Nutrition of the elderly

WELLNESS AND AGE
CHAPTER XV
University of Szczecin,
Faculty of Physical Education and Health Promotion,
Department of Health Promotion
Uniwersytet Szczeciński,
Wydział Kultury Fizycznej i Promocji Zdrowia,
Zakład Promocji Zdrowia
KATARZYNA SYGIT
Nutrition of the elderly
Żywienie osób w starszym wieku
Keywords: nutrition, elderly, lifestyle, health promotion
Słowa kluczowe: żywienie, osoby starsze, styl życia, promocja zdrowia
INTRODUCTION
The aging process of the human body causes a gradual reduction of physical fitness and an increased incidence of chronic diseases. Limiting factor of these processes is to maintain a normal nutritional status [26]. With age, decreasing the efficiency of digestion, absorption of nutrients and their use in metabolic processes. Decreases: the secretion of gastric juices, digestive enzymes, aggravated absorption in the
small intestine impairs efficient operation of the kidney, followed by escape of calcium, dehydration tissues worsens blood circulation and oxidation of tissue disorder
is a lot of functions regulated by hormones and so on. In contrast, the poor state of
economic elderly people affected not only reduce the quality and quantity of the
products they buy, but also the possibility of making purchases. Loneliness, social
isolation, and often inadequate nutrition, worsen their nutritional status [15].
The aim of this work is to show the importance of proper nutrition to maintain
good health of the elderly based on literature review.
RATIONAL BALANCED NUTRITION OF THE ELDERLY
Heterogeneity of the elderly and various health problems cause difficulties in the
development of universal recommendations for dietary this period of life. It is difficult to create a model of nutrition accepted by this group of people, which would
simultaneously be optimal in economic terms, flavor and customary and allow to
implement all the recommendations of rational nutrition. Nutritional recommendations promoted in European countries and targeted to people from risk groups, including the elderly, according to W. Roszkowski, can be reduced to a few principles
WELLNESS AND AGE
of nutrition, according to which the elderly should: daily consume a variety of foods;
increase your intake of essential fatty acids, starch and dietary fiber; reduce the intake of fat, cholesterol, sugar and salt; limit alcohol consumption; weight control;
increase physical activity [2, 17, 22].
Rational nutrition of older people are frequently confronted with the following
factors:
 senile changes, which include: the weaker the secretion of saliva  and digestive juices, dental problems, and impaired intestinal motility contribute to the
deterioration of food intake and absorption, and delayed excretion of debris;
 other changes that often lead to conditions such as polyps, a hernia, excessive
contractility of the sphincter, which is the cause of pain, retention of food in
the stomach or bile in the gallbladder;
 chronic heart disease, chronic respiratory insufficiency, dysphagia cerebral,
diabetes and gout, kidney disease;
 medication (excessive in relation to the needs), which affect the work of the
gastrointestinal tract and metabolism of nutrients (eg. diuretics, antibiotics,
etc.);
 adverse living conditions, for example. Solitude person inefficient, depression, impoverishment combined with the need to conserve forced to make
sacrifices, adverse to health;
 conducting single farm is not motivated to diversify the menu [3, 10, 12, 17,
20].
THE DEMAND FOR NUTRIENTS
Nutrition should provide delivery of energy, appropriate nutrients: proteins, fats
and carbohydrates, minerals and vitamins. The demand for these components is
different in the very elderly than in the young. Developed standards of nutrition old
people take into account several parameters:
 Gender and age divided into two subgroups: men 65 to 74 years of age and
over 75 years of age, women 55 to 64 years of age and over 65 years of age.
 Physical activity: older people with lower mobility are less energy demand.
 Body weight: overweight people have lower caloric needs, especially that
generally lead less mobile lifestyle. Large deviations of body weight than
those provided standards adversely affect the development of old age and
disease processes in old age.
 Involution changes in the gastrointestinal tract: impair digestion and absorption, can result in deficient bands need correction using an appropriate diet.
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 Disease processes that require medical nutrition therapy and diseases typical
of old age, which leads to severe depressive syndromes refused food intake
[13].
