5.4 Adult and elderly nutrition: Nutrient requirements, age-related changes, and chronic disease prevention

As we age, our nutritional needs evolve. Adults and elderly individuals require specific nutrients to maintain health and prevent chronic diseases. This section explores how energy, protein, and micronutrient needs change over time.

Proper nutrition plays a crucial role in healthy aging. We'll examine dietary patterns that can help prevent chronic diseases, discuss age-related changes affecting nutrition, and explore strategies for optimal nutrition in older adults.

Nutritional Needs of Aging

Energy and Macronutrient Requirements

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• Energy requirements decrease with age due to changes in body composition (reduced lean body mass) and decreased physical activity levels
• Protein requirements may increase slightly to offset age-related muscle loss (sarcopenia) and maintain muscle mass and strength
  • Adequate protein intake is essential for preserving muscle function, immune health, and wound healing in older adults
  • Protein sources should include lean meats, fish, poultry, eggs, legumes, and low-fat dairy products

Micronutrient Requirements and Absorption

• Vitamin D requirements increase due to reduced skin synthesis and decreased absorption efficiency in the elderly
  • Vitamin D is crucial for calcium absorption, bone health, and immune function
  • Sources include fortified dairy products, fatty fish (salmon, tuna), and sun exposure
• Calcium requirements remain high to maintain bone health and prevent osteoporosis, especially in postmenopausal women
  • Adequate calcium intake, along with vitamin D, helps maintain bone mineral density and reduces fracture risk
  • Sources include dairy products, leafy greens (kale, collard greens), and fortified foods (almond milk, tofu)
• Vitamin B12 absorption may decrease with age due to atrophic gastritis and reduced intrinsic factor production, increasing the risk of deficiency
  • Vitamin B12 is essential for red blood cell formation, neurological function, and DNA synthesis
  • Sources include animal products (meat, fish, eggs, dairy) and fortified foods (cereals, nutritional yeast)
• Fluid requirements remain important to maintain hydration, as thirst sensation may diminish with age
  • Adequate hydration is crucial for maintaining blood volume, regulating body temperature, and supporting cognitive function
  • Encourage water, herbal teas, and low-fat milk, while limiting sugary beverages and excessive caffeine intake
• Fiber intake should be maintained or increased to promote regular bowel movements, prevent constipation, and support gut health
  • Fiber helps maintain digestive health, promotes feelings of fullness, and may help regulate blood sugar and cholesterol levels
  • Sources include whole grains, fruits, vegetables, legumes, and nuts

Diet for Chronic Disease Prevention

Dietary Patterns and Nutrient Intake

• Adequate intake of fruits, vegetables, whole grains, lean proteins, and healthy fats (omega-3 fatty acids) is associated with reduced risk of chronic diseases
  • A balanced diet rich in nutrient-dense foods provides essential vitamins, minerals, and bioactive compounds that support overall health and disease prevention
  • Examples of healthy fats include fatty fish (salmon, sardines), nuts (walnuts, almonds), seeds (flaxseed, chia), and plant oils (olive, avocado)
• Dietary fiber, particularly from whole grains, fruits, and vegetables, is linked to decreased risk of cardiovascular disease, type 2 diabetes, and certain cancers
  • Fiber helps lower cholesterol levels, improve blood sugar control, and promote feelings of fullness, which may aid in weight management
  • Whole grain examples include oats, quinoa, brown rice, and whole wheat bread
• Potassium-rich foods, such as fruits, vegetables, and low-fat dairy products, may help manage blood pressure and reduce the risk of hypertension and stroke
  • Potassium helps counteract the effects of sodium on blood pressure and supports proper muscle and nerve function
  • Sources include bananas, spinach, sweet potatoes, white beans, and yogurt
• Limiting saturated and trans fats, added sugars, and excess sodium intake is recommended to prevent cardiovascular disease, obesity, and other chronic conditions
  • Saturated fats are found in high-fat dairy products, fatty meats, and tropical oils (coconut, palm)
  • Trans fats are found in some processed foods, such as partially hydrogenated oils, fried foods, and baked goods
  • Added sugars are found in sugary beverages, desserts, and many processed foods

Specific Dietary Approaches

• Mediterranean-style and DASH (Dietary Approaches to Stop Hypertension) diets, which emphasize plant-based foods and limit processed foods, have been associated with reduced chronic disease risk
  • The Mediterranean diet focuses on fruits, vegetables, whole grains, legumes, nuts, olive oil, and moderate amounts of fish and red wine
  • The DASH diet emphasizes fruits, vegetables, low-fat dairy, whole grains, lean proteins, and limited sodium intake
• Adequate vitamin D and calcium intake, along with regular weight-bearing exercise, is crucial for maintaining bone health and preventing osteoporosis
  • Weight-bearing exercises include walking, jogging, dancing, and strength training
  • Vitamin D and calcium supplements may be necessary for some individuals, as recommended by a healthcare provider
• Antioxidant-rich foods, such as berries, dark leafy greens, and nuts, may help combat oxidative stress and inflammation associated with aging and chronic diseases
  • Antioxidants help neutralize harmful free radicals and protect cells from damage
  • Examples of antioxidant-rich foods include blueberries, spinach, kale, almonds, and green tea

