July 11, 2006
Consumer media confirms that the growing population of older Americans represents an outgrowth at both ends of the “elderly” age spectrum: Nowadays, only centenarians qualify for a birthday greeting from Willard Scott on the “Today Show,” and last November, Newsweek’s Boomer Files article entitled “Hitting 60” presented an analysis of how the baby boomers will redefine what it means to be a senior citizen. Officially, the U.S Census Bureau, which sets 65 years as the beginning of the older adult category, predicts the ranks of older Americans will reach 71.5 million in 2030, more than double its count in 2000. While baby boomers represent most of the jump in numbers, the 85- plus population is projected to climb to 7.3 million in 2020, an increase of 3.1 million from 2000.
Profiling older Americans
Obviously, nutrition and health issues vary greatly in a group that spans 40-plus years, so subdividing into smaller groups helps when trying to determine interests, preferences and needs. Nancy Wellman, Ph.D., R.D., professor and director, National Policy and Resource Center on Nutrition, Physical Activity and Aging, Florida International University, Miami, describes the various segments of older adults as “the young old, who are 65 to 74, the old, who are 75 to 84, and the oldest old, who are 85 and older.” Wellman says: “The 85-plus age group is the fastest growing. Today, those in their 90s are called the ‘new old’.” But the differences among older adults go beyond the wide range of years between the youngest to the oldest, according to Wellman. “The heterogeneity among older adults is huge because education, income and lifestyles all impact dietary choices and overall health status. I encourage you to think of older adults not as one homogeneous group, but as individuals who vary greatly, just like any other age group. Growing old doesn’t mean giving up your individuality!”
Census bureau data for 2004 details differences among older Americans. A greater percentage of older men (72%) are married than women (43%), but a greater percentage of women (43%) are widowed. Living arrangements show that, among non-institutionalized older adults, more women than men live alone, and the number increases with age. Less than 5% of the total population lived in a nursing home in 2000, with the oldest old having the greatest percentage of residents. Senior housing with supportive services was the choice of about 5%. Median income also differs by gender, with men at $21,102 and women at $12,080, indicating that many of the widows living alone probably have limited resources. Interestingly, Americans age 65 and over constitute 3.4% of the U.S. workforce, with about 19% of the men and 11% of the women working or actively seeking work.
“Today the buzz terms are successful aging, active aging and healthy aging. All imply maintaining a good quality of life as we age,” Wellman says. “Healthy lifestyles that include nutritious foods and physical activity result in a compression of morbidity (with) more years of active healthy living and less time being sick. Food and nutrition are essential for successful aging. We want foods that promote our health, reduce our risk of disease, and keep us independent and out of nursing homes.”
According to Wellman, health and nutrition issues among older adults vary just as they do in the general population, but being underweight is more problematic. Obesity is less common, as it takes its toll in earlier deaths. “Studies show that one in six older adults eats less than 1,000 calories per day,” she says. “For many, there may be little interest in preparing meals. We see a lot of the ‘tea and toast’ syndrome, where they equate making toast with cooking, especially among lonely widows.” This type of eating translates to energy and nutrient deficiencies, which can contribute to frailty and increased risk of dehydration. She adds: “Older Americans are interested in healthy eating, but they need encouragement to believe that it makes a difference, and they need permission to indulge. We need to get the message out that it’s never too late to eat healthy, and there’s a payoff no matter what your age.”
Lifestyle and dietary choices of young and middle-age adults can lead to many chronic illnesses, such as type 2 diabetes, cardiovascular disease, hypertension, cancer and osteoporosis, which may wait until the sixth decade or later to surface. Advice for preventing and managing these diseases remains the same for all ages: a diet high in fiber, with lots of whole grains, fruits and vegetables; moderate in sodium; low to moderate in fat, especially saturated and trans fats; and with adequate calcium and vitamin D. But as people age, eat fewer calories and limit their food choices due to physiologic changes or economic limitations, many find it difficult to meet these recommendations.
Additional nutrition-related health conditions that surface in the later decades of life include osteoarthritis, anemia, cognitive decline, age-related macular degeneration (AMD) and cataracts. Osteoarthritis and cognitive decline can affect mobility and activities of daily living, frequently resulting in limited access to food. Anemia can stem from a variety of vitamin deficiencies —iron, vitamin B12, and/or folate. Low intakes of carotenoids and vitamins C and E may increase the risk of cataracts, while low intake of zinc, carotenoids—especially lutein and zeaxanthin, and vitamins C and E may contribute to AMD. Decreased levels of folate, vitamins B6 and B12 may also increase the risk for cognitive dysfunction, as well as hyperhomocysteinemia, a risk factor for atherosclerosis.
The Dietary Reference Intakes now list values for older adults ages 51 to 70 and 70-plus, thus quantifying known differences in nutrient needs for older adults. As one turns 51, the recommended intake for calcium and vitamins B6 and D increases, while the recommended intake for sodium, chloride, chromium and, for women, iron, decreases. At 70, recommendations include another increase in vitamin D and further decreases in sodium and chloride.
