The challenges of healthy ageing: Eating well for older people

There may be some downsides to an ageing body, but as they say, ageing seems to be the only way to live a long life.

Healthy Food Guide senior nutritionist Rose Carr advises that for people 70 and over, a few food and activity changes can help improve your chances of a comfortable older age.

Challenge: I’m gaining weight

If you find that as you age you cannot eat the same amount of food and maintain your weight, you are not alone. Even the healthiest people find their energy needs decrease over the years. An average woman may need around 1000kJ less each day in her 70s than she needed in her 20s, and for a man it might be around 2200kJ less that’s needed — that’s assuming you’re active. So if you don’t gradually reduce your kilojoules over the years, your waistline will naturally increase instead.

The good news is, if your waistline is increasing a little, it’s not such a bad thing after all. For younger people, a body mass index (BMI) measurement of 25-29 is classified as overweight, and increases health risks, but from around age 65 this is no longer the case and from around 70 years of age health outcomes are actually better for those in the ‘overweight’ category. Older people are more susceptible to weight-loss when unwell and it takes longer to regain weight than when you were younger. However, for people carrying a lot of extra weight into older age this can impact mobility and other physical functions, so keeping an eye on the waistline is still important.

Challenge: My appetite has declined but I need more nutrients

Given your energy needs are less, it may at first seem helpful that your appetite is also likely to decline in your 70s, but here’s the catch: your need for some nutrients has actually increased. So you may need to adjust how you are eating as well.

Once you reach your 50s you need more vitamin B6, vitamin D and (for women) calcium. And when you reach the 70s you need 25 per cent more protein. Recent research suggests it’s important to have protein foods throughout the day, rather than just one high-protein dinner, and for people eating less food overall, a higher proportion of protein in the diet is healthier. You also need more riboflavin in your 70s and men now need as much calcium as women have needed since their 50s. Focusing on nutrient-rich foods rather than energy-dense foods becomes even more important as you get older.

Tips for getting the nutrition you need

• Eating a variety of nutritious foods is the best way to get the range of nutrients and the amounts you need. Include:
  – plenty of vegetables, fruit and wholegrain cereals
  – moderate amounts of lean meats, fish, poultry and reduced-fat milk and dairy products
  – small amounts of fats and oils from plant sources (limiting saturated fats from meat and dairy).
• Reduced-fat dairy products such as milk, cheese, yoghurt and ice cream, are the best sources of calcium. They also provide protein and B vitamins. Aim for at least three serves every day and use calcium-enriched milk.
• Eat a rainbow! Aim to use as many different-coloured fruits and vegetables over several days, rather than sticking with the same each day. Use canned and frozen vegetables and fruits to increase their variety.
• Aim to include protein-rich food in each meal such as lean meat, fish, poultry, legumes or eggs. Nuts and seeds, dairy and soy products also add protein.
• Snacking between meals is useful if you prefer smaller meals and/or you are losing weight. Choose nourishing snacks such as yoghurt, Milo with milk, fresh fruit, or a high-fibre muffin.
• If you’ve been on a restrictive diet for some years, whether it is for diabetes, following surgery or any health issue, make sure it’s reviewed by your GP or a dietitian to ensure it’s still suitable as you age.

Challenge: I’m losing weight

Even when you’re pretty healthy you may find your appetite declines so much you experience unwanted weight-loss. While hormonal changes mean older people will feel full more quickly and want to eat less, other factors can also reduce food intake: changes in taste or smell may mean food is less palatable, some drugs will affect appetite, and poorly fitting dentures can make eating a chore. If you’re living alone, you probably want meals you can prepare quickly and simply and most of us just eat less when we dine by ourselves.

If you find you’re losing weight unintentionally, do take it seriously. Firstly, check with your GP that there is no cause more serious than a limited appetite. Once you have covered that off, focus on increasing your energy intake.

Tips for gaining weight

• We often eat more when we eat with others so plan to do this on a regular basis. Plan morning teas, lunches or dinners with friends or family each week.
• Add healthy fats to your food. For example, add a little more canola or olive oil to salads or mashed vegetables, use avocado or a full-fat margarine (choose one low in saturated fat) on bread and crackers, snack on (pitted) olives, nuts and seeds.
• If you can’t eat larger portions, try eating more frequently and never skip a meal.
• Keep a supply of prepared meals in the freezer for when you don’t feel like cooking.
• Leave room for your meal by not drinking in the 30 minutes before the meal.
• Between meals, drink milk and milky drinks to add energy as well as protein, calcium and B vitamins.
• Add milk powder to porridge, milky drinks or creamy soups.
• Drink fruit juice rather than water (avoiding grapefruit juice if you’re on blood-thinning medication).

