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Nutrition in the Elderly

Introduction

The adoption and maintenance of a healthy lifestyle and a balanced diet that provides the necessary energy on the one hand, and the nutrients for the smooth development and promotion of health on the other, is important in all age groups and especially in the elderly. Aging is a normal process and is the result of the accumulation of damage to the body’s cells, leading to a decrease in the physical, cognitive and mental functioning of individuals. Elderly people, that is, people over 65 years of age, constitute a “challenge” for public health, given their increased susceptibility to various diseases, known as geriatric syndromes, which are directly intertwined with the increased risk of developing diseases such as osteoporosis, sarcopenia, etc. In the management of these syndromes, nutrition plays an important role, resulting in great emphasis being placed on it.

 

Nutritional Challenges in the Elderly

Muscle Mass Loss

As we age, our body composition changes. Specifically, we see an increase in body fat and a decrease in muscle mass. Muscle mass naturally decreases over time. It is estimated that after 30 years of age, the loss ranges from 3 to 8% per decade, with the rate of loss increasing more after 60 years of age, making elderly people more susceptible to developing sarcopenia. Sarcopenia is a geriatric syndrome characterized by the loss of muscle mass and strength. As a result, the ability to move and balance of individuals is affected, making it difficult for them to perform basic daily functions. Sarcopenia is widespread in older people, considering that at least 10-16% of the elderly worldwide have sarcopenia.

· Bone loss

During the growth period, in order to increase bone density, an increased rate of bone synthesis is observed in relation to the rate of bone degradation. This process begins to slow down at around 20 years of age and by the age of 30, bone density has reached its maximum. After the age of 30, the rate of bone degradation prevails in relation to the rate of synthesis, resulting in a decrease in bone density. Consequently, the risk of developing osteopenia and osteoporosis increases.

· Basic sensory disorders

Taste and smell are some of the senses that deteriorate over time. 75% of people over 80 years of age have an inadequate sense of smell, while changes in taste are less common in older age. The loss of these two basic senses often leads to a reduction in food intake, as older people do not enjoy food as much as they used to.

Gastrointestinal disorders

Changes in the gastrointestinal system of older people significantly affect nutritional intake.

  • Reduced saliva secretion & difficulty swallowing (dysphagia)

Saliva production normally decreases over time, resulting in dry mouth. Symptoms of dry mouth are exacerbated by reduced fluid intake, increased caffeine intake, the use of certain medications (antidepressants, antihypertensives, tranquilizers, psychotropic drugs) and smoking. Reduced fluid intake in the elderly is common since the feeling of thirst is reduced. This is due to the ineffective functioning of the thirst sensation mechanism controlled by the Central Nervous System.
Reduced saliva production is also associated with swallowing difficulties, known as dysphagia. Specific diseases that occur in the elderly lead to dysphagia, the most common of which are gastroesophageal reflux, dementia, Parkinson’s and strokes.

  •  Absence of teeth

The absence of teeth and, in general, disorders in the dentition that cause pain, make it difficult to chew food, making the process of eating a less pleasant one.

  •  Nutrient malabsorption

Disorders in the absorption of nutrients affect the entire length of the gastrointestinal system, starting in the oral cavity, due to reduced saliva secretion and therefore the reduced availability of digestive enzymes contained in it. Regarding the stomach, it secretes two basic substances necessary for digestion and absorption: hydrochloric acid, also known as gastric juice, and intrinsic factor, which is a glycoprotein necessary for the absorption and availability of important micronutrients such as vitamin B12, vitamin B9, calcium and iron. Reduced secretion of hydrochloric acid is associated with dyspepsia, which in combination with the lack of intrinsic factor that is normally observed with age, leads to disorders in the absorption of macro and micronutrients.

  •  Reduced colonic motility

The reduction in colonic motility that normally occurs in elderly people leads to the appearance of constipation. This symptom is exacerbated in cases of reduced water intake, reduced fruit and vegetable intake and lack of exercise.

 

Nutritional Management in the Elderly

Nutritional needs differ between the elderly and adults. With age, energy requirements are lower, since the basal metabolic rate decreases, resulting in easier weight gain compared to young adults.

Regarding protein needs, they are increased in order to maintain muscle mass and avoid sarcopenia. Despite increased needs, the elderly often consume less than the recommended daily intake. Therefore, it is important to include foods that provide protein in the diet of the elderly. Such foods are eggs, dairy products, fish, seafood and of course meat. In addition to increasing the total daily amount of protein, it is also important to include it in every meal, as this seems to have a better effect on maintaining muscle mass reserves. In addition, daily engagement in activities of any nature, depending on the preferences of each individual, is capable of contributing to the maintenance and strengthening of reserves.

Regarding the needs for micronutrients, no significant differences are observed between young adults and the elderly. However, special attention should be paid to cases where the needs for specific components are increased due to the presence of diseases, such as osteoporosis. Adequate calcium intake is important for maintaining a healthy skeleton. Important sources of calcium are dairy products, green leafy vegetables (broccoli, cabbage), fish consumed with bones (sardines, anchovies), nuts, mainly almonds, and soy products such as tofu. For maintaining a healthy skeleton, vitamin D adequacy is also important, which is often lacking in the elderly due to their reduced exposure to the sun and reduced kidney function, resulting in reduced availability of the active form of this vitamin. Adequate sun exposure, increased intake of fatty fish (mackerel, salmon, trout, etc.), mushrooms, eggs and foods fortified with vitamin D (dairy products, whole grains) can contribute to the adequacy of vitamin D in the body and ultimately to the maintenance of bone mass. Micronutrient deficiencies can also be a result of reduced energy intake due to the aforementioned disorders. To reduce dry mouth and dysphagia, continuous hydration of elderly people is important. Adequate access to water and herbal teas (tea, chamomile, herbal mixture) during the day as well as an increase in the consumption of foods with a high water content such as yogurt, soups, fruits, vegetables and jelly contribute significantly to enhancing hydration. It is also important to swallow liquids slowly and not before eating meals, which could increase the reduced appetite and ultimately lead to even lower nutritional intake.

Finally, although there are no specific recommendations for fiber intake, their presence in the diet is essential given the increased frequency of constipation among older people with a simultaneous increase in water intake. The inclusion of whole grains, fruits and vegetables and legumes is important for meeting fiber needs. In addition, daily exercise is able to mobilize the large intestine, which in turn will promote the production and secretion of feces, combating constipation.

 

Conclusion

Changes in lifestyle and compliance of older people with their specific nutritional needs can positively affect their health and ultimately their quality of life, enhancing autonomy and independence and increasing their life expectancy. A diet that provides the necessary energy and ratio of nutrients is capable of maintaining or even enhancing the nutritional status of older people, which is significantly affected by physiological changes. However, attention should always be paid to the specific needs of each individual. This is why it is important to create an individualized nutrition plan. In addition, it is important to adopt a healthy nutrition plan throughout life to prevent chronic diseases. A diet based on the Mediterranean model combined with regular physical activity is capable of extending the lifespan of individuals, ensuring longevity.

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aristea
ARISTEA GAZOULI

Chemist - MSc Nutrition and Metabolism
Graduated from the Department of Chemistry, University of Patras, with postgraduate studies in Human Nutrition and Metabolism at the University of Aberdeen. She worked for one year as a researcher at the Rowett Research Institute.