Health and Older Adults
variable health than persons of any other age group, so it is hard to
predict nutritional problems based only on chronological age. Let's
look first at what the experts have to say about the somewhat
controversial and very important subject of how much protein active
older adults need. Then we will examine how aging affects body systems
specific to nutritional health.
show that certain nutrients might play a role in slowing sarcopenia.
Protein is one of them. Eating extra protein will not enlarge muscles,
but in 1995, a Tufts study raised the question as to whether muscle
loss in later years could be partly due to a chronic protein deficiency
among older people. Researchers found that older women who ate protein
at half the recommended level lost lean tissue after just 8 weeks and
showed declines not just in muscle function but in immune response as
well. Women whose diets were adequate in protein had no such declines.
The body has
for everyday protein losses from skin, nails, hair, sweat, and body
fluids, explains Carmen Castaneda-Sceppa, MD, Ph.D., head of the
Nutrition, Exercise Physiology, and Sarcopenia Laboratory at Tufts. She
says that if daily protein intake is not enough, the body uses muscle
as a resource for amino acids, the building blocks of protein. Poor
protein intake does not just contribute to muscle loss from within; it
also prevents proper muscle maintenance due to the absence of adequate
building materials. The idea that a chronic lack of protein depletes
muscle reservoirs in older people makes sense, especially when you
consider that many seniors are eating less protein than they should. In
fact, an estimated one in three people over the age of 60 eats less
than the current recommendation of 0.36 grams of protein per pound of
body weight (or .8 g/kg). This would be 54 grams a day for a 150-pound
person. Some research suggests that older people need even more protein
than originally thought. One study at Tufts, for instance, advised
adults over the age of 55 to eat about 0.45 grams per pound (or 1
g/kg), which is the equivalent of 68 grams for a 150-pound person. This
greater need might be due to a lower efficiency of dietary protein
utilization (Wardlaw, 1999).
the "correct" protein intake for older adults. In any case, make sure
seniors are getting at least the current recommended amount of 0.36
g/lb of body weight to thwart off depletion of lean tissue in the body.
there has been
controversy regarding whether a diet rich in protein is good for bone
or detrimental to bone. A recent study investigated just that.
Scientists considered the association between protein intake and change
in bone mineral density in a group of women and men aged 65 and older.
Half of the participants received a calcium/vitamin D supplement and
the other half received a placebo pill.
The results of
demonstrated that the women and men who had a diet rich in protein had
the most favorable change in bone density over a 3-year period. What is
interesting is that this beneficial effect was only seen in the group
that also received the calcium/ vitamin D supplement. Those individuals
who consumed a diet rich in protein but who did not supplement with
calcium and vitamin D did not receive a benefit from that protein. In
fact, the protein-only group had an increase in fractures over the
three-year study period.
protein is needed
to receive this benefit? In the aforementioned study, the women and men
who benefited most were those whose protein intake averaged about 20%
of calories, or approximately 87 grams of protein a day. Caution
is warranted because numerous studies have shown that a high protein
diet (over 30% of calories) is detrimental to bones.
smell often decreases with age beginning at about age 60. Food often
requires stronger seasonings, which can be a problem for people who
need to cut back on salt and simple sugar intake. Although there are
plenty of other ways to spice up the taste of food, salt and sugar tend
to be the most frequently used—and abused. People often need
suggestions on how to use new and different flavor enhancers. Sharing
recipes that introduce new spices is one means of exposing clients to a
completely new realm of taste.
About 30% or
more of older
people in the US have lost all their teeth often due to gum disease.
Replacement dentures enable some to chew normally, but many older
adults have problems with their dentures. For some unknown reason, this
seems to affect a larger number of men than women. When people have
problems chewing, nutrient dense snacks can help alleviate nutritional
inadequacies. Sometimes just allowing extra time for chewing and
swallowing encourages more eating.
partially lose their sense of thirst, which results in inadequate fluid
intake. Because of this, they are more likely than younger people to
become dehydrated. In addition, 25% of the fluid in our diets comes
from food. If older adults are not eating enough food, they increase
the risk of dehydration even more. Consequently, it is very important
for older people to consume adequate amounts of fluid. You should
monitor your client’s intake during exercise. About 6-8 cups
daily is a good goal; better yet is the newest recommendation of
½ ounce of water per pound of body weight. The approximate
recommendation is the same for younger adults with activity and is
estimated at 1 ml/kcal expended. One cup is about 250 ml, so every 250
calories expended equals the need for about 1 cup of extra water.
