Aging & Health A to Z

Trying to eat a healthy, well-balanced diet becomes much more difficult when teeth are weak, painful, loose, or missing, or when dentures do not fit properly. In the United States, about half of older adults have lost many if not all of their teeth.

Researchers have found that when teeth are missing, especially the back teeth that are needed for grinding up food, nutrition suffers. If you are unable to chew and grind your food well, you will avoid eating things like fruits and vegetables. Instead, you are more likely to rely on soft, easy-to-swallow refined foods, such as white bread, potatoes, puddings. Also, your diet will be much less varied. This increases the risk of being overweight or obese, and leads to higher salt intake and cholesterol levels, while important nutrients like vitamins and minerals remain in short supply.

A lack of vitamins B6, B12, or folate (folic acid) can lead to serious consequences. Older people are at increased risk of B12 deficiency because there is more likelihood of certain factors being present that increase risk. These include the following:

• Poor nutrition
• Reduced ability to absorb nutrients even if nutrition is adequate (from reduced stomach acid and digestive enzymes)
• History of surgery in which part of the stomach or small intestine have been removed
• Long-term medication with antacids or other heartburn medicines
• Long-term alcoholism.

Vitamin B6

Vitamin B6 is needed to keep your nerves functioning properly. You may have a deficiency of vitamin B6 (pyridoxine) if you are malnourished or have trouble absorbing nutrients.  In older adults, B6 deficiencies are common, and may cause:

• Tingling or numbness in feet and hands
• Fragile skin and mucus membranes
• Blood problems like anemia
• Possible higher risk of heart and circulation problems.

Vitamin B12

Although you may not notice any symptoms at first, B12 deficiency can cause severe nerve problems and anemia (not enough red blood cells) if it is not treated. Do not ignore symptoms as simply another sign of getting older, because treatment is simple (pills or an injection) and waiting too long may have irreversible consequences. Make sure to tell your healthcare professional if you notice any of the following:

• Diarrhea or constipation
• Fatigue
• Loss of appetite
• Balance problems
• Shortness of breath, especially during exercise
• Poor concentration, confusion, even dementia in severe cases
• Depression
• Pale skin or gums (signs of anemia)
• Bleeding gums and red, swollen tongue
• Numbness or tingling in your hands and feet. 

Pernicious anemia is caused by lack of vitamin B12, results from the inability of special cells in your stomach to produce molecules called “intrinsic factor”. This factor lets your body absorb vitamin B12.

Folic Acid (a B vitamin)

Folate, or folic acid, is a B vitamin that appears to have a protective function against heart disease and cancer. It is found in many foods, especially artificially fortified foods, as well as dietary supplements. Folate keeps your cells healthy, and helps in the production of new red blood cells and in the prevention of cancer. It is considered important in keeping the heart and circulation healthy because it keeps homocysteine, a heart disease risk factor, at healthy levels. Malnutrition, inability to absorb nutrients well, certain medications, kidney dialysis, liver disease, alcoholism and other chronic diseases may lower your folate levels.

Folate deficiency can cause the following symptoms:

• High homocysteine levels
• Anemia (not enough red blood cells) causing pale skin
• Fatigue and weakness
• Diarrhea
• Poor appetite
• Weight loss
• Irritability, forgetfulness, and other unusual behaviors
• Headaches
• Sore tongue.

When you are young, your body makes vitamin D in your skin whenever you are out in the sunshine. Vitamin D is also found in some foods, like milk and oily fish. However, older skin is not very efficient at producing vitamin D in response to sunlight. If your diet is also deficient in dairy products or fish oils, you may not have enough vitamin D in your body.

Low vitamin D levels are now common in the United States, particularly in northern states where the winters are long and sunshine is weaker. It is especially problematic for older people who do not go outside very much, and who are malnourished. If you are over 65 years of age, your doctor may wish to order a blood test to check up on your vitamin D levels. Most guidelines recommend at least 800-1,000 IU (international units) of vitamin D every day for older adults.

One reason that you need adequate vitamin D is that without it, your bones cannot absorb calcium. This puts you at high risk of developing osteoporosis, or fragile bones. Even with plenty of calcium in your diet, your bones may weaken as you age because of:

• a reduction in physical activity
• certain medications (i.e., steroids like prednisone)
• difficulty in absorbing dietary calcium from the digestive tract
• lower hormone levels, especially in women after menopause.

To make sure that your bones stay as strong as possible so that you can avoid osteoporosis, ask your doctor if a blood test to make sure your vitamin D blood levels are adequate would be appropriate. Get plenty of calcium from milk and other dairy products, and take a calcium supplement if your doctor thinks you are not getting a minimum of 1,200 milligrams of calcium per day.

