E.
Nutrition in the Elderly
1. Factors influencing nutritional status
A major factor influencing nutritional status is decreased consumption of foods
with adequate concentrations of nutrients. Many factors play role in determining dietary
intake. Socioeconomic, psychological, ethnic, physiological, and pathological factors all
influence dietary intake, interacting in a complex and intertwining manner. For example,
financial stress can lead to depression, which in turn adversely affects dietary intake. In
tum, inadequate intake can lead to protein-calorie malnutrition, which in itself can cause
anorexia, depression, and apathy, ultimately setting up a vicious cycle.
2. Nutritional Requirements of the Older Person
Eating right and staying fit are important no matter what your age. As we get older our
bodies have different needs, so certain nutrients become especially important for good
health. Good nutrition is important, no matter what your age. It gives you energy and
can help you control your weight. It may also help prevent some diseases, such as
osteoporosis, high blood pressure, heart disease, type 2 diabetes, and certain cancers.
Calcium and Vitamin D
Older adults need more calcium and vitamin D to help maintain bone health. To meet
these needs, select calcium-rich foods and beverages and aim for three servings of low-
fat or fat-free dairy products each day. Other sources of calcium include fortified cereals
and fruit juices, dark green leafy vegetables, canned fish with soft bones, and fortified
plant-based beverages. Good sources of vitamin D include fatty fish, such as salmon,
eggs and fortified foods and beverages. If you take a calcium supplement or
multivitamin, choose one that contains vitamin D.
Vitamin B12
Some adults older than 50 may not be able to absorb enough vitamin B12. Fortified
cereal, lean meat and some fish and seafood are sources of vitamin B12. Ask your
doctor or a registered dietitian nutritionist if you need a vitamin B12 supplement.
Dietary Fiber
Eat fiber-rich foods to stay regular. Dietary fiber also may help lower your risk for heart
disease and reduce your risk for Type 2 diabetes. Eat whole-grain breads and cereals,
and more beans and peas — along with fruits and vegetables which also provide dietary
fiber.
Potassium
Consuming adequate potassium, along with limiting sodium (salt) intake, may lower
your risk of high blood pressure. Fruits, vegetables, beans and low-fat or fat-free dairy
products are good sources of potassium. Also, select and prepare foods with little or no
added salt. Add flavor to food with herbs and spices.
Know Your Fats
Most of the fats you eat should be polyunsaturated and monounsaturated fats, which
are primarily found in nuts, seeds, avocados, vegetable oils and fish. Choose foods that
are low in saturated fat and trans-fat to help reduce your risk of heart disease.
3. Assessment of Nutritional Status
Assessing the nutritional status of elderly patients is an integral component of a
comprehensive geriatric assessment. Nutrition assessment includes taking
anthropometric measurements and collecting information about a client’s medical
history, clinical and biochemical characteristics, dietary practices, current treatment, and
food security situation.
ABCD’s
Anthropometric
Biochemical
Clinical
Dietary
Anthropometry is the measurement of the size, weight, and proportions of the body.
Common anthropometric measurements include weight, height, MUAC, head
circumference, and skinfold. Body mass index (BMI) and weight-for-height are
anthropometric measurements presented as indexes.
Biochemical assessment means checking levels of nutrients in a person’s blood, urine,
or stools. Lab test results can give trained medical professionals useful information
about medical problems that may affect appetite or nutritional status.
Clinical assessment includes checking for visible signs of nutritional deficiencies such
as bilateral pitting edema, emaciation (a sign of wasting, which is loss of muscle and fat
tissue as a result of low energy intake and/or nutrient loss from infection), hair loss, and
changes in hair color. It also includes taking a medical history to identify comorbidities
with nutritional implications, opportunistic infections, other medical complications, usage
of medications with nutrition related side effects, food and drug interactions, and risk
factors for disease (e.g., smoking, alcohol use, overweight) that affect or are affected by
diet and nutritional status.
Dietary assessment is assessing food and fluid intake is an essential part of nutrition
assessment. It provides information on dietary quantity and quality, changes in appetite,
food allergies and intolerance, and reasons for inadequate food intake during or after
illness.
4. Measures to maintain adequate nutrition in the elderly
Although there are many reasons why older people may become malnourished, there
are also many practical ways for dealing with the problem. If you or someone you care
for is experiencing malnutrition or unintentional weight loss, the best first step is to see
the doctor, who may be able to diagnose an underlying condition or alter a medication
regimen that may be contributing to the problem. A doctor can also provide a referral to
a registered dietitian, who can design a personalized eating plan. In addition, here are
some everyday measures to maintain adequate nutrition in older adults:
Make Meals and Snacks Nutrient-dense
This means making nutrient-rich foods the focus of the meal. For example, instead of
plain chicken broth, try a hearty chicken and vegetable soup. Casseroles, stews, and
roasts are also good meal ideas.
Make Meals Colorful and Appealing
Instead of regular mashed potatoes, try mashed sweet potatoes for a colorful and
nutritious boost. Instead of plain buttered noodles, try pasta with a vibrant red tomato
sauce.
Serve Several Small Meals and Snacks
Older people with diminished appetites is often overwhelmed by large meals, so eating
smaller, more frequent meals and snacks can be less overwhelming.
Do Not Fill Up on Non-nutritious Items
For people with a small appetite, it is important not to fill up on things like coffee, tea,
and soft drinks, which can take the place of more nutritious items.
Serve up a variety of foods. Research shows that elderly adults eat more when
presented with a variety of foods to choose from. Here are some strategies to increase
the variety on the table:
Strive to include foods from every food group and of all different colors.
Invite friends over for a pot luck dinner.
Go out for a buffet-style Sunday brunch.
Make Mealtime Enjoyable and Social
When possible, invite friends or family over for meal times or visit community-based
senior meal sites for social interaction during meals.
Use Nutrition Supplements When Necessary
While a well-balanced diet is the best bet, some people may find it easier to sip a
nutrition supplement drink than to eat a meal. But, talk to your doctor or dietitian to see if
this is something that you should do.
Take Advantage of Services That Are Available
Many communities offer a wide range of nutrition services for older adults, including
community dining sites, home-delivered meals, and home visits with registered
dietitians. Research shows that meal services, such as Meals on Wheels, can improve
or help maintain nutritional status in senior s. Contact your local town or city hall,
department of health, or community hospital to find out what services are available in
your area.
