For the past few months, I have been working as a Registered Dietitian for two nursing homes in the Pittsburgh, PA area. Because I did not have a long-term care rotation during my dietetic internship, this has been my first opportunity working with the elderly. I have been gaining invaluable experience learning about the nutritional issues and needs of the aging population and applying that knowledge to help residents in a skilled nursing facility.
The golden question I know everyone is wondering is, “Sooooo, exactly how old is…OLD?” Well, according to The Academy of Nutrition and Dietetics, the category of “older adults” includes those aged 60 years and older (or about 1 in every 8 individuals in this country).
Before I have some of my reader’s up in arms about the 60 year “young” marker, I will put a disclaimer out there that I sincerely believe there is a distinct difference between someone’s “chronological age” and someone’s “physiological age”. Someone’s physiological age is a person’s age as estimated from their body’s health, while someone’s chronological age is person’s actual age in years from their date of birth
Regardless of your beliefs, it is hard to ignore the fact that “baby boomers” are now reaching retirement age and the number of older adults is thus “booming” at a rapid pace. From 1990 to 2010, the percentage of Americans 65 years or older increased from 4.1% to an astonishing 13.1% of the total population. Not to mention, with the advancements in healthcare and technology, Americans are now living longer than ever. To illustrate this, I really like this interactive map of the United States, which demonstrates the increased life expectancy over the past 25 years. According to the CDC, the life expectancy is 81.1 years for females and 76.6 years for males. Unfortunately, many of the elderly may end up in a nursing home, skilled nursing facility, or assisted living facility. In the U.S., over 1.5 million residents are living in nursing homes…88% of those are 65+ years old. And these individuals aren’t just staying for a month or two either. According to the 2004 CDC National Nursing Home Survey, the average length of stay is 835 days.
Why does nutrition play such an important role in the health of older adults? To start, nutrition has a major influence on 5 out of the 8 most common causes of death in older adults (see figure below). Secondly, 80% of older adults have at least one chronic disease, with about 50% having 2 or more chronic diseases. Diet not only plays a MAJOR role in the prevention of chronic diseases, diet also helps to minimize their complications and associated risks (thus having a factor in your physiological age).
There are many health, physiologic, and functional factors that change our nutritional status and nutritional needs as our bodies age.
1.) Medical/Health Status
- Presence of chronic or acute illness
- Sensory changes – taste, smell, appearance, texture
- Disability and immobility
- Oral health – Missing teeth and ill-fitting dentures can effect your ability to chew
2.) Physical/Functional Status
- Physical limitations
- Physical strength and endurance
- Physical activity – There are numerous health benefits for older adults. Please refer to the figure below.
3.) Cognition and Mental Status
- Change in mental status
- Education level
- Depression – Nearly 19% of adults 65 years and older suffer from depression.
- Emotional needs
- Habitual food intake
- Health/nutrition-related beliefs
4.) Environmental Status
- Living situation – About 29% of non-institutionalized older adults live alone, making it more difficult for them to prepare meals.
- Cultural beliefs and traditions
- Religious beliefs and traditions
- Access to food and proper food storage/preparation
- Socialization – Living alone versus living with a family member
5.) The Nutritional Needs Of Older Adults
- Energy – There is about a 15% decrease in calorie needs between age 30 and age 80. With decreasing physical activity, lean muscle mass diminishes and fat mass increases. To estimate calorie needs:
– For men: subtract 10 calories/day for every year of age above 19
– For women: subtract 7 calories/day for every year of age above 19
- Protein – Evidence has found that dietary intake of protein declines with age, despite the fact that the body’s protein requirements generally stay the same throughout life. (Click here to find out how much protein you should be consuming). It is recommended for adults to consume about 30 grams of high-quality protein at each meal, or a total of 0.8 grams of protein for every kilogram of body weight. Protein malnutrition can lead to other health complications such as muscle wasting, fatigue, and sarcopenia. In long-term care, we measure an individual’s protein needs based on their serum albumin or pre-albumin levels (which is a measure of a visceral protein status or lean muscle mass).
- Nutrients – Many nutrient needs stay the same throughout the lifespan. Because of decreased energy expenditure and decreased caloric requirements, this makes it difficult for individuals to consume an adequate amount of nutrients while still consuming less calories.
- Vitamin D and Calcium – These are two important nutrients older adults should be consuming through their diet due to increased risk of osteoporosis. However, many do not consume enough through dietary sources and thus resort to supplementation. Diet daily requirements for calcium and vitamin D are:
– Calcium – 1200 mg/day
– Vitamin D – Adults 51-70 years old need 10 mcg/day and adults 70+ need 15 mcg
- Vitamin B-12 – To prevent anemia, older adults should be consuming the RDA of vitamin B-12, which is 2.4 mcg. Older adults are at a greater risk for vit. B-12 deficiency due to malabsorption, lack of intrinsic factor, atrophic gastritis, and poor diet.
- Hydration – Dehydration can be a major concern for older adults because many do not consume adequate amounts of water. There are multiple reasons for this, including: decreased perception of thirst, endocrine changes, alterations in cognitive status, side effects of medications, fear of incontinence, and immobility. An individual’s estimated fluid needs is about 25-30 mL of water for every kilogram of body weight.
Lastly, here is an easy and quick tool that I like to use to DETERMINE if someone over the age of 65 is at risk for malnutrition.
Disease – Do you have any chronic illnesses that changes what you need to eat?
Eating poorly – How is your appetite? How many meals a day do you eat? Do you eat fruits and vegetables?
Tooth loss or mouth pain – Do you have problems chewing such as ill-fitting dentures?
Economic hardship – Do you have enough money to buy the types of foods you need?
Reduced social contact – Do you eat alone or with others?
Multiple medications – Do you take 3 or more prescribed or over-the-counter medications?
Involuntary weight loss or gain – Have you lost or gained more than 10% of your body weight over the past 6 months?
Needs assistance – Are you physically able to shop, prepare foods, cook, and feed yourself?
Elderly person – Are you over the age of 80?
Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness