Adulthood and the
Later Years
The senior years are the period from age 51 until the end of life.
Older adults can face a variety of health challenges:
Blood pressure rises
Immune system may have more difficulty battling infections.
The skin becomes thinner and more wrinkled and may take longer to
heal after injury.
Older adults may gradually lose an inch or two in height.
Short-term memory worsens.
Life expectancy in the United States increased in the 20th century.
Factors that enhance longevity include limited or no alcohol use,
regular balanced meals, weight control, adequate sleep, abstinence
from smoking, and regular physical activity.
Beginning at age 51, nutrient requirements for adults change in
order to fit the nutritional issues and health challenges that older
people face.
Because the process of aging affects nutrient needs, some
requirements for nutrients decrease as a person ages, while
requirements for other nutrients increase.
Six lifestyle behaviors seem to have the greatest influence on
people’s health and therefore on their physiological age:
• Sleeping regularly and adequately
• Eating well-balanced meals, including breakfast, regularly
• Engaging in physical activity regularly
• Not smoking
• Not using alcohol, or using it in moderation
• Maintaining a healthy body weight
Due to reductions in lean body mass and metabolic rate, older
adults have lower calorie needs than younger adults.
The energy requirements for people ages 51 and older are 1,600 -
2,200 calories for women and 2,000 - 2,800 calories for men,
depending on activity level.
Energy The decrease in physical activity that is typical of older adults also
influences nutrition requirements.
and
The AMDR(Acceptable Macronutrient Distribution Ranges) for
Macronutrients carbohydrates, protein, and fat remain the same from middle age
into old age.
Fiber is especially important in preventing constipation and
diverticulitis and it may also reduce the risk of colon cancer.
Protein should be lean, and healthy fats, such as omega-3 fatty
acids, are a part of any good diet.
Body Weight 2/3 of older adults in the US are now considered
overweight or obese.
For adults over 65, health risks don’t become apparent until BMI
reaches at least 27.
Older adults who are obese, however, face serious medical
Physiological complications and can significantly improve their quality of life
with weight loss.
Changes
For some older adults, a low body weight may be more
detrimental than a high one.
Low body weight often reflects malnutrition and the trauma
associated with a fall. Many older adults experience weight loss, in
large part because of an inadequate food intake
Older people tend to lose bone and muscle and gain
body fat. Many of these changes occur because
some hormones that regulate appetite and
metabolism become less active with age, whereas
others become more active.
Loss of muscle, known as sarcopenia, can be
Body significant in the later years. As muscles diminish
Composition and weaken, people lose the ability to move and
maintain balance making falls likely.
Optimal nutrition and regular physical activity can
help maintain muscle mass and strength and
minimize the changes in body composition
associated with aging.
Immune System Changes in the immune system also bring
declining function with age. In addition, the immune system is
compromised by nutrient deficiencies.
Thus the combination of age and malnutrition makes older people
Immune vulnerable to infectious diseases. Antibiotics often are not
effective against infections in people with compromised immune
System systems. Consequently, infectious diseases are a major cause of
death in older adults.
Older adults may improve their immune system responses by
exercising regularly.
In the GI tract, the intestinal wall loses strength and elasticity with
age and GI hormone secretions change. All of these actions slow
motility. Constipation is more common in the elderly than in the
young. Changes in GI hormone secretions also diminish appetite,
leading to decreased energy intake and weight loss.
Atrophic gastritis, a condition that affects almost 1/3 of those over
60, is characterized by an inflamed stomach, bacterial
overgrowth, and a lack of hydrochloric acid and intrinsic factor.
GI Tract All of these can impair the digestion and absorption of nutrients,
most notably, vitamin B12, but also biotin, folate, calcium, iron,
and zinc.
Difficulty in swallowing-dysphagia occurs in especially in elderly.
Consequently, the person may eat less food and drink fewer
beverages, resulting in weight loss, malnutrition, and dehydration.
The diet typically provides moist, soft-textured, pureed foods and
thickened liquids.
Regular dental care over a lifetime protects against tooth loss and
gum disease. These conditions make chewing difficult or painful.
