow recommendations regarding medications and eating Some medications need to be consumed with food, some need to be consumed on an empty stomach Medications May Affect Nutrient Needs Older adults should follow their doctor's advice about eating, especially if they have an illness that requires changes in what or how they eat, or if they are taking medications.

Medications Some medications can interact with certain foods, or can affect appetite Some foods can interact with medications Some medications can cause water loss Some medications can cause depression Some medications can interact with certain foods, or can affect appetite Some foods can interact with medications Some medications can increase water loss Some medications can cause depression

Factors That Affect Intake
Many factors can affect food intake among older adults Physical Social Emotional Mental Status Economic Factors That Affect Food Intake Although good nutrition and physical activity can help keep the body healthy, and may lower the risk of some conditions that can occur in later years. However, many factors can affect food intake among older adults.

Physical Changes Physical changes can affect food intake
Body composition Saliva Teeth Digestion Stomach acid Fat intolerance Lactose intolerance Physical Changes That May Affect Food Intake Physical changes with aging can affect food intake. These changes usually occur at different rates from person to person. Some physical functions change little with aging while others greatly change.

Physical Changes Physical changes can affect food intake (cont.)
Constipation Thirst Taste and smell Eyesight Strength, energy and coordination

Body Composition Many adults lose muscle, bone mineral and body water with aging At the same time, many older adults gain body fat Muscle loss can cause people to lose their ability to move and maintain balance, making falls likely Body Composition: Many adults lose muscle, bone mineral and body water with aging. At the same time, many older adults gain body fat. Muscle loss can cause people to lose their ability to move and maintain balance, making falls likely.

Body Composition A loss of muscle is not inevitable
Good nutrition and regular physical activity can help maintain muscle mass and strength A loss of muscle is not inevitable. Good nutrition and regular physical activity can help maintain muscle mass and strength.

Body Composition Strength training can increase muscle and decrease body fat Weight bearing and resistance activities also increase muscle and bone density Since muscle contains more water than fat, building muscle also helps increase body water Strength training can increase muscle and decrease body fat. Weight bearing and resistance activities also increase muscle and bone density. Since muscle contains more water than fat, building muscle also helps increase body water.

Saliva Production of saliva may decrease with age
Saliva moistens food and makes swallowing easier Foods may be dry and more difficult to swallow Saliva: Production of saliva may decrease with age. Saliva moistens food and makes swallowing easier. Foods may be dry and more difficult to swallow.

Teeth Loss of teeth makes eating and chewing some foods difficult
Many older adults unable to adjust to dentures or have dentures that do not fit Very hot or very cold foods may be painful for people with dental problems Teeth: Loss of teeth makes eating and chewing some foods difficult. Many older adults are unable to adjust to dentures or have dentures that do not fit. Very hot or very cold foods may be painful for people with dental problems.

Teeth People with tooth loss, gum disease, or poor fitting dentures tend to eat softer foods or limit food intake which can lead to a poor diet Poor chewing can also increase the risk of choking People with tooth loss, gum disease, or poor fitting dentures tend to eat softer foods or limit food intake which can lead to a poor diet. Poor chewing can also increase the risk of choking.

Digestion Many older adults do not digest foods as well as when they were younger Intestinal secretions change with age Serving four to six smaller meals may be more acceptable Many older adults do not tolerance of high fat or dairy foods Digestion: Many older adults find that they do not digest foods as well as when they were younger. Intestinal secretions tend to change with aging. Serving four to six smaller meals may be more acceptable. Many older adults do not tolerance of high fat or dairy foods.

Digestion Atrophic gastritis affects almost 1/3 of people over 60; characterized by inflamed stomach, bacterial overgrowth, and lack of hydrochloric acid and intrinsic factor. This results in impaired digestion and absorption of vitamin B12, biotin, folate, calcium, iron and zinc Atrophic gastritis, a condition that affects almost a third of those over 60, is characterized by an inflamed stomach, bacterial overgrowth, and a lack of hydrochloric acid and intrinsic factor – all of which can impair the digestion and absorption of nutrients, most notably vitamin B12, but also biotin, folate, calcium, iron and zinc.

