Healthy Diet in Old Age

HEALTHY DIET IN OLD AGE
With advances in medicine, more people are reaching a ripe old age. The factors contributing to longevity include better hygiene, nutrition, preventive medicine, and (possibly) antibiotics. Diseases of old age like diabetes are being better managed. Recognition of the dangers of obesity, made evident by statistics from life insurance companies, have induced many to regulate their weight, resulting in a reduced death rate.
The management of older people has become a problem in modern society. With the joint family system, the elderly were well looked after; they stayed mostly in villages in healthy surroundings, and had good wholesome food. With the exodus of younger people from the countryside into congested cities, accommodation and care for the aged has become a problem.
METABOLIC CHANGES
Old people have considerable weight loss. If they are living alone, their diet tends to become unbalanced as they are reluctant to cook; and, to avoid the trouble of going to a restaurant, they skip meals and frequently subsist on tea and snacks. Their food intake may be further limited by exclusion of certain foods because of high blood pressure, diabetes, heart failure, and kidney diseases. Their appetite may be reduced due to restriction of physical activity by arthritis, worries about their own failing health and constipation. Digestion may be impaired by improper mastication with artificial teeth. A diet for them should, therefore, help them maintain good health.
The elderly do not adjust easily to variations in fluid intake. The proportion of fat increases by 5%-10% and thus the body water decreases. Therefore, a 75-year-old man weighing 70 kg may have as much as 7-8 litres less body water than a 35-year-old of the same weight. The elderly also have impaired response to dehydration. The diagnosis of dehydration is by examining blood, which shows high serum sodium. The urine is not highly concentrated. The thirst sensation is not so acute.
The bones show osteoporotic changes because of deficiency of calcium, protein, vitamins, minerals and hormones. Senile osteomalacia is also common, particularly in women confined indoors and with deficient intake of vitamin D. Osteomalacia manifests as backache, bone pain, and muscle weakness, with low serum calcium and phosphorus, and high phosphatase. Femoral neck fractures are more common during winter.
A large number of the elderly take drugs to increase urine flow (diuretics), resulting in low serum sodium. This causes weakness, confusion, giddiness, low blood pressure on standing up (postural hypotension), falls, transient hemiparesis, and fits.2 The effect of potassium depletion in patients taking diuretics is not as dramatic because potassium is concentrated in the cells. Low potassium produces heart irregularities, especially in patients treated with digoxin.
Potassium deficiency occurs with less than 50 mEq (mmol) intake per day. The patients exhibit muscle weakness, apathy, and fecal impaction. Constipation leads to loss of appetite and further restriction in food intake.
If the kidneys are damaged, great care should be taken while administering diuretics. Potassium supplementation, too, should not be indiscriminate, because rising potassium level in blood may be dangerous and may cause irregularities of the heart and sudden death.
Anemia is common in the elderly. Salicylates and anti-inflammatory drugs taken over a prolonged period for chronic arthritis tend to produce alimentary blood loss and anemia. Iron deficiency is not as common as was supposed; it is not due to impaired absorption, but should be considered as due to some disease. Hypofunction of the thyroid, diminished activity of the bone marrow, and diminished protein intake are other possible factors contributing to anemia in the aged. Vitamin B and folic acid deficiency are also common. Anemia in the elderly should be investigated to exclude cancer.
The elderly are often depressed; this may even be induced by drugs prescribed by physicians. The mental faculty is depressed not only due to arteriosclerosis, but also due to poor intake of vitamins and minerals.

DIETETIC MANAGEMENT
Some dietary advice on purchasing food within the financial means may go a long way in providing better nutrition.
CALORIES
The lower metabolic rate in the elderly reduces calorie requirement. A retired life, arthritis and angina reduce physical activities to a minimum. Calories should therefore be restricted to combat any tendency to obesity. On the other hand, if there is loss of weight, adequate calories should be supplied to regain normal weight.
PROTEIN
Deficiency of protein is common in the elderly, and is one of the factors producing edema, anemia, and lowered resistance to infections. Protein rich foods like meat and fish are expensive, require cooking, and may be difficult to chew without teeth. Among vegetarians, pulses provide an appreciable amount of protein, though in old age such foodstuffs increase flatulence.
The daily protein intake should be about 70 g. If this amount cannot be provided with regular meals, commercial protein preparations or skimmed milk powder should be given as a supplement. If mastication is a problem, minced meat, half-boiled eggs, and milk products like curds, buttermilk, custard and puddings are useful.
FATS
With advancing age, fats are difficult to digest. Older people tend to have higher blood cholesterol level. Much attention need not be paid to reducing it. Ingestion of unsaturated fats, like vegetable oils (except coconut and palm oil), reduces blood cholesterol. About 40-50 g fat daily should be advised.
CARBOHYDRATE
Old people tend to take more carbohydrate and less protein. Bread, biscuits, cakes and pastry are cheap, readily available, do not require cooking, and can be stored; hence, they form the bulk of the diet. Such a diet produces protein deficiency, anemia, and constipation due to lack of roughage. Anemia and constipation in turn reduce appetite and enhance malnutrition.

VITAMIN AND MINERALS
Vitamin deficiency, particularly of vitamin B-complex, is common with an unbalanced diet; a daily supplement of a multivitamin tablet is advised.
Vitamin C deficiency, and sometimes even scurvy, occur in those not eating fruits and vegetables and those who cannot cook (widowers). In institutions for the old, mass catering destroys vitamin C. There is a seasonal variation in vitamin C intake, being lower in winter than in summer. The most useful test to diagnose deficiency is white cell ascorbic acid (normal-over 2 mg per 100 ml).
The blood pressure, particularly systolic pressure, rises with old age. The intake of sodium should not be drastically reduced; a sodium-poor diet is also deficient in protein. Sodium restriction is not more likely to decrease blood pressure in the older than in the younger subject. Calcium supplement mayor may not decrease blood pressure.
Osteoporosis is common; the exact reason is not determined, but it may be partly due to diminished intake and absorption of calcium, and partly to a deficiency of sex hormones leading to loss of protein. A combination of androgen and estrogen has been recommended for senile osteoporosis.
Lactase-deficient people avoid milk, which leads to diminished calcium and vitamin D intake. Seasonal variations contribute to deficient vitamin D and lack of exposure to sunlight. These result in osteoporosis and osteomalacia. Half a litre of milk and 2-3 eggs daily ensure adequate supply of calcium and protein. Sunlight is a very potent source of vitamin D.
Among the Chinese, the increased bone mass and decreased fractures in middle-aged and elderly women are due to peak bone mass in earlier life.

FLUIDS
An adequate fluid intake should be ensured. Intake may be varied according to the diet and season. The excretion of over 1200 ml of urine indicates proper fluid balance. Many old people are reluctant to drink liquids as they have to urinate frequently, particularly with diseases like diabetes, chronic nephritis, and prostatic enlargement. They should be induced to take sufficient liquids during the day, and to refrain from drinking at night so that their sleep is not disturbed. They should not drink water before, during, or immediately after meals, as they may feel bloated, which restricts food intake.
MEAL PATTERN
About 1.5 million people in the US currently reside in 20,000 nursing homes. Many of these require assistance in eating. Normal eating requires more than the serving of complete nutrition. There should be adequate supervision to see that the elderly also consume the food served.
The elderly should be given small frequent feeds and an early dinner. This prevents disturbed sleep due to gaseous distension. Not infrequently, old people have poor coronary circulation, and so physical exertion-particularly climbing stairs immediately after a meal should be avoided.
Secondary hyperparathyroidism is common; this may be the result of both renal insufficiency and hypovitaminosis.
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