Nutrition for Older Adults


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). common cause of death 65

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
  • Medications
  • 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
  • Balance
  • Physical strength and endurance
  • Physical activity – There are numerous health benefits for older adults. Please refer to the figure below.

physical activity benefits in older adults

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
  • Advertising

4.) Environmental Status

  • Living situation – About 29% of non-institutionalized older adults live alone, making it more difficult for them to prepare meals.
  • Economics
  • Cultural beliefs and traditions
  • Religious beliefs and traditions
  • Environment
  • Lifestyle
  • 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


Childhood Obesity: “5, 2, 1, 0” & Staying Fit in Monongalia County

The Women, Infants, and Children (WIC) program has been promoting the “5, 2, 1, 0” message to prevent childhood obesity. The message “5, 2, 1, 0” message consists four major components:

  • Eat 5 fruits and vegetables a day
  • Limit screen time to 2 hours or less per day
  • Get 1 hour or more of physical activity every day
  • Drink fewer or 0 sugar-sweetened drinks


In honor of this healthy message, staff from local West Virginia WIC offices comprised a list of inexpensive places for young children to participate in daily physical activity in Monongalia County, WV. The list is below:

If you have any other ideas to add to the list, please leave a comment below!

Community Nutrition Rotation at WIC

For the past two weeks, I have been on a community nutrition rotation at WIC. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Each county in the state of West Virginia has it’s own WIC office. I have had the opportunity to shadow a registered dietitian at the Monongalia County WIC office located in Morgantown, WV.


WIC provides the following services for eligible participants:

  • Free vouchers for specific, nutritious foods
  • Nutrition education in the form of one-on-one counseling with a dietitian, group classes, or grocery store tours
  • Free immunizations for children
  • Breastfeeding services in the form of one-on-one counseling with a lactation consultant. Breastfeeding pumps are also available for lactating mothers in a limited supply
  • Screening and referrals to other health, welfare and social services

Who is eligible to receive WIC benefits?

Participants must meet all three of the following requirements:

1.  Category

  • Pregnant women
  • Postpartum women (up to 6 months after pregnancy)
  • Infants (up to the infant’s 1st birthday)
  • Children (up to age 5)

2.  Income Level

  • Applicant must meet USDA income standards which are revised each year. Any applicant that has a current medical card, proof of food stamps or TANF eligibility is automatically income eligible for WIC benefits.

3.  Nutritional Risk

  • A nutrition and health assessment includes: height & weight measurements, anemia (low hemoglobin levels), health history & diet assessment.

Food Vouchers

WIC participants receive food vouchers that can be used at local grocery stores (and Wal-Mart).  A new offer from WIC is that participants can now receive a special $20 farmer’s market voucher to spend at local farmer’s markets on fresh fruits and vegetables!

The quantities of foods depend on the type of participant. For example, breastfeeding mothers require more food than mother’s who are not breastfeeding.  The types of foods that participants can receive with their vouchers include:

  • 4 cans of beans, 1 package of dried beans, OR a jar of peanut butter
  • 16 oz of sliced, cheddar, or blocked cheese
  • Eggs
  • Bread
  • Milk (whole, 2%, 1%, or skim)
  • Cereal (only certain brands)
  • 100% juices
  • $10 or $6 voucher for fresh fruits and vegetables
  • Infant baby foods and formula

For a full list of WIC approved foods starting February 1, 2013, click here.

Factors Contributing to West Virginia’s “BIG” Obesity Problem

West Virginia is the #3 “Most Obese” State in the U.S.

Source: Centers for Disease Control.

Source: West Virginia DHHR Bureau for Public Health. Obesity in West Virginia. 2011

According to the Center’s for Disease Control, nearly two-thirds of West Virginian adults are overweight (BMI>;25) and nearly one-third are obese (BMI>;30). The statistics are alarming, but the data that worries me the most is the rate of childhood obesity. In West Virginia, 14.4 % of children ages 2-5 are overweight (85th to ;95th percentile BMI-for-Age). These numbers stay consistent in kids up to 18 years old.

Obesity in WV is Correlated With Being “Unhealthy”

According to the CDC’s Behavior Risk Factor Surveillance System (BRFFS), the obesity rate in WV has increased by 4.6% since 1989. If obesity keeps growing at this shocking rate, by the year 2018 nearly HALF of all West Virginians will be obese! If this holds true in the year 2018, the Nat’l Board of Economic Research estimates that obesity will cost the state of WV nearly $2.3 billion dollars. But why does obesity matter? Why is obesity such a “big” deal anyway?…Obesity is important because it contributes to an individual’s overall health. In fact, West Virginia is ranked #1 in the U.S. for the prevalence of cardiovascular mortality, diabetes, and hypertension (as shown by the graphs below).

West Virginian residents who were obese were less likely to report their overall health as “Excellent/Very Good”.Source: West Virginia DHHR Bureau for Public Health. Obesity in West Virginia. 2011

Obese individuals have the highest rates of cardiovascular disease and hypertension.
Source: West Virginia DHHR Bureau for Public Health. Obesity in West Virginia. 2011

How does your WV county stack up?