Stomach Acid Production and secretion of stomach acid tends to decrease with age This causes decreased digestion and a feeling of indigestion Stomach Acid: Production and secretion of stomach acid tends to decrease with age. This causes decreased digestion and a feeling of indigestion.

Fat Tolerance Many older adults do not tolerate high fatty foods
Fat intolerance can result in abdominal pain and diarrhea Decrease the amount of fat added to foods, choose low-fat foods and use low-fat preparation methods Fat Tolerance: Many adults find that they do not tolerate high fatty foods as well with age. Fat intolerance can result in abdominal pain and diarrhea. Decrease the amount of fat added to foods, choose low-fat foods and use low-fat preparation methods to decrease fat intake.

Lactose Tolerance Many older adults do not tolerate milk and milk products due to lactose intolerance Some can tolerate small amounts of milk, or fermented milk products such as buttermilk, yogurt and cheese Lactaid or Dairy Ease can help with digestion of milk or milk products Lactose Intolerance: Many adults do not tolerate milk and milk products as well with age. Lactose intolerance can result in abdominal pain, bloating and diarrhea. However, some find that they can tolerate small amounts of milk, or fermented milk products such as buttermilk, yogurt and cheese. Lactaid or Dairy Ease can be used to help with the digestion of milk or milk products.

Constipation Constipation is a common problem among older adults
The intestinal wall tends to lose strength and elasticity with age which results in slower intestinal motility Many medications can also cause constipation Constipation: Constipation is a common problem among older adults. The intestinal wall tends to lose strength and elasticity with age which results in slower intestinal motility. Many medications can also cause constipation.

Constipation Sufficient fiber and fluids are important to combat constipation Physical activity is also important in reducing constipation Fiber supplements may be needed as a last resort Sufficient fiber and fluids are important to combat constipation. Increase intake of raw and/or cooked fruits and vegetables, and whole grain breads and cereals to increase fiber intake. Physical activity is also important in reducing constipation. Fiber supplements may be needed as a last resort.

Thirst The combined effects of decreased thirst sensation, decreased body water, increased water loss, incontinence and decreased mobility put older adults at greater risk for dehydration Keep fluids close at hand to encourage increase fluid intake Thirst: The combined effects of decreased thirst sensation, decreased body water, increased water loss, incontinence and decreased mobility put older adults at greater risk for dehydration. Keep fluids close at hand to encourage increase fluid intake. If a person is very weak or frail using a small glass, or using a straw may make fluid intake easier.

Taste and Smell Taste and smell tend to decline with age
The number of taste buds and olfactory cells decrease with age Medicines can also interfere with taste and smell Changes in taste and smell may decrease appetite and food intake Taste and Smell: Taste and smell tend to decline with age. This is because the number of taste buds and olfactory cells, the functional unit in smelling, decrease with age. Medicines, including chemotherapy, also can interfere with the taste of foods. Changes in taste and smell may decrease one's appetite for foods resulting in a poor diet.

Eyesight Eyesight tends to decline with age
This can make shopping, cooking, and possibly eating become more difficult Problems reading small print recipes or seeing oven temperatures may result in less meal preparation Eyesight: Eyesight tends to decline with age. This can make shopping, cooking, and possibly eating become more difficult. Problems reading small print recipes or seeing oven temperatures may result in less meal preparation.

Strength, Energy and Coordination
Strength and energy often decline with increasing age Food shopping, carrying heavy groceries, choosing from a wide variety of foods and preparing meals may become difficult Strength, Energy and Coordination: Strength and energy often decline with increasing age. Food shopping, carrying heavy groceries, choosing from a wide variety of foods and preparing meals may become difficult.

Strength, Energy and Coordination
Decreased strength and coordination can affect ability to eat Keep a reserve food supply on hand for sick days or when the weather is bad Decreased strength and coordination can affect the ability to eat. Keeping a reserve supply of food on hand for sick days or when the weather is bad is helpful. The following are some foods to keep on hand. Protein foods: tuna in water, canned meats, dried beans Fruits: canned fruits, dried fruits Vegetables: canned vegetables, frozen vegetables Dairy: nonfat dried milk Grains: ready to eat cereals, hot cooked cereals, crackers, rice, pasta Convenience Foods: macaroni and cheese mixes, low-sodium canned soups, pudding mixes, dry soup mixes, peanut butter, jelly.

