Dietary Tips for The Elderly

Ageing process involves changes in physiological, pathological, social and psychological conditions of a person. Added to this, due to changing socio-economic environment, elderly people are sometimes left alone to fend for themselves to maintain their health. In such a situation, provision of nutritious recipes involving minimal cooking time and dietary modifications would help them to a great extent. This booklet contains information on the balanced diet for the elderly. Also included in it are some dietary tips, which help in maintaining normal health. Recipes that are incorporated in this booklet (i.e., 1. Easy-to-cook and 2. Ready-to-eat) are based on the criteria of minimal cooking time and convenience. It is hoped that this booklet will be useful to the senior citizens in maintaining their nutrition and health.

The aged or the elderly (more than 60 years of age) belong to post mature adult group of population. These people with all their wisdom and experience contribute their mite to total family income and welfare of society, and as such they should be considered as an asset to the community. It is true, that advances in medical science, improved health care and standard of living have helped people to stay healthy and prolong their longevity. However, during the aging process, certain inevitable degenerative changes that occur, result in functional decline. These are mostly influenced by genetics, nutrition, socio-economic, psychological conditions, illnesses and availability of health care facilities. Hence, proper nutrition and health care are necessary for them to lead a normal life. In this connection, it is important to consider the following inter-related aspects:

1. The ageing process

2. Need for good nutrition

3. Easy dietary tips for the elderly

Ageing process and nutrition

Some of the physiological, social and psychological changes that herald onset of old age are:

1. Lack of physical activity
2. Poor appetite
3. Feeling of unwantedness (loneliness)
4. A sense of neglect

The physiological and pathological changes that inevitably accompany ageing result in degenerative processes and lower functional capacity. These in turn, influence nutritional status of old people. Some of these nutrition related factors that have a direct influence on food intake are briefly described below:

1. Lack of physical activity reduces Basal Metabolic Rate (BMR) and thereby energy intake need to be reduced. However, there are no drastic modifications in mineral and vitamin requirements.
2. Alterations in gastrointestinal tract - a decreased secretion of salivary flow due to involution of salivary glands, a decrease in the volume and acidity of gastric juices and lower rate of absorption.
During old age, people tend to be disinterested in cooking food everyday and often not keen in opting for variety of foods. In some cases, food becomes monotonous and a few start skipping their meals, resulting in malnutrition. On the contrary, there is another group of elderly people who turn obese by overeating a variety of convenient and fast foods, and become the victims of overnutrition. Some of the common nutrition related problems among the elderly are:

1. Diabetes
2. Hypertension
3. Other cardiovascular problems
4. Gastrointestinal problems
5. Kidney problems
6. Arthritis

These indicate that a proper dietary management is necessary for health and well-being of the elderly.

Elderly population and some social and psychological factors

With the discovery of life saving drugs, and eradication of infectious diseases, like expectancy of our people is going up. According to 1981 Census of India, it is stated that the elderly population constitutes 6.1 % and by the year 2000 AD this figure is going to rise to 9.1 %. It is also true, that in majority of elderly people, it is very difficult to change some of the already established food habits, carried over from childhood. Food habits get influenced by several factors such as family, education, occupation, economic status, lifestyles and cultural norms. Factors which have a negative influence on the health and nutrition of the elderly are:

1. Lack of family support in times of need (because of widely prevalent nuclear family system).
2. Feeling of unwantedness
3. Economic constraints
4. Lack of value system among the members in the family.
5. Stressful conditions leading to tensions
6. Loneliness leading to disinterestedness in living and eating, resulting in malnutrition.

While each of these factors needs an indepth consideration in providing proper care for the elderly, the present booklet deals with some dietary tips for maintaining normal health and nutrition. It is necessary to consider the nutrient requirements of the elderly before discussing other aspects.

Nutrient Requirements

Ideally, there are no specific nutrient requirements worked out for the elderly in India. However, one assumes some differences in the requirements of the elderly compared to those of young adults, because calorie intake is proportional to energy expenditure. In the case of minerals and vitamins, there is practically no difference.

