Recently, I have been teaching medical students about nutrition, specifically the unique issues and needs of older adults. Please let me share some of the latest findings with you in case are an older adult and if not, probably know one near and dear.
A number of common problems occur that can affect healthy nutrition in older adulthood. Starting with the mouth, there is decreased saliva formation, loss of taste and smell, decreased appetite and poor dentition, which can all affect how well people start the digestive cycle. Drinking a lot of fluid to offset the dry mouth can result in a full stomach with less total calories which is not a good thing.
Next, come issues of swallowing. This is affected by reflux of stomach acid, changes in esophageal motility, altered tone of the lower esophageal sphincter and, in some cases, by stroke or other central causes. Strokes or cognitive problems can adversely affect the ability to swallow without aspirating food and fluid into the lungs. Thickened beverages and other alterations in food texture are sometimes used to keep fluid intake up and reducing chances of choking and aspirating.
Further downstream is the stomach which as we age secretes less acids, slows its emptying process, and absorbs food and nutrients less efficiently. Feelings of fullness and satiety may be reached earlier causing the older adult to ingest less than they really need. Powerful antacids like proton pump inhibitors, the purple pills, can further reduce absorption of essentials vitamins like B12 and D, as well as calcium and iron. All of these are essential in the health of the older adult.
Of course, constipation is a common problem in the older person for many reasons. It is no joking matter but hold onto your prune juice and fiber as I will devote next week’s column to this vexing condition.
Some other nutrition problems in the older person include frailty, anorexia and sarcopenia. Sarcopenia is due to muscle loss and function, reducing strength, mobility and increasing risk for falls, fractures, disability and acute and long-term care admissions. Research at UTMB and elsewhere has shown resistance exercise, adequate calories and vitamin D and at least 30 grams of high-quality dietary protein per meal for 3 meals a day can forestall this progressive and crippling condition.
Anorexia and energy intake changes with a loss of appetite result in a loss of weight shrinking older adults into “little old ladies and little old men” when they were normally sized previously. This often occasions concerns about cancer or other wasting conditions and the solution is close attention to energy dense and regular feeding and high caloric supplements.
Cognitive impairment and depression can also be worsened by dietary deficiencies, though the roles of dietary supplements have not been clearly proven. The Mediterranean diet, the DASH diet, or a combination called the MIND diet with abundant leafy greens, nuts, and berries can slow cognitive loss according to recent studies.
Addressing the nutritional needs of the older adult is a multidisciplinary team effort including primary care and geriatric physicians, nurses, dietitians, physical, occupational and speech therapists and social services.