With advancing age, the capacity to digest and tolerate large meals often decrease
Many across the world have touted India’s large young population to be its strength, but this demographic trend is slowly changing. With improving healthcare infrastructure including clean drinking water, vaccinations, better access, and advancements in medical care, compounded with a growing economy has increased longevity. As an example, average age expectancy today is 70 years compared to just 50 years in 1975.
It is estimated that India will have a whopping 194 million people more than 60 years of age in 2031 compared to 138 million in 2021, a 41 per cent increase over a decade. As we age, our needs also change – the primary concerns revolve around safety and security, health, financial and social well-being. Orthopedic and medical problems increase and performing routine activities often becomes a challenge.
According to a study conducted by the Agewell foundation, in urban India approximately 25% of the elderly are living alone and 25% are living with their spouses and without their children. Older people who stay alone are more prone to increased health risks due to negligence. Isolation and loneliness in seniors go hand-in-hand in the elderly and these conditions are becoming more and more common. However, among the myriad of problems an often underappreciated and under recognized problem is proper diet nutrition.
A good quality of life during old age is important and it should not be considered merely an extension of life. With progressing age, the body composition changes, and these changes affect nutritional needs of the elderly. Despite the age-related changes which are inevitable, consuming a nutritionally adequate diet has the potential to delay the onset of many pathological problems as well as degenerative diseases and promote healthy aging.
The ability to ingest, absorb and utilise nutrients may vary among elderly; however, they will need fewer calories compared to those required during adulthood due to decrease in the physical activity and lowered metabolism. The approximate reduction in the total energy requirements is 20 percent for those between 60-69 years and 30 percent those between 70-79 years of age.
On the other hand, their body requires all other important nutrients like proteins, vitamins and minerals in amounts which are comparable to the requirements for adults.
In fact, the need for few micronutrients like calcium, iron, zinc and vitamin A may increase as they have important role in prevention of age-related degenerative diseases for elderly. Intake of dietary fibre is particularly important as it has a beneficial effect in various conditions associated with aging such as constipation, diabetes and cardiovascular diseases. Consumption of phytochemicals and antioxidants should also be promoted as they significantly influence the physiological processes modulating the aging and increasing immune competence.
To be able to consume a balanced diet which limits calories but is nutrient-dense few strategies can be helpful. The daily intake of oil should be restricted to 20 grams and the use of ghee, butter, vanaspati and coconut oil should be avoided. Instead, oils containing high level of mono-unsaturated fats (MUFA) and poly-unsaturated fats (PUFA) such as mustard oil, sunflower oil, soyabean oil, olive oil should be used to prevent and control conditions like hypertension and other cardiovascular diseases.
Similarly, the intake of simple sugars from table sugar, candy, chocolates, fruit juice concentrates, and other sugary drinks should be reduced as these provide only empty calories. Although eating too much salt can raise blood pressure at any age, older people need to particularly be careful about how much salt they eat. WHO recommends that adults should consume less than 5 g (just under a teaspoon) of salt per day. Salt in the diet can come from processed foods, either because they are particularly high in salt (such as ready meals, processed meats, cheese, salty snack foods, and instant noodles, among others) or because they are consumed frequently in large amounts (such as bread and processed cereal products). Therefore, along with adding salt to food, intake of processed foods should be controlled.
Apart from cereals and pulses, consumption of at least 200-300 ml of low-fat milk and milk products and 400 g of vegetables and fruits daily should be promoted which will ensure sufficient intake of fibre, micro-nutrients and antioxidants. Flesh foods and eggs are also important as they enhance quality of diet. Along with this adequate water should be consumed to avoid dehydration, hyponatraemia and constipation.
Herbs, spices and condiments are indispensable component of Indian traditional cuisine. Besides stimulating the appetite, they also promote digestion, and have general medicinal and curative property. Therefore, herbs and spices like carom seed ( Ajwain), aniseed ( Saunf), clove ( Laung), fenugreek seeds ( Methi dana) , garlic, ginger , turmeric etc should be included in the diet of elderly. The anti-carcinogenic, hypoglycaemic, hypocholesterolemic effect of many of these herbs and spices have been clinically proven and tested.
The dietary pattern and food preferences may also change at this age. With advancing age, the capacity to digest and tolerate large meals often decrease. Therefore, the quantity of food given at one time should decrease and number of meals may be increased. Due to loss of teeth, modification in consistency becomes mandatory. The diet needs to be well cooked, soft and less salty and spicy. Further, the food should be colourful, attractive and served in pleasant surrounding so as to arouse the elderly’s appetite and interest in food.
Apart from the diet, light physical activity or if feasible exercise should be considered an integral part of daily routine. The risk of obesity and degenerative diseases is considerably decreased by regular exercise. Moreover, sufficient sun exposure is essential to meet the body’s need for Vitamin D. In case of elderly individuals confined to bed, supplements of vitamin D may be required.
These guidelines in the changing dietary requirements in the elderly population are often difficult to manage. There is tremendous scope for the development of geriatric foods specifically catering to the changing dietary requirements in the elderly.
Points to Ponder
- Body composition changes with advancing age, and these changes affect nutritional needs of the elderly.
- The energy requirements of elderly are particularly less than that of adults due to lowered metabolism and decreased physical activity
- During old age, the requirements of all other important nutrients like proteins, vitamins and minerals remain same or increase as compared to that required during adulthood.
- Foods that are nutrient-dense but low in sugar, oil and salt should be included in the menu of elderly person.
- Along with dietary fibre intake of herbs, spices and condiments should also be promoted to prevent age-related diseases and for healthy ageing.
- Food should be soft, colourful, attractive and served in a pleasant atmosphere to as to arouse the elderly’s appetite and interest in food.
- Good /healthy food habits and regular comfortable level of physical activity and exposure to sun are required to minimise the ill effects of ageing and to improve the quality of life.
Authors’ details- Dr Sameer Gupta, Co-Chair, Hospital & Diagnostics Committee, PHDCCI; & Interventional Cardiologist, Group Cath Lab Director, Metro Group of Hospitals, MD, Aurum Senior and Assisted Living, Gurgaon
Co- Author: Dr Vandana Sabharwal, Consultant Nutritionist, Aurum Senior and Assisted Living, Gurgaon, Asst Prof, Department of Food and Nutrition,
Delhi University