Nutritional Care of Older Adults
Laurie B. Steenwyk M.Ed, RD, LDN
Class Overview
Assessing Nutritional Status
 Nutritional Needs of the Elderly
 Nutrition Interventions
 Eating Lifestyles
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Meal planning for optimal health
Assessing Nutritional Status
Factors Impacting Nutritional
Status in the Elderly
Assessing Weight Status
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BMI
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Percent Weight Loss (unintended)
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<23 considered underweight >65 yrs
>5% in 1 month (quadruples risk of death)
> 7.5% in 3 months
>10% in 6 months
Cachexia
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Severe wasting accompanying diseases such as cancer
Mini Nutrition Assessment
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6 question screening
tool
Complete in <5 minutes
Validated for age >65
More sensitive than BMI
Available at:
http://www.mnaelderly.com/
Sarcopenia
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Sarcopenia
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Loss of skeletal muscle associated with aging
Affects 8-40% of adults >60 yrs
50% of adults >75 yrs
Sarcopenic Obesity
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Coexisting loss of skeletal muscle mass
and strength with excess body fat
Nutritional Needs of the Elderly
Energy
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Energy (calorie) needs decrease with age,
mostly due to decreased physical activity
LBM declines with age and influences
energy needs
Protein and vitamin/mineral needs remain
the same or increase
Challenge: adequate micronutrients within
caloric requirement
Nutrients of Concern

Risk for deficiency with age
Water
 Fiber
 Protein
 Calcium and Vitamin D
 Vitamin B12
 Vitamin C and E – antioxidants

Water
Dehydration is a form of malnutrition
 Kidneys’ decreased ability to
concentrate urine
 Adverse effects of medication
 Mobility disorders
 Fear of incontinence
 25-30 mL/kg actual body wt

Fiber
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Fiber Goals for adults over 50:
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Insoluble: Tough, fibrous plant material
that does NOT absorb water
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Men: 30 g per day
Women: 21 g per day
Most grains and vegetables
Soluble: Plant fibers capable of absorbing
water and become gummy or gel-like

Oats, fruit, legumes, pectin, inulin, psyllium
Sources of Fiber
Oats
Barley
Wheat
Quinoa
Flax
Brown Rice
Bran
Legumes
Seeds
Fruits
Vegetables
Protein
Muscle mass (LBM) decreases 15%
per decade after age 70
 Needs increase with illness, injury

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Surgery, wounds, CHF, COPD, Cancer
Optimal intake: 25-30 gm/meal
 Even
distribution most effective in preventing
muscle loss during illness

1-1.6 gm/kg IBW may prevent
sarcopenia
PROTEIN
Sources:

Animal Proteins

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Dairy
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Milk, Cheese, Yogurt, Cottage Cheese…
Legumes and Nuts


Egg, Turkey, Fish, Beef…
Black Beans, Red Beans, Lentils, Walnuts…
Some from grains/breads/plants

Quinoa, Greens, Broccoli, Oats, Pasta…
Vitamin D



800 IU >70 years
Safe upper limit
4000 IU
Supplements are
recommended for
older adults

Sources
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Fortified milk
Fatty fish, fish oil
Liver
Egg yolk
Some enriched
beverages
Exposure to sunshine
during Spring, Summer,
early Fall
Calcium
1000 mg Men <70 years
 1200 mg Men >70
 1200 mg Women >50
 Safe upper limit 2000 mg/day
 A large recent study suggests that
calcium supplements don’t prevent
hip fractures

Calcium

Dairy Sources

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1 cup milk – 300 mg
4 oz yogurt – 200 mg
1 oz cheese – 200 mg
½ cup cottage cheese –
65 mg
¼ cup ricotta cheese 200 mg
Non-Dairy Calcium
Sources
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1 cup Calcium fortified
orange or apple juice
(240 mg)
Enriched, GF almond, soy
or rice milk – 300 mg
3 oz Sardines – 370 mg
3 oz Canned Salmon w/
bones – 180 mg
Almonds
½ cup Broccoli (90 mg)
2 oz Tofu (made w/
calcium sulfate

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Firm Tofu (385 mg)
Regular Tofu (200 mg)
1 T Blackstrap Molasses –
135 mg
1 T Tahini – 65 mg
Other Nutrients in Bone
Health
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Vitamin K


Manganese
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Leafy greens, broccoli, soybean oil
Spinach, peanuts, almonds, brown rice,
green tea
Excesses of sodium, protein and
phosphorus decrease calcium
availability.
Vitamin B-12
6-15% of older adults are deficient
 Another 20% have marginal status
 Compromised absorption

Pernicious anemia
 Lack of intrinsic factor
 Atrophic gastritis
 Long-term use of PPIs

Vitamin B-12 Deficiency

Symptoms
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Folate Deficiency
Numbness, tingling of
arms, legs
Difficulty walking
Memory loss
Disorientation
Dementia
Sore tongue
Poor appetite
Constipation
Possibly depression

Sources
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Meat
Poultry
Fish
Dairy Products
Supplement Recs:

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Adults 2.4 mcg/day
>50 yrs should take
supplement
>65 yrs 100-400
mcg/day
Anti-Oxidants (C and E)
Vitamin C
 RDI 75 mg females
and 90 mg males
 400 mg may be
beneficial to older
adults
 UL is 2,000 mg
 The role of antioxidants in macular
degeneration and
dementia is unclear
Vitamin E
 RDI: 15 mg for adults
 UL is 1000 mg
 Supplements can
increase risk of
bleeding in patients on
anti-coagulant therapy
 Sources: oils, nuts,
peanuts, avocado
Nutritional Interventions
Increasing Calories


