Geriatric nutrition applies nutrition principles to delay effects of aging and disease, to aid in the management of the physical, psychological, and psychosocial changes commonly associated with growing old.
The cornerstone of geriatric nutrition is a well-balanced diet. This provides optimal nutrition to help delay the leading causes of death: heart disease, cancer, and stroke. In addition, ongoing research indicates that good, consuming antioxidants may increase longevity.
Nutrition Complications Associated With Old Age
With age comes many physical changes. Once the body reaches physiologic maturity, the rate of degenerative change exceeds the rate of cell regeneration. The following are typical physiologic changes that can affect nutritional status:
Gastrointestinal (GI) changes include a reduction in digestion and absorption. Digestive hormones and enzymes decrease, the intestinal mucosa deteriorates, and the gastric emptying time increases. As a result, two conditions are more likely: pernicious anemia and constipation. Pernicious anemia may result because of hypochlorhydria, which decreases vitamin B12 absorption .Constipation, despite considerable laxative use among older people, may result from slower GI motility, inadequate fluid intake, or physical inactivity.
Musculoskeletal changes occur. A progressive drop in bone mass starts when people are in their 30s or 40s; this accelerates for women during menopause, making the skeleton more vulnerable to fractures or osteoporosis. Adequate intake of calcium and vitamin D helps to retain bone.
Oral and dental complications
Geriatric nutrition must take into account dental and oral changes. Decreases in all the senses, particularly in the taste buds that affect perception of salty and sweet tastes, may affect appetite. Xerostomia (dry mouth) affects more than 70% of the elderly. Also, denture wearers chew less efficiently than those with natural teeth. Poor oral health e.g. cavities, gum disease, and missing teeth, impairs ability to lubricate, masticate, and swallow food.
Malnutrition is a state of nutrition (under or over nutrition) in which a lack of protein, energy and other nutrients causes measurable adverse effects on tissue and/or body form, composition, function or clinical outcome. The major causes of malnutrition in the elderly include; reduced intake, Inability to eat, Impaired absorption, Excess losses, Altered metabolism, Lack of food availability and diseases e.g. cancer cachexia.
Body composition changes as fat replaces muscle, in a process called sarcopenia. Research shows that exercise, particularly weight training, slows down this process. Because of the decrease in lean body mass, basal metabolic rate (BMR) declines about 5% per decade during adulthood. Total caloric needs drop, and lowered protein reserves slow the body's ability to respond to injury or surgery. Body water decreases along with the decline in lean body mass.
Dehydration in the elderly
Dehydration is the most common cause of fluid and electrolyte disturbances in older adults. Reduced thirst sensation and fluid intake, medications such as diuretics and laxatives, and increased fluid needs during illness contribute to dehydration. Water balance in the elderly is critical in preventing tissue dehydration. Negative water balance, occurring when more water is lost than is retained, results in a severe decrease in all secretions. This "drying out" of tissues and organs, including muscles and joints, may lead to premature aging, xerostomia, fatigue and in severe cases death may result.
Insulin secretion is decreased, which can lead to carbohydrate intolerance, and renal function deteriorates in the 40s for some people. Serum cholesterol levels peak for men at age 60 but continue to rise in women until age 70. Cardiovascular changes may occur putting them at a risk of blood pressure and other heart conditions Immuno-competence decreases with age. The lower immune function means less ability to fight infections and malignancies. Vitamin E, zinc, and some other supplements may increase immune function.
A number of changes may occur in the aging person's social and psychological status, potentially affecting appetite and nutrition status. These include: Depression, Memory impairment caused by various types of dementia, Alzheimer's disease, or other neurological diseases, Excessive alcohol intake (over 15% of total calories) increases morbidity and mortality, and leads to both physical and psychosocial problems. Social isolation becomes more common because of declining income, health problems, loss of spouse or friends, and assistance needs. All of these may affect appetite and possibly nutritional status.
Importance of healthy eating at old age
For seniors, the benefits of healthy eating include increased mental acuteness, resistance to illness and disease, higher energy levels, a more robust immune system, faster recuperation times, and better management of chronic health problems. As we age, eating well can also be the key to a positive outlook and staying emotionally balanced.
