Aging Well: Eating right is worth the effort

The Issue:

Eating a nourishing diet is one of the top three life habits that can protect health and delay disability -- and may be more influential than genetics in helping older people stave off the decline that can come with aging, according to the Centers for Disease Control and Prevention. ¹

Yet, doctors often fail to screen older adults for nutritional risk, says researcher Nancy Wellman. “Good nutrition and a healthy diet is one of the most overlooked areas for healthy aging,” says Wellman, director of the National Policy and Resource Center on Nutrition and Aging. “Food is so basic, it’s often taken for granted.”

Physical and Psychosocial Barriers

Poor nutrition in old age can evoke images of a frail pensioner prying open a can of cat food. But experts say in real life, a constellation of physical, social and psychological problems can keep older adults from eating well and enjoying food.

Certain medications can diminish appetite or interfere with nutrient absorption, says Karen Zulkowski, a researcher at Montana State University’s College of Nursing. Swallowing or dental problems can also make seniors tentative about eating, she adds.

Even truly physical barriers can keep older people from a good diet. “In an urban area, the grocery store can be right across the street, but the elderly aren’t safe walking across the street to get the food,” Zulkowski says.

Psychosocial concerns can also dampen appetite, Wellman says. “Maybe their spouse has passed away, and they can’t imagine sitting at the table looking at the empty chair.”  

The Facts:

Hypertension, coronary heart disease and diabetes are all preventable, in part, by a lifelong healthy diet. ²

A 2004 study of older Canadian adults found that the seniors with a poor diet had fewer good physical health days and reported lower satisfaction with their overall life.  ³

Poor health and other barriers may prevent older adults from accessing food even when they have money to purchase it, according to a 2001 Journal of Gerontology study. ⁴

Some medication side effects can blunt appetite and impair digestion in older adults, according to an Archives of Internal Medicine study. ⁵

Persistent oral health problems are linked with lower consumption of some foods and nutrients, and dental health is closely linked with nutrition status according to two Journal of American Dietetic Association studies. ^6,7

Frequency of social contact is among the factors that can affect diet in older adults, according to a 2005 Journal of Nutrition Health and Aging study. ⁸

A small 2001 study of healthy older people found that protein, carbohydrate and fat -- each macronutrient working alone -- enhanced the seniors’ performance on memory tests. ⁹

Older women who followed a low-fat diet were generally able to avoid weight gain over seven years, according to January 2006 Women’s Health Initiative results. ¹⁰

Older women who switched to a low-fat diet and ate more fruits and vegetables did not have a significantly reduced risk for breast or colon cancer, according to results of the 2006 Women’s Health Initiative. ^11,12

Postmenopausal women who participated in intensive education sessions that encouraged them to follow a low-fat, fruit-and-vegetable rich diet achieved only modest reductions in cardiovascular disease risks over eight years.¹³

A study of nutrition education strategies for older adults found few successful ways to change behavior but suggests that the most effective approaches are conducted in a social setting, while providing hands-on activities, incentives and access to health professionals. ¹⁴                                               

Nutritional Assessment Provides a Map for Change

Uncovering the problems behind a poor diet or altered eating pattern takes more time than is available in a routine 15-minute doctor’s visit.

“If you are really going to help someone with their diet, you can’t just give them a tear-off sheet, or tell them to eat more,” says Nancy Wellman, director of the National Policy and Resource Center on Nutrition and Aging. “One needs to know where the gaps are in one’s eating.”

Some experts call for nutritional risk assessment for anyone over age 65, but Wellman says an analysis is especially important for older people who have a chronic illness or multiple chronic diseases. “The more complicated a person’s health profile is, the more appropriate it is to make a referral to a dietitian,” she says.

Wellman says physicians rarely have the training or time to suss out nutrition problems, but dietitians regularly “translate the science of nutrition into the art of making healthier food choices.”

A nutritional assessment usually begins with a simple questionnaire that can lead to a longer discussion about lifestyle and food habits. That conversation can often uncover motivation for change. “Sometimes they are willing to do almost anything to stay out of nursing homes. If that means eating better and moving more, it’s an easy sell,” Wellman says.

Wellman’s team recently completed a ten-site study designed to pinpoint simple steps to improve older Americans’ health. Results aren’t published yet, but Wellman said, “We found that when we offered mini-talks on nutrition and exercise, and used pedometers and little food check-offs, it improved people’s self-reported health status, and increased servings of fruits and vegetables, calcium-rich foods and fiber.”

Susan Moores, a spokeswoman for the American Dietetic Association, says crafting a successful meal strategy with seniors requires both cheerleading and a velvet-glove approach.

“You will find that people in their 60s really do not want necessarily to be grouped in with people in their 70s and older,” she says. “And people in their 50s, certainly aren’t real comfortable with the word ‘senior.’ So we have to be real careful with how we talk with folks.”

Diet and nutrition needs can be very different depending on a person’s age and level of independence, she adds. People age 50 to 65 -- even up to age 75 -- may be primarily fighting obesity, Moores says. The “young old” can be overweight and still undernourished because they are not eating the right foods, she says. By contrast, people over 75 have a greater risk for under-nutrition and for not getting enough calories, Moores says.

In the United States, the largest healthy eating program for seniors is the Older Americans Act Program, which provides group dining and Meals on Wheels.

But Wellman says some older adults hesitate to ask for help. Family members and health practitioners have to take cues from older adults to know how much intervention is needed and welcomed, Moores says.

Helping often begins with paying attention, she says. “Be vigilant in watching. Is there an unexpected weight loss? Check out the refrigerator; be a little snoopy,” Moores suggests.