Nutritional Concerns for the Older Adult

When Bernadette Harkins, 89, of Rockville, Md., could no longer feed herself properly, she moved to an assisted-living residence. Today, she can enjoy three meals a day served to her and about 30 other people in their home-like communal dining room.

When Harry, 85, of Moscow, Pa., could no longer feed himself properly, he moved in with his daughter and her family. Today, with her guidance, he's eating six times a day, snacking on high-calorie, high-protein foods, and maintaining a near-normal weight.

Harry, who asked that his last name not be used, and Harkins typify many of today's older generation. Living alone in most cases, they often are unable to meet their dietary needs and are forced to make compromises.

Harry didn't know how to cook. He developed cancer, which made it even more important that he eat a well-balanced diet. Harkins knew how to cook but didn't take time to prepare adequate meals for herself.

"I would snack is what I'd do," she said. "I would think about getting a meal and then just have a cup of tea and toast. I knew I wasn't doing the right thing as far as nutrition was concerned."

Their eating problems stemmed from loneliness and lack of desire or skill to cook. Other older people may eat poorly for other reasons, ranging from financial difficulties to physical problems.

The solutions can be just as varied, from finding alternative living arrangements to accepting home-delivered meals to using the food label recently revised by the Food and Drug Administration and the U.S. Department of Agriculture. Physical activity also is important in maintaining a healthy lifestyle.

Nutrition remains important throughout life. Many chronic diseases that develop late in life, such as osteoporosis, can be influenced by earlier poor habits. Insufficient exercise and calcium intake, especially during adolescence and early adulthood, can significantly increase the risk of osteoporosis, a disease that causes bones to become brittle and crack or break.

But good nutrition in the later years still can help lessen the effects of diseases prevalent among older Americans or improve the quality of life in people who have such diseases. They include osteoporosis, obesity, high blood pressure, heart disease, certain cancers, gastrointestinal problems, and chronic undernutrition.

Studies show that a good diet in later years helps both in reducing the risk of these diseases and in managing the diseases' signs and symptoms. This contributes to a higher quality of life, enabling older people to maintain their independence by continuing to perform basic daily activities, such as bathing, dressing and eating.

Poor nutrition, on the other hand, can prolong recovery from illnesses, increase the costs and incidence of institutionalization, and lead to a poorer quality of life.

Whether it happens at age 65 or 85, older people eventually face one or more problems that interfere with their ability to eat well.

Social isolation is a common one. Older people who find themselves single after many years of living with another person may find it difficult to be alone, especially at mealtimes. They may become depressed and lose interest in preparing or eating regular meals, or they may eat only sparingly.

In a study published in the July 1993 Journals of Gerontology, researchers found that newly widowed people, most of whom were women, were less likely to say they enjoy mealtimes, less likely to report good appetites, and less likely to report good eating behaviors than their married counterparts. Nearly 85 percent of widowed subjects reported a weight change during the two years following their spouse's death, as compared with 30 percent of married subjects. The widowed group was more likely to report an average weight loss of 7.6 pounds (17 kilograms).

According to the study, most of the women said they had enjoyed cooking and eating when they were married, but, as widows, they found those activities "a chore," especially appreciate their cooking efforts.

For many widowed men who may have left the cooking to their wives, the problem may extend even further: They may not know how to cook and prepare foods. Instead, they may snack or eat out a lot, both of which may lead people to eat too much fat and cholesterol and not get enough vitamins and minerals.

At the same time, many older people, because of chronic medical problems, may require special diets: for example, a low-fat, low-cholesterol diet for heart disease, a low-sodium diet for high blood pressure, or a low-calorie diet for weight reduction. Special diets often require extra effort, but older people may instead settle for foods that are quick and easy to prepare, such as frozen dinners, canned foods, lunch meats, and others that may provide too many calories, or contain too much fat and sodium for their needs.

On the other hand, Mona Sutnick, Ed.D., a registered dietitian in private practice in Philadelphia, pointed out that some people may go overboard on their special diets, overly restricting foods that may be more beneficial than detrimental to their health.

"My advice for a 60-year-old person might be 'watch your fat' but for an 80-year-old who's underweight, I'd say, 'eat the fat, get the calories,' " Sutnick said.

Some older people may overly restrict foods important to good health because of chewing difficulties and gastrointestinal disturbances, such as constipation, diarrhea and heartburn. Because missing teeth and poorly fitting dentures make it hard to chew, older people may forego fresh fruits and vegetables, which are important sources of vitamins, minerals and fiber. Or they may avoid dairy products, believing they cause gas or constipation. By doing so, they miss out on important sources of calcium, protein and some vitamins.

Adverse reactions from medications can cause older people to avoid certain foods. Some medications alter the sense of taste, which can adversely affect appetite. This adds to the problem of naturally diminishing senses of taste and smell, common as people age.

Other medical problems, such as arthritis, stroke or Alzheimer's disease, can interfere with good nutrition. It may be difficult, if not impossible, for example, for people with arthritis or who have had a stroke to cook, shop, or even lift a fork to eat. Dementia associated with Alzheimer's and other diseases may cause them to eat poorly or forget to eat altogether.

Lack of money is a particular problem among older Americans who may have no income other than Social Security. According to 1994 U.S. Census Bureau data, nearly 12 percent of people 65 and over are below the average poverty level for their age group. In 1994, the poverty level for a person 65 and over was $7,108 a year.

According to the 1994 data, the mean annual income for people 65 and over was $16,709, almost $10,000 less than what they earned on average between ages 55 and 64.

Lack of money may lead older people to scrimp on important food purchases-for example, perishable items like fresh fruits, vegetables and meat- because of higher costs and fear of waste. They may avoid cooking or baking foods like meats, stews and casseroles because recipes for these foods usually yield large quantities.

Financial problems also may cause older people to delay medical and dental treatments that could correct problems that interfere with good nutrition.

Many older p

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