It’s no secret that a well-balanced diet and regular physical activity are vital components of a healthy lifestyle for anyone. But for adults over age 60, eating well and staying active can have a remarkable impact on quality of life and even life expectancy. A substantial body of research shows that in order for seniors to retain mobility and functional independence, maintain a healthy weight, and keep type 2 diabetes, heart disease, and even certain cancers at bay, they must consume foods high in nutrients and keep a consistent exercise routine. In fact, a 2013 study published in the Journal of the Academy of Nutrition and Dietetics found that older adults with a high intake of fruits, vegetables, whole grains, and fish have better physical function and general health than their counterparts who consume less nutritious food. Another study, published in the British Journal of Sports Medicine in 2013, found that seniors who exercise regularly are seven times more likely to age healthily, which the study defines not only as “the absence of clinical disease,” but as “freedom from physical disability, plus preserved cognitive, affective, and social functioning.”
Ironically, at the precise time when healthy lifestyle changes can have the most dramatic impact on an older adult’s quality of life, he may face additional challenges to being able to make positive lifestyle choices. Some seniors have chronic illnesses that affect their ability to shop for and prepare foods. They may take medications that alter their taste or decrease their appetite. In some cases, they may lack access to fresh, healthy food, whether due to limited income or a shortage of supermarkets in their local communities. One study found that among seniors, lack of transportation to food stores could lead to food insecurity or hunger risk.
When it comes to exercise, some seniors may fear falling, be chair-bound, or hold the belief that their bodies are simply no longer capable and they should “slow down” — a common misconception about the elderly in our culture. Too much rest can cause sarcopenia, or loss of muscle mass, which may lead to falls. Other seniors may have balance disorders that limit their range of motion and could make them more vulnerable to falls and injuries during exercise.
When considering what types of healthy lifestyle changes to suggest to your patients, remember that there is almost no age-related health issue that can’t be controlled, delayed, or improved to some degree with proper nutrition and appropriate physical activity. While the life circumstances, physical abilities, budget, and medical conditions of your patients will vary widely, all of them can benefit from a healthy lifestyle that suits their individual needs.
Healthy Eating Over 60: A Snapshot
A good first step in helping seniors assess their nutritional health is to refer them to ChooseMyPlate.gov’s nutrition guide, says Ruth Frechman, registered dietitian in Burbank, California, and author of The Food Is My Friend Diet. ChooseMyPlate, developed by the USDA, offers a helpful graphic to illustrate what your plate should look like at mealtime.
“Half your plate should be filled with fruits and vegetables, a quarter should have a small portion of protein, and the last quarter a small portion of carbohydrates,” says Frechman.
Following these guidelines alone can prevent seniors from consuming too much sodium as well as too many empty calories and added sugars — what you get in most processed foods. Frechman notes that because many older adults have high blood pressure, they should be careful not to consume more than 1,500 milligrams of sodium per day.
“Most sodium comes from frozen, canned, processed, and restaurant food,” she says. “Many restaurants will list the nutrition facts of their dishes, and some have more sodium in one meal than you need for the entire day.”
Many dietitians agree that older adults should make reading food labels a regular practice, and when they’re dining out, they should review nutrition facts before ordering. Reyna Franco, a registered dietitian in New York City, cautions seniors to lessen their consumption of food high in trans and saturated fats — found in butter, bacon, steak, and full-fat dairy products — and boost their intake of monounsaturated and polyunsaturated fats, which can be found in salmon, avocado, nuts, flax seeds, and olive oil.
“Many studies have shown that these good fats can help improve joint pain and arthritis, which seniors often suffer from,” Franco says. “They also promote cardiovascular health, brain function, and memory.”
Another important thing to note is that many seniors require certain vitamins and minerals in greater amounts because of age-related physical changes, such as loss of bone mass and slowed gastric acid production. Common vitamin deficiencies in the elderly are calcium, vitamin D, and vitamin B.
In order to prevent osteoporosis, women over 50 need 1,200 milligrams of calcium per day. Men need 1,000 milligrams of calcium per day, and once they reach 70, they begin requiring just as much as women. Some excellent sources of calcium are fat-free and 1 percent milk, yogurt, and cheese, collard greens, black and pinto beans, and almonds. But many older adults don’t consume enough of these foods in order to meet their daily calcium requirement.
Vitamin D is essential to the absorption of calcium in the body, but it is difficult for anyone, not just seniors, to get enough of it from natural sources such as the sun and certain foods (salmon, cheese, and egg yolks). A study published in JAMA Internal Medicine suggests that adults over 65 can reduce their risk of bone fractures by taking an oral vitamin D supplement of at least 400 IU each day.
Vitamin B, which helps convert food into energy in the body and is essential for heart health and healthy nerves, can be lacking in seniors because various medications may interfere with its absorption. Urge your older patients to consult with their gerontologist or primary care physician about supplementing their diet with fortified foods or oral vitamins to correct any deficiencies they may have.