Because diuretic use is quite common in older adults, there is an even
greater chance that a senior will become dehydrated. Watch carefully if
your clients are taking diuretics; they will already have a lower fluid
volume as a result of the drug.
|Some important signs of
dehydration are fatigue, confusion, dry lips,
sunken eyes, increased body temperature, decreased blood pressure,
constipation, decreased urine output, and nausea.
for older people is constipation. To keep the intestinal tract
performing efficiently, older people generally need to consume more
dietary fiber than they did in their youth. Regular consumption of
nuts, fruits, vegetables, beans, and whole grains usually provides
enough fiber. If fiber intake increases, however, water intake also
needs to increase to help accommodate this greater bulk. Because
medications can cause constipation, a physician should be consulted if
this condition persists. Mineral oil is sometimes taken as a laxative,
but it should always be taken with caution. It binds fat-soluble
vitamins (A, D, E, K) and limits their absorption, so it should not be
taken with meals.
with age, so older people tend to become more lactose intolerant. Most
can still eat moderate amounts of cheese and yogurt though, so adequate
calcium intake is still possible. In addition, stomach acid production
slows as people age, which can cause poor absorption of vitamin B12.
Vitamin B12 deficiency can then lead to pernicious anemia, a condition
characterized by abnormally large and immature red blood cells that
cannot transport and deliver oxygen efficiently. This results in lack
of endurance and rapid onset of fatigue during exertion. Lastly, less
stomach acid, along with the use of aspirin and antacids, can interfere
with iron levels. Again, this can impact endurance and other body
processes that rely on proper levels of iron in the blood.
Gallbladder, and Pancreas
liver tends to
function less efficiently. When there is a history of significant
alcohol consumption, fat buildup in the liver accounts for some of this
decline. Alcohol abuse is a problem among a small but significant group
of older adults who might be chronic alcoholics or who might have
developed alcoholism later in life while dealing with loneliness and
depression caused by retirement or the loss of a spouse. When liver
function deteriorates significantly, there is an added possibility for
vitamin A toxicity. Elderly
people, in general, should not supplement with vitamin A.
functions less efficiently with age. Gallstones can develop and block
bile secretion causing it to pool and back up into the liver instead.
Gallstones also interfere with fat digestion by restricting the release
of bile into the small intestine.
function of the pancreas declines with age, the pancreas has a large
reserve capacity. With advancing age, the pancreas begins to produce
less insulin. Insulin is necessary to remove glucose from the blood, so
it should be clear that one of the major signs of a failing pancreas is
high blood glucose. This is different from what happens in obese
people. Although blood glucose levels in obese individuals also rise,
the cause is not normally a lack of insulin production. Instead, blood
glucose remains elevated after a meal because target cells become
insulin resistant, so the insulin that is present cannot do its job.
deteriorates with age, the ability of the kidneys to excrete the
products of protein breakdown significantly decreases. Although an
increased protein intake of 1g/ kg of healthy body weight has been
recommended for physically active older adults, this recommendation
does not apply to people whose decreased kidney function causes urea to
accumulate in the blood. Urea is a main by-product of protein
metabolism that is formed in the liver and excreted by the kidneys.
Another problem with aging is that kidney stones often develop.
Surprisingly, coffee, tea, and wine consumption might decrease the
chance of kidney stones, while orange and grapefruit juice consumption
have been shown to increase the risk.
less efficiently with age. Consuming adequate protein, an array of
vitamins (especially vitamins E and B6) and zinc helps maximize the
health of the immune system. Recurrent sicknesses and poor wound
healing are warning signs of a diet that is deficient, especially in
protein and zinc. Eating too little food or too few animal proteins is
usually the cause. As mentioned earlier, older people often eliminate
meat from their diet because it is too hard to chew. Balanced nutrient
supplements help ensure adequate vitamin and mineral intake.
somewhat with age, but what does this have to do with nutrition? The
decrease in lung efficiency contributes to a general downward spiral in
overall body function. More specifically, breathing difficulties limit
physical activity and endurance and frequently discourage eating. These
changes eventually cancel other efforts to maintain overall health.
both hearing and vision indirectly affect a person's ability to maintain a balanced and healthy diet.
