An older adult’s nutritional health can dramatically affect her ability to ward off diseases, recover from surgeries, and live a long, healthy life. The relationship between seniors and nutrition is complex, and a number of variables affect an individual’s diet.
Having enough money to buy food is one major factor, but dietary decisions aren’t guided solely by budget. Level of education is strongly associated with nutrition, and for some, religion or ethnicity play an important part. A person’s physical limitations and the medications she takes, her level of social interaction and caregiver support, her oral health, and even her pet ownership status can determine what she eats, how much she eats, and when.
Seniors and Malnutrition
According to the National Institute on Aging (NIA), to maintain good health, a woman over 50 who is “somewhat physically active” should consume 1,800 calories daily. Men of the same age need 2,200–2,400 calories. Many older adults eat much less than that; in fact, an estimated 5 to 10 percent of those living outside an institution are malnourished, according to an RN Journal report, while the number of poorly nourished adults is much higher.
The harmful effects of an inadequate diet and malnutrition can manifest throughout the body in a variety of ways. For example, an iron deficiency can increase the risk of stroke, anemia, and dementia, inadequate amounts of calcium can lead to bone loss, and low levels of zinc can weaken the immune system.
Detecting poor nutrition requires vigilance, as symptoms may be confused with illness or the side effects of medications. Caregivers need to pay extra attention to older adults who take multiple medications, who are sick, or who have had a recent illness, especially if those adults have been recently hospitalized. Some signs to watch for include:
- Changes in mood
- Dull skin tone
- Confusion or limited cognitive abilities
- Weak appetite
- Spoiled foods
Poor nutrition can also result in an excess of nutrients. Consuming too many carbohydrates and fats, coupled with inactivity, can lead to obesity. Zinc, found in both certain foods and in products such as denture adhesives, can damage nerves and interfere with antibiotic therapies.
Obstacle 1: Nutrition on Tight Budgets
Since many older adults live on fixed incomes of limited amounts, money plays a major role in food choices. The average Social Security payment is around $1,200 monthly. This is the primary financial resource for most recipients. Seniors often have to make hard budgetary choices between food, rent, medications, energy costs, insurance co-payments, and even pet care. Among these and many other demands, skimping on food is one of the easiest ways to save money, and reliance on fast and processed foods, frozen dinners, and other unhealthy alternatives might replace a healthy diet.
Since so much food is packaged for couples and families, shopping for one person can become a chore that often results in poor choices and waste. Single-serving, pre-cooked microwaveable food is cheap and convenient, and adults who cook and eat for themselves often do so as quickly and as cheaply as possible. Suggest that your patients find family members, friends, or neighbors to share meals and buy groceries with. Another option is to find congregate meal sites at senior centers, churches, and other locations. In many cases, transportation assistance is available.
With careful planning, an inadequate income won’t necessitate poor nutrition. Comprehensive aids to help seniors plan meals are available at the National Institutes of Health’s Eating Well as You Get Older site, which also includes links to other helpful resources. At ChooseMyPlate.gov, the United States Department of Agriculture (USDA) maintains a similar treasure trove of useful information that includes menu planners, shopping tips and guides, recipes, and information for caregivers and professionals.
To help save money while buying healthier food, remind seniors that the outer aisle of most grocery stores contains fresh, raw, and tasty alternatives to frozen dinners. Making and sticking to a shopping list, using coupons and shopping during sales, reusing leftovers, buying generic brands, comparing “per-unit” prices, and even training pets to eat cheaper food maximizes food dollars. A Helpguide.org publication titled Eating Well on the Cheap can teach seniors to make the nutritional most out of their budget. Some tips from the guide include:
- Prepare large portions of foods that store well and make multiple meals, like soup.
- Eliminate junk foods.
- Shop at discount stores.
- Buy generic food brands.
- Shop for canned fish, chicken, and vegetarian options like beans that can serve as inexpensive sources of vital protein.
- Purchase produce when it is in season and buy grains in bulk to save money.
- Use leftovers in soups and stews.
Utilizing government and local assistance programs, adult day care, senior nutrition sites, and delivered meals (such as Meals on Wheels) can boost food budgets and free up the burden of cooking.
Obstacles 2 & 3: Medications and Physical Limitations
Older adults take more prescription and nonprescription medications than any other age group. Beyond the burdensome out-of-pocket costs that cut into food dollars, medications can profoundly impact seniors’ nutritional health. Side effects from nausea to constipation can limit what seniors eat, reduce their appetites, and can alter the taste of food.
Chronic diseases more common to seniors than other adults can rob them of their appetite, upset their stomachs, and make eating an unappealing, almost impossible chore. Food goes a long way toward making life enjoyable, and the nutritional impact of chemotherapies for cancer treatments, heart-healthy diets, and diabetic restrictions are life-altering events for food lovers.
It can be extremely challenging for older adults to change dietary habits that took years to develop, and easy shortcuts are not always the best answers. For example, an over-reliance on vitamins and supplements can lead to such dangerous consequences as vitamin A toxicity.