Social Changes Loneliness is a major problem for may older adults who live and eat alone Can decrease appetite and motivation to cook or eat Monotonous meals, snacking, and eating easily prepared and softer foods, which can result in a poor diet Social Changes: Loneliness is a major problem for many older adults who live and eat alone. When one is lonely there is little motivation to prepare and eat a well-balanced meal. Loneliness can decrease ones' appetite and lead to monotonous meals, snacking, and eating easily prepared, cheaper and softer foods. Such dietary habits can eventually lead to a poor diet.

Social Changes Doesn’t necessarily relate to living alone
Physical isolation may be far less important than the frequency of communication Loneliness doesn’t necessarily relate to living alone. Physical isolation may be far less important than the frequency of communication. Someone who lives with others but is ignored can be lonelier than someone who lives alone but has daily communication.

Emotional Changes Feelings or worthlessness can cause a loss of interest in food As people age they continually give up parts of their lives; jobs, home, spouse and peers. May suffer overwhelming grief with the loss of a spouse, friend or family member Emotional Changes: Feelings of worthlessness or rejection can cause a loss of interest in food and subsequent decreased food intake. As people age they must continually give up parts of their lives; jobs, home, spouse and peers. Food may be the one last thing left they can control. Although not inevitable, depression is common among older adults. Depression can cause loss of appetite and decreased motivation to cook or even eat. Overwhelming grief at the death of a spouse, friend, or family member can leave a person, especially an older person feeling powerless to overcome depression.

Emotional Changes Depression is common among older adults, which can decrease appetite and decrease motivation to cook or eat Some medications and nutritional deficiencies including B6, B12, folate, and iron can cause symptoms of depressions When a person is suffering from depression eating may not seem worthwhile. It’s also important to remember that some medications and nutritional deficiencies including B6, B12, folate and iron, can cause symptoms of depression.

Mental Status Changes Dementia is a leading cause of weight loss and nutritional problems for older adults Memory loss, disorientation, impaired judgment, apathy, combative feeding behavior, and appetite disturbances are factors identified with weight loss Mental Status Changes: Dementia is a leading cause of weight loss in the elderly. Memory loss, disorientation, impaired judgment, apathy, combative feeding behavior, and appetite disturbances are factors identified with weight loss.

Mental Status Changes In beginning stages impaired memory and judgment can lead to Not completing meals Forgetting to eat Eating the same meal twice There can be many causes of dementia; but whatever the cause, dementia is likely to pose nutritional problems. In beginning stages impaired memory and judgment can lead to not completing meals, forgetting to eat or eating the same meal twice.

Mental Status Changes In intermediate stages agitation can result in increased calorie needs Individuals seldom consume sufficient calories to meet increased needs and often begin to lose weight Individuals may require assistance with eating such as cutting food In intermediate stages agitation can result in increased calorie needs. Individuals seldom consume sufficient calories to meet increased needs and often begin to lose weight. Individuals may require assistance with eating such as cutting food.

Mental Status Changes During final stages individuals may be unable to swallow and may require tube feedings Others may simply refuse to eat Nutritional supplements are very important in meeting the needs of individuals with advanced dementia During final stages individuals may be unable to swallow and may require tube feedings. Others may simply refuse to eat. Nutritional supplements are very important in meeting the needs of individuals with advanced dementia.

Economic Changes Many older adults have limited incomes which can decrease diet quality Less money for food Housing facilities for storing and preparing food Transportation to shop Economic Changes: Many older adults have limited incomes, which may result in less money for food. Some older adults have to move into less expensive living areas which may have poor facilities for storing and preparing foods. There may be little money for transportation to grocery stores. These limitations can dramatically decrease the quality of ones' diet and affect ones' attitude towards eating.