Falling is the leading cause of fractures in older people. At best, a broken hip can mean a long stay in hospital in people over 65 years of age, and is often the reason people have to move into retirement homes or long-term care institutions.

Low vitamin D levels have been linked to an increased risk for falling. This may be due to weakened bones that can break spontaneously, or from some other effect of vitamin D on brain function, nerve health, and muscle strength.

Researchers have found that people in lower socioeconomic situations have some predictable barriers to eating a healthy diet. These barriers include factors such as:

• financial limits (high costs of many fresh fruits and vegetables, lean meats)
• transportation or mobility problems that restrict shopping
• easy access to neighborhood stores that stock energy-rich, nutrient-poor foods (potato chips, sugary beverages and cereals, refined sugary baked goods)
• lack of education about nutrition
• poorer dental health.

As a result, diets among older people in lower socio-economic situations tend to be high in fatty meat products, full-cream dairy products, fats, sugars, preserves, potatoes, and cereals. Intake of fresh fruits and vegetables, fish, and whole-grain baked goods may be low, and levels of essential nutrients such as calcium, iron, magnesium, folic acid, and other vitamins are often inadequate for good health.

Learning about good nutrition can even out some of the effects of socioeconomic limitations. A good nutritionist or dietitian will have information about how to find cheaper, more accessible food sources, and government programs like Food Stamps that can help.

Many ethnic and cultural groups have strong traditions that relate to foods, food preparations, and rituals. For example:

• Observant Jews and Muslims will only eat meats from certain animals (never pork), prepared according to religious rituals.
• Traditional Muslims may avoid medications with gelatin or alcohol in the preparation or anything that has come in contact with blood or a blood product.
• Jews will not eat dairy products and meat at the same meal
• Many Asian Indians, such as Sikhs and Hindus, are vegetarians, or at least avoid beef.
• Fasting is an important ritual in many traditions, including Muslim, Jewish, and Hindu
• Many ethnic groups tend to eat fewer fruits and vegetables (Cambodians, Alaskan Natives).
• The Korean and Filipino diets are extremely high in salt.
• If hospitalized, some ethnic groups (i.e., Haitian Americans) prefer to fast rather than eat unfamiliar hospital foods.

If you or a loved one is suffering from malnutrition and prefer traditional foods, let your healthcare professional know what your food restrictions or preferences are. A good dietitian or nutritionist will be able to devise a healthy diet for you that adheres to your own preferences and medical condition.

If you are like most older adults, you have probably tried an alternative remedy for a medical problem. If you are malnourished and are suffering some of its side effects—fatigue, frequent illnesses, weakness, slow wound healing, memory loss, or other effects—you may have chosen to try some form of alternative medicine rather than see a healthcare professional. This decision may be taken under the mistaken belief that complementary approaches are often effective, less expensive, and never harmful. These assumptions are not correct.

Alternative remedies may include herbal medicines, large doses of vitamins, folk remedies, energy healing techniques (eg, magnets, crystals), or homeopathy. Other approaches, such as acupuncture or chiropractic techniques, are also popular.

You must always tell your healthcare  professional if you are using any kind of alternative medical approach, and report all herbal remedies, large doses of vitamins or minerals, and over-the-counter (non-prescription) medications. Many of these products can interact with or interfere with other medications, with serious or even life-threatening consequences. For example:

• vitamin A in large doses can cause bone problems
• vitamin B6 in large doses can damage nerves
• many herbal remedies may be toxic, such as kava kava (causes liver damage), licorice root (raises blood pressure), and gingko biloba (thins blood and may interfere with some heart medications).

Herbal remedies are not tested by the Food and Drug Administration (FDA) in the same way that prescription medicines are tested. Therefore, some may have dangerous impurities in them. For example, some Ayurvedic remedies and folk remedies from the Caribbean have been found to be contaminated with poisonous heavy metals.

The best way to reverse nutrient deficiencies is to follow your healthcare professional’s and nutritionist’s or dietitian’s recommendations.

Physical Activity
Researchers have found that physical activity has many benefits in older people, particularly if they are undernourished:

• It can increase your appetite
• It can improve your brain function, which will enable you to nourish yourself in a more healthy way
• It may strengthen muscles and bone
• It may improve many other types of conditions, including type 2 diabetes mellitus, osteoporosis, arthritis, and psychological illnesses such as depression.

