Nutrient Needs of Older People

We have often seen at home, the grandparents share their food with the young ones saying – Give the food to the kids, they need it more than us.” This is very dangerous when our elders start feeling that now they don’t need to eat like before. We understand that energy requirements decline with age but not the needs of the body. Their appetite reduces with time, but the body still needs proper nutrient intake. This need has to be taken care of with less quantity and more quality.

A person’s daily calorie needs depend on his/her height, weight, muscle mass, activity level and several other factors. But, definition of balanced diet is not the same for all age groups. It differs with age, gender, needs, etc. Older adults generally need fewer calories. It is even common to lose muscle and strength as you age. However, the nutrient needs are just as high or higher than when they were younger. Therefore, eating nutrient-rich, whole foods becomes extremely important.

Lower food intake among the elderly has been associated with lower intakes of calcium, iron, zinc, vitamins, etc. Low energy intakes or low nutrient density of the diet may increase the risk of diet-related illnesses and pose a health problem. A varied diet that concentrates on fruits, vegetables, whole grains, legumes, dairy foods and lean meats can meet the basic nutritional requirements of older adults.

Physiological changes associated with age, including slower gastric emptying, altered hormonal responses, decreased basal metabolic rate, and altered taste and smell may contribute to lowered energy intake. Experts even highlight that constipation is a common health problem among the elderly. It is especially common in people over 65, and it is two to three times more common in women. Eating fibre may help relieve constipation. It passes through the gut undigested, helping form stool and promote regular bowel movements.

Other factors such as marital status, income, education, socioeconomic status, diet-related attitudes and beliefs, play a role as well. And when we talk specifically about people above 60 year of age, things get more complicated for many more reasons. Dr Seema Puri, Associate Professor in Department of Nutrition of Institute of Home Economics at University of Delhi raises concerns like “Malnutrition in elderly is multifactorial and often influenced by socio-psychological factors like loneliness, depression, loss of a spouse, living alone etc. and not only economic reasons. Hence, it is important to address these issues too.”

Now, how to address the issue? Age-related nutritional problems may be remedied to some extent by providing nutrient-dense meals. Dr. A. Laxmaiah, Head, Division of Community Studies at National Institute of Nutrition, recommends “Geriatric population should take more of vitamin D, Calcium, vitamin B12, because deficiency of these nutrients is very high in older age groups. This could be due to low absorption.” Dr. Seema Puri adds here – “Calcium and vitamin D are very important and the needs are increased – so exposure to sunlight for vitamin D, consumption of fortified foods and calcium rich foods like dairy are important.”

A person’s daily calorie needs depend on his/her height, weight, muscle mass, activity level and several other factors. But, definition of balanced diet is not the same for all age groups. It differs with age, gender, needs, etc. Older adults generally need fewer calories. It is even common to lose muscle and strength as you age. However, the nutrient needs are just as high or higher than when they were younger. Therefore, eating nutrient-rich, whole foods becomes extremely important.

Nutritional supplements are believed to fulfill the deficiency of food elements in our diet. The purpose of the nutritional supplement is to add that little extra to your normal diet. Elders need more of certain nutrients generally missed out due to their low appetite for food. So, supplements are seen by many as having the potential to fulfill the needs.

An elder needs a few nutritional supplements like Calcium, Vitamin D for bone health Vitamin B6 needed to form red blood cells and Vitamin B12 to keep the red blood cells healthy. As per Dr. K Damayanti, Retired Scientist at National Institute of Nutrition in Hyderabad – “Multi vitamin and mineral supplements are not recommended on regular basis. But in case of Vitamin B12, it has some issue with absorption due to lack of intrinsic factor. Absorption powers of a human body gradually reduces with age, so supplements are preferred to be given via injections or in higher doses if it is in form of tablets” Taking supplements at old age is not recommended till the time body needs of a particular nutrient is filled with the help of regular foods and diet. Taking supplements seem to be one of the easiest ways for older adults to meet their daily nutrition requirements, but eating healthy food is the best way to get the nutrients they need.

Experts are unanimous about the quantity and quality of food intake by elder people. Older people must eat more of fruits and vegetables and energy dense foods as their capacity of stomach is less and absorption of vitamins and minerals is less during the old age. Consuming adequate fruits and vegetables provide potassium, along with limiting sodium (salt) intake, which may lower risk of high blood pressure and diabetes.

Dr Laxmaiah recommends – “Including whole grains, legumes, fruits and vegetables will provide fibre vitamins and minerals.”

Dr K. Damayanti suggests similar solutions. She emphasises that “Elderly people need less calories and more fibres, vitamins and minerals. So there is a need to consume micronutrients dense and fibre rich foods. Calcium and Vitamin D requirements for elders are higher than adolescent group so it is essential to consume milk and milk products.” Dr. Laxmaiah recommends older adults to adequately consume low-fat or fat-free dairy products and choose foods that are low in saturated fat to help reduce risk of heart disease.

The elderly are even encouraged to consume nutrient-dense foods such as nuts, oilseed, fruits, vegetables, legumes and flesh foods to meet the daily requirements of vitamins and minerals to prevent multiple micronutrient malnutrition. Nuts and oil seeds are not only rich sources of micronutrients and fibre but also good source of proteins and fats for elders. It is advisable to consume at least 30g of nuts every day. Antioxidants and phytonutrients present naturally in foods are beneficial to promote healthy ageing like in dark coloured fruits and vegetables, herbs and spices, garlic, turmeric, cinnamon, red wine, green tea etc.

When asked about how much the caloric needs of a person gets altered with ageing, Dr. Seema Puri highlights Indian Council of Medical Research recommendations, “As a person ages, his basal metabolic rate slows down. Also the physical activity decreases and therefore the needs of calories also decrease. The recommended estimated energy requirements (EER) based on BMR and physical activity levels, for the sedentary elderly man and woman weighing 65kg and 55kg are 1700 Kcal and 1500Kcal respectively.” She even confirms gender also makes a difference in calorie intake during ageing as women tend to have more fat mass and men have higher muscle mass which is the active tissue.”

Beyond all the nutrition advises, experts also recommend elders to be encouraged to maintain physical activity. For old age people there are many factors to be considered, still with some precautions and understanding, leading a healthy life and reaching a centenary will not be a problem.

• As per the 2011 Census report, India has a total of 6.05 lakh individuals over the age of 100.

• Japan is the country with the highest rate of centenarians, at 6 for every 10,000 people or approximately 0.06 percent.

• Residents of Okinawa in Japan are more likely to live to 100 years of age than people in most other regions of Japan. It has been home to more than 1,000 centenarians throughout the past 40 years.

• Okinawa’s diet is low in calories and fat while high in carbs. Their unique diet and lifestyle are credited with giving them some of the longest lifespans on the planet.

---