Tips For A Healthy Diet Include a variety of food following the USDA Daily Food Plan food groups Avoid empty calorie foods Use fresh fruits for desserts Encourage snacks if food intake is low Encourage adequate water, fiber and physical activity to prevent constipation Tips To Maintain a Healthy Diet Include foods from the USDA Daily Food Plan food groups first. Avoid empty calorie foods such as desserts, sweets and fats that provide few nutrients for the calories. If food intake is low encourage in between meal snacks or supplements, or try supplementing the meals themselves. Drink at least 6 to 8 glasses of fluid each day to prevent constipation and dehydration. Adequate fiber from whole grain breads and cereals, fruits and vegetables, and exercise can also help with constipation.

Tips For A Healthy Diet Include a variety of foods and spices, unless specific foods or spices aren’t tolerated Current recommendations suggest limited benefits of special diets for people over 75 years of age. Therapeutic benefits need to be weighed against affect on dietary intake Include a variety of foods and spices, unless specific foods and spices are not well tolerated. If milk causes intestinal distress, try fermented cheeses, yogurt, or smaller servings. Drinking milk with meals may improve lactose intolerance. Lactaid or Dairy Ease can be used to help with the digestion of milk or milk products. Current recommendations suggest limited benefits of special diets for individuals over 75 years of age. Therapeutic benefits need to be weighed against the impact on nutrient intake.

Tips If Appetite Declines
Eat meals at regular times Have the main meal earlier in the day Plan 5-6 smaller meals Have special event meals Ask people what are some food they enjoy Tips if Appetite Decreases Eat meals at regular times. Have the main meal of the day at breakfast or lunch when appetite is larger and keep dinner small. Plan 5 or 6 smaller meals, between meal supplements, or supplement the main meal. Have special event meals. Ask individuals about foods they enjoy. Older adults like familiar foods and foods they grew up with: Puddings (banana pudding, bread pudding, tapioca) Hash browns Fried cornmeal Biscuits, cornbread

Tips If Appetite Declines
Keep the physical surroundings pleasant and calm Allow enough time for meals Encourage daily physical activity to increase appetite Remember medications can affect appetite Make sure the physical surrounds are pleasant and calm. Allow ample time for meals so they are not rushed. Encourage daily physical activity, such as walking, to increase appetite. Remember medications can affect appetite. Periodically check with their physician about medication use.

Tips If Smell and Taste Decline
Use herbs and spices Use a variety of flavors Use a variety of visual clues Colors Shapes Temperature Textures Tips if Taste and Smell Decreases Use herbs and spices, unless they are not tolerated. Taste decreases with age and using herbs, spices and lemon juice can increase the flavor of foods. Try having residents grow herbs, either in a garden or in a pot on a sunny windowsill. Serve food with a variety of flavors Serve food with a variety of visual cues such as colors, shapes, textures and temperatures. Remember flavors are not as easy to detect in very cold and very hot foods.

Tips If Chewing and Swallowing Decline
Use gravies and sauces to moisten food Serve a beverage with the meal Eat slowly and chew thoroughly Be sure dentures fit properly Maintain as normal of a diet as possible Ground meats are dry and difficult to swallow, try soft high protein foods Tips if Chewing and Swallowing Decreases Food Intake Use gravy or sauces to moisten food if swallowing is a problem. Serve a beverage with the meal to help with swallowing. Eat slowly and chew food thoroughly. Be sure dentures fit properly. Try to maintain a normal diet. Ground meats are dry and difficult to swallow. Use soft high protein foods to maintain protein intake if the individual is not able to chew regular meats. Try moist meat loaf, grilled cheese, deviled eggs, egg salad, soft meat salads, meat or milk-based soups, milk-based puddings and custards. These softer meats or meat alternatives are easier to chew and swallow.

Tips If Chewing and Swallowing Decline
Precut foods and use in casseroles, soups or gelatin Mash foods if it is an acceptable form Shred raw vegetables or fruits for salads, gelatins or stir-fry Watch for signs of choking Casseroles or dishes like stroganoff may be easier to chew and swallow. Try precutting foods and putting the smaller bite size pieces into casseroles, soups or gelatin. Foods prepared this way are easier to eat but the individual still feels like they are eating regular foods. Try mashing if that is an acceptable food form such as mashed potatoes or mashed baked squash. Try shredding raw vegetables or fruits and using the shredded vegetables and fruits in salads, gelatins or stir-fry. With sandwiches, meat slices may be difficult, unless they are thin enough to bite through. Lettuce and tomatoes may slide out of sandwiches making them difficult to eat. May help to cut sandwiches in fourths. Watch for signs of choking.