Some tips for staying active include:

• Get a dog and walk it regularly
• Organize a group to go walking together several times each week
• Park your car at the far end of the mall to force yourself to walk further
• Cut your grass with a pushing machine, rather than one you ride
• Try taking the stairs more and more often.

Older adults with dementia are at extra risk for malnutrition since they are unlikely to be able to shop and cook for themselves. Even with a good caregiver, people with dementia need a lot of help actually finishing the food that is placed in front of them. This is due to the fact that these patients may not be physically able to carry out the processes of chewing and swallowing. The situation is often complicated by the fact that many people with dementia do not like to accept help with eating. Also, they may be taking sedatives or other medications that interfere with appetite or taste.

If they are in a nursing home or long-term care facility, they are more than likely to suffer from malnutrition.

Some approaches that may help in this situation include the following:

• Consult a dietitian for information about appropriate foods and feeding techniques
• Check with a pharmacist or healthcare professional about the medications the person is taking, and whether there are any adjustments that should be made to improve appetite and avoid drug-nutrient interactions.
• Make sure the older person is getting enough fluids and that their mouth is not too dry. Sucking on candies or chewing gum may be helpful.
• Check to see how much food remains on the plate after a meal.
• Try to serve the person foods that he or she prefers.
• Make meals a pleasant social event, including friends or family when possible.
• Serve more frequent small meals instead of three large ones.
• Offer nutritious snacks, including nutrient-rich drinks or protein bars

Not only can depression lead to lack of appetite and malnutrition, but being malnourished can bring on symptoms of depression. Also, many older adults take a variety of medicines and some of these alone or interacting with others may bring on a depressive mood.

If you are caring for an older adult who has become malnourished and is possibly depressed, or if you think you might be at risk of these conditions, check with a healthcare professional as soon as you can. Besides improving your diet or that of your loved one, the following approaches can be helpful:

• Increasing physical activity or an exercise routine can improve appetite, improve social interactions (if exercising in a group) and alleviate depressive moods
• Try to make mealtimes an enjoyable, social occasion, with foods that you or your loved one particularly enjoys, in a pleasant setting.
• Check with a pharmacist or your healthcare professional to eliminate or adjust drug prescriptions that may be contributing to lack of appetite or depressed mood.
• Discuss whether an antidepressant or counseling might be appropriate.
• Make sure that alcoholic beverages are consumed in moderation.

Malnutrition in older adults can lead to poor skin health. For example, there is a layer of fat under the skin that normally acts as a cushion against pressures from outside. When this cushion of fat disappears, an older person who is confined to a chair or bed much of the time has a much higher risk of developing pressure sores or pressure ulcers. These areas of skin breakdown often resist healing.  

The poor skin health in malnutrition is partly a result of protein deficiency, which leads to a lack of materials in the body with which to carry out repairs of unhealthy tissue.  It can also be a response to lack of certain micronutrients such as vitamins B2 or vitamin C. Your healthcare professional will do blood tests and recommend specific supplements.

For some people, malnutrition may bring on diabetes mellitus through a process that is still not understood. Although it is found most often in the developing world, and most often affects people who were malnourished at a young age, it may also affect older adults who are suffering from malnutrition. This type of diabetes is most likely to require insulin, rather than dietary control alone.

Even if you eat a fairly healthy diet, your chances of having a deficiency of vitamin D and potassium increase as you get older. Many older people have low vitamin D levels due to lack of exposure to the sun, aging skin, and use of sunscreen. Older people who take diuretics (water pills) for high blood pressure may also lose a great deal of potassium in their urine. If you are also suffering from malnutrition, the result is an increased risk of high blood pressure (hypertension).  The stress of being malnourished can also cause in increase in blood pressure.

High blood pressure raises your chance of developing heart disease. Therefore, making sure that you have sufficient vitamin D, potassium, and also magnesium and calcium, will help you avoid heart problems.

If you lack some specific nutrients, particularly vitamins, your nerves may be damaged. Some of the most well-known effects are the following:

• Thiamine (vitamin B1) deficiency: damages the outer layer of nerves which can lead to numbness and tingling in hands and feet within months of severe deficiency and may increase your risk of heart failure.
• Vitamin B 6 deficiency is linked to numbness and seizures.
• Vitamin B12 deficiency may also affect the outer layer of nerve cells, causing you to lose feeling and control in hands and feet.
• In extreme cases, a deficiency may cause a condition called burning-foot syndrome.

Researchers have found that if you are suffering from a protein or energy deficiency, your sleep patterns may suffer. Older adults who are suffering from this type of malnutrition may find that they have more difficulty falling asleep and staying asleep.