Nutrition and Ageing

Medical science has sharply lowered the mortality rate as a result of infection; diseases, thus bringing about a higher average life expectancy and a larger percentage of elderly people.

Since an estimated third to one half of the health problems of the elderly may be associated with their food intake, it is plain that good nutrition and a good quality of life go together.

Unfortunately, the effects of poor nutrition are often only noticed after the passage of several decades. Only when the symptoms of poor nutrition become evident do the elderly take notice of the effect of their present eating habits.

And then they tend to put their faith in nutritional miracles, with the result that they become easy prey for quacks and the promoters of so-called health foods. The use of vitamins and mineral supplements is relatively common among the elderly. But is it really necessary?

Advantages of good nutrition

The intake of sufficient quantities of the correct kinds of foods will meet all the nutritional needs of the elderly. Good nutrition also boosts resistance to diseases and stress. It allows the inherited constitution to come into its own, so that the elderly person who is genetically programmed to remain "young" for a longer period, is enabled to reach a high age

Although heredity plays a part in the incidence of diseases resulting in premature ageing and death, the incidence and seriousness of heart attacks, strokes, hypertension, diabetes mellitus, gall‑bladder, liver, kidney and skin diseases, as well as many other ailments, are decidedly influenced by nutrition.

What should the elderly eat?

• A variety of foods, not too fatty, too sweet or too salty, and containing sufficient food fibre, should be eaten daily. These include the following:
  • 2 small portions of meat, fish, chicken or egg
  • at least 2 cups (400 ml) of milk, buttermilk or yoghurt (cheese may be used as a substitute
  • 5 or more portions of fruit and/or vegetables
  • 3 or more slices of brown or whole-wheat bread (porridge may be eaten instead of the bread)
  • little butter, margarine or oil
    

The elderly should eat the following foods sparingly:

• fatty meat or other fatty or oily foods
• sugar, jam, sweets and other sweetened foods
• refined grain products such as white bread, rusks and biscuits and other baked goods made with cake flour, non‑dairy creamers, and milk blends without the Real Dairy mark, and large quantities of tea or coffee.

An elderly person with a good appetite who eats balanced meals seldom needs vitamin or mineral supplements or so‑called "health drinks". Dietary supplements should only be taken if prescribed by the doctor. The available money should rather be spent on milk, fruit and vegetables.

Drink sufficient water (6‑8 glasses per day) to quench thirst. Water is essential to good health, as it dilutes the urine and prevents kidney damage from a high concentration of waste products.

Three meals of more or less the same size should be eaten daily. Three smaller meals with nutritious snacks in between are recommended when the appetite is small

Body changes with ageing

The following changes in the bodies of the aged may affect their nutrition:

• Sense of taste and smell. The number of taste buds varies from person to person, but does not decrease with age. The sense of smell gradually diminishes and this may be the reason why some older folk lose their interest in food.
• Chewing problems. A large percentage of elderly people do not have all their own teeth. Some are toothless and others struggle with ill-fitting dentures. Food is therefore insufficiently chewed or kinds that require little chewing are given preference. Foods which are firmer and contain a lot of food fibre, such as fruit and vegetables, are replaced by soaked bread and rusks (usually white) and other soft foods. Such food has a small volume, consequently there is a decrease in the movement of the bowel and gut. This results in the slower passage of food along the digestive tract and gives rise to such problems as indigestion and constipation.
• The salivary glands shrink and less saliva is secreted. Normally saliva plays an important part in the digestion of starchy foods, especially if they are thoroughly chewed and mixed with saliva. Thus a lack of saliva can retard the digestion of starches. When too little saliva is secreted dry foods are not moistened properly and are therefore difficult to swallow. Consequently softer and moister foods are given preference.
• The digestive tract degenerates. Less gastric acid and less of the enzymes needed for digestion are secreted; intestinal motility decreases and constipation increases. Although most of the nutrients are still well absorbed, it would nevertheless seem that the absorption of a few, such as calcium and iron, may decrease.
• The choice of foods may be determined by the degree of discomfort that follows a meal. Eventually the variety of foods tolerated by the elderly becomes so small that insufficient nutrients are ingested.
• The body composition changes. Fat increases and muscle tissue decreases. This does not imply an increase in weight, but only a partial replacement of muscle tissue by fat. This is a normal phenomenon and should not be confused with the general but abnormal weight increase known as "middle‑age spread". One should remember, however, that fatty tissue is less active than muscle tissue and therefore uses up less energy. Less food will then be required to maintain the same body weight.
• Hormone secretion decreases. The hormone insulin is essential to the utilization of sugar (glucose). As one grows older and less insulin is secreted, the excessive intake of sweetened food should be avoided.
• Muscle co-ordination decreases and this makes it difficult to manipulate eating and kitchen utensils.

Diseases of the Aged

Most of the diseases from which older people suffer also occur in younger people. Many of these conditions are chronic and correct nutrition is essential to enable the body to function as well as possible in the circumstances.