A Delicious and Nutritious Meal Plan
Some older adults will face challenges preparing wholesome meals, but that’s no reason for them to resort to microwavable frozen dinners. A bit of planning ahead can work wonders. Encourage your senior patients and their caregivers to make sure there are tasty, nutritional options in easy reach for breakfast, lunch, and dinner. This will optimize the chances that they eat healthily on a regular basis, thereby lowering their risk of malnutrition and vitamin deficiencies.
Lisa Moskovitz, registered dietitian and CEO of NY Nutrition Group in New York City, focuses on easy meal preparation with her senior patients to ensure they stick to an eating schedule. “It can be hard to remember to eat regularly when you’re retired,” Moskovitz says. “But meals don’t have to be overwhelming or too big.”
For each meal, a good rule of thumb to follow is to pick both a high-fiber and a protein-rich food and eat them together, which helps ward off constipation and keep you fuller between meals. Here is a sample menu with some tips to help seniors ensure they’re not only eating the right foods, but also consuming enough food to sustain them throughout the day.
Breakfast: A piece of whole grain toast, two eggs or a scoop of fat-free or low-fat cottage cheese, and berries. Another option is oatmeal with walnuts, fruit, and honey — if an aging patient’s taste has dulled or weakened, using a dash of cinnamon and nutmeg can boost the flavor of hot cereal.
Lunch: A salad topped with a scoop of tuna and crackers, or a sandwich of whole-grain bread, lean protein, and lettuce. For a no-fuss lunch, Moskovitz recommends “just half of an avocado and some turkey slices on a sandwich, or a can of tuna with carrots, celery, and a little pepper.”
Dinner: Grilled chicken or fish served with brown rice or whole grain pasta and your patients’ favorite vegetables, preferably steamed or sauteed (because boiling drains nutrients) in a light tomato sauce. Franco urges seniors to use frozen vegetables, which are less expensive and easier to prepare. “You can keep them for longer, they won’t spoil, and the nutrients are locked in.”
Snack: Nix the sugary pudding cups and other sweet treats in favor of smart, natural snacks, such as an apple with peanut or almond butter, a yogurt with berries, or baby carrots with hummus.
It’s important to remember that some of your senior patients may not have the income to meet their daily caloric needs, let alone make healthy swaps. Other seniors may have physical limitations that prevent them from cooking. Seniors living independently can take advantage of the Meals on Wheels program, which operates in all 50 US states and delivers meals directly to their homes at low or no cost. For other public assistance programs that make food available to at-risk seniors, visit Feeding America’s website.
Exercise and Aging
Countless studies show a positive correlation between exercise and the health outcomes and longevity of seniors. A 2014 study published in the American Heart Association’s journal Circulation found that regular walking improves cardiac health and reduces the risk of heart rhythms and other abnormalities in older adults. And a recent study supported by the National Institutes of Health found that a balanced exercise program of aerobic, resistance, and flexibility training reduces a frail elderly person’s risk of mobility disability, the inability to walk or move without assistance, by 18 percent.
Though seniors may know that exercise is a good idea, a December 2011 newsletter from the National Institutes of Health reports that only about 25 percent of those between the ages of 65 and 74 actually engage in it. This number drops to 11 percent once people reach 85 years of age.
Some aging patients will certainly have medical conditions that prevent vigorous movement, but it is a myth — a dangerous one, in fact — that they should remain totally inactive to “save their strength.” Quite the opposite is true. The body naturally begins losing muscle mass each year after age 30, and for seniors who don’t challenge their muscles, the results can be devastating.
“If you’re sitting all day, the body will adapt to that and at a certain point, you’ll drop below the level of functional independence,” says Kay Van Norman, an exercise and wellness specialist for older adults and president of consulting firm Brilliant Aging. “Seniors should understand that though it is common for people to lose function as they age, it is not necessarily normal and it shouldn’t be expected.”
Van Norman advises that age-related physical changes in seniors be distinguished from changes caused by a sedentary lifestyle, such as accelerated loss of strength and joint mobility, or “fatigue with even small exertions, which points to low cardiovascular endurance.” As a healthcare professional, you have the unique opportunity to play a role in recognizing and addressing these changes in your senior patients and in encouraging them to increase their physical activity — whether that means taking up gardening, committing to one walk each day, or, if your patients are vulnerable to falls, getting them started with a physical therapist to assess what sort of exercise routine is appropriate.
There are many opportunities for older adults, no matter their physical capability, to safely boost their fitness levels, Van Norman maintains. Even seniors who cannot walk without assistance can still engage in safe, guided group exercise; there are chair aerobics and chair yoga classes for wheelchair-bound seniors available at many fitness and senior centers throughout the country.
Robin Nelson, fitness coordinator at the North Austin YMCA in Texas, says that older adults who are new to exercise should seek out beginner fitness classes at local gyms or join the Active Older Adults program at a local YMCA, which help seniors not only become more active, but also stay socially connected.
“The really nice thing about coming to a community like the Y is that you meet new people, and that contributes to your social health as well,” Nelson says. “It’s a great way to break social isolation and stay motivated.”