Older persons nutrition: what’s important?

Eating healthy is important in all stages of our lifecycle, it becomes much more important at childhood and as we age.  This is linked to a variety of changes, including nutrient deficiencies, decreased quality of life and poor health outcomes. Luckily, there are ways to help deficienciesand/ or to slow down other age-related changes. This article will focus many on health changes experienced during aging and ways to prevent or slow down those effects. 

Changes in nutritional needs:

Aging is linked to muscle loss – Sarcopenia

Sacorpenia is a natural aging process which is associated with gradual and progressive loss of muscle mass, muscle strength, and endurance. Although several underlying mechanisms contribute to age-related decreases in skeletal muscle, inadequate dietary protein intake may accelerate this process (1). Eating a protein-rich diet could help fight sarcopenia, the age-related loss of muscle and strength. Research shows added benefits when a protein-rich diet is combined with resistance exercise (light walking included). Adequate dietary protein intake and movementare important to healthy aging. Greater muscle protein breakdown is more likely when older ageis accompanied by acute or chronic disease, e.g., cancer, heart failure, chronic lung disease, or CKD undergoing dialysis. If protein breakdown not offset by increasing protein intake, along with maintaining physical activity, older adults are at higher risk for sarcopenia, frailty, disability.(1). Dietary protein intake and physical activity are the key modifiable means of stimulating muscle protein anabolism. 

Aging is linked to reduced stomach acid 

Research studies have estimated that 20% of elderly people have atrophic gastritis. Atrophic gastritis is a condition in which chronic inflammation has damaged the cells that produce stomach acid This result in a low production of stomach acid which affects the absorption of nutrients, such as vitamin B12, calcium, iron and magnesium (2). This could also lead to less vitamin B12 absorption from foods. Vitamin B12 is bound to proteins in the food and needs to be separated by stomach acid before it is absorbed.

Changes in appetite

Poor appetite is a common problem in older people living at home and in care homes, as well as hospital inpatients. It can contribute to weight loss and nutritional deficiencies, and is associated with poor healthcare outcomes, including increased death rates (3). There are numerous factors that could cause older adults to have a poor appetite such as changes in hormones, medication side effects or disease conditions, changes in taste and smell, as well as changes in life circumstances just to name a few.  It’s common for elderly people to experience reduced appetite. If this issue is not addressed, it can lead to weight loss, nutritional deficiencies and poor health (3). Eating small frequent meals that are nutrient dense can help with meeting nutritional requirements without forcing down large quantities of food. 

Common nutrient deficiencies

Various studies show that there are other nutrients that are deficient relating to poor dietary intake and increased nutrient needs associated with aging in most older persons and may need attention.

  • Potassium: A higher potassium intake is associated with a lower risk of high blood pressure, kidney stones, osteoporosis and heart disease, all of which are more common among the elderly. Potassium is abundant in fruits and vegetables e.g. banana so adopting a diet high in fruits and vegetables is essential 
  • Omega-3 fatty acids: heart and heart related e.g. stroke are one of the leading causes of death among the elderly. Evidence shows that omega 3 fatty acids from food (oily fish e.g. pilchards, salmon, seeds such as chia seed and flaxseed or supplements can lower heart disease risk factors like high blood pressure and reduce bad fats levels in the blood and their effect. 
  • Magnesium: Magnesium is an important mineral in the body. Unfortunately, elderly people are at risk of deficiency because of poor intake, medication use and age-related changes in gut function. Magnesium supplement could be beneficial for older adults.
  • Iron: Deficiency is common in elderly people. This may cause anaemia, a condition in which the blood does not supply enough oxygen to the body. Including good iron food sources or taking a supplement containing iron can be essential. 