Of all the nutritional diseases of the elderly obesity is probably the most common. Obesity increases the incidence and/or aggravates the discomfort of many complaints, e.g. bronchitis, shortness of breath, gallstones, hernias and all diseases of the bones and joints (such as osteoporosis and arthritis). Wrong eating habits sometimes play an important part in causing diseases and in some cases a change of diet forms part of the treatment.

Cardiovascular Diseases

From childhood cholesterol and other fatty substances are deposited in the blood-vessel walls. This can develop into a condition in which the blood-vessels are narrowed and their walls hardened. If the blood-vessels supplying the heart muscle with blood are seriously constricted individuals may suffer from angina (heart-cramp) when they are tense or become physically active. If the flow of blood to the heart muscle is interrupted, a heart attack occurs. As the blood vessels become hardened they lose their elasticity, which may cause fragility of the walls and bleeding. When this occurs in the blood vessels supplying the brain a stroke results.

A more prudent life-style and eating habits may decrease the incidence of coronary heart disease. Existing damage cannot, however, be eliminated.

Constipation

One is constipated when irregular bowel movement causes discomfort and indigestion. People who have healthy living and eating habits usually have one or more motions every day, but this is not absolutely necessary.

The most common causes of constipation are:

• too small a food residue in the intestinal tract;
• neglect of the call to defecate which usually goes hand in hand with living at too fast a pace and irregular toilet habits;
• inactivity;
• certain diseases of the digestive tract, e.g. cancer and diverticulitis a form of inflammation occurring most frequently in the colon or large intestine);
• medicines such as certain painkillers and remedies containing iron.

What stimulates movement of the bowels?

• The presence of food in the stomach and intestines stimulates movement of the food residue to the lowest part of the colon (rectum). This stimulation usually occurs after the first meal of the day or even after a glass or more of water on an empty stomach.
• Physical activity increases the stimulating effect of food and liquid. Immobility, as when one is confined to bed, can promote constipation. There is a lack of adequate stimulation for the forward movement of the contents of the intestinal tract. Further, the immobile person is dependent on someone else for aid in responding to the urge to defecate. If there is no response at the right time, the urge disappears.
• Food residue in the colon. The volume of the residue is determined by the amount of food and liquid ingested, the amount of food fibre in the diet, and the ability of the fibre to hold water. If the food intake is small because of illness or a slimming diet the residue is, of necessity, also small, Only plant foods (cereals, fruits, vegetables, dry legumes and nuts) are sources of food fibre. The fibre of cereals is found mainly in the bran, and the coarser the bran the more water it can hold. If the edible peel and pips of vegetables and fruits are eaten, the fibre intake will be appreciably more. Strained fruit and vegetable juices contain no fibre.
• The best treatment for constipation is prevention. Drink a lot of water and eat sufficient food fibre, get sufficient exercise and avoid the unnecessary use of laxatives.

Hypertension

The possible causes of hypertension are:

• An inherited tendency; sex (men run a greater risk than women); age; tension; and two factors related to nutrition, viz excessive use of salt and obesity.
• It is known that tension can cause a sudden and temporary rise in blood pressure. Food that contains a lot of salt can cause hypertension in individuals with an inborn sensitivity to salt. Non‑sensitive individuals remain normal on the same diet. The possibility of a person developing heart problems is much greater if he has high blood pressure and is, in addition, obese. A loss of weight is sometimes the only prescription for moderately high blood pressure.

Gout

Gout runs in families. It is a form of arthritis; usually the big toe is the first joint to be affected. Individuals suffering from gout have an excess of uric acid in the blood and uric acid crystals in and around the affected joints. Normally uric acid is systematically excreted in the urine and only small amounts are found in the blood.

Uric acid is formed in the body from purine. Liver, kidneys, brains, gravy, meat extract and sardines are the richest sources of purine.

Other kinds of fish, all kinds of meat, dry legumes, wheat-germ and rolled oats are moderately rich sources. Half of the uric acid in the blood of normal people is formed by the body itself. The other half, contributed by food, nevertheless plays a very important part in the control of gout and prevention of acute attacks.

The obese should follow a diet that will reduce weight slowly. Fasting leads to an increase in blood uric acid and may bring on an attack of gout.

Diabetes Mellitus

One of the symptoms of those who suffer from diabetes is too high a blood sugar (glucose) level. The glucose comes from digested food and is normally transported rapidly from the blood to the tissues. The ability of the elderly to handle glucose becomes impaired. The bloodstream can therefore easily become overloaded with glucose.

Diabetes which develop at an advanced age is usually of a mild nature. As a rule, no medication is necessary, as the diabetes can be controlled by diet alone:

• Eat starchy foods (such as brown and whole-wheat bread, potatoes and sweet potatoes) and dry beans, peas and lentils instead of sugar, sweets and other sweetened foods and liquids.

• Eat fat and fatty foods sparingly and eat only moderate quantities of meat, fish and eggs.

• Appease the appetite with vegetables and satisfy the craving for sweetness with fruit. Choose those fruits that are not very sweet and where possible eat vegetables and fruit unpeeled.

• A fibre-rich diet helps to keep the blood sugar level normal.

• Control body weight and follow a balanced slimming diet if you are over-weight.

• Eat small amounts of food more often.