Eating Right

S

ome studies have estimated that as many as 55 percent of elderly patients admitted to hospitals suffer from malnutrition. With the elderly population expanding dramatically, and the over-85 segment growing the fastest, nutritional intake promises to take an ever more prominent place in projections for the health of our aging society.

This article will focus on how to maintain a balanced, simple-to-follow diet that will minimize your risk of disease and malnutrition.

A Mature Food Pyramid

Many people are familiar with the Food Guide Pyramid for healthy eating released by the United States Departments of Agriculture and Health and Human Services in 1992. But in 1999, scientists at the USDA's Human Nutrition Research Center on Aging at Tufts University in Boston released a pyramid specially designed to meet the nutritional needs of people over seventy.

Water
This new pyramid is based on eight 8-oz. glasses of water or other nonalcoholic, caffeine-free beverages per day. We already discussed the benefits of sufficient water.

Fiber rich carbs
The next level of the pyramid suggests that an elderly person's diet include six or more servings a day of fiber-rich bread, cereal, rice, or pasta. Fiber is important in the prevention of constipation and to help lower cholesterol. It also protects against colon cancer, and helps maintain a normal blood sugar level. Fiber should be gradually increased in the diet, in order to avoid cramps and gas, up to a level of 20-35 grams daily. Remember to drink enough water! Here are some tips to help increase fiber:

  • Read labels, and look for "100% whole wheat or grain". If it says "brown flour" it's not whole grain.
  • Combine fiber rich foods such as a high fiber cereal and a banana.
  • Eat the skins from fruits and vegetables such as apples and baked potatoes.
Fruits and vegetables

The next level recommends three or more servings of vegetables and two or more servings of fruit. They should be consumed in their "food form", not simply as juice, as the actual fruit is rich in fiber. The fruits and vegetables with the richest colors (dark green, orange, yellow, and red) have the greatest quantities of nutrients. Vegetables in the cabbage family, including broccoli, kale, cauliflower, and mustard greens, are high in cancer-fighting nutrients.

Protein
Next comes the protein level: three or more servings of milk, yogurt, and cheese, and two or more servings of meat, poultry, fish, dry beans, eggs, and nuts. Older adults generally need 60-75 grams of protein a day. Dairy choices should be of the low-fat variety. In the meat category, include fish, which may reduce cardiac risk, dried beans, which have lots of fiber, and lean meat and poultry. Remove the high-fat skin from poultry.

Protein is important in maintaining muscle mass, boosting immunity, and aiding in wound healing. Seniors with poor dental health who have mouth pain or difficulty chewing will benefit from choosing soft foods. Beans, low-fat yogurt, and low-fat soft cheeses can help provide the desired amount of protein. The frail elderly may need nutritional supplements such as Ensure or Sustacal to meet their protein and calorie needs. Instant breakfasts contain similar nutrient content for lower costs.

Fats, oils and sweets
The tiny tip of the pyramid recommends using fats, oils, and sweets sparingly. These foods tend to be nutrient-poor and high in calories. Liquid oils should be used in cooking, and trans fatty acids, such as those found in margarine and many processed foods, should be avoided. Fats should comprise no more than 30 percent of a person's total daily calories.

Should You Consider Supplements?

"Should I take nutritional supplements?" This is one of the most frequent questions heard in a doctor's office. Although food is the best source of nutrients, few elderly are able to meet their needs for certain vitamins and minerals, so it is a good idea to take one multivitamin per day. The Tufts University food pyramid is topped by a flag that recommends that elderly people take calcium, vitamin D, and vitamin B12 supplements.

Calcium
Calcium is an important component of osteoporosis prevention, the fragile bone disease that makes people susceptible to fractures of the hip, spine, or wrists. An estimated 28 million people in the United States have the disease, and 80 percent of those suffering with osteoporosis are women. Current recommendations for calcium intake are 1000 milligrams of elemental calcium per day for men, and 1500 milligrams for post-menopausal women. Although dairy products are rich in calcium, one must consume a quart of milk or more a day to get the recommended amount, so most people take some of their calcium in the form of pills.

Vitamin D
Vitamin D actually activates calcium, aiding in its absorption. Older people who are housebound are at increased risk of vitamin D deficiency, as the vitamin is converted by skin to its active form through sunlight. Two multivitamins containing 400 international units (IU) of vitamin D each should meet the daily requirements for frail elderly individuals who get little sun exposure; one multivitamin should suffice for older adults who get moderate sun exposure.

Vitamin B12
Vitamin B12 is usually found in sufficient quantity in any diet containing animal foods. But 10-30% of elderly do not produce enough stomach acid to release the vitamin from the protein that binds it, so it cannot be absorbed. Additional B12 can be provided with vitamin supplements and cereals fortified with vitamin B12. Both vitamin B12 and folic acid help to lower blood levels of homocysteine, which is related to an increased incidence of heart disease. One multivitamin will provide sufficient additional Vitamin B12 and folic acid, unless an older adult is significantly deficient in Vitamin B12 (measured by a blood test), in which case larger replacement amounts are required.

Antioxidants
Many beneficial effects have been attributed to the antioxidant vitamins, which include vitamins A, C, and E. Antioxidants protect the body from the damaging effects of free radicals, the byproducts of metabolism, and may thereby slow the aging process and fight age-related diseases such as cancer and heart disease. But this has not been unequivocally proven. I recommend a daily, 400 IU vitamin E supplement to my patients. Vitamin E is also found in meats, fish, whole grains, nuts, peanut butter, and olive and canola oils, but a supplement is necessary to achieve good antioxidant effect.

A Helping Hand

Understanding what comprises a balanced diet is only half the battle; many other factors may prevent elderly people from obtaining the sustenance they need. A major problem is simply getting food on the table. Economic impoverishment, social isolation, depression, or functional dependence due to illness or disability can all result in difficulty with eating. But there are many sources of help.

Help in the home
A good home attendant can make an enormous difference in the life of a senior who is unable to cook or shop for herself. Attendants can also work on making eating both a nutritious and pleasurable experience. Meals-on-Wheels delivers meals to qualifying homebound disabled or ill seniors.

Community
Many older people may not feel motivated to eat because they are depressed, live alone, or have no family members nearby. Eating is a social activity that nourishes the body and soul. Senior centers can provide older people with the benefits of a meal and the company of people.

Professional organizations can help
In difficult cases where food intake is adversely affected by Alzheimer's disease or another type of dementia, family members and caretakers can turn to the Alzheimer's Association, which offers a wealth of information and support.

Nutritional experts
Lastly, a dietician can assess your nutritional status, answer questions, and offer suggestions to help compensate for nutritional deficiencies.

Copyright HLTHO - Healthology
Contact Us