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Health - Nutrition And The Elderly

Dr. Monica Goel

Nutrition and exercise are crucial to a healthy body. Eat a variety of nutrient-rich foods. You need more than 40 different nutrients for good health, and no single food supplies them all. Your daily food selection should include bread and other whole-grain products; fruits; vegetables; dairy products; and meat, poultry, fish and other protein foods. How much you should eat depends on your calorie needs. Use the Food Guide Pyramid and the Nutrition Facts panel on food labels as handy references. Skipping meals can lead to out-of-control hunger, often resulting in overeating. When you're very hungry, it's also tempting to forget about good nutrition. Snacking between meals can help curb hunger, but don't eat so much that your snack becomes an entire meal.

Balance your food choices over time. Not every food has to be "perfect." When eating a food high in fat, salt or sugar, select other foods that are low in these ingredients. If you miss out on any food group one day, make up for it the next. Your food choices over several days should fit together into a healthy pattern with proper nutrition.

Select foods based on your total eating patterns, not whether any individual food is "good" or "bad." Don't feel guilty if you love foods such as apple pie, potato chips, candy bars or ice cream. Eat them in moderation, and choose other foods to provide the balanced nutrition and variety that are vital to good health.

The weight that's right for you depends on many factors including your sex, height, age and heredity. Excess body fat increases your chances for high blood pressure, heart disease, stroke, diabetes, some types of cancer and other illnesses. But being too thin can increase your risk for osteoporosis, menstrual irregularities and other health problems. If you're constantly losing and regaining weight, a registered dietitian can help you develop sensible eating habits for successful weight management and nutrition. Regular exercise is also important to maintaining a healthy weight.

Just as there are no "super foods" or easy answers to a healthy diet, don't expect to totally revamp your eating habits overnight. Nutrition is important. Changing too much, too fast can get in the way of success. Begin to remedy excesses or deficiencies with modest changes that can add up to positive, lifelong eating habits. For instance, if you don't like the taste of skim milk, try low-fat. Eventually you may find you like skim, too.

The elderly are at risk for many problems, amongst them the risk of malnutrition. There are many reasons.

1. Social - Eating is a social activity. A simple event such as a loss of companionship may lead to disinterest in eating. Buying and preparing delicious food is an activity that may be restricted by limitations in mobility and finances, and the lack of social stimulus. Difficulty in hearing and vision may make buying groceries or even cooked food a chore. The elderly may find themselves eating food which is convenient, lacking variety and taste.
An unwarranted fear of many high quality nutrient-dense foods may aggravate the problem, especially in this age where there the message of a low fat-low cholesterol diet is heard loud and clear, although this is applicable mostly to younger persons. Examples of nutrient-dense foods are milk, steamed egg with milk (e.g. in egg tarts), milkshakes, soups and meat dishes with eggs, pan fried fish with gravy, stir fried dishes with unsaturated fats like samosa and other fried stuff.

2. Dentition - the ability to chew and break foods into smaller pieces for swallowing is an important first phase in the absorption of foods. Many elderly are edentulous or have ill-fitting dentures. This may interfere with their ability to chew food or fruits. They may resort to eating food which is soft but do not provide sufficient nutrients. Examples of ways to preserve nutrients are to chop up or mince before cooking, use a pressure cooker, cook with the lid on to make stews or creamy soups.

3. Changes in taste and smell - Taste and smell are an important stimulus for our appetite and encourage us to eat more variety and in sufficient quantities. With age, the number of our taste buds diminishes, and our ability to smell becomes less acute. Similarly, our sense of thirst diminishes, and this may cause us to drink less water than is actually needed by our body.

4. Changes in metabolic needs - There are a number of changes with aging:-
a) Changing demands - As we grow older, our metabolism rate decreases and hence our energy consumption and caloric requirement becomes less. Most of us also become more sedentary with increasing age. If we eat the same amount as we did when we were younger, we would overeat in terms of calories. Being overweight is associated with diseases like osteoarthritis and heart disease.
Demand for minerals and vitamins remain important. Of note we need to maintain an adequate intake of folate, iron, vitamin B6 and zinc. Vitamins E and C also helps to keep our immune system in good condition. Adequate calcium helps to maintain the strength of our bones.
b) Changing absorption -Some elders develop atrophic gastritis with age, leading to an inability to produce gastric acid and other factors important for the absorption of nutrients. This may lead to a deficiency in iron or vitamin B12.
c) Changing metabolism – A decreased ability to use protein efficiently to build lean muscle mass may necessitate a higher amount of high quality protein in the diet.

5. Disease states - The elderly may suffer from illnesses like diabetes, high blood pressure, coronary artery disease, and hypercholesterolemia. This may result in restrictions in their diet and lead to malnutrition if they do not take enough nutrient dense foods. Other diseases like cancers or tuberculosis may cause them to lose their appetite. Depression which is a common and under-diagnosed problem among the elderly also causes disinterest in food.

6. Medication related nutritional problems - Some medications alter the taste of foods. Other medications can cause gastritis, or interfere with the absorption of certain nutrients. Elderly persons who are taking more medications are at greater risk for this problem

As we grow older, our bodies become less forgiving, and we need to make a greater effort to eat well to maintain our health.

(Dr. Goel did her MBBS and an advanced course in Dermatology from India’s Premier Medical School - All India Institute of Medical Sciences, New Delhi. She also has a Masters in Public Health Management from Indian Institute of Health Management Research, Jaipur - An institute of repute in Health Management. )

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