(Condensed from an article by Jennie McCrary, MS, RD, LD; IDEA Fitness Journal; March, 2008; Pgs. 52-59)
According to “The State of Aging and Health in America 2007,” a report released by the Center for Disease Control and Prevention (CDC) and the Merck Company Foundation, about 80 % of older Americans are living with at least one chronic condition, and 50% have at least 2. The cost of providing health care for one person aged 65 or older is three to five times more than for a younger person.
But as the CDC emphasizes, poor health is not an inevitable consequence of aging. To maintain health over these additional “golden” years, it is important to pay attention to nutrition and physical activity patterns early and at all stages of aging. (See “Determine Nutritional Health for a checklist to gauge your nutritional status.)
Aging is a normal, gradual process of physical change over time. Although some health problems are an unavoidable aspect of aging, many more are preventable and can be influenced by three major behaviors: eating a healthy diet, staying physically active, and avoiding tobacco. In fact , there is evidence that these three behaviors alone are more influential than genetic factors in fighting age-associated decline. Nutrition in particular is a major determinant of healthy, successful aging, which is defined as the ability to maintain a low risk of disease and related disability; good cognitive function; and an active social life.
Aging is generally associated with a slower metabolism, which leads to accumulation of extra body fat, particularly around the middle. Digestion slows, and the body becomes less efficient at managing the rise in blood sugar after eating. One of the first signs of aging is loss of muscular strength, giving way to stiff joints. Muscular strength remains similar up to age 45 and decreases by 50 % between the ages of 50 and 80.
Preserving bone health also becomes a concern as the body naturally loses bone density. The kidneys work harder to remove waste and keep the body hydrated, while the circulatory system becomes less efficient. Blood vessels may become clogged and constricted. In addition, maintaining cognitive health becomes increasingly important.
While prevention is often the focus of the younger and middle-aged adult, maintaining current levels of health and managing disease or conditions becomes the focus of the older adult.
Special Nutrition Needs of the Aging Body
Gradual loss of lean muscle mass and reduced energy expenditure lower caloric needs. However, nutrient needs do not drop, and in some cases they increase. As a result, packing more nutrition into fewer calories becomes a challenge for older adults. For this reason, focusing on quality food choices becomes paramount. Certain nutrients require greater attention as people age. Which vitamins and minerals are critical depends on the health status of the individual. Most often, vitamin D and vitamin B are marginalized in older adults…..followed by calcium and iron. Inadequate dietary intakes of energy, folate, vitamin D, vitamin B6, calcium and zinc have been reported in community-dwelling adults over 60 years old. Nutrients are interactive; many nutrients are needed within each system of the body for that system to run efficiently. Those needs continue as we age. So, in essence, all nutrients have benefits in aging.
Below is a list of some of the most important nutrients:
Calcium: As it ages, the body does not absorb calcium as easily as it used to. Increased calcium excretion accompanies decreased absorption. Age-associated loss of bone density increases risk for fracture and osteoporosis. Loss of skeletal calcium in postmenopausal women can reach more than 40%. Because bone fractures are a significant contributor to morbidity and mortality in older people, achieving daily calcium needs is critical; yet only 5% of older women and 10% of older men consume the DRI recommendation.
Vitamin D: Evidence suggests that vitamin D, best known for its role in bone health, may have a function in preventing a number of diseases. According to the dietary guidelines, the need for the “sunshine vitamin” increases from 10 to 15 micrograms (mcg) after age 50 as blood levels of vitamin D decline. For the elderly, higher amounts (25 mcg, or 1,000 IU) from both fortified foods and supplements have been recommended.
Even with supplementation, however, older adults are not consuming these higher amounts. Deficiency is common in the elderly and associated with many age-related conditions, including high blood pressure, cancer, fractures and falls. The major causes of vitamin D deficiency are decreased exposure to sunlight, a decline in the synthesis of vitamin D in the skin, poor nutrition and decreased renal function. Because of this vitamin’s role in calcium absorption and mineralization, chronic deficiency leads to osteomalacia, or softening-bone disease.
Vitamin B12 and Folate: Most individuals over age 50 have a reduced ability to absorb naturally occurring vitamin B12 and must therefore consume it in its crystalline form (fortified foods or supplements). The major causes of vitamin B12 deficiency are atrophic gastritis and pernicious anemia. Atrophic gastritis affects nutrient bioavailability and is a problem that increases with age; research indicates that 40-50% of individuals over age 80 have the condition. Consequently, a significant portion of older people are at risk of impaired absorption of vitamin B12, folic acid and other vitamins and minerals. Pernicious anemiaresults from an age-related loss of gastric intrinsic factor. Vitamin B12 deficiency can cause cognitive dysfunction and neurological problems in older people. 90% of women and 95% of men do not meet the DRI of vitamin B12.