There are many nutritional standards developed by institutions concerned with
nutrition.
Caloric intake for people of old age by A. Szczygła shown in Table I.
The differences in caloric requirement shown in Table result of the difference of
body weight between groups of people.
Table I Caloric requirement for people in old age by A. Szczygieł [23]
Sex
Age
55—64
Women 65—74
75+
65-74
Man
75+
Calories / day
Data from
FAO
the UK
1850
2050
1600
2050
1600
1900
2100
2350
2100
2100
According to the Institute of Nutrition and Food in Warsaw in people over 60
years of age with low physical activity, the demand is:
 men - 1800-2200 calories per day;
 women - 1500-1850 calories per day;
With moderate physical activity need the following:
 men - 2200-2650 calories per day;
 women 1850-2250 calories per day [9, 27].
Given the increase in obesity in civilized societies, in people of retirement age
should be taken as a lower recommendation consumption of energy (as suggested by
nutritionists in the US), for healthy men an average of 2,200 calories and women of
the same age on the growth of an average of 163 centimeter - 1600 calories. Energy
requirements for older people decreases so an average of 30% compared to men 2025 years old. However, taking into account the fact that in Poland many people of
retirement age are still working hard physically, energy demand should be in accordance with their energy expenditure [13].
Table II. Nutrient requirements
of people over the age of 65 by L. Hryniewieckiego [6]
Type
of component
Energy
Protein
Daily requirement
Reduction of energy intake of calories to 2,100 in men and
1,800 in women calories
85 g, increased consumption of animal protein to 50% of
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WELLNESS AND AGE
demand; the percentage of energy from protein 12-14%.
Reduction in the consumption of 60 g (30% of energy),
the increase in the consumption of fatty acid mono- and
Fats
polyunsaturated, and the decrease of saturated fatty acids
of commutation.
Reducing the intake of simple sugars to 75g, increased
Carbohydrates
consumption of plant fibers to 25-35g.
Calcium: 1.0-1.5g, magnesium: 0,35-0,5g, iron: 15mg,
Minerals
zinc: 15mg, selenium; 70mg
Vitamin A 1500 IU, vitamin D: 5-10μg, vitamin E: 15-13
vitamins
mg vitamin C: 80-95 mg witaminaB1: 1.5 mg niacin: 16
mg pyridoxine: 2.5 mg.
Supplied with food energy should come from:
12-15% protein
25-30% of fats
55-60% from carbohydrates.
By reducing energy consumption in old age need to pay attention to cover the
demand for protein, vitamins and minerals [13, 27].
THE DEMAND FOR PROTEINS
Overall, it is emphasized that with aging comes a negative nitrogen balance. Proteins are gelling, growing emaciation. Insufficient supply of calories causes wear old
man protein foods in energy production and can consequently lead to a deficiency of
the protein in the body.
The demand for this nutrient in the elderly by FAO / WHO should not be less
than 0.75 g / kg body weight per day. Some national studies stating nutritional deficiencies in the form of a low protein intake for this age group, recommend eating
this component at 1.5 g / kg body weight [1]. It seems, therefore, that it would consume protein in amounts of at least 1 gram / kilogram of body weight per day, including 50% of full value of protein. It should be remembered that this is a recommendation for the elderly and healthy [27].
Of course, in planning protein requirements should take into account the quality
and digestibility of protein digestion and the state organ of the patient. Not without
significance are the economic conditions in which there is an old man. Financial
constraints mean that old people often feed incorrectly; their diet is low protein
because of the relatively high price of protein products, especially meat. Therefore,
when laying menus for old people should use other protein products, a full valence,
not necessarily of animal origin. Protein should provide 10-15% of the caloric intake
[24, 27].
THE DEMAND FOR FATS
Fats should cover approx. 20 -35% of energy. Of course, in the elderly is a need
to be coated with grease 20 rather than at 35%. Half-fat food is in the form of socalled. invisible fats, which of course should be taken into account in the calculation
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of caloric. Is, for example. Grease which is located in milk meat, vegetables, fish,
nuts. In addition, fats serve in isolated form, as butter, lard, margarine, oils. If, therefore, the calculation of caloric intake that you should put 70 grams of fat a day, in
the form of a separate serve only half [21, 22].