5-6 small meals/between meal snacks
Calorically dense foods

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Drink calories

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Nut butters, dried fruits, fruit purees, starchy
vegetables, legumes, cheese, yogurt
Milk, juice, smoothies, soups
Increase fats

butter, sour cream, cream cheese, oils,
mayonnaise, avocado
Oral Nutrition Supplements

Use 1.5 -2.0 cal/mL

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Ensure Plus, Ensure Clinical Strength, TwoCal,
Boost Plus, etc
Serve 3-4 oz portions several times
Use as a “med pass”
Dilute with whole milk or serve frozen to
reduce sweetness
Encourage 1 sip every 5 minutes to reduce
early satiety
Texture

Meats: chopped, ground, pureed

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Use puree molds or small colorful
dishes
Piping soft foods, garnish with
sauce
Cut hard fruits, vegetables into
bite sized pieces
Finger foods work well with
dementia or severe arthritis
The Dining Experience
Buffet service, family style service
 Encourage selection
 Avoid social isolation
 Music
 Aroma
 Appearance and presentation

Home Meals

Financial limits


Eggs, peanut butter, canned beans, tuna,
turkey, frozen veggies, rice
Limited cooking ability

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Weight Watchers, Healthy Choice, Kashi Meals
Precut fruits and veggies
Prepared soups, crackers, whole grain bread,
bagels, quick oatmeal, cheese, yogurt,
cottage cheese, frozen veggies, bananas,
grapes, hummus
Appetite Stimulants
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Limited evidence of effectiveness in the
elderly
Megace
Remeron
Eldertonic
Marinol
Periactin
Oxandrin
Eating Lifestyles
The Mediterranean Diet
The DASH Diet
The New American Plate
MyPlate for Older Adults
2009
Version



Fruits,
Vegetables,
grains, olive oil,
beans, nuts and
seeds are grouped
together at the
base
Herbs and Spices
are added at base
Fish is promoted
over poultry and
dairy
Benefits
9% decrease in overall mortality
 9% decrease in death from
cardiovascular disease
 6% decrease in death from cancer
 13% decrease in incidence of
Parkinson’s and Alzheimer’s Disease

Safi, F. et al, Adherence to Mediteranean Diet
and Health Status: Meta-analysis. British
Journal of Medicine, 2008: 337:a1344.
Key Mediterranean Principles
Generous amounts of fruits and
vegetables
 Healthy fats: olive oil
 Small portions of nuts
 Red wine in moderation, for some
 Very little red meat
 Fish on a regular basis

DASH Diet Pyramid
Dietary Approaches to Stop Hypertension
DASH Benefits
Reduces blood pressure, especially in
older adults.
 Also protective against

Osteoporosis
 Cancer
 Heart Disease
 Heart Failure
 Stroke
 Diabetes

Key DASH Principles
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Limits sodium to <2300 or <1500 mg/day
Generous amounts of fruits & vegetables
Whole Grains
Emphasizes low fat dairy
Monounsaturated Fats


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<27% of calories from fat
Legumes, nuts or seeds daily
Lean protein: fish, poultry, soy products
High in calcium, potassium and magnesium
New American Plate
Proportions:

2/3 plate should be plant based
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Whole grain
Vegetables
Fruit
Legumes
1/3 from protein
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Fish
Lean Beef
Poultry
Dairy
1/3
2007 Expert Report on
Cancer Prevention
Joint effort of AICR and World Cancer
Research Fund
 7000 global scientific studies
reviewed
 10 lifestyle recommendations for
cancer prevention

Diet Recommendations
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Limit sugary drinks and energy dense foods
Eat more of a variety of fruits, vegetables,
grains, legumes
Limit red meat and processed meats
Limit salt and foods processed with sodium
MyPlate for Older Adults
MyPlate for Older Adults
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Bright-colored vegetables such as carrots and broccoli.
Deep-colored fruit such as berries and peaches.
Whole, enriched and fortified grains and cereals such as brown rice
and 100% whole wheat bread.
Low- and non-fat dairy products such as yogurt and low-lactose
milk.
Dry beans and nuts, fish, poultry, lean meat and eggs.
Liquid vegetable oils, soft spreads low in saturated and trans fat,
and spices to replace salt.
Fluids such as water and fat-free milk.
Physical activity such as walking, resistance training and light
cleaning.
http://now.tufts.edu/news-releases/tufts-universitynutrition-scientists-unveil-
Resources

Food & Nutrition Information Center


http://fnic.nal.usda.gov/lifecyclenutrition/aging
Tufts Human Nutrition Research
Center on Aging

http://hnrca.tufts.edu/
Resources

DASH Eating Plan Booklet, free on the
web:
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new
_dash.pdf

Mayo Clinic


http://www.mayoclinic.com
Use their search engine and type in “DASH Diet” or
“Mediterranean Diet” to view numerous consumer friendly
articles.
Oldways: Mediterranean diet info
http://www.oldwayspt.org/med_pyramid.html
Resources

AICR: The New American Plate
 Printable brochures, Cookbook, recipes
http://www.aicr.org/site/PageServer?pagename=reduce_diet_
new_american_plate

Linus Pauling Institute


micronutrient information center
http://lpi.oregonstate.edu/infocenter/
Questions???