THE NUTRITION IN THE ELDERLY. Aging is not a disease, but a phase of life.
Thanks to a healthy lifestyle, including proper nutrition and physical exercise, it is possible to age well and prevent many diseases.
More than changing, it would be necessary to go back to a past well being, breaking a vicious circle of new incorrect habits…unfortunately in the last decades almost all the western population has acquired wrong eating habits typical of the western diet, rich in sugars and saturated fats, fast and characterized by ready made industrial foods with high caloric density.
Malnutrition does not only mean eating little, but it also means eating badly. A diet that does not provide qualitatively and quantitatively useful substances, over time predisposes us to a pathological state. A state of malnutrition indicates an organism lacking one or more essential components of the diet: proteins, some amino acids, some essential fatty acids, vitamins and minerals.
In Western society, more and more “old”, it is important to ensure everyone the opportunity to age well and to plan a correct nutrition and tailored to the person is essential for everyone, but in the elderly, often affected by diseases, it becomes a real necessity.
Diet therapy in the over 60s is useful for:
Control and prevent malnutrition (imbalance between nutrient and energy intake and the amount of these needed by the body to ensure its functions).
Reduce the amount of adipose tissue if present (especially in the abdominal area) and avoid the loss of lean mass (sarcopenia-cachexia).
Improve the response to any therapies, reducing side effects (metabolic changes, anemia, leukopenia, plateletopenia, dysgeusia, vomiting, irregular evacuation and dysbiosis, etc. …).
Reduce the load of toxins from the outside, which can reduce the efficiency of the immune system.
Reduce inflammation (glucose, insulin, growth factors, cytokines and sex hormones).
Improve quality and length of life (weakness, nervous system alterations, etc…).
In the nutritional management of the elderly, it is important to control:
The intake of liquids (drinking plenty of water must be an imperative!): the stimulus of thirst is progressively reduced as the years go by and this can also lead to severe dehydration. In addition, water is an important source of essential minerals for the aging body. LARNs recommend men over 65 to consume 2.5 liters of fluids every day and women 2 liters (about 8 glasses). An alternative to water can be given by centrifuged drinks, which also provide vitamins, minerals and antioxidants, or tea (excellent green tea with antioxidant properties) and herbal teas. Even food can be a source of liquids: for example in fruits and vegetables water can be up to 85% of the food.
Menu and portions: the general rules of nutrition in the elderly are similar to those of adults, but there are some small tricks that make food a real elixir of life.
In case of overweight, reduce the number of calories taken every day: this is a necessary step in the elderly in which basal metabolism and muscle mass progressively decrease and therefore less energy is consumed. But be careful not to reduce too much! Situations of sarcopenia (lack of muscle mass) and consequent dinapenia (lack of strength) could occur even in subjects with excess weight.
Eat foods rich in fiber: fruits, vegetables, legumes and whole grains, thanks to fiber, help to avoid digestive problems and constipation (the intestine with the years becomes more and more “lazy”!) and to maintain a good bacterial flora, fundamental elements for the prevention of colon cancer. A person over 65 needs 4-5 portions of fruit and vegetables per day to ensure the necessary intake of fiber, vitamins and minerals. A portion of fruit corresponds to about 120-150 grams, while a portion of vegetables corresponds to 200 grams. These foods sometimes can be difficult to chew or to digest especially in the elderly people, therefore it is good to eat mashed, cooked or grated foods, definitely easier to chew and swallow. In the elderly who have particular difficulties in eating fruits and vegetables (teething problems, dysphagia, lack of appetite) could be used food supplements (after medical consultation).
Micronutrients (vitamins, minerals and antioxidants). They are all extremely important, but certainly in the elderly should not be deficient:
Calcium and vitamin D are fundamental for the good health of bones which tend to weaken as we age. Milk and dairy products are rich in these elements, but they should not be abused because they also contain many fats. Moreover milk activates metabolic and hormonal mechanisms which, according to some studies, have the effect of favoring the growth of some tumors. Alternatives do exist and they are also numerous: unsweetened vegetable milk, oily nuts, legumes and aromatic herbs!
Vitamin B12: important in various metabolic processes (especially neurological, immune and hematological) is found mainly in foods of animal origin, little is needed but is essential.
Among animal proteins, fish is to be preferred, also considering its content in omega 3.
Potassium: fundamental for the good functioning of nerves and muscles, including the heart. If the level of this mineral is lowered too much, arrhythmias are risked, which could be very dangerous. Beans, peas, pistachios, chickpeas, apricots, bananas, cauliflower, spinach are just some of the foods naturally rich in potassium.
Macronutrients. Let’s see what is better to choose and the most suitable quantities:
Fats: vegetable fats are best (extra virgin olive oil, preferably unrefined and pressed, sesame and flax seeds, walnuts and so on), trying to avoid butter, lard and margarine. Three tablespoons per day of extra virgin olive oil are sufficient to ensure the right intake of “good” fats in an elderly person.
Carbohydrates: complex carbohydrates (bread, pasta, rice) must be present in every meal for a total of three portions per day (a portion is equal to a 50 gr sandwich or 70-80 grams of pasta or rice), making sure to prefer whole grain varieties. Simple sugars must instead be limited to a minimum: better to take them from fruit than from sugar.
Protein: two portions per day are needed, better if of vegetable origin or derived from fish or white meat. One portion corresponds to about 100 grams of fish, 70 grams of meat or 30 grams of dried legumes.
Pay attention to the type of cooking!
A very important aspect is the type of cooking used to prepare a food.
Unfortunately some cooking methods alter the quality of foods.
Cooking at low temperature and for short times are to be preferred, better in glass or ceramic pans.
Attention must also be paid to quality, which is often not the cheapest choice. A food is healthier the less it is processed by industry and the more it is similar to how Mother Nature created it. Certainly organic and integrated pest management foods are to be preferred for the lower quantity of pesticides present.
Finally, we must also evaluate the psychological aspects.
With the passing of the years many problems can occur that can turn mealtime into a stressful situation.
Bad chewing (teething problems or the presence of prosthesis) pushes many elderly people to avoid “difficult” foods and, sometimes, even to avoid an invitation to lunch or dinner for fear of showing others their discomfort.
Taste and smell diminish with time and there is the risk that all dishes taste the same and that eating becomes not only a habit but also a burden. In this case it is important to exalt the taste of foods (for example with the use of spices).
Some people, especially those who are alone and have motor difficulties, suffer from depression, a psychological state which determines the consumption of meals which are often the same, fast and not very balanced. Finally, economic factors must be considered, which play a relevant role: unfortunately, many people over 65, retired and alone, are not able to meet their daily expenses and this leads to the penalization of food choices, especially in terms of quality.