- Live longer and stronger - Good nutrition keeps muscles, bones, organs, and other body parts strong for the long haul. Eating vitamin-rich food boosts immunity and fights illness-causing toxins. A proper diet reduces the risk of heart disease, stroke, high blood pressure, type-2 diabetes, bone loss, cancer, and anemia. Also, eating sensibly means consuming fewer calories and more nutrient dense foods, keeping weight in check.
- Sharpen the mind - Scientists know that key nutrients are essential for the brain to do its job. Research shows that people who eat a selection of brightly colored fruit, leafy veggies, certain fish and nuts packed with omega-3 fatty acids can improve focus and decrease the risk for Alzheimer´s disease.
- Feel better - Eating well is a feast for your five senses! Wholesome meals give you more energy and help you look better, resulting in a self-esteem boost. It´s all connected - when your body feels good you feel happier inside and out.
What your body needs
Older adults can feel better immediately and stay healthy for the future by choosing healthy foods. A balanced diet and physical activity contribute to a higher quality of life and enhanced independence as you age.
Fruit: Focus on whole fruits rather than juices for more fiber and vitamins and aim for around 1 ½ to 2 servings each day. Break the apple and banana rut and go for color-rich pickings like berries or melons.
Veggies: Color is your credo in this category. Choose anti-oxidant rich dark leafy greens, such as kale, spinach, and broccoli as well as oranges and yellows, such as carrots, squash, and yams. Try for 2 to 2 ½ cups of veggies every day.
Calcium: Aging bone health depends on adequate calcium intake to prevent osteoporosis and bone fractures. Seniors need 1,200 mg of calcium a day through servings of milk, yogurt, or cheese. Non-dairy sources include tofu, broccoli, almonds, and kale. Vitamin D is essential for calcium absorption. It is obtained through sun exposure and from foods e.g. fatty fish, egg yolk and fortified milk.
Grains: Be smart with your carbohydrates and choose whole grains over processed white flour for more nutrients and a higher fiber count. If you are not sure, look for pasta, breads, and cereals that list "whole" in the ingredient list.
Water: Seniors are prone to dehydration because our bodies lose some of its ability to regulate fluid levels and our sense of thirst is dulled. Sip water every hour to avoid urinary tract infections, constipation, and possibly confusion.
- Reduce sodium (salt) to help prevent water retention and high blood pressure. Look for the "low sodium" labels and season meals with a little salt.
- Enjoy good fats. Reap the rewards of olive oil, avocados, salmon, walnuts, flaxseed, and other monounsaturated fats. Research shows that the fat from these delicious sources protects your body against heart disease by controlling "bad" LDL cholesterol levels and raising "good" HDL cholesterol levels.
- Fiber up. Avoid constipation, lower the risk of chronic diseases, and feel fuller longer by increasing fiber intake. Your go-to fiber-foods are raw fruits and veggies, whole-grains, and beans.
- Minimize "bad" carbohydrates. Bad carbohydrates - also known as simple or unhealthy carbohydrates - are foods such as white flour, refined sugar, and white rice that have been stripped of all bran, fiber, and nutrients. Bad carbohydrates digest quickly and cause spikes in blood sugar levels and short-lived energy. For long-lasting energy and stable insulin levels, choose "good" or complex carbohydrates such as whole grains, beans, fruits, and vegetables.
- Look for hidden sugar. Added sugar can be hidden in foods such as bread, canned soups and vegetables, pasta sauce, instant mashed potatoes, frozen dinners, fast food, and ketchup. Check food labels for alternate terms for sugar such as corn syrup, molasses, brown rice syrup, cane juice, fructose, sucrose, dextrose, or maltose. Opt for fresh or frozen vegetables instead of canned goods, and choose low-carbohydrates or sugar-free versions of products such as tortillas, bread, pasta, and ice cream.
- Cook smart. The best way to prepare veggies is by steaming or sautéing - it preserves nutrients. Boiling may drain essential nutrients.
Information Source Links
- Ministry of Medical Services, GOK. Kenya National Clinical Nutrition and Dietetics Reference Manual. Nairobi, Kenya: Ministry of Medical Services Republic of Kenya; (2010).
- Patrick Holford; Improve your digestion; The drug free guide to achieving you´re a healthy digestive system;
- Sharon R, Kathryn P, Ellie W. Understanding Normal and Clinical Nutrition.8th edition.USA: Yolanda cossio; (2008)
- www.helpguide.org, May 2012