There is no single age used to define “older adult,” but the Dietary Reference Intakes (DRIs) categorize adults into ages 51-70 and 70 and older.  Aging brings along with it physiological, emotional, and social changes that can affect nutrition. Blood pressure may rise, the immune system may weaken, skin becomes thinner, the pace of healing slows, height may gradually decrease, muscle mass declines, and short-term memory may not be as sharp as it once was. Despite these changes, many older adults remain in good health and continue to be active into advanced age. Nutrition plays a key role in maintaining independence, mobility, and quality of life over the years. Even the fitness and nutrition choices made earlier in life set the stage for continued health and happiness into old age.

Nutrient Needs in Older Adults

Because the process of aging affects nutrient needs, some requirements for nutrients decrease as a person ages, while requirements for other nutrients increase. Changes in metabolism, body composition, and absorption all can influence dietary requirements.

Energy and Macronutrients

Lean body mass and metabolic rate decline with age, so older adults have lower calorie needs than younger adults. Estimated energy requirements for adults 51 and older range from:

• 1,600-2,200 calories/day for women
• 2,000-2,800 calories/day for men

Older adults with a higher activity level and more muscle mass will have requirements on the higher end of the range, while those that are sedentary with little muscle mass will have lower needs.

The AMDRs for carbohydrates, protein, and fat remain the same from middle age into old age:

• 45-65% Carbohydrates
  • Focus on high-fiber whole grains and vegetables for digestive health
• 10-35% Protein
  • Lean protein helps preserve muscle mass
• 20-35% Fat
  • Focus on unsaturated fats, including omega-3 fatty acids.

Micronutrients

Several micronutrient recommendations change in older adulthood:

• Calcium. To slow bone loss, the recommendations increase from 1,000 milligrams per day to 1,200 milligrams per day for women at age 51 and for men at age 71.
• Vitamin D. Also to help protect bones and support immune health, recommendations increase from 600 IU to 800 IU per day for men and women at age 70.
• Vitamin B₆. Recommendations increase to 1.7 milligrams per day for older men and 1.5 milligrams per day for older women to protect against cardiovascular disease.
• Vitamin B₁₂. While the RDA remains the same at 2.4 mcg/day, absorption decreases in older age, so obtaining vitamin B₁₂ from fortified foods or supplements is encouraged.
• Iron. Needs decrease to 8 mg/day for women after menopause.

Common Health Concerns in Older Adults

Older adults may face serious health challenges in their later years, many of which have ties to nutrition.

• Increased occurrence of cancer, heart disease, and diabetes
• Loss of hormone production, bone density, muscle mass, and strength, as well as changes in body composition (increase of fat deposits in the abdominal area, increasing the risk for type 2 diabetes and cardiovascular disease)
• Increased occurrence of dementia, resulting in memory loss, agitation and delusions
• Decreased kidney function, becoming less effective in excreting metabolic products such as sodium, acid, and potassium, which can alter water balance and hydration status
• Decreased immune function, resulting in more susceptibility to illness
• Increased risk for neurological disorders and psychological conditions (e.g., depression), influencing attitudes toward food, along with the ability to prepare or ingest food
• Dental problems can lead to difficulties with chewing and swallowing, which in turn can make it hard to maintain a healthy diet
• Lower efficiency in the absorption of vitamins and minerals
• Being either underweight or overweight

Sensory Issues

Taste buds and smell receptors begin to decrease in size and number with age. As a result, the taste and smell threshold is higher in older adults, meaning that more of the same flavor or scent must be present to be detected. These changes can make food seem less appealing and decrease appetite, leading to a higher intake of foods high in sugar and sodium to compensate.

Aging can also result in vision loss. Age-related macular degeneration is the leading cause of blindness in Americans over age sixty.^[1] Loss of vision can make food planning and preparation extremely difficult, and people who suffer from it often depend on caregivers for their meals. Self-feeding also may be difficult if an older adult cannot see their food clearly. Friends and family members can help older adults with shopping and cooking. Food-assistance programs for older adults (such as Meals on Wheels) can also be helpful.

Dysphagia

Some older adults have difficulty getting adequate nutrition because of dysphagia, which impairs the ability to swallow. Stroke, which can damage the parts of the brain that control swallowing, is a common cause of dysphagia. Dysphagia is also associated with advanced dementia because of overall brain function impairment. To assist older adults suffering from dysphagia, it can be helpful to alter food consistency. For example, solid foods can be pureed, ground, or chopped to allow more successful and safe swallowing. This decreases the risk of aspiration, which occurs when food flows into the respiratory tract and can result in aspiration pneumonia. Speech therapists, physicians, and dietitians work together to determine the appropriate diet for dysphagia patients.

Obesity in Old Age

Similar to other life stages, obesity remains a concern in older adulthood. Reduced muscle mass and physical activity mean that older adults need fewer calories per day to maintain a normal weight. Excess weight can increase the risk for cardiovascular disease, type 2 diabetes, and arthritis.

For older adults who are carry excess weight, dietary changes to promote weight loss should be combined with an exercise program to protect muscle mass since dieting has the potential to reduce muscle as well as fat. Although weight loss among older adults can be beneficial, it is best to be cautious and consult with a healthcare professional before beginning a weight loss program.

Sarcopenia

Sarcopenia is the age-related decrease in muscle mass and strength that can occur in older adults. Muscle decline begins gradually in midlife and accelerates after age 60.  Sarcopenia can cause:

• Frequent falls and bone fractures
• Muscle weakness
• Slow walking speed
• Difficulty with shopping and cooking

Sarcopenia may be prevented with adequate nutrition, especially ample protein intake, and regular weight bearing exercise.

Some older adults may even experience sarcopenic obesity, in which excess body fat coexists with low muscle mass.

The Anorexia of Aging

In addition to concerns about obesity among senior citizens, being underweight can also be a major problem. A condition known as the anorexia of aging is characterized by poor food intake, which results in dangerous weight loss and can be caused by reduced taste and smell, depression, side effect of medications, social isolation, or difficulty chewing or swallowing. Anorexia of aging leads to a higher risk for immune deficiency, frequent falls, muscle loss, and cognitive decline.

Nutrition interventions for anorexia of aging can include increasing the frequency and variety of meals, adding high-calorie foods (such as nuts, potatoes, whole-grain pasta, and avocados), using flavor enhancements with meals (butter, salt, sugar), offering oral nutrition supplements between meals to improve caloric intake, and monitoring weight weekly to make changes as needed to limit continued weight loss.^[2]

Longevity and Nutrition

Bad habits and poor nutrition have an accrual effect. The foods you consume in your younger years will impact your health as you age, from childhood into the later stages of life. Good nutrition today means optimal health tomorrow. It is best to start making healthy choices from a young age and maintain them as you mature. However, research suggests that adopting good nutritional choices later in life may still help to reduce the risk of chronic disease proving that it’s never too late to benefit from positive change.^[3]

Positive diet changes to make can include eating more dark, green, leafy vegetables, choosing lean sources of protein such as lean meats, poultry, fish, beans, and nuts, and engaging in moderate physical activity for at least thirty minutes per day several days per week. The resulting improvements will go a long way toward providing greater protection against falls and fractures, ward off chronic illness, and preserve strength and independence.^[4]

attributions

This chapter is an adaptation of “Nutrition in Older Adults” in Nutrition: Science and Everyday Application, v. 1.0 by Alice Callahan, PhD; Heather Leonard, MEd, RDN; and Tamberly Powell, MS, RDN licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.