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Nutrition for Seniors

Holly Alley, MS, RD, LD
Nutrition Specialist,
Department of Food and Nutrition

If you're over 65, you're one of the fastest growing parts of America's population. It is estimated that by the year 2000, people over 65 will make up 20% of our population.

People of any age are healthier if they are well-nourished. Well-nourished older people feel better, recover faster from illnesses, spend less time in the hospital, and can possibly live independently longer than older people who don't eat well.

But it's not always easy to eat well. As you age you may lose some of your ability to taste, smell, and see. You may have greater difficulty in preparing food due to illness, arthritis or loss of sight. You may lose teeth, making it difficult to chew. Or you may not have enough money to buy the food you need.

Nutrient Needs

There's not enough research right now to know the exact nutritional requirements of elderly people. However, we can identify some common nutritional problems.

During the aging process, changes occur in the body that can affect nutrition. There may be less absorption and greater excretion of nutrients. This means you need to take in more nutrients to absorb the same amount. Yet, calorie needs decrease with age because your metabolism slows down. Therefore, nutrient-dense foods are needed. Nutrient-dense foods are those that provide vitamins and minerals without too many calories. These include fruits, vegetables, plain breads and cereals (as opposed to pastries and other high fat, high sugar baked goods), low-fat dairy products, lean meats and low-fat meat substitutes such as beans, peas, lentils, fish, eggs, and low-fat cheese. These foods should be the basis of your diet.

Calcium may be a concern for some senior citizens for several reasons. The stomach may secrete less hydrochloric acid, which may reduce the amount of calcium absorbed. Hormonal changes may also decrease calcium absorption and increase loss of calcium through the kidneys. In addition, you may lose some of your ability to digest lactose, the sugar in milk. This is called lactose intolerance. If you're Black or Oriental you are more likely to be lactose intolerant than if you are White. Because of lactose intolerance, some people may decrease their intake of dairy products which are good sources of calcium. But you still need the calcium. So, if you are lactose intolerant, experiment to see how you can still eat dairy products. Drinking small amounts of milk at one time and drinking milk with meals might make the lactose more easily digested. Also, fermented milk products such as cheese, buttermilk, yogurt and acidophilus milk might be easier to tolerate than other dairy products. You can also buy a product (available at drug stores) which will change the lactose in regular milk to a different kind of sugar. The product is the enzyme lactase which breaks down the milk sugar lactose. Then lactose intolerant people can drink the milk without problems. You can also get some calcium from collard, mustard and turnip greens, broccoli, pinto beans, salmon and sardines canned with the bone.

Another nutrient to be concerned with is iron. It's difficult to get all the iron you need if you only eat a small amount of food. That's because most foods contain only a little iron. You have to eat many sources of iron to get enough. The best source of iron is meat. You can also get iron from whole grain or enriched breads and cereals, dry beans, and from some fruits and vegetables. Vitamin C helps you absorb more iron from foods, so include foods with vitamin C (such as citrus fruits, greens, and tomatoes) in the same meal as foods with iron. Cooking with iron utensils will also increase the amount of iron in your diet. But don't take iron supplements unless your doctor has diagnosed anemia. Too much iron can damage important organs.

As you age you also need more water. You dehydrate faster now than when you were younger. Dehydration puts you at risk for hypotension (low blood pressure), heat stroke, nausea, dryness of mouth, vomiting, and constipation. Even though your body may need more water, you may not feel thirsty. Try to drink 6-8 glasses of water a day even if you don't feel thirsty. And don't limit your water intake in an attempt to decrease the number of times you have to go to the bathroom. It's important that you get plenty of water! Water can come from drinking water, fruit juices, milk, and other beverages, and from foods such as soups and fruit. However, the caffeine in coffee, tea, and some soft drinks can cause you to lose body water, so use caffeinated beverages only in moderation, if at all.

Supplements?

People often wonder whether they should take vitamin-mineral supplements. Unless your doctor prescribes them, you may be wasting your money on unneeded supplements. Generally if you are eating over 1200 calories a day, you should be able to get all the vitamins and minerals you need from the foods you eat. However, if you are taking supplements, here are some precautions to follow. It's usually best to take a multi-vitamin and mineral supplement that gives no more than 100% of the RDA instead of taking one nutrient supplement by itself. This is because nutrients interact with each other. If you take single doses of nutrients, nutrient interaction can be harmful. An excess of one nutrient may actually cause a deficiency of another. For example, if you take large amounts of calcium, you may decrease absorption of iron and zinc.

Single doses of nutrients can also be toxic. Vitamin A is especially a concern for older people. Elderly people store up some forms of vitamin A more efficiently than younger people and have had toxic reactions when taking supplements in only moderate amounts. It's much safer for you to get the vitamin A you need from plant sources (such as carrots, sweet potatoes, greens, apricots, and cantaloupe).

Living with Chronic Diseases

About 85% of older persons have one or more chronic diseases. This means that you may need a special diet low in fat, low in sodium, and/or low in sugar, yet high in nutrients.

Learning to decrease fat may be the most important diet change you can make. Decreasing fat helps treat heart disease, diabetes, hypertension and obesity. Here are some tips for decreasing fat in your diet:

• Use low-fat, non-fat or skim milk for drinking and cooking.
  
• Trim fat from meat before cooking.
  
• Bake your food instead of frying.
  
• Add less fat and oil to food.
  
• Eat more fresh fruits and vegetables.
  
• Take skin off chicken before cooking.
  
• Season vegetables with fat free low sodium broth.
  

Decreasing sodium is part of the treatment for controlling hypertension. Here are some tips to decrease sodium:

• Take salt off the table.
  