Elderly people sometimes avoid social situations involving food and
shopping for groceries simply because they cannot hear well.
Furthermore, degenerating eyesight can affect people’s
to get to the grocery store, locate the foods they need, read label
contents, and prepare foods at home. Macular degeneration is the usual
cause of degenerating eyesight in the elderly. On a positive note,
regular consumption of foods rich in carotenoids, in particular dark
green, leafy vegetables such as kale, collard greens, spinach, Swiss
chard, mustard greens, and romaine lettuce, might decrease the risk of
developing this problem. Vitamin C also plays a part in preventing
cataracts in the eyes and is just one more reason to eat fruits and
in Lean Tissue
The loss of
tissue with age leads to a lower metabolism, decreased muscle strength,
and reduced energy needs. Even if the person does not lose weight, a
larger percentage of the body is in the form of fat as lean mass is
lost. Older adults benefit from physical activity because it stimulates
food intake, raises energy expenditure, and maintains or increases
muscle mass. By eating more, seniors increase their chances of
consuming adequate amounts of nutrients.
amounts of vitamin B6, folate, and vitamin B12 is important to avoid
elevated blood homocysteine levels, which is an additional independent
risk factor for heart disease. Much controversy surrounds the treatment
for elevated LDL in adults over the age of 70-75. If these people
consume extremely restrictive diets limited in saturated fat and energy
that lead to inadequate total weight, or if their diets lack variety,
they might become undernourished. This can be a worse predicament for
them than having high LDL.
increase with advancing age. This becomes problematic because
hypertension is heavily implicated in both stroke and heart attack in
older adults. Blood pressure can be lowered in many people by severe
sodium restriction, but this is a difficult diet to follow. Minerals
such as calcium, potassium, and magnesium also deserve attention when
it comes to hypertension. When people consume at least 1000 mg of
calcium per day, they often register slightly lower blood pressures,
especially systolic blood pressure, as compared to those who consume
one-third to one-half that much. Potassium supplementation in the range
of 4g/day (about 2g above typical needs) has also been shown to
moderately decrease blood pressure. Finally, some studies indicate that
magnesium is capable of lowering blood pressure at intakes equal to
twice the RDA. Suggesting an adequate calcium level to clients (1200
milligrams a day) is a safe recommendation. Defer any other nutritional
recommendations to the experts. One final point: Excess alcohol intake
is responsible for about 10% of all cases of hypertension. A prudent
intake is one drink per day with a meal, or none at all.
everything else, bone
density also decreases with age. For older adults in general, calcium
intake should increase to 1200 mg/day. Maintaining adequate vitamin D
at 10 to 15 ug/day (15 ug/day for adults 70+) is a first step in
preserving the health of bone.
Many older people suffer from hidden osteomalacia, a condition
primarily caused by inadequate sun exposure which leads to decreased
vitamin D synthesis in the skin. When they can't get regular sun
exposure, older people need a dietary (e.g. milk) or supplemental
source of vitamin D. Again, alcohol consumption should be in
moderation, if at all.
and Nutrient Needs
and old age
often go hand-in-hand. Medications can improve health and quality of
life, but some of them also affect nutrient needs at any age.
Two-thirds of older adults take at least one prescription drug, while
one quarter of the elderly population regularly takes multiple
prescription drugs. Many drugs affect appetite or absorption of
nutrients, so if they are taken over the long term, malnutrition can
result. Unfortunately, this is true for many elderly people; they often
continue taking prescription drugs for long periods of time before any
improvements are noted. These seniors should definitely work with their
physicians and pharmacists to coordinate all medications taken.
