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Ensuring adequate nutritional intake for all older adults is an essential factor in promoting health and well-being, and maintaining functional independence.
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Adequate nutritional intake can prevent comorbidities such as increased susceptibility to acute and chronic illness, impaired immune function, and malnutrition.
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The ability to consume the appropriate quality and quantity of foods is influenced by food accessibility, availability, acceptability (preference), preparation, and the eating
Physical Medicine and Rehabilitation Clinics of North America
Nutritional Needs of the Older Adult
Section snippets
Key points
Dietary guidance for older adults
The goal of nutrition recommendations in the aging population is one of disease management and also of health protection so that individuals can live long and enjoy good health. Older adults often have numerous medical conditions that require a change in food or nutrient intake. Maintaining a nutrient-dense diet is essential to promoting health and preventing nutrition-related complications that could contribute to declining health, functional dependency, and frailty. Although older adults are
Dietary guidelines for Americans and MyPlate
Lifelong dietary patterns affect the likelihood of age-related chronic disease. Regardless of age, eating healthful foods and limiting poor food choices should be a priority. For adults of every age, low-fat dairy, lean meats, adequate fiber, whole grains, fruits, and vegetables should be emphasized. Trans fats, sodium, sugar, and excess calories should be minimized. The 2015-2020 Dietary Guidelines for Americans (the Dietary Guidelines) and MyPlate offer dietary guidance for whole foods and
The dietary reference intakes
For most older adults, aging is a continuum of deteriorating health and functionality leading to increased disability and dependency, which in turn further influence an individual’s nutritional needs. Although chronologic age is used as a cutoff for the Dietary Reference Intakes (which include the age categories 51–70 years, and >70 years), actual nutrient requirements may be wide-ranging in the older adult population. Selected nutrients of concern in older adults are discussed in Table 1.
Energy
Energy intake and energy requirements commonly decrease with advancing age. This causes a challenge for many older individuals because, although they require fewer calories to maintain their weight, nutrient needs stay the same and, in some cases, increase.5, 6 Meeting nutrient recommendations while simultaneously maintaining a healthful weight is fundamental to dietary guidance for older adults. Lower energy requirements result from decreased energy expenditure, losses in lean body mass, and
Micronutrients: vitamins and minerals
Age-related changes in nutrient absorption or metabolism can contribute to higher dietary requirements for many vitamins and minerals. Recommended intakes of vitamins and minerals for older adults attempt to take into consideration the variability among this age group by offering recommendations for those ages 51 to 70 years, and for those ages 70 and older.29
Nutritional and dietary supplements
The majority (if not all) of the nutrients an older adult consumes should come from food rather than supplements, to the extent possible.33 Many older adults, however, find it difficult to eat enough nutrient-dense foods to meet their needs, so nutrient supplementation may be indicated to maintain health and body weight. Numerous dietary supplements and nutritional products are marketed to older adults using targeted advertising.64 More than one-half of older adults report using complementary
Body system changes and nutritional status in older adults
Eighty-five percent of noninstitutionalized older adults have at least 1 chronic health condition that could be improved with proper nutrition.66 Efforts to consume a nutritious diet can be influenced by health status and factors that may occur naturally with aging or as a result of illness and interfere with and older adult’s ability to meet their nutritional needs, especially when calorie needs are reduced. Age-related changes in the body may influence how a disease manifests and progresses,
Factors that affect diet and food intake in older adults
Nutrition impacts how a person will age; in turn, the process of aging affects nutritional needs. Numerous factors affect adequate food intake, making the task of maximizing nutrition in older adults complicated. Each adult arrives at old age with different nutritional requirements built on lifelong eating behaviors influenced by physiologic, behavioral, social, environmental, and psychological factors. Food provides more than just nourishment for older adults; it also contributes to a sense of
Health, medical, and physical factors that influence diet
Arthritis, cardiovascular disease, diabetes, cancer, obesity, osteoporosis, gastroesophageal reflux disease, food intolerances, alcoholism, poor oral health, pressure injuries, anorexia of aging, malnutrition, constipation, and dehydration can result from chronic dietary inadequacies and require dietary modifications as part of their treatment.78 Medications can cause side effects that affect food intake, lower appetite, influence the absorption or metabolism of nutrients, or lead to changes in
Environmental, social, and cultural factors that affect diet
Psychological factors that have a strong influence on an individual’s nutritional well-being include food security, education, finances, literacy, language, and cultural beliefs. Ethnic, cultural, and long-standing food-related behaviors have a significant effect on food choice and preparation methods. Older individuals are more likely than younger individuals to maintain habitual and cultural food choices, which necessitates dietary guidance that is considerate of food preferences and access
Promoting nutrition and healthy lifestyles for older adults
Food not only is critical to one’s physiologic well-being, but also contributes to quality of life. Many older adults require specialized nutrition services to maintain their independence and health. Enabling older adults to stay at home and in their communities versus in institutional care helps to preserve higher quality of life, reduce long-term health care costs, and maintain their independence and ties to family and friends.80, 81
Nutrition programs for older adults
The aim of the home and community-based long-term care system is to promote health through an array of services, including nutrition programs, that help to maintain the quality of life and independence of older adults and prevent or delay institutionalization. Participation in food and nutrition programs can improve dietary quality and health indicators for older adults. Federal food and nutrition assistance programs are a critical source of nutrition support for many older adults. The
Physical activity
Physical activity and exercise have consistently been linked with diseases and conditions that have significant nutritional implications in older adults. Regular physical activity is associated with lower mortality rates; chronic disease prevention, reduction, and management; and improved mental and cognitive capability, depressive states, psychological health, independence, balance, bone strength, muscular strength, and overall quality of life across the life span.86, 87 Physical activity and
Clinical and end-of-life nutrition and hydration considerations
At the end of life, older adults are vulnerable to poor decision making, abuse, and neglect. Appropriate and compassionate end-of-life care, including attention to nutrition and hydration, should be made while the older adult is able to communicate their wishes soundly. It is common to have an interprofessional heath care team involved with end of life care decision making of frail geriatric patients.
There are several methods for feeding a person at the end of life. The expression “food first”
Summary
Good nutrition is a critical component of healthy aging. The maintenance of good health for the growing population of older adults requires approaches that recognize multiple levels of influence on the individual—medical, social, cultural, environmental, organizational, and personal factors. It can be difficult for older adults to meet their nutritional needs because of their increased requirements for some nutrients, lower energy needs, and numerous health and lifestyle barriers to adequate
Acknowledgments
The author acknowledges the assistance of Nancy Munoz, DCN, MHA, RDN, FAND, Robin B. Dahm, RDN, LDN, and Eva Kaminski Shaw, BA, in reviewing this article.
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Disclosures: M. Bernstein receives a portion of author royalties from Jones and Bartlett Learning in association with the publication of Nutrition, Discovering Nutrition, Nutrition for Older Adults and Nutrition Across Life Stages.