Nutrition in Old age

•Ageing is not a disease.

•The process of aging brings about physiological, psychological and immunological changes that influence the nutritional status.

•Certain nutrients & changes in lifestyle can help to slow the visible signs of aging & can prevent many disorders & increase life expectancy. •Goal of nutritional care should be to help the aged live a healthy, purposeful and independent life.

Ageing

Modified food pyramid for older adults

Normal Diet for a 70 yr old male

Early morning Tea

Breakfast Broken wheat porridge

Poached eggs

Toast with butter

Diced apples

Mid- Morning Coffee

Biscuits

Lunch Lentil Dal

Palak Saag

Grated Salad

Chapatis

Fruit Custard

Evening Tea Vegetable Upma

Tea

Dinner Lauki Kofta Curry

Potato & Cauliflower Vegetable

Grated Carrot Salad

Boondi Raita

Chapattis/ Rice

Bed –Time Milk

FACTORS AFFECTING DIETARY INTAKE AND NUTRITIONAL STATUS IN OLDER PEOPLE

Nutrient deficiencies among older people may be due to: Nutrient deficiencies among older people may be due to:

• Ill health and other medical Ill health and other medical conditions such as diabetes and conditions such as diabetes and heart disease.heart disease.

• The side effects of common The side effects of common drugs.drugs.

• Poor dentition. Poor dentition.

• Drug-nutrient interactions.Drug-nutrient interactions.

• Mobility and physical activity.Mobility and physical activity.

• Tremor. Tremor.

• Social isolation & depression.Social isolation & depression.

Nutrition related concerns during old age1.Oral health status:

• Tooth loss & use of dentures can lead to difficulties chewing and swallowing.

• Hence they prefer soft, easily chewed foods and avoid some nutritionally dense options such as whole grains, fresh fruits and vegetables and meats.

• Preparing foods that are moisture rich such as hearty soups and stews, adding sauces and pureeing and chopping foods can make meals easier to eat.

• Also fortified foods with increased nutrient density may be given.

2. Gastrointestinal Status:

• Decreases in taste sensation and saliva production make eating less pleasurable and more difficult .

• Weakened tongue or cheek muscles can make chewing and swallowing both difficult and dangerous.

• Gastric changes like constipation can also affect a persons ability to eat due to inflammation pain and discomfort.

• All these affect the availability of nutrients and increase the risk of developing a chronic deficiency disease such as osteoporosis.

• Include sufficient fluids and fibers in the diet and physical activity.

• Thickened liquids and texture-modified foods can help people with weakened tongue or cheek muscles.

3. Cardiovascular Ailments:

• CVD may be due to environmental influences such as smoking, exercise and diet.

• Changes include decreased arterial wall compliance and decreased maximum heart rate.

4. Renal disease:

•Blood flow is reduced along with the number of functioning nephrons.

•The progressive decline in renal function can lead to an inability to excrete concentrated or dilute urine.

• Renal function is also impacted by dehydration and medications.

•Cataracts are thickenings in the lenses of the eyes that impair vision.

•Oxidative stress appears to play a significant role in development of cataracts, and the antioxidant nutrients such as vitamin C , vitamin E and carotenoids may help reduce the damage.

•Another common cause of vision loss among older people is macular degeneration.

•Dietary fat may also be a risk factor, but the omega fatty acids of fish oils may be protective.

•Similarly , foods rich in antioxidant nutrients and wine , with its protective phytochemicals, seem to reduce the risk of developing macular degeneration.

5.Cataract and Macular degeneration

•Osteo-arthritis is the most common type of arthritis that disables older people.

•It is a painful, chronic disease of the joints that occurs when the cushioning cartilage in a joint breaks down.

•Osteo-arthritis may be due to excessive weight. Weight loss may relieve some of the pain. Aerobic activity and strength training offer improvements in physical performance and pain relief.

•Rheumatoid arthritis: a disease of the immune system involving painful inflammation of the joint and related structures.

•Omega-3 fatty acids commonly found in the fish oil, helps prevent or reduce the inflammation in the joints that makes arthritis so painful.

6. Arthritis

•A degenerative disease of the brain involving memory loss and major structural changes in neuron networks.

•Providing well-liked and well-balanced meals and snacks in a cheerful atmosphere encourages food consumption.

•To minimize confusion, offer a few ready-to-eat foods, in bite-sized pieces with seasonings and sauces.

•Nutrients influence the development and activities of the brain.

•Severe dietary defiencies of the B vitamins impair mental ability, including memory.

7. Alzheimer’s disease

Dietary Principles

Energy

•Aging brings a decrease in energy requirements.

•Decreased energy requirements with aging are due to reduced duration and/or intensity of physical activity.

•Regular exercise produces corresponding increases in energy requirements.

Carbohydrates• Carbohydrates are an essential component of a well balanced diet.

• Dietary fibers may help prevent gastro-intestinal disorders like constipation & also in the management of diabetes.

• Dietary fibres also help in the management of cholesterol & triglyceride levels in the blood

• Examples: Fresh fruits, whole- grain products, vegetables, legumes22

Proteins

•Due to decreased appetite and poor digestive capacity, old people are likely to consume lessprotein.•But the fact remains that despite a decrease in calorie requirement the need of protein remains the same, hence the food should be a richer in protein.

