Network Health Dietitians July 08 Issue 36

nutrition for older adults
Key points
Dr Joanne Lunn • Diet and lifestyle throughout the lifecourse will be ultimately
Senior Nutrition Scientist
responsible for healthy ageing and it is never too late to adopt
healthy habits.
BNF, London, UK
• It is important for older people to keep physically active.
• People aged 65 years and over should take a vitamin D supple-
Over the past hundred years there have been considerable
ment as well as regularly eating food sources (e.g. oily ﬁ sh, cod
improvements in life expectancy that have contributed to liver oil and margarine).
an ageing population. This has several implications for public
• Some older people, especially those living in institutions, may
health. Good health is essential for older people to remain
have low intakes or low blood levels of a range of micronutrients.
independent and to play a part in family and community
life and life-long health promotion and disease prevention
• National survey data have highlighted potential areas of
change that could improve the nutrient intake of older people
activities can prevent or delay the onset of non-communi-
but it is important to take into account other factors which may
cable and chronic diseases, such as heart disease, stroke affect older people’s dietary intakes (e.g. illness, poor dentition,
and cancer.
drug-nutrient interactions).
Up until now, ‘healthy’ life expectancy, has not increased at
the same rate carrying considerable implications for quality of
properties: they are needed to maintain an efﬁ cient immune
life and associated costs to healthcare providers. The focus of
system, which is known to become less effective with ageing.
public health nutrition is now turning towards improving health
Minerals
and quality of life in later years and health professionals are
The body’s requirements for iron are lowest in old age, but
now increasingly aware that good nutrition, being physically
factors associated with old age may increase the risk of iron de-
active and not smoking, are essential to ensure that people
ﬁ ciency anaemia. Such factors include chronic blood loss from
may have long, healthy and active lives.
ulcers or other disease conditions, poor iron absorption due to
The changing nutritional needs of older adults
reduced stomach acid secretion, or medicines like aspirin that
It is important that older people continue to enjoy their food
can cause blood loss from the gastrointestinal tract (Horwarth
and that they keep active (e.g. walking, gardening, dancing,
2002). Older people should be encouraged to consume foods
climbing stairs) in order to maintain a good appetite, maintain
containing bio-available haem iron. Calcium absorption is
mobility and prevent obesity. The physiological changes that
reported to decline with age (WHO 2002) and elderly adults,
occur with ageing may affect requirements for several nutrients,
and in particular, postmenopausal women who are at risk of
and the higher prevalence of disease and drug administra-
osteoporosis, should continue to include foods rich in calcium,
tion in older people may also affect nutritional requirements
such as milk and dairy products, in their diets.
and nutritional status (BNF 1996). However, currently, there are
Other dietary considerations
no speciﬁ c instructions on the dietary requirements for healthy
In addition to the recognised essential nutrients, there are other
elderly people and recommendations for the general popula-
food components, e.g. phytochemicals which are in plant-
tion still apply.
derived foods that may have important roles in maintaining
Energy and macronutrients
health. Research to identify the health-promoting potential of
Older adults often have reduced energy needs because of
phytochemicals has revealed a number of interesting issues,
their reduced total energy expenditure (Beaufrère et al. 2000).
although much more information is still needed (see Denny &
If energy intakes are lower, it is important that the foods chosen
Buttriss 2007).
are micronutrient dense so that other nutritional needs are met
Many diseases associated with ageing are chronic neuro-
degenerative diseases, which are not easily treated. Because
Micronutrients
many of these diseases have been linked to increases in oxida-
Ageing affects the requirements for certain micronutrients but
tive stress, strong efforts have been aimed at exploring dietary
it is difﬁ cult to distinguish changes in nutrient needs resulting
and therapeutic antioxidant strategies to combat the cellular
from the ageing process alone, in contrast to those resulting
damage. Recent attention has focused on the protective ef-
from disorders prevalent in older people (BNF 1996). Again, it is
fects of a major class of dietary polyphenols called ﬂ avonoids,
particularly important that, despite lower energy requirements,
which have been shown to protect against both age-related
nutrient density of the diet is high, such that nutrient needs may
cognitive and motor decline in animal models.
be met (Roubenoff et al. 2000).
In summary, intakes of most nutrients are the same for most
Vitamins older adults as they are for younger adults, although nutrients
There is accumulating evidence that older people may have usually need to be provided through lower overall food intakes.
greater needs for vitamins B12, B6 and folate owing to the Of course, a healthy diet is only one of the factors which inﬂ u-
prevalence of disorders that reduce absorption (e.g. as a result ence health and ageing. Other lifestyle practices, such as physi-
of atrophic gastritis). Deﬁ ciencies in these vitamins may impair cal activity, also make a signiﬁ cant contribution to health. Table
cognitive function, immunity and strength, and may also con- 1 outlines some lifestyle recommendations for healthy ageing.
tribute to increased risk of megaloblastic anaemia and heart A BNF Task Force is in the ﬁ nal stages of the preparation of a
disease (Roubenoff et al. 2000). Elderly people may also have report on the impact of health on ageing and the role for diet
increased requirements for vitamin D, which is necessary for and lifestyle intervention. The ﬁ nal report is due to be published
absorption of calcium and is important for bone health. at the beginning of 2009. See www.nutrition.org.uk/ageing for
Vitamin C plays an important role in the maintenance of
more information.
connective tissue and wound healing. Although there is little
evidence that recommended intakes of vitamin C need to be
increased in older people, a study on healthy European adults
References
(Heseker & Schneider 1994) suggested that, with increasing age,
Beaufrère B, Castaneda C, de Groot L et al. (2000) Report of the IDECG Working Group on body
weight and body composition of the elderly. European Journal of Clinical Nutrition 54: S162–3.
there is some impairment of vitamin C absorption. The diet should
BNF (British Nutrition Foundation) (1996) Nutrition in Older People. British Nutrition Foundation, London.
therefore include good sources of vitamin C, such as citrus fruit
Heseker H & Schneider R (1994) Requirement and supply of vitamin C, E and beta-carotene for
elderly men and women. European Journal of Clinical Nutrition 48: 18–27.
juice, fruit or vegetables. Vitamins C, E and carotenoids play an Roubenoff R, Scrimshaw N, Shetty P et al. (2000) Report of the IDECG Working Group on the role
important role as antioxidants, and have been inversely associ-
of lifestyle including nutrition for the health of the elderly. European Journal of Clinical Nutrition 54:
ated with age-related conditions. These vitamins are especially
S164–5.
WHO (World Health Organization) (2002) Keeping Fit for Life: Meeting the Nutritional Needs of Older
important for the elderly because of their potential protective Persons. WHO, Geneva.
26 NHDmag.com July ‘08 - issue 36
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