Nutrition for the Elderly

Borja Bandera 13 November, 2020 Well-being habits Leave a comment

Are you a senior citizen? This is what you should know about your diet: Nutrition for the Elderly.

We tell you how to approach nutrition and how an older adult should eat.

Index

1. Grow old healthily
2. What physiological changes occur over time?
3. What food do older adults need?
4. Is processed food bad for the elderly?
5. Why do elderly people lose muscle mass?
6. Why do older adults need to consume more protein?
7. Why do old people lose their appetite?
8. How to deal with loss of appetite in the elderly?
9. How to treat dehydration in older adults?
10. Conclusions
11. Bibliography
12. Related Entries

Grow old healthily

The beautiful thing about nutrition, both clinical and sporting, is that it varies greatly depending on a person’s stage of life.

When we talk about nutrition, by default, we address the adult public, but an increasingly large population group, seniors, have recommendations that are quite different from those of a middle-aged adult.

None of us can escape the passing of time, but healthy ageing involves doing things differently from the majority of the Western population at present.

Just as our physiology is not the same in the morning as it is at night, neither is it the same in childhood and in the last stage of life.

Time changes our physiology.

What physiological changes occur over time?

Less absorption of important micronutrients

There is a high prevalence of atrophic gastritis in those over the age of 60.

This decreases the production of gastric acid and the absorption of nutrients such as B12, folic acid, beta-carotene, iron and calcium (Russell, 2001).

Of course, the simple fact of being older increases the prevalence of other digestive or non-digestive disorders, which can cause deficits in the absorption of macro- and micro-nutrients (SIBO, neoplastic pathology, surgeries, prolonged antibiotic treatments, etc.).

Less energy needs, more nutrient needs

As we age our total daily energy expenditure decreases.

This is due to slight but continuous declines in our BMR (basal metabolic rate), in energy expenditure resulting from physical activity and exercise.

However, for the reasons mentioned above, and others that will be mentioned later, there is a greater need for certain micronutrients.

What food do older adults need?

That it’s more important than ever to consume nutritionally dense foods.

In other words, consciously seek to ensure that the ratio of NUTRIENTS/CALORIES is high.

We can achieve this by eating 90% unprocessed food or good processed food: vegetables, fruit, legumes, nuts, meat, fish, eggs.

Some nutrients that are difficult for the older amongst us to get enough of are calcium, vitamin D and B12.

Is processed food bad for the elderly?

That said, this recommendation, which is correct for a healthy senior adult profile, can be nuanced in the elderly suffering from illnesses.

In such cases, energy needs increase and hyporexia and other factors can make it difficult to include enough unprocessed or well-processed food.

This, despite many people’s concerns, leaves the door open to include some processed foods that provide energy and are easy to consume.

There are (many) situations where it is preferable to avoid a calorie-protein malnutrition by consuming foods that would not be classified as healthy.

The perfect, once again, can be the enemy of the good.

I wish the entire population was used to porridge or avocado toast for breakfast, but the reality is quite different. Nevertheless, in this post you’ll find some breakfast examples

Why do elderly people lose muscle mass?

An adult loses, on average, 3-8% muscle mass every decade from the age of 30 (English & Paddon-Jones, 2010).

A despairing fact…

But it’s also true that the average adult doesn’t work out, or at least not enough. This means these figures could be greatly reduced.

Moreover, you can reverse this and gain muscle mass above that age threshold. The problem is that this is something we don’t even think about.

This loss of muscle mass, strength and function is called SARCOPENIA, KRATOPENIA and DYNAPENIA, respectively, and brings with it an increased risk of falls, a deterioration in quality of life, and an increased risk of death from any cause.

It’s another epidemic, silent and less conspicuous than others, like obesity.

Why does Anabolic Resistance occur?

It seems like the elderly must are weak and frail when they don’t have to be.

Due to certain phenomena, among others, there is Anabolic Resistance:

Less anabolic hormones (mainly testosterone and GH);
Lower capillary density;
More inactivity or fewer myocyte satellite cells;

There is less anabolic response in the muscle to certain concentrations of amino acids.

In short, it costs more to generate muscle for the same stimulus and with respect to other stages of life.

