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Making Sense of Nutrition Advice for Seniors
Updated on: October 2022
Reviewed by: Nancy Leahy, RN, APNP
Nutrition can be especially confusing for seniors, but of course these days nutrition is confusing for everyone. Every month a new study comes out that revises our understanding of what, and how much, we should eat. And even when experts agree on nutrition advice, it can be next to impossible to understand how to apply that advice to senior nutrition.
The confusion isn’t just about what seniors eat: it’s also about what they don’t. Because aging affects all systems in the body, seniors frequently have additional challenges to face when it comes to eating properly. Illness, disability, and isolation can prevent seniors from getting the food they need to maintain a healthy lifestyle, and even some of the more common effects of aging, such as the loss of taste and smell and the loss of appetite, can make seniors less interested in taking in calories and nutrients.
Unfortunately, nutrition is just as important for seniors as it is for younger people: undernourished seniors can have problems fighting infection, experience cognitive issues, and suffer from the sort of muscle weakness that can put them at risk for catastrophic falls.
Fortunately there are ways to address all these issues, and, armed with those strategies, and with a full understanding of how standard nutrition advice can be modified to suit seniors’ unique needs, there’s no reason why age should prevent an otherwise healthy senior from getting all the nutrition they need—or, if they’re fighting illness or injury, getting the nutrition they need to heal.
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Senior Nutrition: The Big Challenges
Still, there’s no escaping the fact that age can make it harder for some people to eat and drink as much as they should. And as a result, malnourishment can be a significant issue among the elderly, exacerbating problems and dangers that are already present. For example, a 1995 study found that 43% of senior patients who were admitted to an intensive care unit were malnourished.
Where do these challenges come from? Here’s a quick look at some of the issues that can prevent seniors from getting all the food they need.
In this article we’ll be focusing mostly on the problems that individual seniors can face, but if you’re a senior, or have a senior in your life, it’s important to keep some broader concerns in mind. For example, many seniors find themselves less interested in eating because they live alone—an effect that can be especially profound for people who have recently lost loved ones.
Many seniors also have problems keeping up their nutrition because, living on a fixed income, they have trouble affording food. In fact, a survey conducted by the AARP Foundation of people 50 and older found that many—even many whose income was double the federal poverty line—had found themselves needing to cut down on what they’d spent on food in the previous year. If you’re a senior wrestling with either of these issues, you might find it hard to admit that you’re having problems.
Still, understand that a lack of interest in mealtimes can lead to health issues, just as they will for younger people. If you have a senior in your life, be sure to check in: ask specifically if they’re skipping meals out of loneliness or cutting down on their food budget. There are services that can help provide companionship, even if you can’t, and of course there are services like food pantries and Meals on Wheels that exist primarily in order to help seniors in need.
Lack of Appetite
Now to consider physical barriers to good nutrition. The first sounds simple: lack of appetite. To a certain extent, the loss of appetite among seniors is understandable, and possibly benign: aging tends to cause loss of muscle mass; the loss of muscle mass means seniors need fewer calories, and this naturally causes older people to be less hungry. The problem, however, is that it’s difficult to maintain healthy levels of vital nutrients—vitamins, minerals, and essentials like protein—as your intake of all foods decline.
Other factors in loss of appetite are less benign, however. As we get older, we start producing less of the hormones that trigger hunger in our bodies, meaning that we can even start to get fewer calories than we need to maintain ordinary activities. Older people are also likely to be taking medications that suppress appetite or even cause nausea. What’s more, GI issues and other infirmities can also cause seniors to lose their appetite.
Loss of Sense Of Smell and Taste
Another related effect of aging is our tendency to lose our senses of smell and taste. Younger people don’t have to wait until they get to the table to appreciate the smell of cooking food: older people, however, may not appreciate kitchen aromas, and even when they’re eating, they may not enjoy the taste or smell of their food as much as they used to. Unfortunately, too, some medications can dull the sense of taste, and so again they may contribute to seniors’ disinterest in food.
Quite apart from actual GI illnesses or the side effects of illnesses elsewhere in the body, our GI system tends to run into problems simply because we’re getting older. As we age, our intestines become less efficient at absorbing nutrients. Digestion slows, too, and as our stomachs take longer to empty, they cause problems like reflux and heartburn, and can make gas issues more likely. What’s more, as appetite decreases for other reasons, so does our intake of the fiber essential for good gut health, leading to a vicious cycle in which poor nutrition leads to digestive issues that then lead to poor nutrition.