Increased prevalence of Constipation

Constipation excessively affects older adults; constipation affects more people in nursing homes compared to older persons in communities. Loss of mobility – reduced movement, medications, underlying diseases, ignoring calls to defecate are some of the contributing factors to constipation (4). It is especially common in people over 65, and it’s two to three times more common in women. Increasing fibre intake can help with constipation. Common fiber-rich foods include cereals (sorghum, brown rice, corn/ mealies) vegetables, fruits, potatoes and sweet potato with skin and legumes and beans. The mechanism of action of fiber that help with improving stool consistency and frequency thus reducing constipation include (5): 

  • Fibre increases stool bulk and increases stool movement in the large intestine
  • Fibre gets fermented in the large intestines short-chain fatty acids (butyrate, propionate, acetate, etc.), which increase osmotic load and increases stool movement
  • short-chain fatty acids are food to good bacteria which keep inner lining of the gut and directly or indirectly increase stool movement 
  • Fibre contains water

Unattended constipation can impair life (impair health) and later cause further damage to the gut. 

Calcium and Vitamin D 

Calcium and vitamin D are important nutrients for maintaining optimal bone health. Your body stands to benefit from getting more calcium and vitamin D as you age. Calcium and vitamin D are two of the most important nutrients for bone health. Calcium helps build and maintain healthy bones, while vitamin D helps the body absorb calcium. Unfortunately, older adults tend to absorb less calcium from their diets (6). During the aging process, changes occur in many factors involved in the regulation of calcium homeostasis. There is a decline in intestinal calcium absorption with age, resulting in secondary bone loss. In addition to the intestine, there are age-related changes in the kidney that affect calcium homeostasis. With age, there is a decline in kidney function and a gradual decrease in the glomerular filtration rate, which is associated with progressive structural deterioration of the kidney (6)

  • To counter aging’s effects on your vitamin D and calcium levels, it is advisable to consume more calcium and vitamin D through foods and/ or supplements.
  • A variety of foods contain calcium, including dairy products (milk, yoghurt) and dark green, leafy vegetables (e.g. spinach). 
  • The greatest source of vitamin D is sun exposure – everyone including older persons are advised to spend some time in the sun. 
  • Older people can also benefit from taking a vitamin D as well Calcium supplement with guidance from a healthcare professional 

Dehydration

Your ability to recognize hunger and thirst may also be reduced with aging. Drinking an adequate amount of water is important much more with aging, as the body may become less able to recognize the signs of dehydration. Older persons also tend to have thin skin, and this increases skin dehydration.  Sipping water at a preferred temperature during the day helps prevent dehydration and dry mouth. 

Take home message:

  • Aging is linked to changes that can make you prone to deficiencies in calcium, vitamin D, vitamin B12, iron, magnesium and a need for several other important nutrients e.g. omega 3 fatty acids
  • Aging may reduce the ability to recognize sensations like appetite and thirst
  • Make a conscious effort to stay on top of your water and food intake, eat a variety of nutrient-rich foods
  • Dietary supplements such as a calcium supplement, a multivitamin & mineral supplement and a omega 3 fatty acid – consult with your healthcare professional before taking any dietary supplements
  • All these actions can help you fight deficiencies and staying healthy during aging 

References: 

  1. Denise K Houston, Barbara J Nicklas, Jingzhong Ding, Tamara B Harris, Frances A Tylavsky, Anne B Newman, Jung Sun Lee, Nadine R Sahyoun, Marjolein Visser, Stephen B Kritchevsky, Health ABC Study, Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study, The American Journal of Clinical Nutrition, Volume 87, Issue 1, January 2008, Pages 150–155, https://doi.org/10.1093/ajcn/87.1.150
  2. Sipponen P, Maaroos HI. Chronic gastritis. Scand J Gastroenterol. 2015;50(6):657–667. doi:10.3109/00365521.2015.1019918
  3. Pilgrim AL, Robinson SM, Sayer AA, Roberts HC. An overview of appetite decline in older people. Nurs Older People. 2015;27(5):29–35. doi:10.7748/nop.27.5.29.e697
  4. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010;5:163–171
  5. Bae SH. Diets for constipation. Pediatr Gastroenterol Hepatol Nutr. 2014;17(4):203–208. doi:10.5223/pghn.2014.17.4.203

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