Nutrition Needs for Older Adults

Nutrition for older adults is different than it is for younger adults. Changes in the body from aging leads to changes in nutrition needs as well. Any dietitian or nutrition consultant working with older adults needs to be well versed in what makes geriatric nutrition different.


This article will cover the physiology of aging and the specific nutrients older adults need more or less of.






Defining the Older Adult


Most dietitians work with a variety of patients - from young to old. This article is specific to the nutrition needs of the older adult; that is any adult aged 65 or older. This is the same criteria used by Healthy People 2020 as part of their overarching goal to improve the health, function, and quality of life in older adults (1).


In 2014, 14.5% of the population in the United States was age 65 years and older. It is projected that by 2060, 23.5% of the population in the United States will be age 65 years and older (1). This is a large population that will only continue to grow. And we know that older adults have complex nutritional needs.



Physiology of Aging


Older adults have complex nutritional needs because the physiology of aging is complex. There are so many different things going on inside the body as a normal part of healthy aging. When someone leads a “less healthy” lifestyle, they may experience even more issues within their bodies.


Normal changes that occur in the gastrointestinal tract as a part of aging include dry mouth, poor dentition (problems chewing), altered taste and/or smell, decreased esophageal reflexes, increased gallstone formation, decreased glucose tolerance, decreased insulin and beta cell production, decreased metabolic capacity of the liver, decreased hepatic drug clearance, and increased fecal incontinence (2).


These changes impact how well the older adult can chew food. How enjoyable it is to eat. How well their body processes medications. And how comfortable they may feel out in public. And these are just the changes that happen inside the GI tract.


Outside the GI tract, other changes that occur as a part of aging include decreased skin elasticity, increased age related macular degeneration, increased hearing loss, decreased breathing capacity, decreased globular filtration rate and renal blood flow, decreased sensory perceptions, decreased cognition and memory, loss of lean body mass, degeneration of the joints, and decalcification of the bones (2).


These changes impact how the older adult experiences the world through sight, sound, and cognitive functioning. They effect independence, muscle strength, and bone health. Understanding these changes can help to understand why nutrition and health needs change as the body ages.


Nutrition Needs- Dietary Reference Intakes for Older Adults


Dietary Reference Intakes (DRIs) are a set of reference values used to plan and assess nutrient intakes of healthy people (3). In general, the DRIs cover Recommended Dietary Allowances (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). Nutrient needs may vary based on both age and gender.


For adults the DRIs are broken down into 4 primary age groups: 19-30 years, 31-50 years, 51-70 years, and >70 years of age. You may notice that among the two highest age groups, the “51-70 years” of age group overlaps between “older adults” and younger adults.


Minerals


There are two minerals that older adults need less of as the age - sodium and chloride. The DRIs for these minerals are the same for both men and women.

Adequate Intakes for Sodium & Chloride (3):




Table salt, or sodium chloride, is often important to older adults who may be experiencing a decreased sense of taste and smell. Salt helps to bring out flavors, but there are many other ways to make food flavorful. Older adults should be taught how to use spices and salt alternatives as a way to make food taste good, yet have lower levels of sodium and chloride.

While older adults need less sodium and chloride, there is one mineral they need more of - calcium.


Recommended Dietary Allowances for Calcium (3):








Calcium, along with vitamin D, are vital in protecting the bones of the aging adult. As mentioned in the physiology of aging, decalcification of the bones can occur as a normal part of aging. A slight increase calcium is needed to help protect the bones during this phase of life.


Vitamins


There are two vitamins that older adults need more of as they age - vitamin D and vitamin B6.


Recommended Dietary Allowances for Vitamin D and Vitamin B6 (3):







Not included on this list, but equally important, is vitamin B-12. While the DRI for vitamin B-12 for older adults is the same as younger adults, the older adult is more likely to absorb less vitamin B-12 than the younger adult. In fact, 10-30% of older adults may malabsorb vitamin B-12 coming from food sources. It is frequently recommended that this population eat vitamin B-12 fortified foods or supplements containing vitamin B-12, like a multivitamin (3).