Related to gut problems are problems elsewhere in our GI system, particularly with chewing. As we get older, we lose muscle mass everywhere, even in our jaws, and this can make both chewing and swallowing more difficult. What’s more, age can lead to dental issues, and this, too, can interfere with seniors’ ability to chew—and, by extension, cause problems in their digestive system.
Disabilities And Mental Health
More than 38% of people over 65 had at least one disability as of the last census, according to the U.S. Census Bureau. And physical disabilities can also take a toll on nutrition: They can prevent seniors from being able to shop for food or prepare their own meals, and can, in some cases, even prevent them from feeding themselves. And cognitive issues like dementia can also get in the way of seniors’ ability to make their own meals, even when other functions aren’t affected. Finally, many seniors struggle with depression, and depression often leads to a lack of appetite.
Some Basic Nutrition Strategies
With all these hurdles in the way of good nutrition, what can seniors—and the people who care for them—do? The short answer, though it involves a lot of details that we’ll get to later, is simply to get in the habit of eating regular, nutritious meals. But there are some things to stay mindful of even if you’re fully on board with more healthy eating.
What About Supplements?
Remember one of the fundamental issues in senior nutrition: that even when a lack of appetite comes from needing fewer calories, taking in less food can prevent seniors from getting the vitamins, minerals, and other essential nutrients that they still need—and may need more of now that they’re older. In such a situation, many doctors will recommend that seniors take dietary supplements. These supplements don’t have to come in pill form either: liquid meal replacements like Ensure can also help seniors get the nutrients they need—and also provide some badly-needed calories.
It should be noted, however, that not all researchers agree on the importance of supplements. A 2014 review by the U.S. Preventive Services Task Force, for example, recommended against daily multivitamins for adults who had no serious health problems. And even seniors may be able to avoid using supplements as long as they’re continuing to eat healthy, so you might be better off spending your money on actual food. Finally, it’s important to note another caveat about supplements: they are also implicated in choking incidents among seniors.
But that’s the cost-benefit analysis for otherwise healthy people. For seniors having real problems getting enough nutrition from the food they eat, taking supplements can be a useful, and healthful, strategy. And there are particular supplements that seniors may need more than younger people.
- Since seniors are less likely to get sun exposure, they may need help getting vitamin D, for example, even though vitamin D is now known to help with chronic pain and help prevent heart disease.
- Senior digestive systems also have difficulty absorbing vitamin B12, and so supplements might be necessary, especially since a deficiency in B12 is linked to dementia.
- Many older women supplement with calcium, since loss of bone mass is known to be a problem faced by women, but men, too, have to deal with this issue, especially as they get older.
- Finally, while the body has no trouble absorbing Omega-3 fatty acids, your brain cells, the chief beneficiary of Omega-3 in your body, tend to have a hard time taking on this essential nutrient as you get older. As a result, the amounts you take in in food might not be enough to support this nutrient’s benefits for mood and memory. For that reason, an Omega-3 supplement may be essential.
There’s one last nutrient that you may want to supplement for: protein. It’s such an obvious need that you may not think about it as a nutrient, but it’s essential to maintain muscle mass (which in turn helps with a variety of important functions from simple activity to immune system strength). And if appetite is reducing the intake of food, there’s a good chance that a senior won’t be getting enough protein. Mixing protein powders into shakes or using meal replacement drinks will help you stay healthy.
One secret weapon in keeping seniors well-nourished is easily accessed, fairly palatable, and mostly free. And that’s water. The problem is, however, that, once again, age interferes with our body’s ability to get as much water as it needs. For one thing, older bodies retain less water than younger bodies do, sometimes as much as 5-10% less. To make things worse, older people are less likely to feel thirsty, even when they’re on the verge of being dehydrated. What’s more, drinking water can lead to some unpleasant effects: a single glass can make a senior feel full, cause bloating or gas, and can cause significant problems for those dealing with incontinence.
Despite all these issues, good hydration is essential. After all, being dehydrated can cause serious problems in its own right. For example, dehydration may make people as much as twice as likely to die from a stroke. Not having enough water can also cause unpleasant health issues such as headaches, fever-like symptoms, dizziness, and a lack of energy—as well as problems with memory and focus. Finally, dehydration can lead to a loss of appetite and other unpleasant GI problems like heartburn and constipation.
