Senior-Level Sustenance
January 1998 -- Nutrition Notes

By: Andrea Platzman, R.D.
Contributing Editor

  Malnutrition poses a serious health problem for persons ages 65 and up. It is estimated that 5% to 15% of older Americans suffer nutritional deficiencies. This problem demands attention since older people currently represent 12.8% of the U.S. population about one in every eight Americans. By the year 2030, this will rise to 20% of the total U.S. population.  Older people suffer nutritional deficiencies for several reasons: inadequate food intake, drug-nutrient interactions, and certain chronic diseases. Age-related physiological changes can affect food selection and consumption: declining senses of smell, taste, hearing and vision; poor dentition or ill-fitting dentures; functional disability; and depression. Widowed seniors may not know how to cook. They might be lonely and replace meals with alcohol. Or, they might be undergoing medical treatments that reduce the body's ability to absorb nutrients, and suppress appetite as well. Food preparation often becomes an overwhelming task for those affected by arthritis, reduced vision and other conditions. Limited budgets can prevent the daily consumption of fresh fruit, vegetables and meat.  The aging process changes nutritional status and nutrient requirements. As the body ages, it becomes less efficient at digesting, absorbing and utilizing nutrients. Balancing nutrients with proper caloric intake is essential, since many seniors, in order to reach nutrient adequacy, may spill over the top in calories.Making bones  "Aging alters the body's need for certain nutrients, such as calcium and vitamin D needs that may not be met without conscious changes in the diet," says Nancy Wellman, Ph.D., R.D., professor and director of the National Policy and Resource Center on Nutrition and Aging, Miami, FL. "Reduced intakes, as well as lower absorption of vitamin D and calcium, are among the many factors related to loss of bone mineral. This leads to susceptibility to fractures and related problems."  Men and women ages 65 or older need 1,500 mg of calcium daily. For women, bone loss is very rapid just before menopause; a loss of about 3% of skeletal mass occurs annually for about five years. For every year after that, bone loss slows down to about 1%. For men and women, bone calcium continues dwindling throughout life, as does the ability to absorb dietary calcium.  Vitamin D helps the body absorb calcium and deposit it in bones and teeth. Most vitamin D comes not from dietary sources, but from sunlight. In addition to absorbing vitamin D less efficiently, older adults, who may have difficulty in moving or who find themselves socially isolated, often do not get enough sunlight for its manufacture.  "Since vitamin D can be harmful, it is best not to take more than 100% of the Daily Value in supplements, which is 400 IU," says Nancy Cohen, Ph.D., R.D., associate professor, extension faculty member, Nutrition Education Program at the University of Massachusetts, Amherst.Combating deficiencies  Vitamin B12 deficiency is present in about 15% of the older population, primarily as a result of atrophic gastritis or the inability to secrete gastric acid and pepsin in sufficient amounts in the stomach. Approximately 30% of seniors develop atrophic gastritis, which results in a decreased ability to absorb vitamin B12, folate, calcium and iron from food.   Pernicious anemia, or a B12 deficiency, damages the myelin sheath surrounding the nerves. "Over time, neurological problems that can impair balance and sensation can occur, in addition to the onset of dementia and mental confusion," says Dr. Patrick Stover, assistant professor at Cornell University, Ithaca, NY. He notes that folic acid fortification can mask a B12 deficiency.Folic factors  Because of folic acid's role in the prevention of neural-tube defects, as of January 1998, certain grain products will be fortified at levels ranging from 430 to 1,400 µg per pound. In addition, breakfast cereals can add folic acid up to 400 µg per serving. But, seniors also can benefit; folic acid also has been credited with protecting against heart disease, stroke and even cancer, three common chronic diseases of the aged.  Studies show that folic acid helps reduce blood levels of homocysteine, a product from the amino acid methionine and a strong predicator for heart disease and stroke. "It looks as if folic acid can be protective against heart disease, but it is also important to get enough of the B complex, including vitamins B6 and B12," says Katherine Tucker, Ph.D., associate professor at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston.  Preliminary research indicates that folic acid seems to reduce the risk of polyps and colorectal cancer. "One of folic acid's roles is to transfer methyl groups to DNA," Stover says. "Some studies have shown that this methylation might decrease the onset of cancer."  Folic-acid deficiencies can arise from chronic diseases such as rheumatoid arthritis, alcoholism and malabsorption syndromes. "Folic acid supplementation can benefit the older adult since the supplement will provide more of the vitamin for absorption," says Carlene Russell, M.S., R.D., L.D., F.A.D.A., a consulting geriatric dietitian. "This population frequently takes medication that reduces the absorption of folic acid."Weighty issues  The decrease in lean body mass and increase in fat stores, along with a decrease in physical activity, creates a need for a diet lower in calories and higher in protein than during more active years. According to the American Dietetic Association, the Recommended Dietary Allowance for protein for seniors increases from 0.8 g/kg body weight to 1.00 to 1.25 g/kg body weight.   Many older adults have noticed the pounds creeping up on them, even though they have not changed their eating patterns. "Their BMR, or basal metabolic rate, slows with age," Cohen says. "BMR measures the calories one burns by 'doing nothing' just breathing and metabolizing your food. Therefore, seniors cannot afford to consume empty calories as much as younger folks can, or they will gain weight. Increasing physical activity will help reduce body weight as well as increase BMR."  According to the National Health and Nutrition Examination Survey, 85% of older adults believe that nutrition is important for their health, yet 30% say they skip at least one meal a day. Poor nutrition can have grave consequences for this group, resulting in a host of dangerous risks to health and well-being. "Foods for the older adult should be convenient, easy-to-eat, flavor-and-aroma-enhanced, as well as nutrient-dense," Wellman says.  Andrea Platzman is a registered dietitian who is a consultant for the food industry, and regularly writes for nutrition publications. She earned a master's degree in nutrition from New York University, and has a culinary and business background. Back to top