Source: West Virginia DHHR Bureau for Public Health. Obesity in West Virginia. 2011

Factor’s Contributing to West Virginia’s Obesity Epidemic

So the million dollar question is: Why are so many West Virginian’s overweight or obese?

The answer is not a simple one. Obesity is a complex issue that involves both genetic and environmental factors. But what is it about the environment in West Virginia that is making it’s residents SO unhealthy and SO overweight?

1. Fruit and Vegetable Consumption: A healthy diet is probably the most important factor in maintaining a healthy weight. The diet of West Virginian’s, however, is of poor quality. Everywhere you turn there’s a fast food joint offering fatty convenience foods. But, like in any region, the food is just a part of the culture. For example, the pepperoni roll is famous in WV since it was invented in Fairmont, WV around 100 years ago. Good old southern cooking is absolutely delicious…there’s no denying that. But there is also no denying how unhealthy it can be as it’s fried up in butter, fat, and salt.

Not to mention, West Virginian’s aren’t eating enough fruits and vegetables. According to the 2007 CDC BRFFS, fruit and vegetable consumption in this state is very LOW. West Virginian adults consuming 2 or more servings of fruits daily was only 24.9%, compared to a national average of 32.8%. And West Virginian adults consuming 3 or more servings of vegetables daily was only 26% compared to the national average of 27.4%.

2. Access to Healthy Foods: To give a picture of the overwhelmingly easy access to fatty, fried, fast foods…here is another alarming statistic: In Huntington County, WV (which is in the #1 most obese county in the entire country!) there are more pizza joints than there are health clubs available in the entire state!

3. Physical Inactivity: The state of WV used to be bustling with manufacturing jobs, mostly coal mining. In recent years, however, the coal mining industry has been on the downfall and the manufacturing jobs that used to require strenuous labor and physical activity are now not as readily available to it’s residents.

As you can see in the figure below, West Virginian’s are more physically INactive compared to the national average rates. According to the CDC BRFFS, 33.2% of West Virginians reported physical inactivity compared to the national average of 24.2%.

Source: West Virginia DHHR Bureau for Public Health. Obesity in West Virginia. 2011

4. Access to Community Streets/Sidewalks: West Virginia, “Wild and Wonderful”, undoubtedly has the most beautiful landscape of all the U.S. states. Wouldn’t that encourage people to get outside and enjoy the beauty that surrounds them? Well, you would think. But have you ever tried to walk, run, or bike along any streets in WV? It is QUITE a dangerous endeavor. Cars zip by as they swerve around narrow and hilly back-country roads. And there are nearly no sidewalks available for people to use…unless of course you’re willing to get in your car and drive somewhere that has a safer place to walk or bike (but whose going to do that?). In addition, WV has yet to pass the Complete Streets legislation, which aims to ensure that pedestrians, bicyclists, and motorists have safe access to community streets.

5. The Economy: Having a low SES status can sometimes be an indicator of the overall health of an individual. According to a Gallup poll, WV ranked as having the LOWEST score in an economic confidence index.

6. Education: According to the U.S. Census Bureau, WV has the LOWEST rate of attaining a Bachelor’s degree. In WV, only 17.3% of the population will get a college education.

7. Dental Problems: West Virginia has the HIGHEST rate of tooth loss in the U.S. Nearly one-third of adults by the age of 35 have lost at least 6 or more permanent teeth and 42% of WV adults over the age of 65 have lost ALL of their natural teeth.

Having a toothless smile is no laughing matter. Having little or no teeth truly does affect a person’s ability to consume food. After all, would you be able to bite into an apple or chomp on a salad without having any teeth?

8. Disabilities: West Virginia has the HIGHEST rate of disabilities according to the U.S. Dept. of Commerce. The study looked at individuals ages 16-64 years old with disabilities that included functional limitations in physical, mental, and communication disabilities, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL).

Being physically disabled affects a person’s ability to exercise and burn off extra calories…thus causing more subsequent weight gain.

9. Depression: West Virginia is tied with Mississippi for the HIGHEST rate of depression in the U.S. according to the CDC. Nearly 5.3% of adults in WV meet the criteria for clinical depression.

10. Overall Well-Being: According to a Gallup poll that took into account diabetes, frequency of physical activity, consumption of produce, city optimism, and the uninsured – WV ranked as having the LOWEST score of overall well-being.

11. Lack of Registered Dietitians: According to an article in the Journal of the Academy of Nutrition and Dietetics, WV has the second lowest number of Registered Dietitians (RDs) per capita in the state. With only 17 RDs per 100,000 WV residents, this creates a lack of access to accurate nutrition information and accredited nutrition professionals to combat the obesity problem.


BOTTOM LINE: Needless to say, the state of West Virginia has A LOT of confounding factors contributing to it’s obesity epidemic and Registered Dietitians have A LOT of work to do in the future. So we know the obesity problem exists, but how can we fix it? Well…I’ll have to save that blog post for some other time. 🙂


West Virginia Department of Health and Human Resources Bureau for Public Health. Obesity in West Virginia. 2011.