Equally difficult to overcome are some of the physical changes associated with growing older and their impact on seniors and nutrition. Shopping for groceries can become a major expedition, and along with standing long enough to prepare a meal, actions such as opening a jars can become major chores for many seniors. In addition, memory loss from dementia or such emotional disorders as depression may cause a person to leave pans on the stove, forget when he’s had his last meal, or to not eat at all.
The impact medications, treatments, and physical issues can have on a senior’s nutrition is acute, but it can be minimized in several ways by:
- Discussing the impact of prescribed medications on an older adult’s diet with a healthcare professional. A pharmacist can help with this too, in addition to answering the same questions about nonprescription medicines. When needed, professional dietitians offer services ranging from counseling to meal planning.
- Preparing foods that return the most caloric and nutritional value for the dollar.
- Arranging to have groceries and prepared foods delivered.
- Remembering the importance of proper hydration and drinking adequate amounts of water.
- Engaging in appropriate physical activity. From appetite stimulation to enhancing digestion, the right exercise at the right time is important.
- Instead of three square meals daily, eating healthy snacks throughout the day can decrease nausea and more likely provide essential calories.
Obstacles 4 & 5: Sensory Deprivation and Social Isolation
As people grow older, it’s not uncommon for them to experience sensory losses, which can negatively impact nutrition. Most common are vision and hearing loss and decreased tactile sensitivity. From misread labels to using the wrong ingredients, declining vision and blindness can significantly affect a person’s nutritional well-being. A person with hearing loss might not hear a timer or smoke alarm go off, and reduced tactile sensations can lead to serious burns.
Directly associated with eating, a decline in a senior’s ability to smell and taste food can have a devastating effect on her nutrition. Taste buds lose sensitivity as people grow older, and the ability to smell sometimes declines as well. Food becomes bland, and to compensate, additives are used to enhance flavor. Chief among these is salt (and salt substitutes), an unhealthy option for many seniors. An older adult’s sense of smell can become so diminished that she is unable to smell spoiled food.
Good, safe nutrition in spite of sensory loss can be achieved by:
- Enhancing food flavor with fresh ingredients, herbs, and lemon juice instead of salt. Healthy sauces and gravies can go a long way in making bland foods taste better.
- Using differently textured foods and incorporating as much variety as possible into meals.
- Relying on foods that don’t require cooking and using recipes that involve microwaving fresh food.
- Talking with healthcare providers about lifting or modifying food restrictions to address acute malnutrition.
- Accessing adaptive feeding tools and techniques to help people maintain eating independence.
- Reinvigorating mealtimes by making them a social event, or making them special by pulling out the good china or adding fresh flowers and candles.
Social isolation among seniors can be the result of embarrassment over the loss of sight and hearing and a justifiable fear of accident from sensory losses. Isolated seniors are far less apt to eat well. Help begins by resolving vision and hearing loss problems. When that isn’t possible, suggest that your senior patients and their caregivers arrange meal deliveries, engage neighbors and friends, and find transportation to meal sites. These measures can drastically improve a senior’s nutritional well-being.
Obstacle 6: Oral Health
Dental and oral health can have major impacts on seniors and nutrition. Inflamed teeth and gums affect taste and chewing, while infections can blossom into life-threatening issues. Ill-fitting dentures make biting painful, and something as tiny as a blueberry seed under a partial denture could ruin a meal. In addition, dentures that don’t fit well can interfere with proper chewing, and foods that aren’t thoroughly masticated may lead to indigestion and other GI issues.
People with dentures that don’t fit well tend to eat quickly — yet another cause of digestive problems. Food that is eaten in a hurry or not fully chewed can increase the risk of choking. The best solution to these problems is to replace worn or improperly fitting dentures, but affordability is a problem for some. Talk to your senior patients about their dentures if they are experiencing GI distress. Instead of replacing them, in many cases dentures can often be adjusted.
Burning mouth syndrome (BMS) is another oral problem more common among older adults. Burning, tingling, numb and puckered sensations in the mouth can range in severity from annoying and short-term to never-ending irritation so strong a person may be unable to eat properly. BMS needs to be evaluated by a dentist or doctor; in many cases, treatment with a magic mouthwash can provide both relief and often a cure.
Seniors and Nutrition: Resources
Labels on food products are very useful in helping seniors make healthy choices by teaching them important nutritional information, such as the amount of sugar, sodium, and fat in a given food. Seniors should be encouraged to learn what they can about nutrition’s role in their lives, and providing them with authoritative resources can help. Here is a sampling of useful online resources:
- The USDA’s Dietary Guidelines for Americans, the “cornerstone of federal nutrition policy.”
- Food-A-Pedia, another USDA site that provides nutritional information on over 8,000 food items.
- Healthy Eating After 50, a comprehensive guide published by the NIA.
- The Senior Farmers’ Market Nutrition Program, which provides coupons to purchase fresh fruits and vegetables from farmers’ markets and roadside stands.
- Young at Heart, a publication by the Weight-Control Information Network that has a holistic guide to good health, including nutrition.
- A directory of food assistance programs, maintained by the USDA.
Growing older is not an inevitable pathway to dietary misery and malnutrition. A critical component of life is proper nutrition, and as a person grows older, it takes more effort to maintain that. By having seniors use common sense, allow others to help, and take advantage of the vast resources available in the community and online, you can help them eat healthily.