11 August 2015

How nutritional needs change with age

Changing nutritional needs: what’s the best diet to follow?

As we age, our ability to digest, absorb, metabolise and excrete nutrients, such as calcium and iron, decreases, so it’s vitally important for older people to eat a varied diet. The British Nutrition Foundation (BNF) recommends that older people should eat plenty of fruit and vegetables, plus some fortified foods such as margarine or bread, and breakfast cereals with added vitamins and minerals such as iron, B vitamins and calcium.

The BNF also suggests that functional foods can be of benefit for some health conditions. For instance: cholesterol-lowering spreads and soya products for heart health and probiotic drinks and yoghurts, plus foods with added fibre for gut health.

Many older people have reduced appetites (perhaps due to poor mobility, or reduced sense of taste and smell) and this can make it harder to ensure their diet has enough variety to include all the nutrition they need.

Other factors that can influence older people’ nutrition, including bereavement, social isolation, low income, being in a care home, problems with their teeth, deteriorating vision, and dementia.

If you want to encourage your older relative to eat more healthily, our article entitled Help your older parent eat a balanced diet has some useful tips.

Watch your weight – and waist

Being a healthy weight is important for people of all ages, but after about the age of 50 in women and 60 in men, people typically become less active and need to consume fewer calories as our energy needs decrease. In addition, as we age our metabolic rate reduces. It is therefore important that older people have a nutrient dense, rather than calorie dense, diet.

There are two opposing weight problems for older people in the UK:

Malnutrition – Around 1 in 7 older people in the UK suffer from malnutrition (particularly women) and this rate rises for people living in institutions. Older people who are underweight and malnourished are more at risk of becoming ill and will take longer to recover from bouts of sickness.Although more common in adolescent girls, some older women can develop anorexia due to psychological reasons and this may leads to significant weight loss. Our articles How to prevent elderly anorexia and How to cater well for people in care homes offer helpful advice on these issues.

Obesity – In the 65+ age group in the UK, 54% of men are overweight (compared to 32% of women) and 31% of men are obese (compared to 34% of women). Only 16 % of men are within normal Body Mass Index (BMI) compared to 32% of women. Being obese carries a greater risk of chronic diseases, including heart disease, stroke, cancer, and type 2 diabetes. The BNF says that older people are at increased risk of developing heart disease and type 2 diabetes if their waist measures more than 94cm in men and more than 80 cm for women.

Our article Dietician’s recommendations for elderly nutrition provides guidance managing weight issues via healthy eating for older people.

Important vitamins and minerals

Iron – Iron deficiency can lead to anaemia, provoking symptoms of tiredness, weakness, headache and pale complexion. The recommended nutrient intake (RNI) of iron for women aged 19-50 is 14.8mg/day. After the menopause, this falls to an RNI of 8.7 mg/day – the same as for men aged 50+. Lean red meat is a good source of iron, but iron supplements are also useful.

Vitamin D – Vitamin D has a vital role in bone health and muscle strength. It is made in the skin when exposed to sunlight, but as older skin is less efficient at producing vitamin D, it’s recommended that people aged 65+ should take a daily supplement containing 10μg of vitamin D. Foods high in vitamin D, such as oily fish, eggs, and fortified breakfast cereals, should also be included in the diet.

Vitamin B & Folate – Low intake of folate and vitamins B12 and B6 is linked to tiredness, lack of energy, anaemia, depression, increased risk of stroke, and even dementia. Vitamin B12 is found in meat, fish, eggs, dairy products and Marmite (love it or hate it!). Good sources of folate include green vegetables, such as broccoli, peas, and Brussels sprouts. Deficiencies in the diet can also be improved with supplements.

Calcium – Calcium absorption is often reduced in older people due to hormonal changes. Dairy products and vegetables are good sources of calcium, but most older people should consider taking a calcium supplement. It’s generally recommended that the over 50s should take 1,200 mg/day.

The importance of oily fish

Oily fish, such as mackerel, pilchards, salmon, sardines, trout and fresh tuna, have many benefits for older people. A healthy diet should include between two and four portions (140g) of oily fish a week. Alternatively, supplements can be taken. The omega-3 fatty acids found in oily fish may help to:

prevent heart disease
alleviate some of the symptoms of rheumatoid arthritis
improve swollen and tender joints, grip strength and mobility.
preserve eye health
prevent cognitive decline
improve immune function.

Oily fish are also a source of Vitamin D. The NHS Livewell website has good information on fish and shellfish for a healthy diet.

Oral & dental health

Around 58% of adults aged 75+ in the UK have no natural teeth and rely on dentures. As a consequence, they tend to eat fewer fruit and vegetables and may not get enough Vitamin C.

If your older parent still has some or all of their natural teeth, then the emphasis should be on maintaining good oral hygiene and reducing sugary foods and drinks to prevent tooth decay, and gum disease. Eating tinned or stewed fresh fruit and vegetables is an excellent alternative to those who have difficulty in chewing.

Summary of tips for a healthy diet for older people

Stay active to encourage appetite and maintain muscle mass.
Stick to a varied, well-balanced and enjoyable diet
Take regular exercise
Watch your weight and waist measurement
Try to spend some time outdoors to boost Vitamin D/take supplements.
Reduce your intake of foods that are high in energy and low in nutrients, such as cakes, biscuits and soft drinks.
Make sure you eat foods high in fibre for bowel health
Cut back on salt
Include oily fish in your weekly meal plan
Reduce your alcohol intake
Drink plenty of water
Look after your teeth