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Nutrition and Aging Part I

Nutrition and Aging

A healthy lifestyle includes choices about diet, exercise, and sleep. Although good health is a preferred outcome for everyone, the amount of thought, time, and energy that people invest in these basic choices varies widely between individuals.  The body’s specific needs in these areas also changes as we age.

Last week’s column outlined specific food choices which contribute to a healthy diet for older adults When considering the role of nutrition in aging, however, individual food choices are only the tip of the iceberg. Adequate nutrition, as an element of good health, increases the chances that older adults will be able to maintain their independence, which is a common desire for members of this population.

A variety of physical and social factors are associated with the ability to prepare and consume the food which is necessary for optimal nutrition. The physical factors which impact nutrition include oral hygiene, medical conditions, mobility, sensory functioning, and cognition.

Oral hygiene has an obvious influence on the ability to eat. The presence and condition of natural teeth or dentures will determine the types of foods that an individual may or may not be able to eat. If natural teeth are rotting and painful, or dentures don’t fit appropriately, eating becomes difficult and nutritional status will suffer due to inadequate intake.

The ability to swallow appropriately is also significant, since individuals who suffer from impaired swallowing (also known as dysphagia) may experience increased discomfort with eating or they may not be able to eat preferred foods. These individuals are also at a higher high risk of choking or developing aspiration pneumonia (food particles end up in the lungs instead of the stomach). Dysphagia may result from certain disease processes including stroke, Parkinson’s disease, or gastro esophageal reflux.

Sometimes the cause of dysphagia may not be able to be identified, but changing the texture of food, as well as the thickness of liquids consumed, may be necessary.

Changes in appetite may also be the result of medical conditions which directly affect the digestive tract such as irritable bowel syndrome, hernias, or lactose intolerance. In addition, older adults often take more medications than younger ones, and these medications can have side effects which impact the ability and desire to eat.  Common side effects may include loss of appetite, nausea, constipation, or bloating. If any of these symptoms are experienced, check with a physician to determine if medication may be the cause.

Less obvious causes of dietary changes are medical conditions which affect an individual’s mobility. Does the individual have the endurance and strength to navigate through a store to purchase groceries? What about carrying the grocery bags into the house once they arrive home? One possible option to solve these difficulties is home delivery programs such as Giant Direct Powered by Peapod.

Mobility will also affect the meal preparation process. The design and organization of a kitchen will play a role in how much mobility is required. Frequently used items should be kept in cabinets which are within easy reach, and a table at which to sit and work is helpful for those who cannot stand for long periods. A basket or tray can be attached to a walker for assistance in moving items around the kitchen.

Sensory function affects an individual’s desire to eat. Because the senses of smell and taste are closely linked, one may interpret the loss of smell to be that of taste instead. Some loss of smell normally occurs with aging, but medications, illness, injury, and smoking can cause additional loss. Loss of taste occurs less frequently than loss of smell, and normal aging changes are only slight and usually unnoticeable. The use of increased amounts of salt or sugar to compensate for the loss could be dangerous for people who have high blood pressure or diabetes and who should be following special diets. The use of other seasonings such as lemon juice, vinegar or herbs may improve the flavor of foods that taste bland.

Food safety also becomes a risk when these senses are affected because a person has a decreased ability to detect the unpleasant smell or taste of spoiled food. Changes in eyesight present additional challenges when trying to purchase, prepare, and consume meals.

Symptoms of dementia present their own unique set of complications related to mealtime. Someone in the early stages of dementia may forget or incorrectly measure ingredients when cooking, which will affect the taste of the food and can cause frustration and negative associations with meals. As dementia progresses, individuals may forget altogether about mealtime, that they just ate (and insist that they are hungry), or which meal of the day they are eating (and request certain foods not traditionally served at that time of day).

Food preferences may be forgotten, leading to disagreements with caregivers and dissatisfaction with food choices. The ability to independently put together even a simple meal gradually becomes unmanageable. At the end stage of dementia, an inability to feed oneself and to chew and swallow food appropriately, is present. All of these changes may result in reduced food intake.

These are some of the physical barriers which may alter food intake and the digestion/absorption of nutrients necessary for good nutrition.  Next week’s column will address underlying social factors that can influence an older adult’s nutritional health.

Karen Kaslow, RN, BSN