Nutritional Programs for the Elderly

  • Common Deficiencies in the Elderly
  • Important Factors to Good Health for the Elderly
  • Dietary Nutrient Program for the Elderly

    This program is designed primarily for people over age 65, an age group that continues to increase in numbers in our society. An important point I would like to state early is that we need to care for ourselves in our younger years so that we can stay healthy in our older ones. Also, our society needs to learn to better care for our elders and to incorporate them into a meaningful life to keep them feeling useful and youthful.

    Being old or aging is as much a state of mind involving how we live and our attitude toward life as it is a physical condition. Of course, our genetics are also important. Some people become old in their 50s and 60s, while others only really start to age (or degenerate) a year or two before they die in their 80s or 90s. Psychologically, even some young people are old. They are limited and resist change and lose the positive energy and love of life. Youth, like age, is really a state of mind.

    With regard to nutritional status, elderly people are sometimes even more difficult to nourish than teenagers. Many are resentful or rebellious and eat an unbalanced diet consisting of a limited number of foods. Malnutrition is fairly common in the elderly, with low calorie and protein intakes, as well as many deficiencies of important vitamins and minerals. Many elders eat less because of such reasons as apathy, diminished sense of taste and smell, poor teeth, low income, or inability to obtain or prepare foods, and they further have reduced digestion and absorption, which makes their intake needs even higher than usual. The government RDAs become relatively meaningless for the elderly; they simply need more nutrients!

    Many old-age problems, such as insomnia, anorexia, fatigue, depression, diminishing eyesight and hearing, fragile bones, and fractures, are a result of poor diets and nutritional deficiencies. This can also lead to a weakened immune system and more infections. The thymus gland, which produces the important T lymphocytes that mediate the cellular immune system and help to regulate antibody formation, tends to diminish in activity with aging—especially with a low vitality diet, living under stress, and possible emotional factors, such as loss of friends and relatives, anxieties of aging and loneliness, and depression—thus leading to problems of weakened resistance, infections, and sometimes cancer. Tissue weakness due to lack of cellular support can lead to decreased skin protection and increased aging of the skin. Free-radical formation and a reduction of neurotransmitter chemicals, such as acetylcholine, gamma-aminobutyric acid (GABA), glycine, L-glutamine, norepinephrine, and serotonin, caused by deficiencies of amino acids and the B vitamins including inositol and choline—all may contribute to aging, internally and externally, mentally and physically. (This is discussed further in the Anti-Aging Program.)

    Most elderly people have reduced production of gastric hydrochloric acid, which minimizes the breakdown of complex carbohydrates, fats, and proteins. The general function of the other digestive organs, such as the pancreas, which produces digestive enzymes, is also reduced. Often the digestive lining does not function as it once did, and absorption of nutrients, particularly minerals, decreases.

    Common Deficiences in the Elderly

    Calories Potassium Vitamin B1
    ProteinZincVitamin B2
    FiberChromiumVitamin B6
    FluidsIronVitamin B12
    CalciumCopperFolic acid
    MagnesiumVitamin AVitamin C

    Many elderly people simply do not obtain enough calories. Calorie count can be easily increased with more food, but it is important that it be more nutrient-rich food, so that the important vitamins and minerals are also provided. Less protein may be needed for tissue production, but because of poorer assimilation, as much protein as usual is needed. Amino acid intake is necessary to build cells, for energy, and for tissue repair.

    Fiber, in foods and as a supplement, is very important to colon health and function. It reduces the incidence of colon cancer and possibly other types of cancer, as well as pulling some chemical toxins from the body. Eating more fresh fiber foods, such as vegetables and whole grains, offers many other benefits as well. Extra bran (insoluble fiber) or psyllium (soluble fiber) will help bowel function when natural-fiber foods are not eaten in sufficient quantities. Constipation, a common problem in the elderly, can be reduced and eliminated with adequate fiber and water.

