Nutrition Through Life Cycle – Old Age

Introduction

In the Nutrition Through Life Cycle – Adulthood post we have seen about the requirements of adults. You have observed that the requirements vary with occupation. You must have noticed that there are changes in appearance, mental outlook and body functions of people, as they move from adulthood to middle age and then to old age. You would certainly like to know what happens when people age and how it affects the nutritional needs of the elderly amongst your family. You would also like to know about the special needs of these persons and how to meet these to ensure their good health.

 

Ageing An Individual Phenomena – Variations In Ageing

You must have noticed the changes that occur with age in people around you. For example, some lose their teeth and need dentures, others complain about difficulties in digestion. The changes vary from one person to another. But one thing is worth noting that ageing is a continuous process; it starts at birth and continues throughout our life. The process is hastened in later years of life.

Another thing you may have noted is that no two persons of say sixty or sixty-five years look alike. Some may look ten years younger, others a few years older than they are. In other words, their actual age, which is also known as chronological age, does not coincide with their biological age.

It is hard to specify which birthday makes you aged. You must have seen people, who are still active when they are 70 years old, and others, who are feeble at 60. What is it that accounts for such a difference? How do you judge age? Age can be judged by your activity, agility, endurance, muscle coordination and attitudes, than by the number of years you have existed. Some of the factors which affect ageing, can be controlled by you. For instance, your good selection to meet your body’s needs through youth, adulthood and middle age, can be an asset. Leading an active life may help you to be agile, and retain your muscle coordination. A happy positive attitude may help you to face difficult situations with composure and dignity.

One of the factors which affects ageing is heredity. If your parents lived to a ripe old age, you have a fair chance of doing the same, provided you have retained their healthy way of living. On the contrary, if they suffered from many of the common ills of older people, such as fatigue, slow recovery from illness, sleeplessness, worry and even overweight, it could be traced to poor food habits and a resultant poor nutritional state. You could avoid these handicaps, and take steps towards a healthier you.

As you grow older, your body is the sum total of the care, use, misuse or neglect it has undergone. The illness or diseases that you may have suffered also leave their mark. If you suffered accidents, the cumulative effect of these on the body is felt in old age. The infection [Diarrhoea, Dysentery, etc.] you may have suffered due to environmental factors also leave their mark on certain systems of the body. How well the need of the body was met by foods you ate throughout the years affects not only the ageing process, but also your resistance to disease.

Since these factors vary from one person to another, there are greater variations in the nutrition and health status of old people than in young people. You will realize that nutritional care of this age group is very much based on individual needs. Let us understand what physiological changes occur with age.

 

Physiological Changes In Later Years

Some changes occur in our body, mind, social and economic status with age. If you understand these, you can help the elderly in your family and neighborhood to adjust food intake accordingly.

The digestive system undergoes considerable change with age. The amount of acid and digestive enzymes secreted by gastric glands decreases. Thus the digestion and absorption of nutrients is decreased. About 10 percent of the elderly suffer from reduced secretion of hydrochloric acid or gastric acid. This takes away the first line of defense of the body, since gastric acid acts as an antiseptic also. As a result, you hear about frequent Diarrhoea and upsets due to increased infections in this age group.

The movement of the alimentary tract becomes sluggish with age. Food stagnates, bowels do not move regularly and constipation is a common problem. It may have been habitually treated with drugs, further reducing its activity.

As you know that the proper mastication helps the process of digestion of food. You observe that with teeth fallen, decayed or functionless, food is often swallowed than chewed by the elderly members of your family. If they have poorly fitted dentures, they do not use these. You will realize that the dentures should be well fitting and checked regularly to ensure proper chewing of food to help its utilization in the body. You find that the ability to smell and note differences in taste reduces with age, which leads to decreased enjoyment of food.

Please note that a good diet and physical activity throughout your life is an insurance that carries many benefits. Good eating habits in early life will lead you to a vigorous, mature youth. If you continue these, it will extend your years of useful life and delay or prevent the appearance of many of the so-called symptoms of old age.