Observe that over 50% of dietary fats were given in the form of fats plant, rich in
linoleic acid (soybean oil, sunflower). Should not be forgotten that the correct ratio
of the unsaturated fatty acid families, the 6 acids of the 3 should be 5: 1. It is worth
remembering that the increased amount of fat in the diet greatly increases the caloric
content of the diet and leads to obesity. Besides, in the elderly greasy meals are not
well tolerated. The most common cause abdominal discomfort (bloating, belching,
heartburn, etc.) [26, 27].
THE DEMAND FOR CARBOHYDRATES
Caloric 55 - 70% cover the carbohydrates. They are the basis of nutrition. The
source of carbohydrate products are high in polysaccharides, such as. Starch, which
only in the digestion process are decomposed into simple sugars. These products
include primarily flour products: bread, cereal, potatoes. In addition, 'contained in
plant foods dietary influences on the proper movement of the contents of food in the
intestines [26].
It is recommended to consume complex carbohydrates (starch) with plenty of dietary fiber (whole meal bread, vegetables, fruit etc.).
The elderly should be especially limit the intake of sugar and sweets between
meals, since these products satisfy hunger and cause a reduction in apatite, which is
the reason for the inadequate consumption of more nutritious protein, starch, minerals and vitamins [15, 17].
THE DEMAND FOR MINERALS
With proper nutrition of the elderly is not observed deficiency of minerals. Rarely, however, we are dealing with properly nourish the old people. Improper nutrition
is often due to the habits, needs economic or finally - existing disease processes that
force the old man to adhere to a very strict diet or by themselves cause teams malnutrition. The most commonly observed deficiencies to be followed by iron deficiency
anemia hypochromic. Iron deficiency often arises in connection with small, me
bleeding and too little in this situation, the supply of iron in the diet [2.14].
Women who have crossed the age of 60 should be compared with women 26-60
years old, to increase calcium intake by 30-35%, phosphorus by 25%, while the
lower iron intake by 10-20%. Many authors believe that the Polish population of the
elderly in 10-20% have anemia caused by iron deficiency. This involves not only
inadequate intake of iron-containing, but also the underlying diseases, such as.
Chronic inflammation, kidney disease, cancer etc. The demand for calcium for their
age group by Polish standards (Institute of Nutrition and Food in Warsaw) is: in
women - safe level of 1000 mg / person / day, and the recommended standard - 1100
mg / person / day; men - similarly 800 mg / person / day and 900 mg / person / day /.
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WELLNESS AND AGE
The demand for phosphorus population of people over age 60 are: women - safe
level - 750 mg / person / day, and the recommended standard - 800 mg / person /
day; men - similarly - 650 mg / person / day and 700 mg / person / day.
Demand for other minerals for older women increased by an average of 10%.
while men in the elderly should increase the supply of all minerals in their diet by
17-18% [4,20,22].
THE DEMAND FOR VITAMINS
The wrong foods in the diet and a wrong way of preparation, as well as functional disorders in the gastrointestinal tract may lead to syndromes resulting from vitamin deficiencies.
Vitamins are nutrients whose job is to regulate metabolic processes. They are so
very important in the elderly, which often reduces the intake of foods containing
them. Besides frequent in old age disease states also require higher doses of vitamins
for medicinal purposes. In the older age increases especially the need for vitamin D
needs with age for this vitamin increases, which is related to the reduction of exposure to air and contact with UV rays and reducing hydroxylation of vitamin D in the
kidneys. safe standard intake of vitamin D in women and men over the age of 60
(according to the Institute of Nutrition and Food) is 5 mg / person, the standard recommended - 10 5 mg / person [9].
