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Elderly
Successful aging is defined not only by longevity alone but also by sufficient well being socially, mentally and physically. Aging is a normal process that begins at conception and ends with death. Heredity and nutrition may slow aging. Goal of nutritional care should be to help the aged achieve healthy, purposeful an independent life. Aging is due to tissue damage due to free radicals. Free radicals are continuously formed due to exposure to environmental factors. These highly reactive substances lead to damage and alterations in the structure of proteins, lipids, carbohydrates and chromosomal material which leads to changes associated with aging. These changes can be retarded with the right nutritional support.

Changes in organs that influence nutritional requirements
  • Loss of taste.
  • Reduced saliva production so chewing and swallowing becomes difficult
  • Loss of teeth causes problems in eating
  • Decreased digestibility and absorption of nutrients
  • Poor nutrient absorption leads to osteoporosis, anemia and poor protein levels
  • Constipation
  • Poor immunity
  • Deterioration of brain function
Elderly
 
Nutritional Requirements
Energy: after the age of 35 the basal metabolic rate reduces due to reduced muscle mass and metabolically active tissue mass. As the muscle stores decreases the fat stores increases. This change in body fat is due to low physical activity. Thus the energy requirement decreases after the age of 30. Although the energy decreases the requirements of protein vitamins and minerals remain the same. Details of the requirements are mentioned in the Recommended Dietary Allowance (RDA).

Protein: There is a decrease in the skeletal mass as there are decreased stores of protein that are inadequate to meet the demands of protein synthesis. The food should be protein rich as compared to that of the adults. But due to poor digestion and appetite the elderly consume less protein. Deficiency of protein leads to odema (water retention), anemia and low immunity.

Carbohydrate: As Impaired Glucose Tolerance (IGT) is common among elderly. Insulin sensitivity can be enhanced by balanced energy intake, weight management and regular physical activity. Emphasis is placed on complex carbohydrates and controlling the intake of simple carbohydrates. Whole grains and pulses should be included in the diet and carbohydrates should constitute of 50 % of the diet. As the caloric requirements are reduced so carbohydrate intake is also reduced.

Fats: Emphasis should be placed on reducing the total fat intake especially saturated fats. Polyunsaturated and Monounsaturated oils should be preferred for cooking.

Minerals: Calcium needs increase during old age especially among women over fifty. The calcium is required as there is rapid demineralization of the bones leading to osteoporosis. The increased calcium intake would prevent fractures and dental decay. Iron intake should also be adequate to compensate the mild anemia that occurs with age. If necessary, iron can also be supplemented. Moderate restriction of sodium by restricting intake of salt and salty foods will delay or prevent cardiovascular diseases. Delayed wound healing, decreased sensation of taste and anorexia are signs of zinc deficiency. Healthy elderly display a good zinc balance despite dietary intake. Older people who avoid flesh foods may be at risk of zinc deficiency and should be supplemented.

Vitamins: Elderly people are at a risk of Vitamin D deficiency due to decreased exposure to sun or decrease in renal mass. Dietary supplementation of this vitamin along with calcium would improve bone density. Stress, smoking and some medications increase Vitamin C requirement. The antioxidant vitamins like A, C and E would help reduce oxidation and also promote immunity. The other vitamin requirements are similar to adults except Vitamin B6 and B12 which could be due to poor liver function and frequent gastritis which interferes with vitamin absorption.

Fibre: Fibre promotes bowel movement thus helps prevent constipation but the increase in the fibre intake should be done gradually or it would increase bowel discomfort and flatulence. When soluble fibre is consumed it helps keep blood glucose and cholesterol in check.
 
Dietary Guidelines
  • Food must be soft and easily chewable
  • Fat should be restricted
  • Consumption of foods rich in fibre should be encouraged
  • Coffee, tea and carbonated beverages should be restricted
  • Foods rich in calcium like milk and its products should be given
  • Green leafy vegetables should be given liberally
  • Foods given to the elderly should consist of familiar items as new foods are difficult to accept
  • Small and frequent meals should be given
  • Dinner should be light
  • Foods high in sugars , fats or both should be restricted, best avoided
  • Plenty of fluid should be given
Problems with the elderly
  • Osteoporosis
  • Obesity
  • Neurological dysfunction
  • Anemia
  • Malnutrition
  • Constipation
 
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