by Alicia S. Landry, PhD, RD, LDN, SNS, Assistant Professor/University of Central of Central (UCA)
After age fifty, there are many metabolic and physiologic changes impacting the nutritional needs of an individual. A slower metabolic rate with age is due to a decrease in muscle mass; this results in lower caloric needs. Many older people experience difficulty obtaining sufficient nutrients to support or achieve optimal health. These challenges may be related to inadequate dentition or swallowing issues, cognitive and psychosocial changes, as well as insufficient income. Inadequate energy intake can eventually lead to chronic fatigue, depression, and a weakened immune system.1
As health practitioners, it is critical that we encourage older adults to consume nutrient-dense diets. The significance of this was noted in 2006 when the inclusion of separate nutrition recommendations for individuals 70 and over2 was made. Meeting daily protein requirements is essential for the aging adult because protein provides essential nutrients for the maintenance of bone structure and muscle mass. The Recommended Dietary Allowance for protein is 0.66 grams/kilogram/day for adults over 70 years of age, however, recommendations for older adults suggest that 1.2 grams/kilograms/day will meet the needs of many older adults. Carbohydrate in the form of high quality fiber, more complex carbohydrates and few simple starches or sugar should equate to 130 grams/day. Fats are the most efficient source of energy but there is no determined recommendation so these should be chosen wisely and should include fats with omega 3 and omega 6 fatty acids.2 Adequate Calcium and vitamin D are also important in the diets of older adults.
Older adults may experience changes in taste and appetite. Physical ailments, prescription medications, and loss of a significant other may impact appetite; emotional factors such as loneliness and depression can affect diet and appetite. Limited budgets may make affording food needed to support a balanced, healthy diet difficult.
“While federally funded programs provide food to millions of older adults each year, there are still many older adults going hungry.3 Food assistance programs can improve nutritional well-being, functional independence, and quality of life.1 General assistance programs such as the Supplemental Security Income (SSI), is intended to increase a person’s income to the defined poverty threshold. However, if SSI benefits are paying for expenses like medications and doctor visits, there may not be enough left for nutrient-dense food. Federal nutrition assistance through the United States Department of Agriculture (; http://www.fns.usda.gov/programs-and-services) include the Supplemental Nutrition Assistance Program (SNAP) and Senior Farmers’ Market Nutrition Program. Unfortunately, only about eight percent of participants in SNAP are aged 60 or over. Many eligible older adults report a “stigma” associated with receiving food assistance and therefore never try to obtain the benefits. According to USDA guidelines, households may have $2,250 in countable resources, such as a bank account, or $3,250 in countable resources if at least one person is age 60 or older, or is disabled. Resources that are not considered include homes and land, resources of people who receive SSI, resources of people who receive Temporary Assistance to Needy Families (TANF), and most retirement (pension) plans. An income test is performed and deductions for medical and shelter costs are included.
“Meals and snacks are provided by Adult Day Care Centers. Commodity foods can be obtained through the USDA’s Commodity Supplemental Food Program. Adult Day Cares are funded through the Child and Adult Care Food Program (CACFP) which provides aid to adult care institutions to provide nutritious foods for the health and wellness of older adults and disabled persons. The Commodity Supplemental Food Program supplements older adults’ diets with foods like low-fat dry milk, juice, rice, oats, peanut butter, dry beans, as well as canned meats, fruits, and vegetables.
“The US Department of Health and Human Services (US DHHS) administers the Older Americans Act Nutrition Program which includes Congregate Nutrition Services, Home-Delivered Nutrition Services, and the Nutrition Services Incentive Program. All people 60 and over as well as their spouses are eligible to receive meals through US DHHS programs regardless of income. The Home-Delivered Nutrition program aims to serve frail, homebound, or isolated individuals who are age 60 or over. The Nutrition Services Incentive Program provides grants to states, territories, and eligible tribal organizations that provide congregate and home-delivered meal programs, like senior centers and Meals on Wheels programs. A sample meal pattern that would be served daily at a congregate feeding site or home-delivered may be seen in Table 1. A very helpful resource may be found with the Older Americans Act Nutrition Programs Toolkit provided online by the National Resource Center on Nutrition, Physical Activity & Aging. Privately funded nutrition resources for aging adults include the National Foundation to End Senior Hunger, Feeding America, local food banks, as well as Meals on Wheels Association of America and others. Meals on Wheels provides a nutritious meal, visit, and safety check with each delivery. Depending on the funds available and the sponsor organization, days/times of delivery and meal composition varies. Regardless, older adults receiving Meals on Wheels food often are able to live at home, independently for a longer time.
Not only is the number of older adults continuing to grow, many older adults are experiencing inadequate savings and retirement. Adequate nutrition can save healthcare dollars and significantly improve quality of life for our aging adults. All health professionals can promote healthy nutrition practices in older adults and identify signs of malnourishment, feeding difficulties, or psychosocial changes impacting nutrient intake.
Table 1. Sample Meal Pattern
| Food Type | Recommended Portion Size |
| Protein foods | 3 oz., cooked portion |
| Vegetables and fruits | Two ½ cup portions |
| Enriched white or whole grain bread or alternative | 1 serving (one slice bread or equivalent) |
| Butter or margarine | 1 tsp |
| Dairy | 8 oz. fat-free or low-fat milk or calcium equivalent |
| Dessert | One ½ cup serving (fruit, pudding, gelatin, ice cream, sherbet, etc.) |
| Source: US Department of Health and Human Services | |
References:
1. Drewnowski A, Shultz JM. Impact of aging on eating behaviors, food choices, nutrition, and health status. J Nutr Health Aging. 2001;5:75–79
2. Otten JJ, Hellwig JP, Meyers LD, editors. IOM. Dietary Reference Intakes: The essential guide to nutrient requirements. Washington, DC: The National Academies Press; 2006.
3. Coleman-Jensen, A., Rabbitt, M., Gregory, C., & Singh, A. (2015). Household Food Security in the United States in 2014, Table 2. USDA ERS.