# A healthy diet for older people

A recent query made me realise that many people don’t know what types of food older people should be eating and if they should take supplements or not.

I have previously written two DietDoc topics on Diets for older people - physiological problems associated with ageing and Nutrition and the elderly - coping with eating problems, which may help readers to understand what types of changes occur when we get older and how certain eating problems of old age can be circumvented.

Healthy seniors

It stands to reason that any person, no matter how young or old he or she may be, who suffers from any one of the major illnesses (diabetes, obesity, kidney or heart disease, etc), will have to use a specific diet prescription to treat the condition. Such individual diet prescriptions should preferably be worked out and applied under the guidance of a registered dietician, particularly if the patient suffers from multiple conditions (e.g. diabetes and hypertension and kidney disease).

Nowadays there are, however, many older people, who are well and active for their age and do not have any of the major diseases. To answer the question as to what such individuals should eat, the Dietary Guidelines for Americans - Key Recommendations for Older Adults (US Dept of Agriculture, 2010), are a good place to start.

Calculating energy requirements

Mahan and her co-editors (2011) suggest that the Daily Recommended Intakes (DRIs) for energy for adults can be used to calculate the energy requirement of older persons, provided an adjustment is made for increasing age.

Example:

The DRI for energy for adults aged 18 years is 12 830 kJ/day (3 067 kcal/day) for men and 10 060 kJ/day (2 403 kcal/day) for women.

To compensate for the reduced energy requirement due to ageing, these authors suggest that we subtract 42 kJ/day (10 kcal/day) for men and 29 kJ/day (7 kcal/day) for women for each year of age older than 19 years.

If the person in question is a man of 80 years (i.e. 80-19 = 61 years x 42 kJ = 2 562 kJ/day), then his approximate energy requirement would be 12 830 minus 2 562 = 10 268 kJ/day (2 452 kcal/day).

If the person in question is a woman aged 82 years (i.e. 82-19 = 63 years x 29 kJ = 1 827 kJ/day), then her approximate energy requirements would be 10 060 minus 1 827 = 8 233 kJ/day (1 967 kcal/day).

In other words, a healthy man aged 80 years would require about 2 500 kJ less energy every day than when he was 19 years old.

A healthy woman aged 82 years would require about 1 800 kJ less energy every day than when she was 19 years old.

Too much or too little

Many older persons tend to continue eating the same amount of energy that they did when they were younger and/or more active, which tends to cause exponential weight gain over time and contributes to the obesity epidemic. We should all be conscious of the need to reduce our energy intake over time as we get older.

On the other hand many older people tend to eat too little food and have a serious energy deficiency which can lead to emaciation and a variety of problems such as a suppressed immune system.

The trick is to consume enough energy to maintain a healthy weight throughout life and to moderately reduce energy intake as we grow older without reducing our nutrient intake.

Healthy eating

According to the Dietary Guidelines for Americans - Key Recommendations for Older Adults (US Dept of Agriculture, 2010), healthy eating throughout life should include:

• limiting our intake of sodium
• limiting our intake of solid fats (as opposed to the intake of liquid fats such as oils)
• limiting our intake of added sugar, particularly liquid sugar in the form of sweetened cold drinks and undiluted fruit juices
• limiting our intake of refined grains
• increasing physical activity and spending less time doing sedentary activities

Protein requirements

Mahan et al (2011) recommend that up to 1.2 g of protein per kg body weight can be used by adults over the age of 65 years. Unless seniors have problems with their kidneys or diabetes where 0,8 g of protein/day is regarded as more appropriate, the slightly higher protein DRI should help active, healthy seniors to maintain lean muscle mass and their immune function.

Nutrient-dense foods

The most vital message of the Dietary Guidelines for Americans - Key Recommendations for Older Adults (US Dept of Agriculture, 2010), is that older persons must focus on eating nutrient-dense foods and drinking nutrient-dense beverages.

The recommendations are as follows:

• Select fat-free or low-fat milk and milk products (yoghurt, cottage cheese) to boost calcium intake to maintain healthy bones and prevent osteoporosis.
• Eat seafood, lean meats, poultry and eggs, to boost the intake of high quality protein, vitamin B12, iron and trace minerals such as zinc, selenium and iodine to prevent anaemias, suppressed immune function and thyroid problems
• Include dry beans, peas, lentils and soy products as an excellent source of dietary fibre, vitamins, minerals and plant protein, without added cholesterol or saturated fat. The correct preparation of such legumes is important to make things easier for older people who may have problems with chewing and digestion.
• Concentrate on including vegetables as often as possible, particularly dark green or dark yellow vegetables which are rich in beta-carotene (e.g. spinach, butternut, pumpkin, sweet potatoes, peas)
• Try to eat at least 50% of all grains as whole grains (i.e. high-fibre breakfast cereals or porridges, wholegrain breads, rolls and biscuits). Seniors who have problems with chewing high-fibre cereals and grains, may benefit from eating cooked porridges, high-fibre Pro-Nutro and low-GI products that contain plant protein as a source of dietary fibre.
• Seniors should, whenever possible, eat actual foods rather than liquid meal supplements, although the latter have a role to play whenever an older adult has problems with eating or needs to gain weight. Select whole foods that contain added vitamins, iron and other minerals to obtain as many nutrients as possible from a given food.
• Use alcohol in moderation - only one drink per day for women and two drinks a day for men - and not necessarily every day. Alcohol should never take the place of nutrient-dense foods and drinks such as milk.

Should seniors use vitamin and mineral supplements?

This is also a question that is often asked in relation to the nutrition needs of our older citizens. If you are still able to eat a balanced, nutrient-dense diet as outlined above and do not have problems with chewing and absorbing nutrients, then you may well not require any vitamin or mineral supplements. On the other hand, older persons who struggle to eat a balanced diet, may benefit greatly from taking a multivitamin and mineral supplement (e.g. Supradyn Forte), plus a calcium supplement (e.g. MenaCal.7) and Salmon oil capsules to boost Omega-3 intake. In general taking a multivitamin and mineral supplement 3 times a week should be adequate as it is also not a good idea to overdose on vitamins and minerals.

Probiotics

The use of probiotics (“good or beneficial microorganisms”) can benefit people of all ages, including older people.  Try using Bifidoforte or Bifidoflora (which contain Bifidobacteria), which are recommended specifically for the treatment of disorders of the colon (large intestine), or Intestiflora (which contains Lactobacilli and Bifidobacteria), to restore the function of the intestinal flora after antibiotic treatments. You should be able to purchase these probiotics at health shops.

Anyone over the age of 65 years, not suffering from a major disease, can apply these recommendations to ensure balanced nutrition and good health. Older persons who do have a major condition such as heart disease, hypertension or diabetes, should consult a registered dietitian for an individual diet prescription.

- (Dr IV van Heerden, DietDoc, January 2012)

(Pic: iStock)

References

(Mahan LK et al (2011). Krause’s Food & the Nutrition Care Process. Ed. 13. Elsevier, USA; US Dept of Agriculture (2010). Dietary Guidelines for Americans, 2010, ed. 7, Washington, DC, 2010. US Gov Printer.)

The diets of older people
Nutrition and the elderly: eating problems

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