How does nutrition help you age well and why?

What we eat matters.

Ageing affects everyone in different ways but there are some common issues that most people aged 70 and over will experience at some stage. Common food-related issues among older adults include:

• loss of muscle and the need for more protein
• constipation and the need for more fibre
• reduced cognitive functioning
• decreased appetite, and
• undernutrition.

Food provides the nutrients and energy you need as you age. So what can you do to help older adults in your care stay healthy while ageing?

A healthy diet should include fruits, vegetables, legumes, nuts, whole grains, and fish. Here you’re going to look at some of the nutrients that are most important for healthy ageing and why they help combat the issues listed above.

Loss of muscle and the need for more protein

Muscle loss is a natural part of ageing and is called sarcopenia. It is thought to be driven by the reduced ability of our muscles to make new protein (muscle protein synthesis) after consuming protein-containing foods and doing exercise. This reduced synthesis is known as anabolic resistance¹. Eating enough protein at regular intervals and combining this with physical activity, such as regular strength training, is therefore vital to maximise muscle response (we’ll discuss this in more detail in Step 1.8). To ensure that enough protein is consumed, it may be necessary to choose protein-rich foods or protein-enriched recipes for foods an older adult is used to, or help them to change their eating habits.

Why is protein important? Proteins are the body’s building blocks. They’re used to build and repair tissues and help our bodies fight infections. There are many different types and some must be obtained from food because they’re essential for bodily processes but the body can’t produce them itself.

Older adults should try to eat a variety of nutrient-dense proteins. Meat or fish, dairy products, eggs, or egg-based products, vegetables, nuts and legumes such as beans, chickpeas, and soy-based products all contain protein. There is also protein in flour and cereal products. It’s important to ensure that every meal contains protein and that you use different protein sources at breakfast, lunch and dinner.

Constipation and the need for more fibre

Maintaining a high fibre diet is also crucial – it’s contained in foods like vegetables and whole grains such whole grain bread, rice or pasta. Beans and pulses can also be a good source of fibre.

Medical conditions and some medications can cause constipation, as can lack of exercise, inactivity and changes in routines. So ensuring older adults stay physically active is very important. Hydration is also key to preventing constipation; aim for 6-8 cups or glasses of fluid a day, more if the weather is hot.

Reduced cognitive functioning

Cognition is our ability to learn, a collective term for our ability to interpret, understand, and remember. A diet diverse in fruits and vegetables, especially berries, lettuce, tomatoes, apples, grapes, kale, onions, and cabbage is recommended². It’s a good idea to check vitamin D levels in frail, elderly people, especially if they have low exposure to sun and are therefore at risk of vitamin D deficiency. Vitamin D supplements are recommended in most European countries. For example, the new Nordic recommendation³ for adults over 75 years is 20 µg/day and for other adults 10 µg/day. In the UK, the government recommends that all adults and children over five should consider taking 10 µg/day during the autumn and winter when we are exposed to less sunlight, and adults who are frail, housebound or living in a care home are advised to take 10 µg/day throughout the year⁴. In France, the recommendation for adults is 15 µg/day⁵.

Decreased appetite

As we age, our ability to taste and smell food can change. The sense of smell is directly linked to the ability to taste food. As these senses become weaker, our enjoyment of food is diminished and this can lead to reduced appetite. Eating food that is good for us is vitally important to our overall physical and mental health, so working on ways to stimulate appetite is essential. Try serving a broad range of differently coloured foods to ensure a variety of flavours and experiment with new combinations of ingredients, put together in a different way.

Undernutrition

For older adults living at home, undernutrition (not eating enough of the right food to give your body the nutrients it needs) can be a serious issue. It can worsen existing health conditions, slow down healing and recovery processes, make people more susceptible to infections, increase the risk of falling, impair mobility, and increase the risk of depression. So it’s crucial to treat it with proper nutrient-dense food or by enriching diets and food with protein, fat and other essential nutrients, and by ensuring any specific dietary needs are met.

What can be done? Enriching food for older adults

Although older adults are less active and their energy requirement decreases, many lose their appetites and eat less than they should. It may be necessary therefore, to enrich their food to maintain the nutrient and calorie requirement.

The Association of UK Dieticians has produced a useful resource on eating, drinking and ageing well which can be downloaded and printed for easy reference. It contains details of the recommended amounts of different food types (fruit and vegetables, dairy, fats, etc), vitamins and fluids for people over 65 years.

You’ll look at fortification of foods in more detail later in the course.

Task

Before moving on to look at the the common signs of undernutrition, take a moment to research the Vitamin D recommendations in your country. Share them in the Discussion area so that a global list is built up and consider if the older adults in your care might benefit from supplements. Make a note of your decision in your Action plan

References

1. Cuthbertson et al., Anabolic signaling deficits underlie amino acid resistance of wasting, ageing muscle. The FASEB Journal 19(3): 1-20, 2005.
2. Gehlich KH, et al. Fruit and vegetable consumption is associated with improved mental and cognitive health in older adults from non-Western developing countries. Public Health Nutr. 22(4):689-96. 2019.
3. Blomhoff, R., et al. Nordic Nutrition Recommendations 2023. Copenhagen: Nordic Council of Ministers, 2023.
4. UK Vitamin D and care homes guidance. Updated 24 February 2021.
5. Les références nutritionnelles en vitamines et minéraux. April 2021.