 

Nutritional Needs Of Elderly

Please remember, you need the same nutrients that you needed earlier, in this stage of life also. One change that definitely accompanies the ageing process is a decreased energy need. With age your basal metabolism and activities are slowing down. On an average, men and women, in the 55-75 years age span, need 400 to 500 calories less per day, than they did before this stage. You may have noticed that elderly persons in your or in your neighbor’s family eat much smaller amount than others in the family. Now you know why.

The need for other nutrients is not altered. Therefore you do not find changes in recommendations for nutrients except energy.

The need of the body for proteins does not change with age. It is important to take sufficient foods from group 2 to meet the protein need.

In selecting foods to meet the energy needs, you will be well advised to reduce the animal fat [Ghee, Butter, Lard] in the diet of elderly relatives, since intake of these is associated with higher incidence of atherosclerosis. It is advisable to include some vegetable oils such as Groundnut, Cotton, Corn or Soyabean.

In minerals, common salt [Sodium Chloride], calcium, iron and iodine may be specially mentioned. Our requirement per day of common salt is based on water intake and is about 1 gm per liter of water. But you habitually consume 5-10 gm salt daily, and our normal water intake may be only 1- 1.5 liter. So it is advisable to reduce the salt intake and increase water intake. Those, who suffer from blood pressure, heart or kidney diseases, must further reduce salt intake. In old age, bones lose calcium and become lighter [Osteoporosis]. As a result, these light bones break easily and fractures are common when your elderly relatives slip and fall. You need to pay special attention to meet the calcium needs of the elderly in your family.

Iron deficiency is common among those elders who suffer from reduced gastric secretion of acid. Sources of iron are pulses and leafy vegetables. As you have learnt, taking vitamin C rich foods such as Guava, Amla, or Mausambi help absorption of iron in the body. The requirement for fiber and water is the same as in adult life. But as mentioned earlier constipation is a common problem of the elderly in India. Therefore you must see that the elderly do take adequate amounts of foods from groups 3 and 4 and drink sufficient amount of water to ensure proper utilization of food and elimination of waste.

 

Special Needs Of Elderly

As you have just read, a number of changes affect the elderly people. The extent of these changes varies from one person to another. You must remember that food and nutritional care of the elderly has to be on an individual basis.

It is good for you to remember that the healthy person needs no special dietary change in old age, except reduction in energy intake. How would you know if the energy intake meets the energy need? A good guide is to be sure that the person maintains his normal weight at the age of 25 for the rest of his life. Of course, here you presume that the person had desirable weight far height at 25 years of age. While this is true of some, you may have observed older people who actually need to reduce. At the other extreme you have elderly people, who do not meet their energy needs. Among those, who live for over 70 years of age, you may have noted some who are extremely underweight. You can help these people to regain normal weight, after you find out the reasons for their reduced intake. It is good to remind them that food is cheaper than drugs/medicine and proper food intake can be an insurance against ill-health.

Some of the special needs of the elderly are due to physical problems. Some of them lack teeth or have poorly fitting dentures and need foods which are soft-cooked and easy to swallow. To ensure that they take sufficient amount of vegetables these have to be pressure cooked and at times mashed and blended. Otherwise they may tend to eat only Rice and Pulse and have a nutritionally restricted diet.

You find that the ability to absorb and retain calcium from foods is reduced with age, because old people tend to be inactive and stay indoors. To ensure that the calcium and phosphorus in the diet is properly absorbed and utilized, you should encourage your elderly relatives to take a walk in the sunlight. Increased physical activity and exposure to sunlight, be it for work or recreation, decreases chances of getting osteoporosis, a bone disorder in which there is a general decrease in total bone mass.

You will be interested to know that your grandmother’s need for calcium is likely to be slightly greater than grandfather’s. But both do need to take sufficient calcium in their diet. Milk is the food of choice for the elderly as also the young. It is easy to drink even for those who have no teeth. Another good source is roasted, and ground ragi [Nechani] as a snack. When milk and milk products are not well tolerated, calcium may be taken in the form of calcium gluconate, or lactate.

Socio-Economic Realities: As you realize, this is the stage of life when those who were working, retire. Due to retirement, there is generally a reduction in income and decreased physical activity. If you develop hobbies at an earlier stage to utilize your leisure hours, you will be able to spend your time in an enjoyable manner.