    Fluid intake by older people may also be low. Drinking enough clean water is crucial to good internal organ function for clearing impurities and for waste elimination. It also keeps the skin healthier and prevents dehydration, which may lead to all kinds of problems.

    A number of common vitamin and mineral deficiencies occur in the elderly, mainly from not consuming enough fresh, nutrient-rich foods. Vitamin A is commonly low, and this can lead to poor vision, dry skin, and weakened immunity. Thiamine and riboflavin (B1 and B2) may not be adequate in the diet because of low intake of whole grains, and this may affect the skin and energy level. Pyridoxine (B6) is often low, especially with avoidance of whole foods and with eating refined flour products. Folic acid may be deficient because of avoidance of leafy greens, and vitamin B12 may be inadequate because of both low intake and poor absorption. Folic acid and vitamin B12 are important for building blood cells and for energy. Supplemental B12, even through injections, is often helpful for enhancing energy levels in the elderly. Vitamin C intake may also be inadequate, because of avoidance of citrus fruits and fresh, raw vegetables; this deficiency may lead to poor tissue health, healing abilities, and disease resistance.

    The diets of the elderly population are often deficient in many minerals. In fact, deficiencies of minerals and hydrochloric acid (HCl)—needed for adequate absorption of most minerals, such as iron, calcium, and zinc—are very common. This inadequacy of digestion by limited production of HCl (and digestive enzymes) may well in fact be one of the most common health factors affecting the elderly, though it may be less obvious than some more externalized problems. Vitamin B12 absorption may also be low because of weak intrinsic factor, which is produced by the same parietal cells that produce hydrochloric acid. Calcium intake is one of the biggest concerns. Calcium deficiency is more common in women than in men. Low-calcium foods, lack of exercise, low hydrochloric acid, and poor digestion lessen calcium availability. Antacids, especially those containing aluminum, are best avoided because of their interference with calcium absorption and the possibility of aluminum toxicity, which has been implicated in Alzheimer’s disease and other types of senility. Avoiding both aluminum cookware and the storage or heating of foods in aluminum foil are also good ideas. Imbalances among calcium, phosphorus, and magnesium and possibly low levels of vitamin D also affect calcium bone metabolism. Magnesium in the diet (whole grains, nuts, seeds) may also be low, while phosphorus intake is often normal or elevated, and excess phosphorus may allow even more bone loss when calcium is deficient. Occasionally, older people with arthritis avoid calcium with the support of their doctors. However, there is no reason for that. With arthritis, calcium is being lost from the bones and may precipitate in the joints, but this is a result of the mineral imbalance. Calcium is needed in balance with phosphorus, magnesium, boron, and vitamin D.

    Decreased absorption and limitations in the diet may affect the levels of most of the minerals as well. Iron may be low, but fortunately there is less need for it in the elderly. If anemia is present, check for iron levels as well as B12, folic acid, copper, and protein. Iron-rich foods such as meat, even liver, may be used occasionally for their good protein and other nutrient contents. Copper, important to many energy and enzyme systems, can be obtained from whole grains, nuts, seeds, and many vegetables, and is very high in oysters. Zinc, which is necessary for immune function, acid-base balance, tissue healing, and the prevention of aging, is also often inadequate in the diet. Low immune function due to zinc deficiency is frequently a factor in infections, cancer, and cardiovascular problems. Zinc is present in many of the same foods as copper.

    One of the most commonly deficient minerals is chromium, which is sparse in the soil and foods, and often poorly absorbed. Chromium is important to the proper use of blood sugar, functioning in glucose tolerance factor (GTF) to support the function of insulin. Supplemental chromium is often helpful, and brewer’s yeast, if tolerated, is one of the better foods for supplying this mineral.

    Potassium may also be deficient, because of low intake of vegetables and higher intake of salt. Sodium, chloride, and potassium are the body electrolytes that help balance acid-base chemistry and fluid movement. With weakened kidney function, which is not uncommon in the elderly, electrolyte imbalances occur. Adding potassium in food and supplements and diminishing salt intake will help restore the balance.