• Avoid foods containing salt or sodium. High salt foods include canned vegetables, canned soups, boullion cubes, cheeses, bacon, fatback, hot dogs and bologna.
  
• Cook foods in unsalted water.
  
• Squeeze lemon juice on food instead of adding salt.
  
• Eat more fresh fruit and vegetables.

Instead of adding salt to vegetables and meats, try adding some of these:

Medications can also interfere with your nutritional status. Check with your doctor and pharmacist to see if your medicines have any food interactions. Each medicine is different so make sure they know ALL of the medication you're on (including vitamin and mineral supplements). Another reason to check with health professionals is to avoid being the victim of fraud. Many products make claims that are untrue. You can waste a lot of money or, worse yet, do yourself harm by taking medications or other treatments without the approval of your own doctor.

Two medications used commonly by the elderly are laxatives and aspirin. Habitual use of laxatives may decrease absorption of minerals such as calcium and potassium. Potassium may be a particular concern if you are taking certain kinds of medicine for high blood pressure. Mineral oil can decrease absorption of fat-soluble vitamins. Aspirin is often prescribed to relieve arthritis pain. Sometimes aspirin may cause bleeding in the stomach which could lead to iron deficiency. Chronic aspirin use has also been associated with folacin (a "B" vitamin) deficiency. Check with your doctor or pharmacist if you take these medications regularly.

Loss of Teeth

Another common problem is the loss of teeth and coping with dentures. Fifty percent of people over age 60 have lost all their teeth. When this happens, people often begin eating softer foods which are lower in fiber. If you limit the variety of foods eaten because of chewing difficulties, you may not get enough of all the nutrients. Take care not to eliminate all foods of one food group, such as meats or other protein foods. Make sure meats are cooked tender to make them easier to chew. Meats can be cut in small pieces or ground and used in casseroles. Eggs and cheese are soft meat substitutes. Other good meat substitutes are dry beans, peas and lentils. They're economical and easy to eat when cooked until soft. They also provide fiber to help prevent or treat constipation. If gas is a problem, drain off the soaking water before cooking, then cook in fresh water. Also, adding an acid (such as tomato sauce or vinegar) after the beans are thoroughly cooked may help prevent some of the problem with gas.

Some people may also eliminate vegetables because they are hard to chew, but you don't have to. Vegetables can be grated into salads or cooked longer than normally recommended to soften. Be sure to use the vitamin rich cooking water (pot likker) either with the vegetable or in a soup or sauce. Sauces on vegetables or meats also help make foods easier to swallow.

Sharing Meals

Eating with other people can make meals more fun. Fun can help overcome some of the lack of enjoyment of food that comes from not tasting as well as you once did. This may help keep your desire to eat. Eating with friends or groups can also benefit you if you have trouble fixing food for yourself. You can share meal preparation responsibilities or simply join a group that meets for meals prepared by someone else. Group meals can often be cheaper than preparing food at home for one person.

Congregate meal sites provide one place for senior citizens to enjoy meals together, even when you live independently. Home delivered meals are another option if meal preparation is difficult.

Cooking for One or Two

Planning and preparing meals for one or two may be difficult if you once cooked for a large family. Here are some tips to make it easier and avoid waste:

Prepare several meals at once...

Instead of making one or two servings for tonight's dinner, make three or four. Then label, date and freeze the rest for another day.

When you're shopping, select food carefully...

When you're buying fresh fruit, buy small quantities. Don't be shy about breaking packages or bunches. Buy a few pieces of ripe fruit to eat right away, and a few that aren't so ripe to eat later in the week.

Buy canned and packaged foods in sizes you will use. Vegetables in large cans are not cost-saving if they spoil in the refrigerator before you eat them.

Look for ways to economize...

Compare prices of fresh, frozen, and canned vegetables and fruits. Watch for fresh vegetables and fruits in season.

Frozen vegetables in large economy-size bags can be handy for one or two. You can take out a serving or two and store the rest in the freezer.

Also, learn to compare value by looking at unit prices on food products. The unit price will give you the price per serving, ounce, pound or other common unit.

Convenience Foods

Frozen dinners or entrees may be helpful if you have difficulty preparing foods or if you just want something different. Choose ones that are lower in fat and salt. This means reading the labels. Also balance out the meal with a fruit or vegetable on the side. Compare prices of similar dinners of different brands.

Stay Active

Exercise can help you reduce your risk of heart disease and just make you feel better. It may also help you keep a healthy appetite. Regular exercise is associated with lower blood pressure and can help you lose or maintain your weight. Exercise may also help you reduce stress. It has also been shown that people who exercise build up their muscle strength and are less likely to fall and hurt themselves than people who have weak muscles from lack of exercise. If your main physical activity of the day is making your bed and getting dressed, then even small amounts of very low level exercise can make a big difference for you. Physical activity can help you do your daily chores more easily and more safely.

Walking is a great way for you to exercise and has the added benefit of being one way to socialize. You should be able to carry on a conversation while you're walking. There are also other ways to get exercise. Exercycles or chair exercises are good if you are unsteady on your feet. Pool exercises may be better if you have arthritis because the water takes some of the weight off your joints.

Always check with your doctor before starting any kind of exercise program. Your doctor can help you decide which type of exercise is best for you. Then get active!

References:
Anderson, Jennifer, Food and Nutrition Issues, vol. 5, no.6, Colorado Extension Service, December, 1988.

Bidlack, Wayne, Nutrition and the Elderly, IFT, September, 1986. Environmental Nutrition, October, 1988.

Sports Medicine Digest, vol. 10, no. 6, June, 1988.

USDA Research Briefs, April-June, 1988.

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