This can be amended with two actions, which are extremely important for any senior citizen:

Why do older adults need to consume more protein?

At least 1.2 g/kg of body weight.

If there is chronic illness (depending on the condition), you may need up to 1.5 g/kg of weight.

All meals should contain protein: divide the intake into 0.4 g/kg body weight batches.

This can be a challenge for the elderly, especially at breakfast.

This is why supplementation in this population group (where it is generally not even considered) is of particular interest. Whey protein is almost more important in our elderly than in the gym.

A protein supplement such as Whey Protein, is a simple way to increase the amount of protein without much difficulty: it can be added to coffee, milk or yoghurt without modifying their taste or texture, as long as we are talking about neutral flavours. Here are more recipes with Whey Protein.

Other ways of enriching more elaborated dishes with protein is by adding egg whites, chopped eggs, tuna, textured soy, etc.

Muscle strength exercise

At least 3-4 times a week.
Looking for a suitable stimulus and a principle of progression. Ideally with professional monitoring.

Avoiding “weakening” is a priority for the elderly.

Why do old people lose their appetite?

As we age, there are also changes in our hormones that regulate hunger and satiety.

The clearest example is the decrease in levels of ghrelin (Di Francesco et al., 2008).

When our elderly say that they’re not hungry, there is a physiological substrate behind that statement.

Problems with their teeth, which are usually overlooked.

I have come to see patients in my clinical practice who were only eating biscuits and milk because of such problems.

This is more common than you might think.

Mood changes

Loneliness is yet another pandemic, and particularly affects the elderly population.

To think that physiology and psychology are separate is one of the biggest mistakes in medicine.

Worsening sense of taste and smell: the decline of other organs and systems is accompanied by sensory decline.

Concomitant medication

Let’s not forget how polymedicated our elderly are. Many of the medications used frequently reduces appetite.

Comorbidities

The prevalence of illness is much higher in this population, as might be expected.

In the case of neoplastic disease, for example, it increases total daily energy expenditure while reducing appetite.

That’s why cancer cachexia is a major problem in hospitals.

How to deal with loss of appetite in the elderly?

Look for nutritionally and energy dense snacks, such as nuts or nut creams, and try to eat them quite frequently. As we said, protein supplements in shake format can be very useful.

And of course, let’s not mix tools.

In this case (older patient + serious disease) intermittent fasting is not a good idea, because we’re trying to increase energy intake, not reduce it.

In the case of the senior adults with obesity or who are overweight, it could be something to take into account.

How to treat dehydration in older adults?

We are 60% water, and we need to be well hydrated to stay healthy.

During the adult stage, our osmoreceptors, located in the brain, work perfectly, so we can rely on our sense of thirst.

That’s to say, we drink when we need to.

But as we age these receptors become less sensitive to changes in the osmolality of the blood and don’t give us enough notice. We’re more prone to dehydration.

Make a conscious effort to drink water throughout the day.

Conclusions

The physiological changes generated by the passing of time must be matched with appropriate action.

Clinical and sports nutrition has to be adapted to the person and their needs, and in the case of the elderly, these are very different.

Increased energy and protein requirements make supplementation a useful tool for this population, although society is not yet ready or used to using it widely.

In a few decades, one fifth of the population will be over 60, so what’s discussed in this article will become increasingly important.

A big hug and see you in the next post!

Bibliography

Di Francesco, V., Fantin, F., Residori, L., Bissoli, L., Micciolo, R., Zivelonghi, A., Zoico, E., Omizzolo, F., Bosello, O., & Zamboni, M. (2008). EFFECT OF AGE ON THE DYNAMICS OF ACYLATED GHRELIN IN FASTING CONDITIONS AND IN RESPONSE TO A MEAL. Journal of the American Geriatrics Society, 56(7), 1369–1370.
English, K. L., & Paddon-Jones, D. (2010). Protecting muscle mass and function in older adults during bed rest. In Current Opinion in Clinical Nutrition and Metabolic Care (Vol. 13, Issue 1, pp. 34–39). NIH Public Access.
Russell, R. M. (2001). Factors in aging that effect the bioavailability of nutrients. Journal of Nutrition.