Nutrition Concerns for the Aging Population

Primary aging, also known as senescence, defines the intrinsic age-related changes that take place in the elderly independent of disease processes or the environment. Secondary aging involves the interaction of senescence with disease processes and environmental influences (1). As people age, their body changes physiologically. In this blog post, I will talk about possible micronutrient (MN) deficiencies that may exist in the aging population as well as “Geriatric giants” which is a term coined for risk factors that predispose one to functional decline (2).  I will talk about the role of nutrition in both these topics concerning the elderly.

The three micronutrients that are at the highest risk of insufficiency in the elderly include calcium, vitamin D and vitamin B12.

• Vitamin D: The functions of vitamin D include the maintenance of calcium and phosphate balance, as well as proper bone mineralization (the re-forming of bone in the body). The insufficiency of this MN can be due to age-related absorption changes and an insufficient dietary intake. The recommended dietary reference intakes (DRI) of vitamin D for the elderly 70 years and older for men and women is 800 IU (international units). It is important that elderly people eat sources of vitamin D with each meal and to make sure they get plenty of sunlight. Sources of vitamin D include: sunlight, fortified milk, fortified fat spreads, fortified breakfast cereals, egg yolks, oily fish, liver and red meat (4).
• Calcium: Is important for healthy and strong bones and teeth. Age-related absorption changes and an insufficient dietary intake can lead to calcium insufficiency. The DRI for women and men 70 years and older is 1200mg/d. Dietary sources of calcium include dairy such as milk, yogurt, and cheeses. Other sources include non-dairy products such as dark green vegetables, including kale and broccoli, and fortified foods (14).
• Vitamin B12/ cobalamin: Is necessary for DNA synthesis and red blood cell production (6). Quantity recommendations (2,4 µg/day)(7) are identical throughout adulthood, but crystalline sources (the ‘free’ form) are recommended for both genders of adults 50 years and older. Older people should therefore ingest fortified food sources of vitamin B12 as they are more readily absorbed than naturally occurring food sources (7).

Now I will shift over to the “Geriatric Giants”. I will look at two, namely Anorexia of aging and energy homeostasis & mild cognitive impairment and depression.

• Anorexia of aging and energy homeostasis: Primary aging has been associated with anorexia secondary to a multiplicity of non- physiologic and physiologic causes, as well as progressive decreases in caloric intake. A decreased appetite, decreased energy intake and decreased energy expenditure can lead to a decreased resting metabolic rate (RMR)(8). Energy dense meals are very important in the elderly to ensure a sufficient energy/ caloric intake.
  1. Frailty: Physical frailty is defined as a “medical syndrome with multiple causes and contributors characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death.” Adults older than 70 should be screened for frailty (9). High quality proteins in the diet of frail elderly adults is important to improve their strength and physical performance capacity as demonstrated in randomized clinical trials (10).
  2. Sarcopenia: Defined as an unintended loss of muscle mass that results in the loss of muscle function and strength, reduced independent mobility, and an increased risk for falls, fractures, disability and admissions to hospital and long term care (LTC) facilities.(11) An adequate total caloric intake, provision of 1.0 to 1.2 g/kg per day of high-quality protein, and satisfactory vitamin D status are pertinent to reduce/ prevent the risk of the development of sarcopenia in older adults (12).

• Mild cognitive impairment and depression: Folate deficiency (vitamin B9) may be a contributing factor of depression in older adults (13). Folate also helps the body produce healthy red blood cells. It is vital for the elderly to consume food sources that contain folate such as broccoli, brussels sprouts, and green leafy vegetables (15).

Some last points on elderly nutrition (16): 

• It is important that older people consume enough fiber to prevent constipation. Fiber is found in whole grains, fruit and vegetables and whole breakfast cereals such as oats, bran etc. Starting the day with a breakfast cereal like oats and then consuming a whole grain like brown rice with vegetables with each meal is a great way of ensuring fiber intake in the diet. Eating fruits as snacks can also be a great fiber contributor. 

• Drinking enough water is important because as people age, their sense of thirst also declines. Older people should drink a glass of water with each meal and snack.

• To help stimulate their appetite and ensure a good caloric intake for their nutritional needs, smaller, more frequent and energy dense meals that look appetizing and have a rich flavor and aroma (beware of too spicy and cold dishes) are necessary.

Optimal nutrition in the elderly is vital because as you age your immune system also becomes weaker. Therefore, the elderly population is a high risk group and should routinely be screened and monitored. Support and motivation during mealtimes are also needed to ensure optimal nutrition amongst the elderly!

Edited by preRD intern, Lauren Gatto.

Written by Anri Pretorius: My name is Anri Pretorius, I am a South African citizen busy with my third year in dietetics. I am studying at the University of Stellenbosch in Cape Town. I love eating healthy foods and am particularly fond of spicy foods. I enjoy participating in any sport and see exercising as one of my favourite hobbies. The most recent sport I took up is cycling. I am a bibliophile and spend my vacations at home reading any book I can find that interests me. I also have two pets, a miniature French poodle and a rescue cat.

References:

 1. Barkoukis H. Nutrition Recommendations in Elderly and Aging. Medical Clinics of North America. 2016. 

2. Morley JE. Anorexia, weight loss, and frailty. Journal of the American Medical Directors Association. 2010. 

3. Opening Statement by Joanne Lupton for Dietary Reference Intakes For Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids [Internet]. [cited 2020 Nov 13]. Available from: https://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=s10490

4. Vitamins and minerals - Vitamin D - NHS [Internet]. [cited 2020 Nov 13]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

5. Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr. 1996;64(2):232–6. 

6. Obeid R, Jung J, Falk J, Herrmann W, Geisel J, Friesenhahn-Ochs B, et al. Serum vitamin B12 not reflecting vitamin B12 status in patients with type 2 diabetes. Biochimie. 2013 May;95(5):1056–61. 

7. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate OBV and C. Vitamin B12. 1998 [cited 2020 Nov 13]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK114302/

8. Bernstein M, Munoz N. Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness. J Acad Nutr Diet. 2012 Aug;112(8):1255–77. 

9. Morley JE. Anorexia, Weight Loss, and Frailty. 

10. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LCPGM, et al. Protein Supplementation Increases Muscle Mass Gain During Prolonged Resistance-Type Exercise Training in Frail Elderly People: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Med Dir Assoc. 2012;13(8):713–9. 

11. Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Med Dir Assoc. 2015 Sep 1;16(9):740–7. 

12. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the prot-age study group. J Am Med Dir Assoc. 2013 Aug 1;14(8):542–59. 

13. Araújo JR, Martel F, Borges N, Araújo JM, Keating E. Folates and aging: Role in mild cognitive impairment, dementia and depression. Vol. 22, Ageing Research Reviews. Elsevier Ireland Ltd; 2015. p. 9–19. 

14. Vitamins and minerals - Calcium - NHS [Internet]. [cited 2020 Nov 13]. Available from: Vitamins and minerals - Calcium - NHS (www.nhs.uk)

15. Vitamins and minerals - B vitamins and folic acid - NHS [Internet]. [cited 2020 Nov 13]. Available from: Vitamins and minerals - B vitamins and folic acid - NHS (www.nhs.uk)

16. Healthy Eating for Seniors - healthline [Internet]. [cited 2021 Jan 17]. Available from:   Healthy Eating for Seniors (healthline.com)