The good news, however, is that staying hydrated doesn’t necessarily mean constantly refilling of your water glass. Not everyone needs the proverbial “eight glasses of water” anyway, and people can maintain hydration using beverages they enjoy, including fruit juices, coffee, and tea. What’s more, juices, milk, soft drinks, and other beverages may also contain calories, enabling a senior to meet two nutrition needs at a time.
Tackling GI Problems
As mentioned above, a variety of digestive issues can contribute to poor nutrition for seniors, but there are things you can do to make gut problems much less of a hurdle.
Just Eat Better
The simplest way to improve GI health is to eat a more balanced and healthy diet in general. The more nutrition you bring in, the better off all parts of your body will be, including your digestive system. There’s obviously a chicken-and-egg element to this approach, but if you can replace some unhealthy food with healthier food, or begin to eat more high-fiber foods, for example, you may be able to make it easier to stay well-nourished.
We all have certain foods that we love that also cause us digestive problems. For younger folks, that might not lead to any larger issues, but in older people, who might have trouble staying well-nourished at the best of times, missing a meal because of an upset stomach could be a much bigger deal. If you can, try to eliminate from your diet anything that might cause you problems: find alternatives, and, if that’s not possible, reduce your intake.
Eat Softer Foods
If you’re experiencing problems chewing or swallowing, there are a number of steps you can take to make it easier to take in calories. Instead of cereal for breakfast, you can make smoothies. Instead of raw fruits and vegetables, you can cook them so they’re easier on your teeth and throat. You can keep drinking water through the meal in order to ensure that your food has enough moisture to be easy to chew. You can also elect to go with softer food in general, such as bananas, or cooked cereals. There’s no reason to be ashamed of taking such measures: even younger people can have dental problems, and better nutrition may eventually make chewing and swallowing easier.
Again, just eating a variety of appetizing foods is often enough for seniors to get enough nutrition. But given the challenges some seniors face, it can help enormously to take a different approach to meals and to food in general. That’s because much of the standard advice about what’s healthy and preferable in terms of the food you eat doesn’t apply as much when you’re not eating enough. Here are some ways to think about food that may make it easier to get the nutrition you need as a senior:
Is A Weigh-Reduction Mindset Still Appropriate?
As we get older, it’s always possible that the effects of our diet over the course our lives could catch up with us. And it’s also true that addressing some of the biggest diet risks—excess salt and fat in the diet, for example—can still have beneficial effects. By the same token, studies suggest that getting in a couple more servings of fruits and vegetables every day can cut problems related to cardiovascular disease by almost a third.
But for seniors who just aren’t getting enough to eat, such considerations really should be laid aside. Your body needs calories in order to perform basic functions, and if “healthy” foods aren’t appetizing enough for you to get those basic calories, then don’t be afraid to eat cookies, or some other favorite food, in order to boost your intake. Especially as seniors progress through their 70’s and 80’s, favorite foods can be a source of joy and satisfaction as well as essential nutrients.
Don’t be afraid of prepared food:
In a similar vein, for seniors who are having difficulty preparing their own meals, having pre-prepared food available can make it much easier to find nourishment. Since seniors take in less food in general, it’s better to have nutrient rich foods like fruits and vegetables making up significant parts of the diet, but again, if getting enough calories is a problem, don’t be afraid to rely on microwaved meals and other items from the pantry and freezer. In fact, pre-prepared frozen fruits and vegetables can be a great source of vitamins and fiber.
Have more meal times:
One easy way to address a lack of appetite and the slowing of the digestive system is to have more, and smaller meals. This can be as simple as making it easier to snack during the day by leaving healthy snacks in easy reach, but it can also mean planning for second breakfasts and lunches. Interestingly, people who snack during the day will often also eat more at mealtimes, so nibble away!
Spice up your foods:
As mentioned above, we tend to lose our senses of taste and smell as we get older. Fortunately, though, there’s an easy solution to this problem: spicing up your meals. If possible, avoid using salt to give your food more flavor, but feel free to add more herbs or other spices to your favorite foods, and feel free to exceed the recommended spice levels in your favorite recipes. Finally, food can become more appetizing if it’s attractive to look at, so it can help to add bright, fresh fruits and vegetables to your plate and to individual dishes.
What to Eat, Though? And How Much?
Even if you do find ways of increasing your intake of food, there remains the question of what you should eat. This is obviously a subject of a lot of controversy: every day a new study urges us to eat particular foods, abandon others, and–often–to ignore previously published advice. Even the general nutrition guidelines have changed dramatically over the years, with the government and other researchers releasing new models of how to eat every decade or so.
