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What reporters should know about nutrition and aging

AHCJ Staff

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By Melinda Hemmelgarn, M.S., R.D.

Eating “well” is critical throughout the lifecycle to prevent chronic disease, and support both physical and mental health. Each stage of life presents unique nutritional needs and challenges; however, dietitians who work with seniors, or adults, aged 65 and older, consistently identify the following nutrition-related concerns specific to aging, many of which are interrelated and influence a senior’s ability to live independently.

Reporters should be aware of these concerns and explore how the community and those who support seniors are addressing these needs.

Body composition changes

As we age, our bodies tend to deposit more fat in our mid-section and within our muscles, with metabolic consequences. According to Ronnie Chernoff, Ph.D., R.D., associate director of education/ evaluation at the Geriatric Research, Education and Clinical Center at the Veteran’s Healthcare System in Little Rock, Ark., at any given weight, the older we are, the more body fat we have. For example, the body composition of a 25-year-old male includes approximately 61 percent water and 14 percent body fat; but by age 70, his body composition changes to 53 percent water and 30 percent fat. The loss of water reflects a loss of muscle.

Because muscle is more metabolically active than fat, the less muscle we have, the lower our metabolic rate and the fewer calories we burn, making it more difficult to maintain a healthy weight. A decline in physical activity among seniors also contributes to both muscle and bone loss. Physical activity and adequate dietary protein are key to reducing the rate of age-related loss of lean muscle mass, and maintaining a healthy weight.

Sarcopenia, or the loss of lean body mass, often occurs in tandem with obesity. Obese adults have an increased risk for chronic diseases including cardiovascular disease and diabetes. Plus, excess weight exacerbates joint pain and hinders mobility.

Alice H. Lichtenstein, D.Sc., senior scientist and director of the Cardiovascular Nutrition Laboratory at the USDA Human Nutrition Research Center on Aging at Tufts University says “government statistics continue to show that elderly obesity rates are on the rise, indicating there is a need to educate older adults about the importance of moving regularly and consuming a diet of nutrient-rich foods with a calorie content matched to energy needs.”

Notes:

  • The Dietary Guidelines for Americans provide estimated calorie needs for ages 51 and over, based on age and activity. They range from 2000 calories per day for a sedentary male to 2,800 calories per day for an active male; and 1600 calories per day for a sedentary female, to 2200 calories per day for an active female.

  • Becky Dorner, R.D., advises seniors to contact their health care provider if they experience unintended weight loss of >5 percent in 30 days or further weight loss after this. According to the Academy of Nutrition and Dietetics, “there is strong evidence of an association between underweight (defined as a BMI of

Specific age-related nutrient needs

According to Katherine Tucker, Ph.D., Tufts Human Nutrition Research Center on Aging, even though we require fewer calories as we age, in some cases nutrient needs become greater, reflecting a change in the ability of aging bodies to digest, absorb, and utilize nutrients. However, in most cases, nutritionists agree that meeting nutrient needs from foods is preferable to supplements. The Dietary Guidelines for Americans (include specific recommendations for older adults, including:

  • Consume foods fortified with vitamin B12, such as fortified cereals.

  • Choose foods that provide more potassium, dietary fiber, calcium and vitamin D.

  • Limit sodium to 1,500 mg/day.

Notes:

  • B12 absorption decreases with age.

  • Older adults, especially those living in institutions, who are not exposed to sunlight are likely to be deficient in vitamin D; plus, the skin’s ability to synthesize Vitamin D from sun exposure becomes less efficient with age. Fortified dairy products provide some vitamin D.

  • Limiting sodium intake is nearly impossible if consuming processed foods or eating away from home.

  • Sensory changes in taste and smell are common with age, and contribute to the challenges of meeting nutrient needs.

Hydration

Age-related decline in thirst can put older adults at risk for dehydration, particularly during periods of sustained hot weather, says Registered Dietitian, Susan Moores, M.S., R.D. Inadequate fluid intake is associated with constipation, dry skin, mental confusion, fatigue and headache. However, explains Moores, “older individuals also don’t drink enough fluids because they don’t want to have to get up to go to the bathroom.“

Notes:

  • Best beverage choices include those that are low in added sugars, which contribute calories but few essential nutrients.

  • Eating foods with a high water content (fruits, vegetables) can help meet fluid needs.

Poor dental health.

Recommendations to eat more fruits and vegetables to prevent chronic disease, constipation, and maintain a healthy weight abound. But without proper dentition, eating health-protecting foods becomes difficult if not impossible. According to the Nutrition Screening Initiative, tooth or mouth problems that make it difficult to eat, are one of several key factors that put seniors at risk for malnutrition.

According to the Alliance for Aging Research, nearly one-third of older adults have untreated tooth decay which puts them at risk for severe infection and chronic illness, including stroke, heart disease and diabetes. And at least 25 million adults both pre- and post-retirement go without dental care because they can’t afford it, and Medicare lacks adequate dental coverage.

