Transcript Vitamins
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 USDA Daily Food Plan 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
USDA Daily Food Plan
The amount of food recommended from each
USDA Daily Food Plan 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 www.choosemyplate.gov
USDA Daily Food Plan
For a typical 2,000 calorie diet the USDA Daily
Food Plan recommends:
2 cups of fruit
2 ½ cups of vegetables
6, 1-ounce equivalents of grains
5 ½ ounces of protein foods
3 cups of dairy
6 teaspoons of oil
Limit calories from solid fats and added sugars to
260 calories per day
Calories
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
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
Protein
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
Fat concentrated source of energy
Fat has some important roles
Helps form cell membranes
Carries fat-soluble vitamins
Provides essential fatty acids
Fat
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
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
carbohydrate
Carbohydrate
Most carbohydrate should come from
complex carbohydrate foods
Simple carbohydrates or sugar rich foods
should be limited
Fiber
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
Fiber
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 USDA Daily Food Plan recommends ½
of all grains should be whole grains to
help provide adequate fiber
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
adults
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
females
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
Iron needs for women decrease after
menopause
Like vitamin A, iron is stored more readily in
older adults
Excess iron can increase oxidative stress
Iron
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
exposure
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
B12
People with atrophic gastritis are particularly
vulnerable to vitamin B12 deficiency
B12 deficiency can result in irreversible nerve
damage
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
products
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
Calcium requirements increase with age
Many older adults do not consume enough
calcium
An adequate calcium intake is one way to
help protect against osteoporosis
Calcium
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
day
DRI for calcium for women 51 years of age
and older is 1,200 milligrams per day.
The UL for calcium is for adults 51 years of
age and older is 2,000 milligrams per day
Calcium
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 readyto-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
Folate
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
Folate
Leading food sources of folate are ready-to-
eat cereals, yeast bread, orange juice and
grapefruit juice
Magnesium
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
Magnesium
Leading food sources of magnesium are milk,
yeast bread, coffee, ready-to-eat cereal, beef
and potatoes
Zinc
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
Zinc
Leading food sources of zinc are beef, ready-
to-eat cereals, milk and poultry
Water
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
Water
Older adults are at increased risk for
dehydration
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
USDA Daily Food Plan
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 multivitamin/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”
Medications
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
Medications
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
water
Saliva
Production of saliva may decrease with age
Saliva moistens food and makes swallowing
easier
Foods may be dry and more difficult to
swallow
Teeth
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
Teeth
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
choking
Digestion
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
acceptable
Many older adults do not tolerance of high fat
or dairy foods
Digestion
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
foods
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
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
constipation
Constipation
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
resort
Thirst
The combined effects of decreased thirst
sensation, decreased body water, increased
water loss, incontinence and decreased
mobility put older adults at greater risk for
dehydration
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
smell
Changes in taste and smell may decrease
appetite and food intake
Eyesight
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
preparation
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 USDA
Daily Food Plan 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
calm
Allow enough time for meals
Encourage daily physical activity to increase
appetite
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
gelatin
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
confusing
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