Sodium: Older adults should aim to consume no more than 1,500 milligrams (mg) of sodium per day (about ¾ teaspoon of salt). To manage sodium intake, individuals should read labels, aim for foods with %5 or less of the daily value (DV) for sodium and avoid food with more than 20% of the DV.
Furthermore, because potassium can counterbalance the harmful effects of sodium on blood pressure, older adults should strive to meet the potassium recommendation (4.7 grams per day) with food. Consuming more potassium-rich foods may also help prevent the bone loss that occurs with aging. Potassium needs can be achieved by consuming the recommended daily servings of vegetables, fruits and low-fat or fat-free milk products.
Fiber: Since constipation may affect up to 20% of people over age 65, foods rich in dietary fiber become increasingly important for older adults. Additional causes of constipation among this age group may include side effects of medications and lack of appropriate hydration. Low fiber intake may also contribute to other gastrointestinal diseases common among older adults, including diverticulosis.
Other Nutrients: The role of antioxidants in the aging process is worth mentioning. Zinc, along with vitamins C and E, and the phytochemicals lutein, zeaxanthin and beta carotene from food sources, may help prevent or slow the onset of age-related macular degeneration, the leading cause of blindness in people over age 55. Evidence suggests that low dietary intake of these nutrients may also increase cataract risk.
Concerns That Impact Seniors’ Nutritional Status
Sensory Underload. Age-related changes in sensory input can impact nutritional status and quality of life. Fewer taste buds and a loss of smell can make food seem bland, impacting appetite, nutrient intake and overall enjoyment of food. More than 50% of adults between the ages of 65 and 80 have problems with their senses of smell and taste, increasing to 75% in those over 80. Age related sensory declines can be exacerbated by disease and medication. These alterations in taste and smell often cause older adults to reach automatically for the salt shaker to enhance the flavor of food, a practice that negatively influences blood pressure.
Dental Issues. Poor oral health can also affect food intake and nutritional status. Chewing and swallowing can become problematic for older adults. Intake of proteins and other nutrients may be compromised as meats, fresh fruits and vegetables become difficult to chew. It is recommended that older adults with dental problems chop, steam, stew, grind or grate hard or tough foods to minimize the need to chew. Soft, fresh fruits and vegetables (like bananas and avocados) or juices are good choices. If raw fruits and vegetables are too hard, low-sodium canned varieties can be substituted.
Food safety. It is recommended that seniors avoid eating or drinking raw (unpasteurized) milk or any products made from unpasteurized milk; raw or partially cooked eggs; raw or undercooked meat, poultry, fish and shellfish; unpasteurized juices; and raw sprouts. In addition, to reduce the risk of developing listeriosis, a potentially life-threatening illness caused by bacterium, older adults should only eat certain deli meats and frankfurters that have been reheated to steaming hot.
Malnutrition. Older people are at risk of nutrient deficiency and malnutrition. The prevalence of malnutrition among older adults living independently is 5 – 10% and it increases to 60% for those institutionalized or hospitalized. Regardless of whether an individual is underweight or overweight, malnutrition exacerbates disease in decreases functionality, which affects quality of life. Protein-energy malnutrition and nutrient deficiencies can compromise the elderly immune system. Good nutritional status affects the body’s ability to attain and maintain healthy organs. When organs are healthy, systems work well. When systems work well, decline is slowed.
Food Insecurity. Financial constraints and poverty can be a determinant of nutritional status. Food insecurity (lack of food resources) is a problem among the elderly, affecting 1.4 million households. Not surprisingly, older people who don’t have enough food have consistently lower intakes of key nutrients, including iron, protein and vitamin B12, compared with those who have access to enough food. These older adults are more likely to be underweight, which compromises health and quality of life.
Social Isolation. Living alone, being socially isolated and having decreased independence to shop and cook may lead to depression and can cause a person to eat less and make poor food choices. The impact of these social changes appears to affect the nutrient intake of men more than women.
Studies show that more food is consumed when meals are eaten with others. Social interaction lengthens meal duration and can make eating a more pleasurable experience.
It’s Never Too Late
While early attention to healthy eating and physical activity patterns are most effective for prevention, the positive effects of a healthy lifestyle can be realized at any age. Older adults who achieve healthy aging are better prepared to live more years disease and/or illness free. Regular physical activity can reduce functional declines associated with aging. In addition, wise nutrition choices are crucial for enabling older adults to live a long, healthy active life. Aging is inevitable, but a healthy lifestyle can improve how we age.