Add flavour

Julian Jensen, Committee Chair for the Nutrition Foundation’s Committee for Healthy Ageing and a recently retired dietitian says, “Older people have around one-third the number of taste buds they had when younger, so taste acuity declines.” Her advice to older people is: “Relax a little about using salt. Add it in moderation to cooking, rather than using it to ‘top-dress’ your meals — this way you use less and get a better flavour. And don’t forget about other herbs and spices that can help add more flavour to your food.”

Challenge: I get dehydrated

As you age you become more susceptible to dehydration. On one hand, your thirst sensation can weaken and on the other hand, the kidneys become less able to conserve water so urine is more diluted. For people with bladder control problems this can be compounded by wanting to limit fluid intake and of course getting up in the night can be a drag, so again drinking might be restricted after a certain time in the evening.

For people over 70 years especially, becoming dehydrated means you’re more susceptible to urinary tract infections, pressure ulcers, pneumonia, constipation and bowel obstructions, cardiovascular symptoms as well as confusion.

Tips for staying hydrated

• Count how many drinks you have each day. Aim for the equivalent of eight glasses (for women) and 10 glasses (for men) of fluids each day. This can include water, tea, coffee, fruit juice, milk, soup and even jelly.
• Remember you need to drink more in hot weather or when you’re more active.
• Plan your drinks during the day to ensure you’re getting enough. For example, you may have a routine to wake up with a cup of milky coffee, have juice with breakfast, drink morning and afternoon tea at a regular time.
• Add a slice of lemon or a sprig of mint to a jug of water and keep it in the fridge, refilling it each day.

Use it or lose it!

It’s inevitable that your body will change as you age. It’s been shown muscle mass declines at a rate of around one to two per cent each year after the age of 50 years. As a result, your metabolism slows, strength is reduced and balance is not as good. While you can’t stop this happening, good nutrition and physical activity can help maintain as much muscle as possible and at least delay the decline.

Regular exercise for all adults, including older people, reduces the risk for a wide range of conditions such as heart disease, type 2 diabetes, osteoporosis and depression. And while exercise is good for prevention, don’t forget it can also help to manage chronic disease and disability. Any physical activity is better than none, be it incidental activity such as vacuuming or walking to the letter box, leisure activities such as playing bowls or dancing, or more structured exercise such as a tai chi class or a walking group. If you’ve been inactive, it’s important to start slowly and allow yourself to build up your strength and stamina over time, aiming for 30 minutes or more each day.

Vitamin D

The best source of vitamin D is sunlight, as we get only small amounts from food. As we age our skin is less efficient at producing vitamin D and by 70 years our skin produces only about one-quarter of the amount it could produce at 20. This means getting enough sun exposure at safe times becomes even more important.

Between September and March, it’s a good idea to get outside for a walk, exposing legs and arms to the sun, for around 30 minutes each day before 11am or after 4pm. If you sit in the sun, make sure it is outside, not inside, as glass filters UVB, which is needed for vitamin D production.

During winter, or if you live in the south where UV levels are lower, discuss supplementation with your GP as a once-a-month tablet can be prescribed. A low vitamin D status in older people increases the risk of osteoporosis and fracture, and may also play a role in colon cancer, type 2 diabetes and lung function.

How are older people doing?

The recently published 2008-09 New Zealand Adult Nutrition Survey showed the majority of older people are not getting enough of these nutrients:

• Calcium: Crucial for bone health, increasing dairy intake is the best way to get more calcium.
• Selenium: This mineral is an important part of our antioxidant defence mechanism and we can easily get enough selenium by eating two to three Brazil nuts each day.
• Fibre: Important for bowel health, fibre is found in wholegrain cereals, vegetables and fruit.
• Zinc: Most older men, and some older women, consume less zinc than needed. Important for immune function, zinc is found in meats and shellfish, dairy products, whole grains, beans and nuts.