Nutrition

Care & Treatment

Non-Medication Therapies

To treat malnutrition effectively, the underlying causes must be identified first. Then the causes can be addressed and may be resolved. For example, poorly fitting dentures can be adjusted or grocery deliveries can be arranged. 

Many cities and towns have programs, such as “Meals on Wheels,” that deliver fully prepared meals to housebound older people. Check with local senior citizen centers or government offices for more information.
 
When you get older, you may not need as many calories as you did when you were younger. (Older adults usually need about 1,600 calories a day.) Therefore, it is important that the calories you do get must be from foods that are extra rich in nutrients like proteins, vitamins, minerals, fiber, and fluids. Fiber and fluids keep your digestion regular, and fiber can also lower your cholesterol. To keep your heart healthy, avoid saturated fats, trans fats, and cholesterol. On the other hand, polyunsaturated and monounsaturated fats (such as olive oil and canola oil) are good for you if eaten in moderation.

Generally, try to include the following nutrient-dense foods in your meals every day:

  • Complex carbohydrates. You should eat at least 5 servings of whole grains like whole wheat bread, old-fashioned oatmeal, and brown rice. Avoid refined products with simple carbohydrates like white bread, or instant or sugary cereals.
  • Seeds, nuts, and legumes (such as beans, chickpeas, and lentils).
  • Fruits and vegetables (at least 5 servings a day).
  • Low-fat dairy products (2-4 servings a day), especially if you have osteoporosis (thinning of the bones)
  • At least 2-3 servings of meats, fish, poultry, eggs, nuts, or beans a day.
  • Plenty of fluids (5-8 glasses a day), even if you do not feel thirsty.

Your daily intake of nutrients can be improved by focusing on the quality, timing, and frequency of meals. Adding a variety of foods to the menu helps as well.

Sensory Changes

Your daily food intake can be improved by making your food more appealing. Attractive packaging, food color, texture, temperature, and flavor make it more likely you will enjoy your food. You can make foods more appetizing even if you have a loss of taste or smell. You can use spices, foods of different colors, and interesting textures. Add lemon juice and herbs. Also, it is usually okay to use a little salt, unless your healthcare provider has said you shouldn’t. If you are experiencing under-nutrition, your healthcare provider may adjust your diet restrictions to allow you more flexibility in what you eat.

Dental or Oral Problems

Dental or oral problems can impact your eating. You may experience trouble with poorly fitted dentures, missing or loose teeth, or jaw problems. If this is the case, have your dentist adjust your dentures or address your dental health. Try to prepare foods so that they can be chewed easily but without boiling them to uninteresting mush. Many foods can be chopped, stewed, or grated so that they are still appealing but easier to eat with dental problems.

Arthritis

Arthritis or other conditions can make it difficult to use utensils easily. In this case, consider utensils that are specially designed for people with arthritis. It can also be helpful to serve “finger foods” that can be picked up and held easily.

Lactose Intolerance

Many people have more trouble digesting dairy products when they get older. This can cause unpleasant side effects, such as diarrhea or loose bowel movements. However, there are good options for people with lactose intolerance. Some yogurts and aged cheeses like cheddar are naturally lower in lactose. You can also purchase lactose-reduced products such as milk and ice cream.

Problems with Swallowing (Dysphagia)

Older people may have trouble swallowing. This can be caused by a variety of things, including dry mouth from medications, dementia, muscle loss, or diseases of the nervous system. You or someone you are caring for may have increasing difficulty swallowing food, or regularly feel like food is going down the wrong way. If this is the case, speak to your healthcare provider. Often, simple approaches can help the situation. 

Vitamins and Minerals

Vitamin and mineral deficiencies may occur quite often in many older people. Here are some of the most common

Vitamin D

Vitamin D is particularly important for older adults with osteoporosis, since it helps the body absorb calcium. (Older people are less able to produce vitamin D from sunlight in their skin than younger people.)

Iron

If you have an iron deficiency, you should also make sure to get enough vitamin C. Iron is absorbed better with plenty of vitamin C in the diet.

Calcium

Calcium is absorbed more easily from food than from supplements, so try to get your calcium intake from food sources such as dairy products, dark green leafy vegetables like spinach or kale, or fatty fish like canned sardines or salmon.

Vitamin B12

If you are lacking vitamin B12, try to eat foods high in B12 such as fortified cereals, lean meat, and some fish and seafood.

Potassium, magnesium and sodium

If you are taking certain blood pressure or heart medications, you may need more of these nutrients. Good sources include fruits, vegetables, low-fat milk, and yogurt.

The best way to make sure you get important vitamins, minerals, and plant chemicals is to eat at least 5 servings a day of brightly colored green, orange, and yellow vegetables such as broccoli, kale, spinach, carrots, and squash. If you are taking any herbal or alternative products, let your healthcare provider know. Some of these preparations can interact with medicines or food and cause serious consequences

Fluids

Dehydration is the state of not having enough fluids in your body. Dehydration can be common in many older people because they do not feel thirsty even when they need to take in fluids. However, it is important to take in enough fluids to keep your kidneys and digestion working well. Therefore, you should try to drink 5-8 glasses of water or other liquids each day, even if you don’t feel thirsty. You may need to drink more fluids if you have a fever or an infection, or if you take diuretics (water pills) or laxatives. 

Dietary Supplements 

There are supplements available that can make it easier for older adults to get extra nutrients. They can be found in many grocery and drug stories. These supplements can be in the form of nutritional drinks, nutritional bars and cookies, or powders that can be added to drinks or other foods. These are usually nutrient-dense, may have high or low calorie options, and often have good concentrations of vitamins and minerals. However, these supplements should not replace regular meals. Instead, use them as snacks between meals or before bedtime. Although they can be expensive, these supplements can also be very helpful for some older adults.

Severe Malnutrition

Some cases of malnutrition may be so severe that it may be necessary to use other feeding methods. One option is hand-feeding. Another is being fed with the help of a tube or intravenous line.  In these situations, the malnourished person may need to be in a hospital, at least at the beginning, until caregivers or family members learn how to carry out feeding at home. These feeding techniques can be effective in some cases, such as getting someone over a temporary swallowing problem after a stroke or surgery. However, tube feeding probably does not prolong or add to the quality of life for people in long-term care. 

Counseling is helpful for older people trying to eat well. You can find a registered dietitian in your area by visiting the website of the Academy of Nutrition and Dietetics.

Combating Overnutrition

As you get older, you will probably be less physically active. You also do not need to consume as much food as you did when you were younger because older people have reduced energy needs. However, you may begin to gain weight if you continue to eat the same way you used to without increasing your exercise level. For many older people, this pattern leads to being overweight or even obese. Obesity is linked to many chronic health problems such as diabetes, cardiovascular disease, stroke, and cancer.   

The best dietary strategy is to decide on a target weight that is appropriate for your height and body type, and to aim for gradual weight loss. You can decrease your calorie intake by:

  • eating fewer calorie-rich foods
  • increasing your consumption of nutrient-rich, high-fiber foods, such as vegetables and grains
  • reducing portion sizes

Dietitians or nutritionists can be extremely helpful in finding a diet that you can enjoy while you take off the pounds.  

Updated: January 2018