The amount of energy a person needs from their diet usually reduces with increasing age; nutritional requirements however remain the same. Unfortunately, the process of ageing often means that many older people do not have diets that support good nutrition or good health.  Tooth loss and reduced muscle strength can make chewing and swallowing difficult, while biological changes alter taste and smell and increase the risk of constipation.  Many older people simply stop enjoying food and don’t eat the variety of foods that provide the nutrients they need.  Depression, dementia, social isolation and illness can also contribute to the consumption of a narrow, nutritionally imbalanced diet. As a result, malnutrition, being either over- or under-weight, is a very common problem in older populations. Malnutrition can delay wound healing and recovery from illness, increase dependency and significantly compromise quality of life. Being malnourished can be the cause of disease or it can be the outcome of disease; the most common risk factors are listed in Table 1. 

Table 1.  Common risk factors for malnutrition

  *(over- or under-weight)

Common nutritional deficiencies

Malnutrition can also arise from the lack of specific nutrients in an otherwise healthy diet.  There are several common nutritional deficiencies: 

Anaemia, a lack of iron, is commonly seen in older populations. A diet rich in red meat, green leafy vegetables and fortified breakfast cereals can improve iron intake.  Once trimmed of excess fat, cheaper cuts of meat are as nutritious as more expensive cuts; they may however need to be cooked for longer in stews or casseroles to make them more palatable. It is important to remember that eating vitamin C-rich foods like orange juice, strawberries or broccoli, at the same time, is necessary to ensure that the iron is actually absorbed. 

As we age, the immune system can become impaired, leading to susceptibility to infection and inflammatory disorders.  A diet rich in meat, wholemeal bread and shellfish can provide zinc that supports a healthy immune system. 

Osteoporosis is a common condition of older age, particularly in women.  Eating dairy products such as milk, cheese and yoghurt every day can provide the calcium required to maintain strong and healthy bones.  Choose low fat dairy products that have the same amount of calcium as full fat products – choose one that is also fortified with vitamin D.  Vitamin D is essential in helping the body absorb calcium.  It is found in oily fish, liver, eggs and some fortified milks and breakfast cereals.  It is however, most often obtained by exposing the skin to sunlight.  In Ireland, where sunshine can be scarce, or in cases where an older person is housebound, it is advisable to consult a clinician to assess the need for a vitamin D supplement.

Constipation can severely affect quality of life and is one of the most frequent complaints of older age.  A diet rich in fibre and fluids is required to combat constipation.  Fibre is found in fruit, particularly prunes, strawberries and kiwis, vegetables and wholegrain cereals and breads.  It is vital that sufficient fluids are also taken to bulk up the fibre and allow it to move easily through the bowel.  Without enough fluid, eating more fibre can actually increase the risk of constipation.  The final factor in combating constipation is physical activity.  Increased activity aids digestion and supports increased movement of the bowel. 

Optimal nutrition

The individual nutritional needs of older adults depends on several factors, including age, sex, health status and level of activity.  No matter what individual needs are, it is very important to eat a wide variety of foods that are highly nutritious rather than lots of filling but potentially nutritionally empty calories.  A good option is to have smaller, more frequent meals with more nutritious food choices, such as lean meat and fish, wholegrain cereals and fresh fruits and vegetables.  Foods should be tasted before flavourings such as salt are added; herbs and spices rather than fat or salt can be used to liven up bland food.  Table 2 outlines the recommended dietary guidelines for older adults – the type and amounts of foods that should be eaten daily.   

Table 2.  Recommended dietary guidelines for older adults

All diets need to be considered in terms of health and individual needs.  An individual’s diet may need to be modified due to illness, accident, recovery or other change of circumstance.  In all cases, it is advisable to consult the individual’s primary healthcare provider regularly to ensure nutritional needs are continually met.   

Optimal health

Optimal health, taking account of individual energy and nutrient needs, is best supported by a diet based, as much as possible, on fresh food.  Economic stresses may limit food choices however focus can be placed on foods in season that are generally more competitively priced.  These can be bought in bulk, prepared and frozen in small portions to provide an interesting, varied and nutritionally balanced diet year round.

Diet alone, however, is not enough for optimal health; remaining as active as possible can help people maintain their independence for longer.  Activity, even limited, has many benefits to both physical and mental health.  Regular activity reduces the risk of disease, improves energy levels, mental health and self esteem and helps people to remain independent.

It is never too late to change bad dietary habits or to become more active.  Risk factors for common diseases can be significantly influenced by diet so small changes can have large benefits.  For example, a modest reduction in salt and saturated fat intake can reduce blood pressure and cholesterol levels and so reduce the risk of cardiovascular disease.  Simply increasing the consumption of fruit and vegetables by one to two servings daily could cut cardiovascular risk by as much as 30%.  Physical activity can reduce the risk of depression by up to 22%, reduce anxiety and improve sleep quality, well-being and mood.  In all cases and regardless of age, it is very important to consult with a primary healthcare provider before beginning any exercise regime.

Another important factor supporting good dietary habits is maintaining a good social network.  Making mealtimes a social event with family or friends is not only more enjoyable than eating alone; it can help to maintain an interest in food and consumption of a wide variety of fresh, healthy food choices.  Table 3 outlines the recommendations for optimal health in older populations 

Table 3.  Recommendations for optimal health

Older age can be a time of increased confidence and opportunity to share the wisdom and experience gained throughout life.  Without good health it can, unfortunately, be a time marked by debilitation and illness that impacts severely on independence and quality of life.  Small changes can make a big difference.  For more information on dietary recommendations visit the Irish Nutrition and Dietetics Institute at: http://www.indi.ie or Safefood at: http://www.safefood.eu

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