Pyramid or Plate?
Early attempts by the government to give nutritional guidelines might seem fairly primitive to us now. From promoting the four basic food groups to laying out food recommendations on a “food wheel,” the government’s attempts to clarify what people needed in terms of nutrition could only be as good as the medical research that backed it up.
Then, in 1992, in response to advances in nutrition research, the US Department of Agriculture created a model of nutrition called the “Food Pyramid.” This familiar figure was laid out in six sections, each covering a particular type of food, with the size of each section indicating how much you needed of that type of food every day. The Food Pyramid advice ran along these lines:
- Cereals and grains: the pyramid suggested 6-11 servings each day.
- Fruits: 3-4 servings every day
- Vegetables: 3-4 servings
- Meat and other non-dairy protein: 2-3 servings
- Dairy products: 2-3 servings
- Fats, oils, and sweets: for these extras, the pyramid’s advice was to use them sparingly.
The pyramid was, at times, the subject of controversy: many felt that it placed too heavy an emphasis on grains, and many also suggested that the grain and dairy sections were put into the pyramid—and given such prominence—out of deference to America’s grain and dairy industries. In 2005, partly in response to these criticisms, and also in response to continuing research, the USDA revised their guidelines. They replaced the horizontal sections of the food pyramid with vertical wedges in a figure they called “MyPyramid.” This new pyramid gave less emphasis to grains, dairy, and fruit, and gave vegetables more relative weight in the ideal diet.
Our understanding of our nutrition needs didn’t stop in 2005, however, and in 2011, the USDA changed its approach, got rid of the pyramid, and switched to a new diagram in the shape of a plate. Still, the MyPlate framework goes in the same general direction: fruits and vegetables take up about half of an ideal “plate”—that is, half of a recommended meal or daily diet—with protein and grains taking up the other half, and with dairy relegated to a side dish. Again, this completes a trend that has been obvious since the first pyramid, emphasizing fruits and vegetables and de-emphasizing other elements of our diets.
So What is a Serving, Anyway?
Now that we have this new, improved model of how we should eat, what does it mean? In general terms, MyPlate—and the science behind it—recommends that each meal should include roughly equal servings of fruits, vegetables, grains, and protein. But then the question is: what is a serving? Fortunately, most prepared or packaged foods these days have information on them about “serving size,” and this can be used as a guide. But for those who are making their own dishes, or relying, as per advice, on fresh fruits and vegetables, figuring out the size of a serving can be a challenge. Here are some ways to think about it that might make it easier.
In the MyPlate system, vegetables make up the biggest portion of an ideal meal. So what counts as a vegetable? Basically, any part of a plant (in particular, the stem, root, or flower) that humans can eat that comes out savory rather than sweet after cooking. Overall, vegetables—especially “superfoods” like broccoli and spinach—contain far greater concentrations of vitamins and other essential nutrients than any other kind of food, and that’s one of the main reasons why they take up so much of a plate. But how much is that, really? Well, a standard serving of vegetables is about 3 ounces, and here’s what that could look like:
- A single tomato (sliced or sectioned works)
- Half a cup of corn or other fresh, small vegetable, including peas)
- A full cup of leafy vegetables like fresh spinach, arrugala, or endive (lettuce—which is relatively low in nutrients—doesn’t count))
- Half of a medium sweet potato or potato, or other starchy vegetables like turnips.)
- Half a cup cooked (as opposed to dried, not yet cooked) beans or lentils)
- Half a cup of cooked cruciferous vegetables (think broccoli and cauliflower), squash, root vegetables (think carrots and parsnips), or spinach)
In the MyPlate guidelines, grains make up the second-largest portion. Ideally, the grains you eat should as unrefined as possible in order to provide you with fiber as well as complex carbohydrates. Note, too, that while the term “grains” may make you think of wheat fields, this category also includes things like couscous, quinoa, rice, oatmeal, pasta, and cornmeal. So what does a serving of grains look like?
- Half a cup of cooked grains such as rice or pastal
- Half a cup of cooked oatmeall
- Two-thirds of a cup of breakfast cereals like wheat or cornflakesl
- A quarter cup of heavier cereals such as granola or mueslil
- A single slice of bread, or half a roll
Note: for a lot of people, this may seem like a surprisingly small amount of grains. The key thing to remember, though, is that, especially for seniors, these guidelines can be thought of as minimums, and as suggestions about the ideal proportions for each of these different types of food in your diet. If you’re a senior, and you want a full roll or two slices of bread, bon appetit!
