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					 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
 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
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
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 For Older Adults
 Basic guidelines the same for older adults
 The MyPyramid 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 amount of food recommended from each
  MyPyramid 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
 For 1,600 to 2,600 calories the MyPyramid
  1 ½ -2 cups of fruit
  2-3 ½ cups of vegetables
  5-9, 1-ounce equivalents of grains
  5-6 ½ ounces of meat or beans
  3 cups of milk
  5-8 teaspoons of oil
  Saturated fat and added sugar should not exceed
   132-410 calories per day
 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
Calorie Imbalance
 Weight gain
   Risk for many health problems
   Estimate calories: Multiply weight in pounds by
    activity factor (10 sedentary or for weight loss;
    12-13 moderately active; 15 active)
   Don’t go below 1200 calories
 Weight loss
   Risk for malnutrition
 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
 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
 Fat concentrated source of energy
 Fat has some important roles
   Helps form cell membranes
   Carries fat-soluble vitamins
   Provides essential fatty acids
 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
 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
 Most carbohydrate should come from
  complex carbohydrate foods
 Simple carbohydrates or sugar rich foods
  should be limited
 Two types of fiber
   Soluble and insoluble fiber
 Both types are beneficial
   Constipation
   Diarrhea
   Diverticulitis
   Heart Disease
   Colon Cancer
   Diabetes
 Food is only one factor
 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 MyPyramid recommends ½ of all
  grains should be whole grains to help
  provide adequate 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
Vitamins and Minerals
 Vitamin and mineral needs are similar to
 younger adults, with some differences
  Vitamin A
  Iron
  Vitamin D
  Vitamin B12
  Calcium
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
 Beta-carotene, vitamin A precursor, not a
  problem for over-dosing
Vitamin A
 DRI for adults 51 years and older is 900
  micrograms for males and 700 micrograms for
 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
 Iron needs for women decrease after
 Like vitamin A, iron is stored more readily in
  older adults
 Excess iron can increase oxidative stress
 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
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
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.
Vitamin D
 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
 People with atrophic gastritis are particularly
  vulnerable to vitamin B12 deficiency
 B12 deficiency can result in irreversible nerve
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
Vitamin B12
 Synthetic vitamin B12 is found in fortified
  foods such as cereals
 Protein-bound B12 is found in all animal
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
 Calcium requirements increase with age
 Many older adults do not consume enough
 An adequate calcium intake is one way to
  help protect against osteoporosis
 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
 DRI for calcium for women 51 years of age
  and older is 1,200 milligrams per day.
 The UL for calcium is 2,500 milligrams per day
 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
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
 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
 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
 Leading food sources of folate are ready-to-
 eat cereals, yeast bread, orange juice and
 grapefruit juice
 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
 Leading food sources of magnesium are milk,
 yeast bread, coffee, ready-to-eat cereal, beef
 and potatoes
 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
 Leading food sources of zinc are beef, ready-
 to-eat cereals, milk and poultry
 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
 Older adults are at increased risk for
   Body water decreases with age
   Many medications increase water loss
   Thirst mechanism not as effective
   Self limit fluid intake
   Decreased mobility to reach fluids
Dehydration Signs

0-1%   Thirst

2-5%   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
Vitamin/Mineral Supplements
 Older adults can get the nutrients they need
  by eating a wide variety of foods following the
 Variety is the key
Vitamin/Mineral Supplements
 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 multi-
  vitamin/multi-mineral supplement
Vitamin/Mineral Supplements
 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”
 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
 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
Factors That Affect Intake
 Many factors can affect food intake among
 older adults
  Physical
  Social
  Emotional
  Mental Status
  Economic
Physical Changes
 Physical changes can affect food intake
   Body composition
   Saliva
   Teeth
   Digestion
    Stomach acid
    Fat intolerance
    Lactose intolerance
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
 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
 Production of saliva may decrease with age
 Saliva moistens food and makes swallowing
 Foods may be dry and more difficult to
 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
 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
 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
 Many older adults do not tolerance of high fat
  or dairy foods
 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
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
 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
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
 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
 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
 The combined effects of decreased thirst
  sensation, decreased body water, increased
  water loss, incontinence and decreased
  mobility put older adults at greater risk for
 Keep fluids close at hand to encourage
  increase fluid intake
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
 Changes in taste and smell may decrease
  appetite and food intake
 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
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
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
 Doesn’t necessarily relate to living alone
 Physical isolation may be far less important
 than the frequency of 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
 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
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
 In beginning stages impaired memory and
 judgment can lead to
  Not completing meals
  Forgetting to eat
  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
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
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
Tips For A Healthy Diet
 Include a variety of food following the
  MyPyramid 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 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
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 Declines
 Keep the physical surroundings pleasant and
 Allow enough time for meals
 Encourage daily physical activity to increase
 Remember medications can affect appetite
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 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 Decline
 Precut foods and use in casseroles, soups or
 Mash foods if it is an acceptable form
 Shred raw vegetables or fruits for salads,
  gelatins or stir-fry
 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 & 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
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 Decline
 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
Tips if Strength, Energy
or Coordination Decline
 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
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 Declines
 May help to offer fewer choices and smaller
  portions with snacks as needed
 Serving one food at a time may be less
 Make physical surrounds pleasant and calm
  and avoid unnecessary distractions
Tips If Mental Status Declines
 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
Tips If Mental Status Declines
 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
Tips If Mental Status Declines
 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
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
 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
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

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