Tips If Emotional & Social Factors Decrease Food Intake
Serve food attractively Use a variety of flavors, colors, temperature, shapes and texture Don’t serve same foods every day Make the surroundings pleasant Invite friends or relatives over Eat Out Occasionally Tips if Emotional and Social Factors Decreases Food Intake Serve food attractively. Food tastes better if it looks good to eat. Try colorful tablecloths, placemats or trays, or a centerpiece to improve the appearance. Using colored tablecloths and placemats can also help if vision is a problem to distinguish plates and cups from the table surface. A glass of white milk may be difficult to see against a white tablecloth or placemat. Serve foods with a variety of flavors, colors, temperatures, shapes and textures. Meals with a variety of food flavors, colors, temperatures and textures are more appealing. Don't serve the same foods day after day. Make the surroundings pleasant. Invite friends or relatives over to share a meal from time to time. Eat out occasionally

Tips If Emotional & Social Factors Decrease Food Intake
Encourage other activities to increase feelings of self-worth and self-esteem Seek individuals participation in meal planning and preparation Start a garden and use produce in salads Watch for signs of depression Encourage other activities to increase feelings of worth and self-esteem. Have older adults participate in menu planning and meal preparation. Start a garden, where produce can be used in salads. Watch for signs of depression.

Tips if Strength, Energy or Coordination Decline
Special eating utensils, cups and plate guards are available Some foods take a lot of effort to eat if coordination is a problem such as peas, rice, salads, soup Some foods need something to help them stick together Tips if Strength, Energy or Coordination Decreases Food Intake Special eating utensils, cups, plate guards: Lightweight forks and spoons with extra large handles make holding easier if grasp is weak, or if fingers do not flex completely. Standard eating utensils can be easily built up with a foam rubber curler. Built-up eating utensils can be purchased at self-help equipment firms. If grasp is lacking, a cuff with a pocket holding a standard utensil can be slipped over the hand to facilitate self-feeding. Using a washcloth or rubber cabinet liner under plates to help prevent movement. Some dishes and bowls have suction devices to prevent movement. A plate with a broad edge or plate guard provides a stable area to push food against when filling a spoon or fork. Lightweight plastic cups are easier to handle than glass or china. Stretch-knit coaster slip onto a glass to provide a more secure area to grasp. Even if grasp isn’t the problem, a full glass or cup may be too heavy to lift, and pitchers may be too heavy to pour from. It may be easier to sip liquids through a long straw, instead of trying to pick up a glass Glass holder handles allow a glass to be picked up Cups with a spout may help with spills, but beverages remain HOT! Some foods take a lot of effort to eat if coordination is a problem such as peas, rice, salads, soup. Some foods need something to help them stick together.

Finger foods are ideal because they require less effort to eat Some modifications can help such as soup in a mug or spaghetti pre-mixed with sauce and melted cheese on top to help hold together Finger foods are ideal because they require less effort to eat. Some modifications can help such as soup in a mug or spaghetti pre-mixed with sauce and melted cheese on top to help hold together.

Provide assistance with tasks requiring hand and finger dexterity, such as opening packages of crackers or cartons of milk, and cutting meat Plan the dining room for safety, allowing space to accommodate wheelchairs, walkers, and canes Provide assistance with tasks requiring hand and finger dexterity, such as opening packages of crackers or cartons of milk, and cutting meat. Plan the physical arrangement of the dining room for safety, allowing space around the table to accommodate wheelchairs, walkers, and canes.

Tips If Mental Status Declines
Make mealtime a routine that occurs at the same time and place to avoid confusion Serve familiar foods in familiar ways Have the main meal at noon when appetite is larger and mental abilities are at their peak Tips if Mental Status Decreases Food Intake Make mealtime a routine that occurs at the same time, in the same place, and with as little confusion as possible. Serve familiar foods fixed in familiar ways. Have the main meal of the day at noon when appetite is larger and when mental abilities are at their peak to help optimize food intake.