Haughton B, Stang J. Population risk factors and trends in health care and public policy. J Acad Nutr & Dietetics. Supp, March 2012.

Yet another very informative post by Emily!

Emily Todhunter, WVU Graduate Dietetic Intern

While speaking to patients at Mon General Hospital this week, and giving them the nutrition education that was ordered by their doctor, I came across the same comment made by three separate patients that I had never heard before. When talking about a low-fat diet with patients, all three patients mentioned that they drink 2% or whole milk, because they heard from Dr. Oz that skim milk is bad for you. They weren’t able to say exactly why– I got “I think it has more sodium/sugar” but I told them that skim milk is actually a great choice because it has the same amount of protein as 2% or whole milk, but without all the fat! And a low-fat diet is going to be good for the heart; especially since a lot of these patients just had a CABG (coronary artery bypass grafting surgery), angioplasty & stent placement, or a…

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Although the RD exam seems like a far away goal, I thought I’d reblog this for (sooner rather than) later.

Mission: Dietitian

I was determined to take the RD exam ONE time in my life and then move on with my career.  When I googled “RD Exam Study Tips” I got horror stories on forums where certain people had taken the exam multiple times and couldn’t pass.  It was a little unsettling, yet motivating- this is a test you have to take seriously.
Disclaimer: this is just what worked for me! I offer no guarantees! 🙂

I used Jean Inman’s review – not the seminar, just the CDs and written course – as well as RD-in-a-Flash Flashcards.  I studied passively for a few weeks (just every now and then, scanning over things) then set up a schedule to get through the Inman CDs and the corresponding notes, domain by domain.  The Inman materials were definitely most helpful in reviewing everything that could be on the test.  Having the audio helped keep…

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A great post by Emily!

Emily Todhunter, WVU Graduate Dietetic Intern

Back in the fall I volunteered at the “Go Red for Women” event at the West Virginia Heart Institute.  Other first and second year WVU dietetic interns and I got to meet 1-on-1 with the women who attended the event and give them nutritional counseling based on their lab values (fasting glucose, cholesterol, blood pressure, weight, BMI) they had recorded and received earlier in the event.  In the beginning, I was very nervous to be giving nutritional advice and answering nutrition questions from strangers, but as the day went on, it was actually a very enjoyable and educational experience.

After talking with each of the women about how they can improve their lab values through changes in their diet, I’d ask if they had any nutrition questions they wanted answered.  The question that came up the most frequently was concerning sea salt.  Some women had been hearing about how sea salt is healthier than table salt, and they wanted…

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Healthy Cooking Demonstration

Last week, I had the opportunity to observe a healthy cooking demonstration by Chef Chris Hall.  Chris Hall went to culinary school, worked in several high-end restaurants, and has been a personal chef for clients in the Washington D.C. area.  More recently he has created his own business called MyKitchen.  He has built a licensed commercial kitchen in his home in Morgantown, where he provides cooking lessons and demonstrations.  There are several different types of cooking classes such as Southern Italian, Indian Cuisine, Kids in the Kitchen, Sushi, and a multitude of others.  The class I was able to observe was a 3-hour healthy cooking lesson called “Light, Fast, and Delicious”.  In a class of around 8-10 students, Chef Chris began the lesson by introducing himself and speaking a little bit about his background.  He then began explaining the fundamentals of the kitchen, where to find different types of equipment, and safety procedures.  He then allowed students to pair up and choose one of the eight recipes he had provided.  The recipes were all low-fat, healthy, and quick to prepare.  These recipes included pork Diane, chicken marsala, chicken noodle soup, fruit smoothies, a fish dish, green chile chicken, jumbalaya, and a few others.  I tasted all of the dishes and they were absolutely delicious…definitely not what you would expect from a “low-fat” meal.  Chef Chris was extremely helpful and truly loves teaching others how to cook.  Even if you have never set foot in the kitchen before, he does not mind teaching the basics.  I really liked the atmosphere of MyKitchen.  It felt like I was at my parents or grandparents house learning how to cook a recipe that had been handed down for generations.  And because it was such a small class, everyone got to know each other and got to taste everyone elses healthy creations.

I thought the healthy cooking demonstration was a great learning experience and it inspired me to want to cook more.  I also think that healthy cooking demonstrations should be utilized more in the community nutrition setting.  As a dietitian, we always tell people what to eat…but not how to prepare it.  I think there are major opportunities for educating the public on healthy cooking, just like MyKitchen has been doing.

Chef Chris Hall demonstrating cooking techniques.

The “Light, Fast, and Delicious” class preparing healthy meals in the commercial kitchen.

Check out MyKitchen’s TV commercial at

A Guide to Eating Healthy in Morgantown!

Part of our corporate wellness assignment this week was to create a presentation for the “Lunch and Learn” wellness series for employees at the Davis College of WVU.  Emily and I finally finished our 23-page handout titled, “Eating Healthy While Working On Campus”. The guide includes:

1.) Eat This, Not That – Morgantown Edition

2.) Healthy Vending Machine Choices

3.) Healthy Frozen Meals

To check it out, click the link below!!

Click: Eating Healthy While Working On Campus

A quick health survey!