The research Ś. Ziemlańskiego et al. it shows that administering to the human in
old age increased doses of vitamin C and vitamin E leads to a reduction of lipid
peroxides in serum and an increase in total protein content in the blood, particularly
globulins. Administration while the elderly higher doses of vitamin E seems to be
justified because of the effect of this vitamin in the aging process of organism and
prevention of degenerative diseases. Demand according to the standard safe (according to the Institute of Nutrition and Food) for vitamin E at this age in both sexes is 8 mg / person, and the recommended standard - 10 mg / person [27].
A safe level of intake of folate by older women with low physical activity increases by almost 50%, whereas a moderate and high activity by approximately
25%. Men regardless of the physical activity level of a safe and recommended intake
of folate is high and increased as compared to younger age from 29 to 44%. Polish
norms for folate (according to the Institute of Nutrition and Food) provide for:
women over 60 years old - a safe level - 300μg / person, and the recommended
standard - 320 mg / person; in men the same age - a safe level - 320 mg / person, and
the recommended standard - 340 mg / person.
There is also a shortage of vitamin B. The demand for vitamin B2, especially in
older women Nevertheless they still - (according to the Institute of Nutrition and
Food) - 1.8 mg / person / day, and the recommended standard - 2.0 mg / person /
day; Nevertheless they still safe for men - 2.0 mg / person / day, and the recommended standard - 2.2 mg / person / day [26, 27].
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Table III. Recommended nutrient standards
for older people by A. Szczygieł [23]
Name
Unit Standard
Calories
Total protein
Animal protein
Fats
Carbohydrates
g
g
g
g
Calcium
Iron
Vitamin B1
Vitamin B
Vitamin C
g
mg
mg
mg
mg
A*
2300
2300
65
64
37
37
65-80
67
365-330 360
0,6
10
1,3
1,3
75
B**
C*** D****
2360
65
42
72
360
2350
71
46
34
350
2360
74
49
79
336
1,0
16
1,5
1,6
85
1,0
16
1,5
1,7
90
1,1
17
1,5
1,8
95
0,8
15
1.5
1,4
75
* A = standard board conditionally sufficient.
** B = standard food sufficient for a moderate cost.
*** C = standard wholesome food with a medium-high cost.
**** D = standard food destination.
RECAPITULATE
The basic principles of nutrition of the elderly.
Proper nutrition significantly affects the state of health of older people. It can alleviate and even significantly reduce health problems. It is therefore important that
these people ate meals containing appropriate quantities of nutrients.
Balanced diet should meet the following criteria:
1) cover all the needs of the body, without providing excess calories or without
weighing ingredients harmful to health;
2) remain, as far as possible, according to the tastes and habits;
3) suit your individual ability, which are shaped by changes in age, disease, and
specific conditions of life [5. 21].
Involution changes cause the specific dietary requirements of old age.
 Food should be balanced in terms of energy.
 Proper nutrition requires a balance of energy. To maintain a balance between
the amount of energy supplied with food, and its spending. The human demand for energy - CPM is determined by the overall level of all energy transformations of the body. It consists of: expenditure on maintaining basic bodily functions - PPM and transformation over the basic associated with physical activity and mental conditions deviating from the comfort microclimate
and mental health, as well as the specific dynamic action of food.
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 Day energy supply properly spread over the food and energy components of
diet.
 The proportions of macronutrients in a ration should be adults protein 10 15% carbohydrates, 50 - 60% of the sugars not more than 10% fat and 30%
(35% for the high-activity), including NNKT 3 - 7% of the total energy.
 The proportions of ingredients in energy ration, should be identical percentage in each meal.
 Food should provide all the nutrients and fiber while maintaining the correct
balance between them.
 The amount of energy and nutrients which the body healthy person, depending on age, sex, physical activity and living conditions and working conditions, should receive a daily basis in the form of meals and meals consumed
define standards of nutrition.
 With nutrition standards are correlated so-called standard board. food rations.
They define sets of products from different groups, covering the daily energy
and nutrients for one person.

Meals should be eaten regularly.
 To rationally use the nutrients of food nutritional ration must be distributed
on meals eaten as much as possible at the same time, the interval between
them should not be longer than 5-6 h and not less than 3 h. Children, adolescents, the elderly and convalescents and people high energy requirements
should eat 4-5 meals a day. For people working on night shifts should be
considered easy to digest meal regenerative approx. Hours. second means.
deepest during the performance degradation of the body.