May help to offer fewer choices and smaller portions with snacks as needed Serving one food at a time may be less confusing Make physical surrounds pleasant and calm and avoid unnecessary distractions It may help to offer fewer choices and small portions sizes with between meal snacks as needed. Serving one food item at a time may result in less confusion. Make physical surroundings pleasant and calm, and avoid unnecessary distractions.

Set aside enough time for meals Check food temperature to prevent burns Food consistency may need to be modified to prevent choking Individual may not know what should and should not be eaten Set aside ample time for meals so they are not rushed. Food temperatures need to be checked because individuals may not be sensitive to burning their mouths. Food consistency may need to be modified and tough or crispy foods excluded to prevent choking. Pureed foods may be necessary. An individual may hot have the judgment to know what should and should not be eaten; the caregiver may have to make those decisions.

Be aware that messiness and spills may occur due to loss of coordination If disruptive behavior occurs, try discontinuing mealtime for a few minutes or have someone else try feeding When messiness or spills become a problem due to loss of coordination, there are many steps that can be taken. If the individual clenches his/her teeth, spits out food, becomes unruly, or demonstrates other disruptive eating behaviors, try discontinuing mealtime for a few minutes. Taking a short break can be helpful to both the individual and caregiver. Sometimes just having a different caregiver feed can be helpful.

Individual may spit out food not because they are being difficult, but because they are having a difficult time eating Don’t continue feeding if person is choking Consult with a physician if the individual refuses to eat or is not eating enough If the individual clenches his/her teeth, spits out food, becomes unruly, or demonstrates other disruptive eating behaviors, try discontinuing mealtime for a few minutes. Taking a short break can be helpful to both the individual and caregiver. Sometimes just having a different caregiver feed can be helpful. Be alert to the individual while feeding. An individual may spit out food not because he/she is being difficult, but because he/she is having a difficult time eating. Do not continue to feed an individual if he/she appears to be choking or coughing. If the individual simply refuses to eat a balanced diet or is not consuming adequate calories, consult with their physician about supplemental nutrition.

Tips For The Caregiver Preserve the dignity of the person being fed
Allow sufficient time for feeding Position the person being feed Offer small amounts of food at a time Feeding food too rapidly can increase the risk of choking and food aspiration Tips for the Caregiver Preserve the dignity of the individual who has to be fed. Allow sufficient time for feeding. One study reported one-third of caregivers fed an entire meal in 5 to 10 minutes. The position of the individual being feed is important. Individual should be sitting upright with hips at a 90-degree angle. Only small amounts of food should be offered at a time. Forcing food into the mouth too rapidly can increase the risk of choking and food aspiration.

Tips For The Caregiver Don’t use straws that supply liquid more rapidly than it can be swallowed Infant rice cereal is an inexpensive and effective thickener for thin liquid Foods should be nutrient dense because individuals may tire quickly and consume only limited amounts of food Straws that supply liquid more rapidly than it can be swallowed should not be used. Infant rice cereal is a relatively inexpensive and effective thickener for thin liquid that is difficult to handle. Commercial thickeners are also available. Foods should be nutrient dense because individuals may tire quickly and consume only limited amounts of food.

Nutritional Support is “Mealtimes”
M - Maintain a routine E - Eat well-balanced meals A - Alertness to any nutritional problems L - Light and frequent meals T - Teach the caregiver how to deal with the older adult I - Interactions between drugs and nutrients M - Minimize confusion for the older adult E - Encourage older adult to eat S - Supplement the diet when necessary Remember Nutritional Support for Older Adults is “MEALTIMES”” M - Maintain a routine E - Eat well-balanced meals A - Alertness to any nutritional problems L - Light and frequent meals T - Teach the caregiver how to deal with the older adult I - Interactions between drugs and nutrients M - Minimize confusion for the older adult E - Encourage the older adult to eat S - Supplement the diet when necessary

Nutrition For Older Adults

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