Nutrition and the Elderly

by Food and Drug Administration (FDA)

We all know a Norma Kramer — an older person whose life has slowly started to come apart — a widow living alone who in her depression eats sparsely. Her adult son drops by for dinner one night a week, but that may be her only substantial meal until his next visit. Finally, because she can no longer live well enough alone, Norma Kramer moves into a senior citizen's residence.

Outgoing now and healthy except for painful arthritis — 72-year-old Kramer lives at the Har Sinai West senior high-rise in Baltimore, Md. She looks forward each day to the Eating Together in Baltimore breakfast and lunch program at the residence — for there, not only can she gossip with friends, she also can eat wholesome, hot meals that fortify her.

Kramer's story is true, and altogether too common, repeated in varying versions everywhere by people who worry about aging relatives or friends. Without proper supervision, many millions of older Americans exist in a nutritional twilight zone, grappling with the daily challenge of eating — and often not eating well-balanced meals or any meals at all.

A recent survey completed for the new Nutrition Screening Initiative (sponsored by Ross Laboratories) — targeted at improving the nutritional health status of the aging — shows that while 85 percent of seniors surveyed believe nutrition is important for their health and well-being, few act on their beliefs. Further, 30 percent admit they skip at least one meal a day. These numbers may well soar, as America continues to gray at an escalating rate.

"Twelve percent of the population of the United States is now age 65 or older," says Jeffrey Blumberg, Ph.D., associate director of the USDA Human Nutrition Research Center of Aging at Tufts University. "But in 30 years, the figure will be closer to 20 percent."

Higher Risk of Malnutrition

Sound nutrition plays a major role in good health for people of any age. But, says Paul Kerschner, senior vice president of the National Council on the Aging in Washington, D.C., seniors tend to be at a disproportionate risk of poor nutrition that can adversely affect their health. He describes the unacceptably high levels of poor nutrition and malnutrition among the elderly, which range from 15 to 50 percent. He says the problem is particularly pronounced among those living in institutional settings.

To make matters worse, often the signs and symptoms of malnutrition can baffle and mislead even the professionals. For example, weight loss, lightheadedness, disorientation, lethargy, and loss of appetite are often diagnosed as illness, says Colleen Pierre, American Dietetic Association ambassador and director of the Eating Together in Baltimore program. "What the person really needs is to eat better," she says.

Responding to the widespread gap in nutrition knowledge, the American Academy of Family Physicians, the American Dietetic Association, and the National Council on the Aging have joined forces to promote the Washington, D.C.-based Nutrition Screening Initiative.

Kerschner says that the hoped-for goal of this five-year initiative is to "start good nutritional habits that will forestall inappropriate acute and institutional care and will help people age well and keep in better health." The campaign was initiated, he continues, because the nutritional status of older people was being ignored, not only by older people themselves, but also by the health-care community.

One other goal of the program, he continues, is to point out to institutions that eating is a major part of people's lives. "Even institutions that serve good meals don't present them as part of therapy," Kerschner says. Dietitians and nurses need to realize that meals at any age are an important part of daily life, whether people live at home or in an institution. So just presenting food, then taking it away when a person is finished, doesn't help the person learn good nutritional habits, he says.

A Complex Challenge

Unfortunately, encouraging older citizens to eat well and to pay serious attention to sound nutrition is a complex challenge with no single, simple solution. For one thing, the aging process itself becomes a real barrier, explains Blumberg. As many people age, he says, their biological clock winds down and they also start to lose lean body mass.

Consequently, their interest in food — and their appetites for it — tends to diminish so people cut back on calories. But that's not okay, says Blumberg. "Requirements for many nutrients don't diminish," he says, "and they may even increase with age. Eating less presents real problems leading to deficiency." For example, he says, requirements for vitamin B6 actually increase for older people. "We find that when people are in a depleted but not a deficiency state, there are cognitive changes, changes in the immune systems, and deficits in sensitivity to insulin," he says. But an increase in B6 intake corrects the problems.

Health declines have "a cascading effect," says pathologist Philip Garry, professor at University of New Mexico School of Medicine. But after studying 300 older adults from the ages of 65 to 93, Garry has concluded that even the process of aging itself may be retarded through behavioral changes.

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