 Meals should be eaten alone.
 Slow, quiet food, good chewing promotes the secretion of saliva, digestive
enzymes and food will alkalization, so better used and consumed than to
conditions of discomfort and haste.
 You should fight bad eating habits and traditions
 Rational nutrition is based on the knowledge of the physiology of nutrition
and knowledge of the factors affecting the nutritional value of food.
 It is recommended that women over the age of 60 increased the daily calcium
intake to 1100 mg.
 You have to make sure that the diet did not lack vitamin D. Older people rarely benefit from the sun, so their skin, vitamin D is not synthesized in sufficient quantities. Sources of vitamin D in foods is primarily fatty fish (herring,
mackerel, tuna), milk with a fat content exceeding 1.5% fish oil. In some cases, your doctor may order additional consumption of vitamin D.
 You should also be aware of antioxidant vitamins - C, E and beta-carotene.
Their deficiency can accelerate the aging process and increase susceptibility
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to diseases such as cancer and atherosclerosis. Vitamin E also prevents the
osteoarthritis. Vitamin C and beta-carotene can be found in fruits and vegetables, while vitamin E in vegetable oils and margarines. Among minerals pay
our attention to a corresponding amount of potassium, iron and magnesium
deficiencies which often occur in old age.
 Meals varied and visually appealing are important in stimulating appetite weakened.
 It is advisable to avoid a heavy fog, which long remain in the stomach. Therefore rather not recommended for frying as a method of cooking. Definitely
better is cooking, braising without roasting or baking in the film.
 The daily diet should include dairy products, whole grain cereals, vegetables,
fruits and lean meats and meat products.
 Limit sugar and sweets worth it because of the occurring in the majority of
the elderly decreased glucose tolerance.
 In many cases, the diet should be determined individually due to any disease
or existing overweight or malnutrition [2, 6, 9, 21, 22].
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ABSTRACT
The aging process of the human body causes a gradual reduction of physical fitness and an increased incidence of chronic diseases. Factor reducing these processes
is to maintain normal nutritional status. The aim of this work is to show the importance of proper nutrition to maintain good health of older people based on literature
review. The study particularly highlighted the necessity of adherence to dietary
guidelines developed for older people based on numerous studies that uniquely identifies that include: daily consume a variety of food products; increase your intake of
essential fatty acids, starch and dietary fiber; reduce the intake of fat, cholesterol,
sugar and salt and increase physical activity. It also presents the need of the elderly
for nutrients: the need for protein, fats, carbohydrates and minerals. In conclusion
the basic principles of nutrition of older people on the basis of the Decalogue of
healthy eating.
STRESZCZENIE
Proces starzenia ustroju człowieka powoduje stopniowe ograniczenie sprawności
fizycznej i zwiększoną zapadalność na choroby przewlekłe. Czynnikiem zmniejszającym te procesy jest utrzymanie prawidłowego stanu odżywiania. Celem niniejsze
pracy jest ukazanie znaczenia prawidłowego żywienia dla utrzymania dobrego
zdrowia osób starszych na podstawie przeglądu literatury. W pracy szczególnie
zwrócono uwagę na konieczność przestrzeganie zaleceń żywieniowych opracowanych dla osób starszych opierając się o liczna badania które jednoznacznie określają,
iż należy: spożywać codziennie różnorodnych produkty spożywczych; zwiększyć
spożycie niezbędnych nienasyconych kwasów tłuszczowych, skrobi i błonnika pokarmowego; zmniejszyć spożycie tłuszczu, cholesterolu, cukru i soli oraz zwiększyć
aktywność fizyczną. Przedstawiono również zapotrzebowanie osób starszych na
składniki pokarmowe: zapotrzebowanie na białko, tłuszcze, węglowodany i składniki mineralne. W podsumowaniu omówiono podstawowe zasady żywienia ludzi
starszych w oparciu o dekalog zdrowego odżywiania.
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