•Rich sources of protein are- all pulses, legumes, sprouts, chicken, fish, and egg

• Reduce dietary fat to reduce the risk of heart disease.

• Reduce intake of cholesterol rich foods like egg yolk, palm oil.

• Saturated fat intake should be limited. Eg. Butter, cheese, milk fat, red meats, coconut oil, ghee.

•Increase the in take of monounsaturated fats like olive oils, rice-bran oil, groundnut oil, almonds, cashews, flaxseed oil.

•The diet should include moderate intake of vegetable oils.

Fats

Vitamins & Minerals Eating nutrient-dense foods becomes increasingly important when

calorie needs decline but vitamin and mineral needs remain high.

•Vitamin A: For growth, development and maintenance of healthy skin, as well as vision in dim light. Good sourcesof vitamin A: animal foods such as milk, fortified margarine, butter, cheese, egg yolk, liver and oily fish like salmon, sardine, tuna, mackerel, yellow-orange fruits and vegetables and dark green vegetables.

•Folate (folic acid) : For the formation of healthy red blood cells.Good Sources of Folate:Found in small amounts in foods such as yeast extract, green leafy vegetables and vitamin-fortified foods like bread and breakfast cereals, most fruits, meat and dairy products.

• Iron: To make the compound haemoglobin in red blood cells - essential for carrying oxygen through the body.

Good sources of iron are- liver, green leafy vegetables like spinach, methi, whole wheat bread, iron rich dry fruits, fruits such as apple,

• Calcium: The need for calcium increases during old age especially for women after menopause. To prevent osteoporosis, spontaneous fractures and increased incidence of tooth decay.

Good Sources of Calcium: milk and dairy products such as cheese and yoghurt, shrimps & canned fish with bones such as sardines or salmon.

•Vitamin C : Required for forming healthy connective tissues and bone, also helps the body absorb iron and heal wounds. It is an important antioxidant, reducing the risk of heart disease and some cancers. Good sources of Vitamin A: Citrus fruits, blackcurrants, guavas, other tropical fruits and some vegetables

Vitamin D : For the absorption of calcium from the diet and maintaining healthy bones and teeth. Good sources of Vitamin D: from the sun via the action of UV light on the skin. Food sources include fortified margarine, oily fish, eggs, fortified breakfast cereals and meat or meat products.

• Zinc: To help heal wounds and for the proper functioning of the immune system.

Good sources of Zinc: milk, cheese, meat, eggs, fish, wholegrain cereals and pulses.

• Vitamin B12: To help form healthy blood cells and nerve fibres.

Good sources of Vitamin B12: meat, eggs, fish, milk and fortified breakfast cereals. Because vitamin B12 isn't found in vegetables, vegans who do not eat meat, milk or eggs may develop a deficiency.

• Vitamin E: Important Antioxidant

Good sources of Vitamin E: Vegetable oils, nuts, whole grain and wheat germ.

• Vitamin K: Important for blood clotting Good sources of Vitamin K: dark green leafy vegetables. Lower levels of this vitamin are found in cereals, dairy products, and fruits.

Water• Water stimulates peristalsis &

thus prevents constipation. • The kidneys also need fluid to

dispose waste more effectively. • Some avoid drinking enough

water for the fear of incontinence. This may lead to dehydration.

• The elderly should be advised to consume fluids at regular intervals even if they are not thirsty.

• Water can be consumed as such or in form of buttermilk, soups, and juices.

FiberConstipation is a common complaint

in the elderly. This may be due to • Decreased peristalsis.• Reduced consumption of food.• Improper food selection.• Inadequate food intake.

Increase the consumption of fibre rich food.

Rough fibre and bran may not be advisable for the aged.

However the fibre of tender vegetables and fruits will make the food mass go down the intestinal tract.

Fibre also helps in reducing cholesterol that contributes to atherosclerosis.

SUGGESTED DIETARY MODIFICATIONS FOR THE ELDERLY-

1. Eat a diet that is rich in raw fruits and vegetables and their juices.

2. Increase the amount of fibre in the diet such as oat, rice bran and pectin that is found in fruits and vegetables.

3. Liberal intake of fruits & vegetables to provide vitamins & minerals.

4. Reduce the intake of refined foods such as white flour and its products. These include white bread, donuts, white flour pastas and biscuits that use refined flour. However all whole grain breads, pastas, brown rice are permitted.

5. Avoid refined sugar and its products. Mild sweet flavouring can be done using honey & jaggery in limited quantities.

6. Reduce the intake of saturated fats, cholesterol and animal fats.

7. Reduce the intake of caffeine by limiting or eliminating the intake of coffee, black tea, chocolate.

8. Avoid processed foods as much as possible.

9. Choose nutritious snacks such as nuts & raw vegetable sticks, popcorn without butter and fresh fruits.

10. Swallowing may become difficult due to decreased secretion of saliva. Therefore very dry meals should be avoided.

Good nutrition awareness is a very important part of any

good anti-ageing program. It will give

your body and mind the nutrients that they

require and give you the adequate energy to

perform your much needed daily exercise.

Ageing is not “lost youth” but a new stage of

opportunity and strength.