    Many medicines may interfere with mineral absorption and function. Antacids may bind calcium, as mentioned earlier, as well as other minerals, such as zinc or magnesium. Many diuretic drugs stimulate the kidneys to clear more potassium, lessening body stores. When these drugs are prescribed by a physician, this is often carefully watched, and potassium may then be supplemented. But the diuretics, which are commonly used by the elderly, also increase clearance of zinc, magnesium, and other minerals, and these are not always replaced, so that deficiencies of these minerals can result. Antibiotics can reduce colon flora, a source for the production of B vitamins and vitamin K. This can limit many intestinal functions in any age group. Laxatives can also cause loss of nutrients, and mineral oil, used more frequently years ago, can bind the fat-soluble vitamins A, D, E, and K.

    Dietary factors that should be monitored include excessive consumption of simple sugars and total fats. Intake of sugar, refined foods, and other nonnutrient calories should be minimized. High intakes of sugar will increase blood fats, which will speed up aging and atherosclerosis. Dietary fat is also best kept at a minimum. Lower levels of stomach acid and reduced production of digestive enzymes make fat harder to process. There are more nutritious foods than the fatty foods, though some dairy products, if tolerated, may be helpful. Low-fat or nonfat milk is probably better than whole, unless we are trying to gain weight.

    Prevention of aging is very important. There are many aspects to this; the psychological ones are the most significant. The time to prevent growing old is between the ages of 40 and 60, when a good, well-balanced diet high in vitamins, minerals, and other basic nutrients, and low in fats and refined foods is crucial. Of course, this type of supportive nutrition does not become less important in the senior years. How we lived yesterday affects us today, and what we do today will influence our future. Our whole attitude toward life and how we live our days is really what we are looking at here. The way we feed ourselves is an outcome of our self-image, knowledge, conditioning, education, self-love, and desire to live and be healthy.

    The diet of the elderly should contain a variety of foods. This is often a challenge because of past experience, eccentric likes and dislikes, economics, and the state of health of the teeth and oral cavity. Good teeth or dentures are very important to a healthy diet. Sometimes, whole food groups may be omitted because of inability to chew them. If chewing is a problem, more fresh vegetable juices should be drunk; pureed foods, particularly vegetables, and cooled whole-grain cereals will add a lot of nutrition. Even balanced protein-nutrient drinks may be better than not eating. All of these foods add water content to the diet as well.

    Sufficient fluids and fiber are crucial to any elder’s diet. Fluids are important to prevent constipation and dry skin. Keeping everything moving in the tissues, circulatory system, and intestinal tract is a vital part of feeling good. Stagnation due to poor flow and dehydration can shut us down physiologically and psychologically. Good flow on all levels is essential to regaining health and staying well. Fluid intake should be enough to produce three to four pints of urine a day. More water, herbal teas, juices, and soups, as well as fresh fruits and vegetables (all water-content foods) will help.

    The older body usually uses fewer calories, while the percentage of body fat may rise. Problems of both underweight and overweight occur commonly in the elderly and are often harder to correct at this time of life. At this age, a little (5–10 pounds) excess weight is probably healthier than being underweight. Being too heavy, though, is hard on the bones; in addition, obesity increases the risk of cardiovascular disease and cancer. The three health monitors we do not wish to let rise too much as we age are blood pressure, cholesterol levels, and weight. To maintain weight, it is wise to eat a diet containing the calories required for our ideal weight at ages 25–30. A nutritionist, dietitian, or doctor should be able to help with calculation of these caloric needs.

    Remember, though, those calories need to contain nutrients. Some meats and dairy products may be used to obtain appropriate amounts of protein and vitamin B12. Supplemental amino acids with good levels of methionine and lysine are helpful for protein building when protein food intake or energy is low, since they may be more easily utilized as they do not need to go through digestion. It is important to include plenty of fresh fruits and vegetables (raw and steamed, and even vegetable juices and soups), and the whole-grain cereals and legumes. These high-nutrient foods contain some calcium and other nutrients that are helpful to bone health.