Dentures, even when they fit properly, are less effective than
natural teeth, and inefficient chewing can cause choking. People
with tooth loss, gum disease, and ill-fitting dentures tend to limit
Tooth Loss their food selections to soft foods
People without teeth typically eat fewer fruits and vegetables and
have less variety in their diets.
Consequently, they have low intakes of fiber and vitamins, which
exacerbates their dental and overall health problems.
Sensory losses and other physical problems can also interfere with
an older person’s ability to obtain adequate nourishment.
Sensory It may become difficult to read food labels. Similarly, a person
with limited mobility may find cooking and cleaning up too hard.
Losses and The prevalence of undernutrition is high among those who are
Other homebound.
Taste and smell sensitivities tend to diminish and may make
Physical eating less enjoyable. If a person eats less, then weight loss and
nutrient deficiencies may follow.
Problems
Loss of vision and hearing may contribute to social isolation, and
eating alone may lead to poor intake.
Despite real fluid needs, many older people do not seem to feel
thirsty or notice mouth dryness. Those who have lost bladder
control may be afraid to drink too much water.
Dehydration is a risk for older adults. Total body water decreases
as people age, so even mild stresses such as fever or hot weather
Water can precipitate rapid dehydration in older adults.
Dehydrated older adults seem to be more susceptible to urinary
tract infections, pneumonia, pressure ulcers, and confusion and
disorientation.
To prevent dehydration, older adults need to drink at least 6
glasses of water a day.
Energy and
Energy
On average, energy needs decline an estimated 5% per decade.
Nutrients One reason is that people usually reduce their physical activity as
they age, although they need not do so.
Another reason is that basal metabolic rate declines 1 - 2% per
decade in part because lean body mass and thyroid hormones
diminish.
The lower energy expenditure of older adults means that they need
to eat less food to maintain their weights. Accordingly, the
estimated energy requirements for adults decrease steadily after
age 19
Protein Protein Because energy needs decrease, protein must be obtained from
low - kcalorie sources of high-quality protein, such as lean meats, poultry,
fish, and eggs; fat-free and low-fat milk products; and legumes.
Protein is especially important for the elderly to support a healthy immune
system, prevent muscle wasting, and optimize bone mass.
Underweight or malnourished older adults need protein- and energy-
dense snacks such as hard-boiled eggs, tuna fish and crackers, peanut
butter on wheat toast, and hearty soups.
As always, carbohydrate is needed to protect protein from being
used as an energy source. Sources of complex carbohydrates such
as legumes, vegetables, whole grains, and fruits are also rich in
fiber and essential vitamins and minerals.
Carbohydrate Average fiber intakes among older adults are lower than current
recommendations (14 grams per 1000 kcalories).
and Fiber
Eating high-fiber foods and drinking water can alleviate
constipation—a condition common among older adults, especially
nursing home residents. Physical inactivity and medications also
contribute to the high incidence of constipation.
Fat intake needs to be moderate in the diets of most older
adults—enough to enhance flavors and provide valuable nutrients,
but not so much as to raise the risks of cancer, atherosclerosis, and
other degenerative diseases.
Fat
This recommendation should not be taken too far; limiting fat too
severely may lead to nutrient deficiencies and weight loss—two
problems that carry greater health risks in the elderly than
overweight.
Vitamin B12 An estimated 10 - 30 % of adults over 50 have
atrophic gastritis. People with atrophic gastritis are particularly
vulnerable to vitamin B12 deficiency. It causes anemia, and
neurological effects .The RDA for older adults is the same but with
the added suggestion to obtain most of a day’s intake from
vitamin B12–fortified foods and supplements. The bioavailability
of vitamin B12 from these sources is better.
Vitamins and Vitamin D Vitamin D deficiency is a problem among older adults.
Only vitamin D–fortified milk provides significant vitamin D, and
Minerals many older adults drink little or no milk. Further compromising
the vitamin D status of many older people, is limited exposure to
sunlight. Finally, aging reduces the skin’s capacity to make vitamin
D and the kidneys’ ability to convert it to its active form. To
prevent bone loss and to maintain vitamin D status, adults 51 - 70
years old need 10 mcg daily, and those over 70 need 15 mcg
Calcium Abundant dietary calcium is needed , especially for women
after menopause, to protect against osteoporosis. The DRI
Committee recommends 1200 mg of calcium daily, but the calcium
intakes of older people are well below recommendations. Some older
adults avoid milk and milk products because they dislike these foods
or associate them with stomach discomfort.