Key recommendations in the 2005 Dietary Guidelines for Americans that apply to all age groups include: consume adequate nutrients within calorie needs by adopting a balanced diet plan such as the USDA Food Guide or DASH Eating Plan; manage weight by balancing caloric intake and expenditure; engage in regular physical activity; consume sufficient amounts of fruits and vegetables, whole grains and fat-free or low-fat milk or equivalent milk products; limit fat to 20% to 35% of calories with less than 10% of calories from saturated fatty acids and less than 300 mg cholesterol daily; consume minimal trans fatty acids and more polyand monounsaturated fatty acids; choose fiber-rich fruits, vegetables and whole grains for carbohydrates; consume less sodium and more potassium; drink alcoholic beverages sensibly and in moderation; and handle food safely to avoid food-borne illnesses.
The Dietary Guidelines include several specific recommendations for older adults: Consume vitamin B12 in crystalline form and extra vitamin D from fortified foods or supplements; consume foods rich in dietary fiber and maintain adequate hydration to aid laxation; participate in regular physical activity to reduce functional declines; aim for no more than 1,500 mg of sodium per day and consume 4,700 mg of potassium from food; eat only pasteurized dairy products and fully cooked eggs, meat, poultry, fish and shellfish; and thoroughly reheated deli meats and frankfurters.
Factors such as income, household size and physical limitations influence nutrition and food choices of older adults, according to Wellman. “Many older people, especially women, are low income and live alone. The Older Americans Act Nutrition Programs, which include congregate and home-delivered meals, help address some of these issues. For over half of the low-income participants, the midday meal provides 40% to 50% of daily food. Developing tasty, healthy, nutrientdense food products for these programs represents an opportunity for the food industry,” says Wellman.
She states: “Traditional foods equal comfort foods for many older adults, and it is wise to encourage enjoyment of, for example, ice cream for its hedonic value, while at the same time increasing its caloric and nutrient contributions to a healthy diet, especially for those who are underweight.” She sees prepared foods and entrées that maintain taste appeal with lower sodium and possibly more potassium as valuable options the food industry can provide to nourish older adults. She points to ConAgra’s Golden Cuisine line as an example of convenient, nutritionally appropriate meals for older adults. Aimed at both the on-the-go 55-year-old and the home-bound older adult, these frozen meals meet the government nutrition standards for older persons.
Utilizing familiar brands from ConAgra, each meal provides 3 ounces of cooked protein, one serving of starch and two, one-half cups of crispy vegetables. The line contains traditional foods, such as Salisbury steak patty and mushroom sauce with mashed potatoes, corn and broccoli topped with cheese, and chicken breast with barbecue sauce over a black bean rice blend with green beans and carrots. Positioned as moderately priced and convenient, they can be ordered from various retail outlets on the Internet, delivered by nonprofit senior-service organizations, such as Meals On Wheels, or purchased in bulk packaging at Costco.
Historically, food fortification strategies helped remediate several vitamin and mineral deficits. Today, many common fortified products, such as ready-toeat cereals and liquid meal replacements, provide a wide array of vitamins and minerals in convenient nutrient-dense foods and beverages that appeal to and can benefit older adults with limited food intake. Additionally, several functional foods address major nutritional issues of older adults. Wellman says: “Calcium- and vitamin D–fortified orange juice is an excellent example of a functional food. These nutrients benefit bone health, and the naturally occurring potassium helps control blood pressure. Other products address digestibility and regularity concerns that many older adults have.”
A State-of-the-Science Conference Statement on Multivitamins/Mineral Supplements (MVM) and Chronic Disease Prevention from a recent National Institutes of Health Consensus Panel identified the elderly as a high-use group among the more than half of American adults who take MVM, and raised questions about possible adverse effects from excess intake above the Tolerable Upper Intake Level for users of both MVM and fortified foods. An evaluation of existing science proved inconclusive about the benefits of MVM in prevention of chronic disease but revealed evidence supporting increased bone-mineral density and decreased fractures in postmenopausal women who take calcium and vitamin D supplements.
The panel pointed to the need for research that identifies total consumption from fortified foods and MVM and investigates possible interactions of MVMs with nutrients and medications, as well as the efficacy and safety of individual or paired supplements in random clinical trials.
Daily research reports give credence for the potential addition of myriad nutrients, antioxidants and phytochemicals to lower risk of diseases that accompany aging. Food and beverage manufacturers frequently include these components in products while waiting to garner an FDA-approved health claim. For example, prune juice with added lutein—a GRAS ingredient since 2004 that was denied a qualified health claim for reducing risk of AMD and cataracts in 2005—successfully combines a product commonly used by older adults to ease constipation woes with a substance many recognize from media reports and dietary supplement structure-function claims as potentially beneficial for eye health. For many older adults hoping to join the ranks of centenarians, such products represent viable avenues to successful, healthy aging. Industry can capitalize on these beliefs but must continue to base functional foods targeted to older adults on solid science and ethical marketing strategies for a truly win-win situation.
Angela M. Miraglio, M.S., R.D., is a Fellow of the American Dietetic Association from Des Plaines, IL. Her firm, AMM Food & Nutrition Consulting, provides communications and technical support to the food and beverage industry. She can be reached at [email protected].
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