Pharmacists in particular can advise when to take drugs (with or
between meals) for greatest effectiveness and the fewest number of side
problems include: (1) increased need for certain minerals or fat
soluble vitamins when drugs leach them out of the body prior to
absorption; (2) changes in appetite caused by antidepressant agents or
certain antibiotics; and (3) blood loss from long-term use of aspirin
or aspirin-like medications which strain iron reserves and can lead to
anemia. People who take one or more medications for more than just a
few weeks should closely watch their diets, eat nutrient-dense foods,
and possibly take nutrient supplements to counteract effects of certain
medications. As a personal trainer, you should not advise elderly
clients on supplements;
instead, refer them to their health care provider. A professional who
specializes in nutrient and drug interactions should supervise because
some supplements can interfere with the function of certain
medications, while some medications interfere with the absorption of
nutrients. For example, vitamin K can reduce the activity of oral
coagulants. In addition, certain types of diuretics leach potassium out
of the body.
Be aware of
the fact that
many people think herbal supplements and vitamins are not harmful
because they are "natural." Every year, people poison themselves using
minerals, vitamins, and other supplements even though their intent was
to maximize health. Your clients need to be advised that just like
aspirin or any other medication (prescription or not), vitamins,
minerals, and herbs need to be used with caution. There is the danger
of overdose and toxicity or interaction with medications. The
fat-soluble vitamins A, D, E, and K are examples of
“natural” substances that can easily build up in
when taken in excess. Unlike the water-soluble vitamins, fat solubles
are not filtered out by the kidneys. Instead, excessive amounts are
stored in fat cells throughout the body and in the liver. Excessive
mineral intake can also lead to toxicity, especially with the trace
minerals such as iron and copper. Trace minerals are needed at very low
levels, so they can become toxic at doses not much above typical needs.
Another issue is that many minerals have similar molecular weights and
charges. For example, magnesium, calcium, iron, and copper all have
similar size and the same electrical charge, and this causes these
minerals to compete with each other for absorption. As a result, taking
too much of one can cause a deficiency in another.
much can be
done to prevent heart attack and stroke just by eating a balanced diet
which helps control blood pressure and cholesterol levels and maintains
a healthy weight as adults age.
|Vitamins Slash Billions Off
Senior Healthcare Costs
recent study has found that giving seniors a daily multivitamin could
save the nation several billion dollars in healthcare costs. Results
showed that vitamins can improve overall health which translated into
fewer drugs and less hospital care. Researchers looked at a number of
studies that examined the effects of vitamin supplementation on five
diseases – coronary artery disease, diabetes, osteoporosis,
cancer, and colorectal cancer. While estimates suggest it would cost
$2.3 billion to provide seniors with a daily multivitamin over a
five-year period, this cost could easily pay for itself. The report
estimates that if all seniors took a daily multivitamin, the costs
associated with avoidable hospitalization for heart attacks alone would
drop by approximately $2.4 billion. Meanwhile, it is thought that
another $1.6 billion in costs would be saved as a result of improved
immune functioning and a reduction in the relative risk of coronary
Reported by www.reutershealth.com on the 2nd October 2003.
Young, V., & Evans, W. Increased energy requirements and
body composition with resistance training in older adults. American
Journal of Clinical
Nutrition 60:167-175, 1994.
Joszi, L., et al. Dietary protein adequacy and lower body versus whole
body resistive training in older humans. J Physio 542:631-642, 2002.
Disease Control and Prevention. Promoting
active lifestyles among older adults. Atlanta: CDC,
National Center for Chronic Disease Prevention and Health Promotion.
Nutrition and Physical Activity.
Edelman, S.V. Osteoporosis and diabetes. Clinical Diabetes 20(3):153-157, 2002.
Johnson, J.A. Pharmacogenomics: the inherited basis for interindividual
differences in drug response. Annu
Rev Genomics Hum Genet 2:9-39, 2001.
O'Neill, E., Ryan, N., Clements, K., Solares, G., Nelson M., Roberts,
Kehayias, J., Lipsitz, L., Evans, W. Exercise training and nutritional
physical frailty in very elderly people. The New England Journal of
Medicine, 330(25): 1769-1775, 1994.
The Merck Manual of
Geriatrics. Merck & Co., Inc, 2004.
Physical Dimensions of Aging. Champaign, IL: Human Kinetics. 1995.
Tufts University Diet and
Nutrition Letter. Never too late to build up your muscle.
12(September), 6-7, 1994.
Department of Health
and Human Services and U.S. Department of Agriculture. (2005) "Dietary
Guidelines for Americans 2005." Available on the World Wide Web: www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf.
Gordon. Perspectives in Nutrition. New York: McGraw-Hill, 1999.