Simple solutions include using calcium-fortified juices, adding
powdered milk to recipes, and taking supplements
Iron The iron needs of men remain unchanged throughout adulthood.
Vitamins and For women, iron needs decrease substantially when blood loss
through menstruation ceases. Consequently, iron-deficiency anemia
Minerals is less common in older adults than in younger people. In fact,
elevated iron stores are more likely than deficiency in older people,
especially those who take iron supplements, eat red meat regularly,
and include vitamin C–rich fruits in their daily diet.
Iron deficiency may develop in older adults if they have chronic blood
loss from diseases and medicines and poor iron absorption due to
reduced stomach acid secretion and antacid use. Iron deficiency
impairs immunity and leaves older adults vulnerable to infectious
diseases.
People judge for themselves how to manage their nutrition, and
more than half of older adults turn to dietary supplements. When
recommended by a physician or registered dietitian, vitamin D
Nutrient and calcium supplements for osteoporosis or vitamin B12 for
Supplements pernicious anemia may be beneficial.
Food is the best source of nutrients for everybody.
Supplements are just that—supplements to foods, not substitutes
for them
Age-related eye diseases that impair vision, such as cataract and
macular degeneration. Following a healthy diet as described by the
Dietary Guidelines for Americans is one way to protect against vision
problems.
Cataracts are age-related thickenings in the lenses of the eyes that
impair vision. If not surgically removed, they ultimately lead to
blindness. Cataracts occur even in well-nourished individuals as a result
of ultraviolet light exposure, oxidative stress, injury, viral infections,
toxic substances, and genetic disorders. Oxidative stress appears to play
a significant role in the development of cataracts, and the antioxidant
nutrients may help minimize the damage. Studies have reported an
Vision inverse relationship between cataracts and dietary intakes of vitamin C,
vitamin E, and carotenoids. Other diet-related factor may play a role in
the development of cataracts is obesity.
The leading cause of visual loss among older people is age-related
macular degeneration, a deterioration of the macular region of the
retina. As with cataracts, risk factors for age-related macular
degeneration include oxidative stress from sunlight, and preventive
factors may include supplements of antioxidant vitamins plus zinc and
the carotenoids. Total dietary fat may also be a risk factor for macular
degeneration, but the omega-3 fatty acids of fish may be protective.
The most common type of arthritis that disables older people is
osteoarthritis, a painful deterioration of the cartilage in the joints.
During movement, the ends of bones are normally protected from
wear by cartilage and by small sacs of fluid that act as a lubricant.
With age, the cartilage sometimes disintegrates, and the joints
become malformed and painful to move.
Arthritis One known connection between osteoarthritis and nutrition is
overweight.
Weight loss may relieve some of the pain for overweight persons
with osteoarthritis. Jogging and other weight-bearing exercises do
not worsen arthritis. In fact, both aerobic activity and strength
training offer improvements in physical performance and pain
relief, especially when accompanied by even modest weight loss.
The brain normally changes in some characteristic ways as it ages. For one
thing, its blood supply decreases. For another, the number of the brain
cells diminishes. When the number of nerve cells in one part of the
cerebral cortex diminishes, hearing and speech are affected. Losses of
neurons in other parts of the cortex can impair memory and cognitive
function.
When the number of neurons in the hindbrain diminishes, balance and
posture are affected. Losses of neurons in other parts of the brain affect
still other functions. Some of the cognitive loss and forgetfulness generally
attributed to aging may be due in part to environmental, and therefore
controllable, factors—including nutrient deficiencies.
The Aging Nutrients influence the development and activities of the brain. The ability
of neurons to synthesize specific neurotransmitters depends in part on the
Brain availability of precursor nutrients that are obtained from the diet.
The neurotransmitter serotonin, for example, derives from the amino acid
tryptophan.
To function properly, the enzymes involved in neurotransmitter synthesis
require vitamins and minerals. Thus nutrient deficiencies may contribute
to the loss of memory and cognition
Maintaining appropriate body weight may be the most important nutrition
concern for the person with Alzheimer’s disease. Depression and
forgetfulness can lead to changes in eating behaviors and poor food
intake.