Calories and Fiber


Older adults generally consume fewer calorie needs than younger adults. The exact cause of this is unclear. Researchers have hypothesized that this could be related to having less muscle and a lower physiological nutrition needs as a result of aging (4).

The Academy of Nutrition and Dietetics’ Evidence Analysis Library estimates that the caloric needs for generally healthy older adults are 18-22 calories/ kg body weight per day for women and 20-24 calories/ kg body weight per day for men. The caloric needs for underweight older adults may be as high as 27- 28 calories/kg body weight per day (5).

Because older adults are consuming fewer calories, the RDA for fiber also decreases.


Adequate Intake for Total Fiber (3):









It is important to note that even though the RDA for fiber is lower for older adults, most adults in the United States do not consume enough fiber. It is estimated that adults in the United States consume only 15 grams of fiber per day on average. Fiber is a very important nutrient for bowel health, cardiovascular protection, and other health functions (6).


Along with adequate fiber, older adults should be drinking enough fluid. Excessive amounts of fiber in older adults are not recommended due to limited research in this area. Fiber recommendations should be based on the whole person and any GI symptoms they may be experiencing (6).


Protein


Protein needs may be higher for older adults. The RDA for protein in adults is 0.8 grams per kilogram body weight. This amount does not increase with age. However, research has suggested that older adults may need more protein than the RDA currently recommends.

Older adults may need as much as 1.0 to 1.5 g/kg protein per day. It is also important to spread out the distribution of protein consumed throughout the day. Meaning a balanced amount of protein is consumed at every meal (4).


The primary reason for needing more protein in older adults is sarcopenia. Sarcopenia is a decline in muscle mass with age. We know that older adults have less muscle mass and continue to lose muscle with every passing year. Adequate protein and resistance exercise are important to stop muscle loss.


It is also important to note that a good percentage of adults fail to consume the RDA of 0.8 grams per kilogram body weight. It is estimated that 32-41% of women and 22-38% of men fail consume the RDA for protein (4). For older adults with even higher protein needs, getting enough protein can be a greater challenge.



Wrapping it All Up


As you can likely tell, the nutrition needs of the older adult are indeed much different than that of the younger adult. This article covered a lot of different nutrients and numbers. Below is a very simplified breakdown of how nutrition needs for older adults are different.


Nutrient Needs for Older Adults (when compared to younger adults):










The most important thing you can do for an older adult is complete a comprehensive assessment of their nutrition status and foods consumed. Any nutrients that are consumed in excess or deficiency should be noted and education should be provided. Adding in appropriate foods to meet the RDA and other increased nutrient needs will go far in optimizing the health of the older adult.


RD Nutrition Consultants LLC, is the industry leader in Clinical Dietitian Services Nationwide. We specialize in providing contract Registered Dietitian services in a wide variety of healthcare and wellness organizations.


REFERENCES:


1. Older Adults. Healthy People website. https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults. Accessed November 1, 2019.

2. Niedert K, Carlson, M. Nutrition Care of the Older Adult. Chicago, IL: Academy of Nutrition and Dietetics; 2016.

3. Nutrient Recommendations: Dietary Reference Intakes (DRI). National Institutes of Health Office of Dietary Supplements website. https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx. Accessed November 1, 2019.

4. Posthauer ME, Collins N, Dorner B, Sloan C. Nutritional strategies for frail older adults. Advances in skin & wound care. 2013 Mar 1;26(3):128-40.

5. Unintended Weight Loss in Older Adults. Academy of Nutrition and Dietetics’ Evidence Analysis Library website. https://www.andeal.org/topic.cfm?menu=5294. Accessed November 1, 2019.

6. Slavin JL. Position of the American Dietetic Association: health implications of dietary fiber. Journal of the American Dietetic Association. 2008 Oct;108(10):1716-31.

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