Age-Related Changes in Nutrition

Appetite and Sensory Changes

• Decreased appetite, often referred to as the "anorexia of aging," can lead to reduced food intake and increased risk of malnutrition
  • Age-related hormonal changes, medications, and social factors can contribute to decreased appetite
  • Strategies to stimulate appetite include offering smaller, more frequent meals, enhancing food flavors, and creating a pleasant dining environment
• Sensory changes, such as diminished sense of taste and smell, can affect food preferences and enjoyment, further contributing to decreased appetite
  • Aging can lead to a reduced number of taste buds and olfactory receptors, altering taste and smell perception
  • Using herbs, spices, and flavor enhancers can help improve food palatability and enjoyment

Oral Health and Digestion

• Dental problems, such as tooth loss or ill-fitting dentures, can make chewing difficult and limit food choices, leading to nutritional deficiencies
  • Regular dental check-ups, proper oral hygiene, and well-fitting dentures are important for maintaining oral health and facilitating eating
  • Modifying food textures (e.g., soft, minced, or pureed) can make eating easier for those with chewing or swallowing difficulties
• Atrophic gastritis, a condition common in the elderly, reduces stomach acid production and intrinsic factor secretion, impairing vitamin B12 absorption
  • Vitamin B12 supplements or fortified foods may be necessary to prevent deficiency
  • Proton pump inhibitors (PPIs) and H2 blockers, commonly used for acid reflux, can also contribute to vitamin B12 malabsorption
• Age-related changes in the digestive system, such as decreased intestinal motility and reduced digestive enzyme production, can affect nutrient absorption and lead to constipation
  • Adequate fiber intake, hydration, and physical activity can help promote regular bowel movements
  • Probiotic-rich foods (yogurt, kefir, sauerkraut) or supplements may support digestive health

Medications and Socioeconomic Factors

• Polypharmacy, or the use of multiple medications, can interfere with nutrient absorption and metabolism, as well as affect appetite and taste perception
  • Regularly reviewing medications with a healthcare provider can help identify potential nutrient interactions and side effects
  • Discussing the use of dietary supplements with a healthcare professional is important to avoid adverse interactions and ensure proper dosing
• Socioeconomic factors, such as limited income, social isolation, and reduced mobility, can impact access to healthy foods and contribute to nutritional risk
  • Community resources, such as senior meal programs, food banks, and transportation services, can help improve access to nutritious foods
  • Encouraging social connections and participation in community activities can help combat isolation and improve overall well-being

Strategies for Optimal Nutrition in Adults and Elderly

Meal Planning and Preparation

• Encourage regular, nutrient-dense meals and snacks that are easy to prepare and consume, taking into account individual preferences and chewing or swallowing difficulties
  • Offer a variety of soft, moist, and easy-to-chew foods, such as cooked vegetables, ground meats, and casseroles
  • Utilize convenience items, such as pre-cut fruits and vegetables, canned beans, and ready-to-eat meals, to simplify meal preparation
• Provide education on the importance of a balanced diet, including a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats
  • Emphasize the benefits of nutrient-dense foods for maintaining health, energy levels, and disease prevention
  • Offer practical tips for incorporating a variety of foods into the diet, such as adding fruits to cereals or vegetables to soups and stews
• Recommend fortified foods or dietary supplements to address specific nutrient deficiencies, such as vitamin D, calcium, and vitamin B12, under the guidance of a healthcare professional
  • Fortified foods, such as calcium-fortified juices and vitamin D-fortified milk, can help meet increased nutrient needs
  • Dietary supplements should be used as a complement to, rather than a replacement for, a balanced diet

Enhancing Food Enjoyment and Social Engagement

• Promote the use of flavor enhancers, such as herbs and spices, to improve food palatability and enjoyment for those with diminished taste or smell sensitivity
  • Experiment with different herbs and spices to add flavor and variety to meals
  • Use aromatic ingredients, such as garlic, onions, and citrus zest, to stimulate the senses and improve appetite
• Encourage social eating experiences, such as dining with family or participating in community meal programs, to combat social isolation and stimulate appetite
  • Eating with others can make meals more enjoyable and encourage increased food intake
  • Participating in senior center meals or group dining events can provide opportunities for social interaction and support

Collaborating with Healthcare Professionals

• Collaborate with healthcare professionals, such as dentists and occupational therapists, to address dental issues and adapt eating utensils or food textures as needed
  • Regular dental check-ups and treatment can help maintain oral health and prevent eating difficulties
  • Occupational therapists can provide guidance on adapted utensils (e.g., weighted or large-handled) and techniques for easier eating
• Provide guidance on managing potential nutrient-drug interactions and the importance of discussing dietary supplements with healthcare providers to avoid adverse effects
  • Some medications can interfere with nutrient absorption or increase the risk of deficiencies
  • Dietary supplements can interact with medications and cause adverse effects, so it is crucial to inform healthcare providers about all supplement use

Advocating for Access and Education

• Advocate for policies and programs that improve access to affordable, nutritious foods for older adults, such as senior farmers' market nutrition programs and home-delivered meal services
  • Support initiatives that provide financial assistance or vouchers for purchasing fresh, healthy foods
  • Promote the expansion of home-delivered meal programs, such as Meals on Wheels, to reach homebound or isolated seniors
• Emphasize the role of regular physical activity in maintaining muscle mass, bone health, and overall well-being, and provide resources for safe and appropriate exercise programs
  • Encourage participation in age-appropriate activities, such as walking, swimming, or tai chi, to maintain mobility and strength
  • Provide information on local exercise classes, walking groups, or senior fitness programs to promote physical activity and social engagement