    Older people who are not currently on a wholesome diet can make a slow transition over one or two months to more natural foods. This means a reduction of refined foods, canned and packaged foods, and devitalized foods. It may be helpful to make these changes gradually, so as to allay the threat of upheaval. Though it is more difficult to change our ways as we age, these positive changes are still possible and very helpful. Remember, if we eat vital foods, we will be vital!

    Think of a few people in their 60s, 70s, or 80s. What do you think has led to their degeneration or to their health and vitality? What are you planning for your anti–aging program? Have you already begun?

    Avoiding overeating and underactivity is important, because this nondynamic duo can be disastrous. Likewise, a poor appetite can result from lack of exercise with poor utilization and circulation of previously obtained nutrients. Exercise is necessary at all stages of life, and it is no different for the elderly. Not only will it improve the appetite and the desire for better foods, it may significantly improve our attitude toward life. Exercise is a key to bone health, helping prevent osteoporosis. It will also improve other functions—digestion, assimilation, and circulation, as well as muscle tone. Walking, swimming, and dancing are probably the best all-around exercises for older folks, though any may be suitable depending on past history and present condition. If you are not exercising regularly, it is wise to build up endurance slowly to a good active program. It will help in all walks of life.

    Often there may not be as much enthusiasm for good nutrition, exercise, and life in general in the elderly. When the body is not working as well, it is not as much fun to take it out for a spin. That is why it is so important to care for ourselves well in earlier years so that we can maintain our vitality and spirit. Creating more support programs for the elderly, plus training programs for those who care for the elderly, will help our society and each of us in our later years.

    Loneliness and isolation from family and other loved ones are common for the elderly. Death of a spouse may leave the remaining partner without the enthusiasm or capability to care for him or herself. Encouraging and supporting these folks to attend group or community meals and find new friends can make a big difference. Sharing meals and visiting with relatives may have a special meaning and be a primary encouragement to living. Extended family and local community meetings and meals, especially if they have good food, can be very supportive to many elderly people. Engaging one another in exercise activities, such as walking, hikes, or classes, will help in socializing with peers and boosting morale. Interactive, nurturing therapies, such as counseling or massage, can be very helpful at reducing resistances and enhancing physical energy and flexibility. Our society also needs to learn better how to incorporate this growing age group (in years and in numbers of people) into the functioning community. Connecting our elderly people with the support or care of young children, I believe, is an ideal approach. Young children and elderly people often seem to have a special magic together.

    For single people who cook mainly for themselves, here are some suggestions to economize, be practical, and still eat well. Sharing cooking and meals with a friend or two will allow easier preparation, easier shopping, and reduced costs, especially if the friends take turns shopping and cooking. The more people that food is prepared for, the lower the cost per person. If you are cooking just for yourself, buy smaller quantities of food and prepare simpler meals. With many foods, it is wiser to make extra portions, enough for a day or two. Soups, grains, and casseroles will refrigerate well and can be used over two or three days. Meat dishes and other foods can be packaged in individual meal sizes and frozen for later use. If the appetite is not too good, it is still wise to eat regularly, with smaller, nutritious meals. Many quick-fix foods should be on hand; eggs, yogurt, and instant whole-grain cereals are some examples. Nutritional yeast and molasses can be used in blender fruit drinks, with or without milk, a raw egg, and a piece or two of fruit such as banana or pear (if this is supported by the digestion; it’s not perfect food combining).

    Prune juice and bran are common laxative foods to help keep the elimination regular and avoid the problem of constipation. A morning or evening drink made with 4–6 ounces of prune juice, 2–4 ounces of water, a quarter or half lemon, and 2 tablespoons of wheat or oat bran should do the trick.

