The number of individuals aged 60 years or older is escalating and too often this is also a group most susceptible to many health risks from a nutrient poor diet. Evidence from numerous sources indicate that a significant number of elderly fail to get the amount and types of food necessary to meet essential energy and nutrient needs. Ageing population in developing countries is currently facing a double burden of malnutrition due to social and demographic changes leading to under-nutrition and at the same time it is being observed that their diets are becoming higher in fats, animal products, refined foods and are low in fiber, contributing to rapidly increasing prevalence of obesity and type 2 diabetes. Dietary interventions in the elderly are therefore particularly challenging, because of the paucity of data on which accurate recommendations for which age related changes in nutrient requirements could be based.

The effects of ageing

As people age, establishment of healthy nutritional habits often requires a multifaceted intervention approach to address the wide range of factors contributing to poor nutrient intake which include physiological, psychosocial, and economic changes.

Physiological Changes

The body’s function slows with age, and its ability to replace worn cells is reduced. The metabolic rate slows and can decline up to thirty percent over a lifetime. This results in decreased caloric needs which can be complicated by changes in an older person’s ability to balance food intake and energy needs. Even with a decreased caloric need, many older people have difficulty getting sufficient calories which can eventually lead to chronic fatigue, depression and a weekend immune system. As we age our body composition changes with a decrease in lean tissue mass (as much as 25%) and an increase in body fat. Such changes can be further accelerated because older adults utilize dietary proteins less efficiently and may actually need a greater than recommended amount of high quality protein in their diet to maintain lean tissue mass. Bones also becomes less dense and eyes do not focus on nearby objects as they once did and some go cloudy with cataracts, poor dentition is common and hearing, taste and smell are less acute. Digestion is affected because the secretion of hydrochloric acid and enzymes are diminished. This in turn reduces intrinsic factor synthesis, which leads to a deficiency of vitamin B12. The tone of the intestines also slows down and the result may be constipation or in several cases diarrhoea.

Psychological Changes

Feelings do not decrease with age. In fact, psychosocial problems can increase as one grows older resulting in depression and diminished appetite. The elderly frequently complain that they do not like to cook for one person or eat alone, either at home or in a restaurant. Studies indicate that elderly living alone do not make poorer food choices than those living with a spouse, but they do eat fewer calories. Poor self-esteem may also lead to lack of interest in eating.

Economic Changes

Unless one has carefully prepared for retirement it can typically affect one’s nutritional intake by sacrificing on expensive food items like milk and its products, meats, fruits, dried fruits and nuts, which are rich sources of calcium, protein, zinc, iron, B-vitamins and vital anti-oxidants. It is generally observed that lower the income, the less likely adequate and varied diet will be consumed.