1. Energy
Energy is required for daily activities like walking, carrying out daily work and for vital functions occurring inside the body such as digestion of food, circulation of blood and respiration. Basal metabolic rate gradually decreases after the attainment of maturity due to a decrease in muscle mass tissues and physical activity. Energy requirement is reduced by 11 % and 10% in men and women respectively, compared to that of young adults (2). Hence calorie requirement has to be adjusted taking into consideration the body weight.

2. Protein
Proteins are necessary for building up muscles, replenish vital body fluids like blood and to make good the wear and tear of the body. They are also required for the metabolic processes of the body in the form of enzymes and hormones. About 50-60 gm of proteins are enough in a day's diet, providing about 10-12% of total calories (2).

3. Fats and oils
Fats and oils make food palatable and help in the absorption of fat soluble vitamins like A, D, E and carotene. Fats and oils are concentrated source of energy. Basically, the fat intake may be the same as that of young adults.

4. Carbohydrates
Carbohydrates are energy yielding substances. Senses of taste and smell are less sharp among older people which interfere with the appetite for many foods. During old age, loss of teeth makes it difficult to chew food properly. Elderly people tend to consume more of carbohydrate rich foods which require minimum chewing, are easily digestible need minimum cooking time, stand maximum storage, and are cheaper than protein rich foods. Carbohydrates form the bulk of daily diet. Mixed cereal diet is advisable to avoid the lack of minerals and vitamins which may result from use of single cereal. It is necessary that at least 50% of total calories are derived from carbohydrates (2).

5. Fibre
Apart from digestible carbohydrates such as cereals, sugar etc., several foods contain non-digestible carbohydrates in the form of cellulose, gums, pectin etc. They are called dietary fibre because they are indigestible. Dietary fibre contributes to the bulk of stools and helps to relieve constipation and lowers blood cholesterol level specially among elderly people. An amount of 25-30 gms of fibre is considered to be beneficial (2).

Minerals

6. Calcium
Among the minerals, calcium is necessary for the formation and strength of bones in the body. Lack of this mineral results in Osteoporosis (a bone disease especially seen among females) and periodontal diseases among the elderly. A slightly higher amount of calcium is required by the elderly as compared to adults (i.e., 0.8 to 1.0 g/day) to keep them healthy and also to compensate for lower absorption .

7. Iron
Iron is essential for the formation of haemoglobin in the blood. Since the amount of iron absorbed from food is quite small (ie., 2.5%), it is necessary to have 20-30 mg of iron per day .

Vitamins

Vitamins, though required in small quantities are very essential to maintain one's health. Recent advances indicate that antioxidant vitamins such as A,E,C and B-carotene can delay the aging process. They also prevent degeneration in blood vessels, heart, joints and eye lens etc. Among vitamins, the most important are vitamin A,B,C and D.

8. Vitamin A
Vitamin A is necessary for good eye sight, healthy skin and growth and development. Recent studies also suggest anti-cancer properties to vitamin A.

9. B-complex vitamins
Thiamine and Riboflavin among B-complex vitamins are essential to prevent signs and symptoms such as Angular Stomatitis, Glossitis and Nervous disorders.

10. Vitamin C
Vitamin C is necessary to prevent bleeding gums (scurvy) and for developing resistance against infections.

11. Vitamin D
Vitamin D along with calcium, helps to develop healthy skin and bones.

Source: Milk and Sunshine

Major food sources of these nutrients are given in Table 1.

Balanced Diets For The Elderly

Nutrient requirements for Indians have been worked out by ICMR (1990) (3), according to age, sex, physical activity and physiological status. Considering the lower physical activity during old age, the requirement for energy is expected to be 10-11 % less than that of adults (2), with a little difference in other nutrients. Accordingly, balanced diets for the elderly are worked out (Table 2), based on the Recommended Dietary Allowances for Indian Adults (ICMR, 1989) (3). The nutrients provided by the balanced diets are also indicated at the bottom of the table.

A sample menu pattern worked out based on the suggested balanced diet for the elderly belonging to different regions of the country is indicated in Table 3. Similar menu patterns according to seasons and disease conditions can also be worked out.