    Overall, good nutrition is a vital part of any senior’s health plan—one of the best buys in the health insurance market. Maintaining regular activity and exercise is equally important. Drinking plenty of pure water, avoiding processed and chemical foods, and eating lots of fiber foods, such as the fruits, vegetables, and whole grains, are basic nutritional guidelines for staying healthy. Avoiding or minimizing the use of unnecessary pharmaceutical medications and other drugs, such as nicotine, caffeine, and alcohol, is also important. Most of the above suggestions will help to prevent or slow the aging process. Additional antioxidant nutrients are also a good idea. Many of these free-radical scavengers are included in this program (they are further discussed in the Anti-Aging program in Chapter 16).

    Important Factors to Good Health for the Elderly

    Regular meals

    Low-fat, high-fiber diet


    Nutritional supplements

    There are many herbs that may be helpful to aging people, including ginseng root, Gingko biloba, and gotu kola leaf. Ginseng has long been used in the Orient to relieve fatigue and strengthen people. Known as the “longevity” herb, it is used regularly by elderly Chinese men and women to slow the aging process. Ginseng tea bags, powder, or concentrate can be used in hot water to make tea and a couple of cups drunk daily. One or two capsules of powdered ginseng root can be taken twice daily to give a feeling of greater strength. Raw pieces of the hard root can be sucked or chewed, but this is not as potent as the tea. Be aware that excessive use of ginseng root can elevate the blood pressure (as can licorice root) and possibly irritate the gastrointestinal mucosa. The trace mineral germanium has been found to be in high concentration in ginseng. Gingko biloba, another popular oriental herb from the leaves of an ancient tree, has been more recently used in this country to help with circulatory problems, senility, and hearing disorders.

    Gotu kola herb is more popular in India, where it also has an ancient tradition. It acts as a brain stimulant, strengthening the memory and other mental powers. Gotu kola can be taken as a tea or in capsules, by itself or with other herbs. In Western medicine, a drug that has been fairly popular among the elderly population (as well as with young men who want to appear alert and quick-witted) is hydergine. It is a cerebral stimulant that improves memory and mental clarity, with very few side effects. It is now used very commonly in people with senility and poor memory.

    Among elderly men, prostate enlargement affecting urine flow and possibly leading to prostate surgery is very common. A swelling of the fibromuscular prostate gland can result from such factors as a high-protein, high-fat diet and insufficient activity, both physical and sexual. A diet that is low in chemicals, fried foods, and fats in general and high in fresh foods with good liquid and nutrient content will help things to move better and keep the prostate healthy. Regular exercise and stretching, especially yoga-type inverted positions, and maintaining some sexual activity also offer preventive benefits. Nutrients such as vitamins A, C, and E and other antioxidants, especially zinc, may be helpful in reducing or preventing prostate problems. Herbs such as saw palmetto berries, corn silk tea, parsley, ginger root, marshmallow root, juniper berries, and uva ursi have also been helpful to many men with prostate problems. An encapsulated formula with some of these herbs taken three times daily or a tea drunk two or three times daily could be tried for a month or two. Refer to an herbal text for further information on these and other herbs related to the prostate or the aging process.

    Most people in their later years would be helped by an easy-to-digest, well-balanced vitamin and mineral formula for nutritional insurance. There are very few people over 60 who do not have some symptoms of early chronic illness—the body degenerates slowly, blood vessels get clogged, senses may diminish, and digestion and assimilation may weaken. So it is wise to use a nutritional supplement to ensure the best chance for the body to get plenty of what it needs for proper functioning. Many of the nutrients offer some protection against inflammation, regulate blood clotting, improve immune function, and improve fat metabolism by helping the body to handle cholesterol and triglycerides. Several high-quality powdered and encapsulated general formulas, which are easier to digest and assimilate, are available from companies such as Nutricology in San Leandro, California; DeBuren International in Mill Valley, California; Karuna Corporation in Novato, California; and TwinLab, in Ronkonkoma, New York. There are many others; check your local health food store or pharmacy.

