Growing Older,
Eating Better
by Paula Kurtzweil
When Bernadette Harkins, 89,
of Rockville, Md., could no longer feed herself properly, she moved to an
assisted-living residence. Today, she can enjoy three meals a day served to her
and about 30 other people in their home-like communal dining room.
When Harry, 85, of Moscow,
Pa., could no longer feed himself properly, he moved in with his daughter and
her family. With her guidance, he ate six times a day, snacking on high-calorie,
high-protein foods, and maintaining a near-normal weight.
Harry, who asked that his
last name not be used, and Harkins typify many of today's older generation.
Living alone in most cases, they often are unable to meet their dietary needs
and are forced to make compromises.
Harry didn't know how to
cook. He developed cancer, which made it even more important that he eat a
well-balanced diet. Harkins knew how to cook but didn't take time to prepare
adequate meals for herself.
"I would snack is what
I'd do," she said. "I would think about getting a meal and then just
have a cup of tea and toast. I knew I wasn't doing the right thing as far as
nutrition was concerned."
Their eating problems stemmed
from loneliness and lack of desire or skill to cook. Other older people may eat
poorly for other reasons, ranging from financial difficulties to physical
problems.
The solutions can be just as
varied, from finding alternative living arrangements to accepting home-delivered
meals to using the food label recently revised by the Food and Drug
Administration and the U.S. Department of Agriculture. Physical activity also is
important in maintaining a healthy lifestyle.
Why the
Concern?
Nutrition remains important
throughout life. Many chronic diseases that develop late in life, such as
osteoporosis, can be influenced by earlier poor habits. Insufficient exercise
and calcium intake, especially during adolescence and early adulthood, can
significantly increase the risk of osteoporosis, a disease that causes bones
to become brittle and crack or break.
But good nutrition in the
later years still can help lessen the effects of diseases prevalent among
older Americans or improve the quality of life in people who have such
diseases. They include osteoporosis, obesity, high blood pressure, heart
disease, certain cancers, gastrointestinal problems, and chronic
undernutrition.
Studies show that a good
diet in later years helps both in reducing the risk of these diseases and in
managing the diseases' signs and symptoms. This contributes to a higher
quality of life, enabling older people to maintain their independence by
continuing to perform basic daily activities, such as bathing, dressing and
eating.
Poor nutrition, on the
other hand, can prolong recovery from illnesses, increase the costs and
incidence of institutionalization, and lead to a poorer quality of life.
The Single
Life
Whether it happens at age
65 or 85, older people eventually face one or more problems that interfere
with their ability to eat well.
Social isolation is a
common one. Older people who find themselves single after many years of living
with another person may find it difficult to be alone, especially at
mealtimes. They may become depressed and lose interest in preparing or eating
regular meals, or they may eat only sparingly.
In a study published in the
July 1993 Journals of Gerontology, researchers found that newly widowed
people, most of whom were women, were less likely to say they enjoy mealtimes,
less likely to report good appetites, and less likely to report good eating
behaviors than their married counterparts. Nearly 85 percent of widowed
subjects reported a weight change during the two years following their
spouse's death, as compared with 30 percent of married subjects. The widowed
group was more likely to report an average weight loss of 7.6 pounds (17
kilograms).
According to the study,
most of the women said they had enjoyed cooking and eating when they were
married, but, as widows, they found those activities "a chore,"
especially since there was no one to appreciate their cooking efforts.
For many widowed men who
may have left the cooking to their wives, the problem may extend even further:
They may not know how to cook and prepare foods. Instead, they may snack or
eat out a lot, both of which may lead people to eat too much fat and
cholesterol and not get enough vitamins and minerals.
Special
Diets
At the same time, many
older people, because of chronic medical problems, may require special diets:
for example, a low-fat, low-cholesterol diet for heart disease, a low-sodium
diet for high blood pressure, or a low-calorie diet for weight reduction.
Special diets often require extra effort, but older people may instead settle
for foods that are quick and easy to prepare, such as frozen dinners, canned
foods, lunch meats, and others that may provide too many calories, or contain
too much fat and sodium for their needs.