Fruit makes up the next largest portion of the MyPlate guidelines. In contrast to vegetables, fruits are supposed to be sweet tasting: they’re usually the seed-bearing part of the plant. In addition to providing essential calories, fruits are low in fat, are even better at supplying you with beneficial fiber than grains, and are a source of essential nutrients. So what does a serving of fruit look like?
- A single large fruit, such as an apple, banana, peach, nectarine, orange, or pear
- Two smaller fruits, like plums, apricots, clementines or mandarin oranges, or kiwi fruits
- A half cup of preserved fruit such as fruit cocktail, or of frozen fruits, such as blueberries, or of diced fruits such as strawberries, or of the smallest types of fruit such as fresh berries and grapes.
Meat and Other Proteins
While meat makes up the smallest portion of the MyPlate guidelines (apart from dairy and fats, which we’ll get to below), that doesn’t mean it’s unimportant. In fact, it’s a testament to how concentrated meats and legumes are in terms of nutrition. In addition to supplying vital protein, meat provides important minerals like iron and zinc, and important vitamins like B12. In addition to well-known sources of protein such as beef, chicken, pork, fish, and eggs, you can get protein from sources like beans, nuts, tofu, and some dairy products, but fortunately or unfortunately, meat is the most concentrated source of protein commonly available. In terms of portion size, the standard advice to eat a serving of meat that’s about the size of a deck of cards still applies—and it applies to all types of meat, including fish, poultry, pork, and beef. For other types of protein, here are some guidelines for serving size:
- Six ounces (just under a cup) of tofu
- Two large eggs
- One ounce (a handful) of seeds and nuts, and a tablespoon of peanut or other nut butters
- A full cup of cooked beans, chickpeas, lentils, or split peas.
Dairy, Oils, and Sweets
Apart from dairy products like cheese that can supplement your protein intake, dairy products would, ideally, make up a fairly small portion of your diet, as would fats such as butter, margarine, and oil (and heavily sugared desserts). But for seniors, that just means that it’s best not to rely on them for calories, not that you should eliminate them completely. In fact, milk products can be a good way to get the calcium your body needs, and oils (particularly oils used as dressing rather than for cooking) can provide you with other nutrients essential for health.
Okay, But What Would a Meal Look Like?
Knowing what single servings would look like is useful, but if you’re a senior—or if you’re caring for a senior—you might feel you’d be better off knowing what a full-on meal would look like. Fortunately the National Institutes of Health has this question covered—and has provided some sample menus tailored specifically to the dietary needs of older adults. Here’s a look at a sample day of meals:
Not every day has to be like this, of course, and unless a senior is struggling with issues related to obesity or heart disease, they could always eat more (What? No dessert?), but this should give you some idea of what you really should be eating in a typical day.
- Half a whole wheat bagel spread with two tablespoons of peanut butter
- One banana
- One cup of coffee with a quarter cup of milk and two teaspoons of sugar.
- A quarter cup of raisins
- A cup of low-fat milk
- One tuna fish sandwich (2 slices bread, 2 ounces—about half a small can—of tuna, 2 teaspoons mayonnaise, 2 tablespoons chopped celery, and a lettuce leaf)
- Four baby carrots
- Spaghetti and meatballs (a cup of cooked spaghetti, a quarter cup of sauce, a quarter cup of canned diced tomatoes, three medium meatballs, and a tablespoon of parmesan cheese)
Salad (one cup greens, a quarter cucumber, a quarter of an avocado (cubed), a quarter cup of canned chickpeas, and three tablespoons of shredded cheese, plus a tablespoon of dressing)
- A cup of water
The Incredible Importance of Nutrition
As we get older, we confront natural challenges to getting enough to eat. And given all the stigma that our society attaches to overeating, it’s easy to ignore the problems that undereating could cause. But they are many, from a lack of energy, to problems with emotions and cognition, to more severe issues like organ failure and the diseases of malnutrition. No matter how old we get, our bodies still need fuel to work effectively.
And not just to work effectively. We also need food in order to maintain the joy of living, to maintain the energy we need to spend time with our loved ones, and to stay as healthy as possible for as long as possible. In short, one of the surest foundations of an independent life for any senior is taking care to eat healthy and eat enough. Just as breakfast is the most important meal of the day, a healthy and adequate diet is the first condition for having a joyful later life.