Whatever the scientific considerations, the factor of economics remains the most important one. While you notice the affluent eating excess of food [Not Necessarily Nutritionally Right], most of the elderly people in India have restricted income and hence limited money for food.

There is a change in the household set-up, as the younger generation takes charge and the former head has to play a secondary role. The elderly housewife is no longer the mistress of the household, as the daughter-in-law may take over the charge. Though these are natural changes, how you handle these will affect you, and often your food intake. Food for the elderly has economic implications. How shall we impress on them and you who look after them that “Providing Proper Food Is A Sound Investment In Health“? How many realize this? You may realize that with most people food is a problem of economic adjustments. You need to ensure use of foods from groups 2, 3 and 4 in the diet to prevent the deficiencies prevalent in elderly people.

As you remember these foods would help to meet the protein, mineral and vitamin needs, of the elderly. Besides group 3 and 4 foods provide fiber, which would help to improve the movement of food in the alimentary tract and prevent constipation.

Ancillary Factors: You will appreciate that a proper philosophy regarding food is needed at this stage. One should eat to live, not live to eat. As the elderly people have a lot of time, they feel like eating many times a day. To take care of this, the total food needed in the day should be spaced out into smaller meals – 4 to 5 times a day.

At the elderly stage of life, one cannot take liberty with food as one used to in one’s younger days. One has to resist temptations to eat fried and sweet foods, because one’s sluggish digestion system may get overloaded. One also needs to drink a lot of water to help efficient movement of food in the body.

You, who look after the elderly, need to remember that food is one of the few enjoyments one has in old age. Therefore you must pay extra attention to ensure that the atmosphere at meal time be happy and relaxed. Remember how these elderly people took care of your likes and dislikes, when you were young. It is your turn now to do the same to them. Extra attention must be paid to prepare soft foods, for those with teeth problems.

Remember, health is not a condition of matter, but of mind too. Anxiety and worries ruin digestion and health. You will notice change of moods, obstinacies in the elderly around you. It needs patience on your part to look after them. Sound common sense and a sunny temperament are your best assets in caring for your aged relatives.

Let us see how we can use this knowledge to plan and prepare acceptable meals for the elderly. If you the elderly citizen, had saved and provided for the needs of this stage, you can maintain your life style and enjoy the evening of your life, as Robert Browning has said, in the Rabbi Ben Ezra:

“Grow old along with me, the best is yet to be.
The last of life, for which the first was made”

 

Planning Meals For Elderly

In planning meals for the aged, you need to ensure that their special needs are met. Some of the aspects that need attention are:

• • Be sure to include foods from all the groups.
  • Be sure to include minimum number of servings of each food group.
  • Include fruits which supply vitamin C.
  • Pressure cook the foods to ensure soft texture.
  • Include milk, ragi, til or small fish to meet calcium needs.
  • Avoid fried foods, sweets, syrups, soft drinks, etc.
  • Include 5-6 glasses of water daily.
  • Ensure happy and relaxed atmosphere at meal times.

With these aspects in view, you can plan the menu to meet the needs of the elderly according to the Daily Food Guide. You can select group 1 and 2 foods as per pattern of the family. You can select the vegetables and fruits according to seasonal availability and choice of the person. The amount of foods from groups 1 and 5 would vary with the energy needs of the person and any individual health problems he/she may have.

Since eating is a social occasion, you may have observed that persons living alone tend to eat poorer diets than couples. You will be interested to know that in western countries they have tried to solve this problem by serving at least one hot meal per day for the elderly in the community setting. Another program is meals-on-wheels, in which a meal is delivered home for the elderly. With the increase in the nuclear pattern of the family, we may have to plan such services in the near future for our elderly citizens.

Activity:

• • Interview an elderly person in your neighborhood and record the menu and food intake of that person.
  • Has the person included foods from all groups?
  • What are the number of servings from each group?
  • Do you think he/she meets the daily requirements?
  • If not, what advice would you give for modifying the diet, within the same cost?
  • Please record the weight and height of the person. Is the person normal, underweight or overweight?

 

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Nutrition Through Life Cycle – The School Age
Nutrition Through Life Cycle – Adolescence
Nutrition Through Life Cycle – Adulthood