On the other hand, Mona
Sutnick, Ed.D., a registered dietitian in private practice in Philadelphia,
pointed out that some people may go overboard on their special diets, overly
restricting foods that may be more beneficial than detrimental to their
health.
"My advice for a
60-year-old person might be 'watch your fat' but for an 80-year-old who's
underweight, I'd say, 'eat the fat, get the calories,'" Sutnick said.
Physical
Problems
Some older people may
overly restrict foods important to good health because of chewing difficulties
and gastrointestinal disturbances, such as constipation, diarrhea and
heartburn. Because missing teeth and poorly fitting dentures make it hard to
chew, older people may forego fresh fruits and vegetables, which are important
sources of vitamins, minerals and fiber. Or they may avoid dairy products,
believing they cause gas or constipation. By doing so, they miss out on
important sources of calcium, protein and some vitamins.
Adverse reactions from
medications can cause older people to avoid certain foods. Some medications
alter the sense of taste, which can adversely affect appetite. This adds to
the problem of naturally diminishing senses of taste and smell, common as
people age.
Other medical problems,
such as arthritis, stroke or Alzheimer's disease, can interfere with good
nutrition. It may be difficult, if not impossible, for example, for people
with arthritis or who have had a stroke to cook, shop, or even lift a fork to
eat. Dementia associated with Alzheimer's and other diseases may cause them to
eat poorly or forget to eat altogether.
Money
Matters
Lack of money is a
particular problem among older Americans who may have no income other than
Social Security. According to 1994 U.S. Census Bureau data, nearly 12 percent
of people 65 and over are below the average poverty level for their age group.
In 1994, the poverty level for a person 65 and over was $7,108 a year.
According to the 1994 data,
the mean annual income for people 65 and over was $16,709, almost $10,000 less
than what they earned on average between ages 55 and 64.
Lack of money may lead
older people to scrimp on important food purchases--for example, perishable
items like fresh fruits, vegetables and meat--because of higher costs and fear
of waste. They may avoid cooking or baking foods like meats, stews and
casseroles because recipes for these foods usually yield large quantities.
Financial problems also may
cause older people to delay medical and dental treatments that could correct
problems that interfere with good nutrition.
Food
Programs
Many older people may find
help under the Older Americans Act, which provides nutrition and other
services that target older people who are in greatest social and economic
need, with particular attention on low-income minorities. According to the
U.S. Administration on Aging, which administers the Older Americans Act, the
nutrition programs were set up to address the dietary inadequacy and social
isolation among older people.
Home-delivered meals and
congregate nutrition services are the primary nutrition programs. The
congregate meal program allows seniors to gather at a local site, often the
local senior citizen center, school or other public building or a restaurant,
for a meal and other activities, such as games and lectures on nutrition and
other topics of interest to older people.
Available since 1972, these
programs, funded by the federal, state and local governments, ensure that
senior citizens get at least one nutritious meal five to seven days a week.
Under current standards, that meal must comply with the Dietary Guidelines for
Americans and provide at least one-third of the Recommended Dietary Allowances
for an older person. Often, people receive foods that correspond with their
special dietary needs, such as no-added-salt foods for those who need to
restrict their sodium intake or ground meat for those who have trouble
chewing.
Other nutrition services
provided under the Older Americans Act are nutrition education, screening and
counseling.
While these nutrition
programs target poor people, they are available to other older people
regardless of income, according to Jean Lloyd, a registered dietitian and
nutrition officer with the Administration on Aging. Although no one is charged
for the meals, older people can voluntarily and confidentially donate money,
she said.
The meals provide not only
good nutrition, but they also give older people a chance to socialize--a key
factor in preventing the adverse nutritional effects of social isolation.
For those who qualify, food
stamps are another aid for improving nutrition. Under this program, a
one-person household can receive up to $115 a month in food stamps to buy most
grocery items.
For the homebound,
grocery-shopping assistance is available in many areas. Usually provided by
nongovernment organizations, this service shops for and delivers groceries to
people at their request. The recipient pays for the groceries and sometimes a
service fee.
In some communities,
private organizations also sell home-delivered meals.