Notes:

  • Dry mouth, a common condition among older adults, especially in combination with receding gums, can result in tooth decay and loss. It is exacerbated by illness, medications, and cancer therapy.

  • Chewing function in people with dentures is only 20 percent to 40 percent as strong as natural teeth, thereby limiting food choices.

Food safety

Safe food handling practices apply to all ages. But seniors with compromised immune systems are at greater risk for food borne illness, and if they become ill, may take longer to recover.

When Moores delivered Meals on Wheels to homebound seniors she discovered that her clients would allow food to remain at room temperature for more than the recommended safety limit of two hours, or leftovers would be stored in the refrigerator beyond safe limits of a couple of days. “Many seniors don’t want to waste food,” says Moores, “so they hold on to it for way past its prime and safety.”

Eating alone/depression

Preparing and enjoying food can be a challenge when seniors find themselves alone, without resources, and with physical challenges. However, eating alone is one of the warning signs of poor nutritional health. Food is often better digested in the company of people we enjoy.

Notes:

  • Eating out with friends is an important social activity, but foods prepared from scratch at home tend to be lower in fat, sodium, sugar and calories than commercially prepared and processed foods, or foods purchased away from home.

  • Community gardens, senior centers, or potlucks can increase social interaction at mealtimes, reduce depression, and improve emotional health and nutritional intake.

  • Dietary guidelines from a variety of health organizations recommend decreasing saturated fat and increasing polyunsaturated fats. But an imbalance of omega-6 vs. omega-3 fatty acids can exacerbate depression.

Poverty

According to the U.S. Census Bureau and the Food Research and Action Center 8.9 percent of all Americans 65 and over, or 3.4 million elderly, live in poverty, putting them at risk for food insecurity, hunger, and malnutrition). Unfortunately, the lowest priced foods, as well as foods often distributed through soup kitchens and food pantries are often high in sugar, fat and sodium, and low in fiber — foods seniors are advised to restrict to maintain health.

Food, drug, and supplement interactions

Taking three or more medications per day is considered a risk factor for malnutrition. That’s because prescription drugs, over the counter medicines, and even dietary supplements — vitamins, minerals, and herbs — can affect how our bodies absorb, use, and excrete nutrients.

Medications may also affect sense of taste, and appetite; others may cause nausea, dry mouth, drowsiness, constipation or diarrhea. Risk of malnutrition is greatest when an inadequate diet is combined with multiple drugs for long-term treatment of chronic disease.

Dietary supplements, no matter their “natural” connotation, as well as certain foods and beverages, can affect how the body metabolizes drugs. For example, the presence or absence of food in the stomach may speed or delay the absorption of some drugs, and affect their effectiveness. Other foods may alter the chemical actions of drugs. For example,

  • Grapefruit juice increases the strength of statin drugs

  • Ginger, garlic, ginkgo, cranberry juice and high doses of vitamin E (400 IU or more) enhance the effects of the blood-thinning drugs, and increase the risk of bleeding

  • Mixing alcohol with pain relievers, and non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can increase the risk of stomach upset, bleeding, and liver damage

  • Mixing medications into food or hot drinks may also reduce the effectiveness of the drug

Notes:

  • Seniors should consult with pharmacists and dietitians for drug-nutrient interactions.

  • Seniors may be reluctant to inform their care providers about their use of alternative drugs or supplements, but should make a list of all medications, including over-the-counter drugs and dietary or herbal supplements to share with their care providers. Or, bring all medications and supplements to their appointment.

  • They should ask the doctor and/or pharmacist the following questions when receiving a new prescription:

    • How do these drugs work in my body and what are common side effects?

    • Are there any foods or beverages that I should avoid while taking these medications?

    • How should I take my medications? – with food, on an empty stomach, with additional fluid?

    • Would any vitamin, mineral or other drug interfere with any of my medications? Is there a risk with alcohol?

Story ideas for reporters:

  • Where and how do seniors receive or shop for groceries? Is there a farmers’ market in your community that has a senior voucher program? What about community gardens at senior centers and care facilities?

  • Explore the role of omega-3 vs. omega-6 fatty acid imbalance on mental and physical health.

  • Investigate if and how agricultural policies support recommendations of the U.S. Dietary Guidelines.

  • How does senior access to dental care compare among rural, urban and institutional settings in specific states, and nationally? How does dentition affect diet quality?

  • Conduct a nutritional risk assessment with a senior sample in your community. Identify key risk factors and policy solutions.

  • Does food at food pantries, senior centers, and nursing homes meet Dietary Guidelines recommendations?

  • What are the most common medications taken by seniors in your community, and are seniors aware of food, supplement and medicine interactions?

  • Talk to registered dietitians in your community hospital and ask about rates of malnutrition among elderly patients admitted, as well as hospital-induced malnutrition.

Expert sources and key resources:

Board certified specialists in Gerontological Nutrition:

USDA:

Melinda Hemmelgarn is a registered dietitian and freelance writer. She’s the author of a weekly weekly “Food Sleuth” newspaper column for more than 25 years and a syndicated radio host.

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