    As with the other programs, the nutrient ranges in the table here are from minimum needs, which may be obtained through diet and/or a basic daily supplement, to optimum insurance levels, which may require higher-dose formulas or even vitamin injections. For the elderly, because of poor digestive function, a powdered general formula taken a few times daily will improve the chances of absorbing sufficient amounts of many important, though hard-to-assimilate nutrients. Many seniors are also helped by digestive aids such as extra hydrochloric acid prior to meals and pancreatic enzymes in between meals to improve the breakdown of food. Some of the formulas I mentioned above, such as DeBuren’s Optimum I and II, also contain these digestive aids to help the nutrients be better utilized.

    When high amounts of supplemental fiber, such as wheat bran, are used (I recommend eating more high-fiber foods), more vitamins and particularly more minerals may be needed to make up for those pulled out through the colon by the fiber. Extra B vitamins are often needed to support function. Usually, double levels of most of the B vitamins are suggested. I think doubling the intake of most of the hard-to-absorb minerals, such as chromium and zinc, can help as well.

    Remember, common deficiencies in the elderly include vitamins A, B1, B2, B6, B12, and C, folic acid, and the minerals calcium, magnesium, zinc, iron, chromium, and other trace minerals. Calcium, magnesium, and vitamin D are important to support a continued healthy skeleton. Plenty of water and good quality vegetable oils (cold-pressed) are also important to keep the skin and tissues healthy. The following table offers some guidelines for setting up a good supplement program.

    Dietary Nutrient Program for the Elderly*

    (Range — RDA to Optimum)

    Calories Men — 1,900–2,600
    Women — 1,600–2,200
    Protein60–80 g.

    Vitamin A5,000–10,000 IUs Chromium200–500 mcg.
    Beta-carotene10,000–20,000 IUs Copper2–3 mg.
    Vitamin D200–600 IUs Fluoride*1.5–4.0 mg.
    Vitamin E**60–1,000 IUs Iodine*150–300 mcg.
    Vitamin K100–300 mcg. Iron10–20 mg.
    Thiamine (B1)1.5–50.0 mg. Magnesium400–800 mg.
    Riboflavin (B2)1.5–50.0 mg. Manganese3–15 mg.
    Niacin (B3)16–100 mg. Molybdenum150–500 mcg.
    Niacinamide (B3)50–100 mg. Phosphorus*800–1,200 mg.
    Pantothenic Acid (B5)7–500 mg. Potassium*2–5 g.
    Pyridoxine (B6)2.5–50.0 mg. Selenium150–300 mcg.
    Pyridoxal-5-phosphate20–50 mg. Silicon50–100 mg.
    Colabamin(B12)***10–500 mcg. Sodium*1.5–3.0 g.
    Folic acid400–800 mcg. Zinc15–60 mg.
    Biotin150–400 mcg.
    Choline250–1,000 mg. Hydrochloric acid5–10 g.,
    Inositol250–1,000 mg. (as betaine or glutamic acid) or 1–2 tablets
    PABA25–100 mg. (prior to or with meals)
    Vitamin C60–3,000 mg. Digestive enzymes1–2 tablets
    Bioflavonoids125–500 mg. (pancreatic enzymes)
    (after meals)
    Boron1–2 mg. Flaxseed or cod liver oil1 Tablespoon
    Calcium800–1,500 mg.
    Chloride*2.0–4.0 g.

    ***As with other life stage support programs, nutrients easily available, such as sodium, chloride, phosphorus, sulfur, and potassium, are not usually supplemented unless there is a deficiency. Of these, potassium may be more commonly supplemented due to poor nutrition or medication.

    ***Can go up to 1600–2400 IUs for intermittent claudication.

    ***Vitamin B12 is commonly used as an injection in the elderly, at least several times a year, to help build up tissue stores.

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    Written by Elson M. Haas MD