Other
Assistance
Family members and friends
can help ensure that older people take advantage of food programs by putting
them in touch with the appropriate agencies or organizations and helping them
fill out the necessary forms. Some other steps they can take include:
-
looking in occasionally
to ensure that the older person is eating adequately
-
preparing foods for and
making them available to the older person
-
joining the older
person for meals.
In some cases, they may
help see that the older person is moved to an environment, such as their home,
an assisted-living facility, or a nursing home, that can help ensure that the
older person gets proper nutrition.
Whatever an older person's
living situation, proper medical and dental treatment is important for
treating medical problems, such as gastrointestinal distress and chewing
difficulties, that interfere with good nutrition. If a medication seems to
ruin an older person's taste and appetite, a switch to another drug may help.
A review of basic diet
principles may help improve nutrition. Explaining to older people the
importance of good nutrition in the later years may motivate them to make a
greater effort to select nutritious foods.
Look to the
Label
The food label can help
older people select a good diet. Revamped in 1992, the label gives the
nutritional content of most foods and enables consumers to see how a food fits
in with daily dietary recommendations.
Some of the information
appears as claims describing the food's nutritional benefits: for example,
"low in cholesterol" or "high in vitamin C." Under strict
government rules, these claims can be used only if the food meets certain
criteria. This means that claims can be trusted. For example, a
"low-cholesterol" food can provide no more than 20 milligrams (mg)
of cholesterol and no more than 2 grams of saturated fat per serving. A
high-potassium food must provide at least 700 mg of potassium per serving.
Less common but also
helpful are label claims linking a nutrient or food to the risk of a disease
or health-related condition. So far, FDA allows only eight of these claims
because they are the only ones supported by scientific evidence. One claim
links sodium, a nutrient found in salt and used in many processed foods, to
high blood pressure. On the food label, this claim would read something like
this:
"Diets low in sodium
may reduce the risk of high blood pressure, a disease associated with many
factors."
More in-depth information
is found on the "Nutrition Facts" panel on the side or back of the
food label. This information is required on almost all food packages. Unlike
before, this nutrition information is easier to read because it appears in
bigger type and is usually on a white or other neutral contrasting background,
when practical.
Some nutrition information
also may be available for many raw meats, poultry and fish and fresh fruits
and vegetables at the point of purchase. The information may appear in
brochures or on posters or placards.
Physical
Activity
Besides diet, physical
activity is part of a healthy lifestyle at any age. It can help reduce and
control weight by burning calories. Moderate exercise that places weight on
bones, such as walking, helps maintain and possibly even increases bone
strength in older people. A study published in the Dec. 28, 1994, Journal of
the American Medical Association found that intensive strength training can
help preserve bone density and improve muscle mass, strength and balance in
postmenopausal women. In the study, subjects used weight machines for strength
training.
Also, scientists looking
into the benefits of exercise for older people agree that regular exercise can
improve the functioning of the heart and lungs, increase strength and
flexibility, and contribute to a feeling of well-being.
Any regular physical
activity is good, from brisk walking to light gardening. Common sense is the
key. But, before a vigorous exercise program is started or started after a
long period of rest, a doctor should be consulted.
Taking time out for
exercise, using the food label to help pick nutritious foods, taking advantage
of the several assistance programs available, and getting needed medical
attention can go a long way in helping older people avoid the nutritional
pitfalls of aging and more fully enjoy their senior years.
For More
Information
To learn more about the food
label and nutrition for older people, write for these publications:
-
Using the New Food Label
to Choose Healthier Foods. FDA, 5600 Fishers Lane (HFE-88), Rockville, MD
20857. Ask for publication number (FDA) 94-2276.
-
Healthy Eating for a
Healthy Life. AARP (American Association of
Retired Persons) Fulfillment, 601 E. St., N.W., Washington, DC 20049.
Ask for publication by title and stock number D15565.
To learn about meal programs
for senior citizens in your area, call the Administration
on Aging's Elder Care Locator, (1-800) 677-1116.
For information about food
stamps, contact your county's food stamp office listed in the blue pages of the
telephone book.
To find a registered
dietitian in your area, call the National Center for Nutrition and Dietetics
Consumer Nutrition Hotline, (1-800) 366-1655.
U.S. Food and Drug Administration
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