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Nutrition in Aged Care

Are you over 70 years old or know someone who is? Do you know how much or what types of foods you or your loved one should be eating? A common thought is that as we get older we require less energy, protein, vitamins and minerals because we might not be doing as much. However, older adults actually have increased requirements for some nutrients such as protein, calcium and vitamin D compared to younger adults.

 

Protein

Protein is needed to maintain muscle and repair tissues. Protein is found from meat, chicken, fish, eggs, cheese, milk, custard, yoghurt and legumes. Older adults have increased requirements for protein compared to younger adults. They require approximately 0.2-0.4g per kg of body weight more protein per day. For example if you weigh 50kg you need an extra 10-20g of protein each day (that’s equal to about 3 eggs!) How can you achieve this? By making sure you’re consuming a variety of protein sources everyday, starting with the protein portion of the meal first and also consuming dairy products.

Studies have found that the timing of protein can also affect muscle mass. Some research suggests evenly distributed intake of protein is associated with increased strength, while other research recommends a larger dose of protein (30g) at lunch to be effective. Although even distribution may be optimal for some people, 30g of protein at the midday meal may be easier for older adults to achieve, as this is usually considered their main meal and many tend to consume a smaller portion for their evening meal. In conclusion, it is important to include enough protein in the diet and consider the patterns of intake for older adults as inadequate protein can result in muscle loss, frail skin, longer healing time and decreased immune function.

 

Calcium

Calcium is needed for bone strength and overall health to prevent fractures. Calcium sources include dairy products such as milk, yoghurt and cheese as well as bony fish and some plant sources like nuts and green leafy vegetables. Older adults require about 300mg more calcium per day than younger adults, which is equivalent to about 300ml of milk.  By including at least 2-3 serves of dairy into your diet each day will help to you achieve the recommended calcium intake.

 

Vitamin D

Vitamin D is another nutrient which older adults require more of than younger adults. Vitamin D is required for bone mineralisation and strength as well as playing a role in maintaining a strong immune system and skin integrity. Our bodies produce Vitamin D from sunlight; however, small amounts are found in foods such as oily fish and margarine. Older adults require  more Vitamin D than younger adults as to the body’s capacity to produce Vitamin D reduces as we age. Vitamin D deficiency is the highest among the elderly population affecting approximately 75% of those in nursing homes. Receiving adequate Vitamin D from diet alone is extremely difficult so it is important to ensure older adults get outside in the sunlight and don’t become housebound.

 

Energy

Although as we get older we generally become less active, go out less and maybe stay inside more especially if we’re not as independent as we used to be. This can lead to this misconception of older adults requiring less food and energy intake, which is only true for some older adults who are less physically active. However, this is very dependent on the person’s disease state. Some medical conditions such as kidney disease, infections, lung disease, dementia, Parkinson’s disease, fever, stroke and pressure injuries or wounds all have increase energy or calorie requirements. Energy requirements will vary depending on the disease and severity of the condition so make sure you contact a dietitian if you are unsure.

 

Fluids

As we get older our thirst mechanism reduces making it harder to stay hydrated. So even if older adults say no to a drink because they aren’t thirsty, this is not an adequate indication of hydration. A fluid is anything that melts in your mouth including water, cordial, tea, coffee, soft drinks, jelly, ice-cream, custard, milk and soups. The minimum fluid intake for older adults is between 1600-2000ml (which is 6-8 cups) a day. Maintaining hydration is extremely important as inadequate intake can result in dehydration, urinary tract infection’s (UTI’s) and confusion. It can be particularly challenging to achieve adequate hydration especially in winter months so older adults should make a habit of continually sipping fluids throughout the day. A simple tip of consuming an entire glass of fluid with any medications can help to boost daily fluid consumption.

 

Why is this important?

Inadequate intake of the nutrients mentioned above can have serious negative impacts on an individual’s health. It can result in weight loss, malnutrition, increased falls and fractures, longer healing time for wounds, dehydration and agitation. Malnutrition affects a high percentage of elderly people in hospitals, residential aged care facilities and those living at home. Weight loss is not a normal part of ageing and weight should be regularly monitored. Malnutrition and unintentional weight loss can lead to a decline in overall health, increased assistance from health professionals and reduced physical and cognitive function. Ensuring sufficient intake of all nutrients is important in the prevention of malnutrition.

 

Tips

Often achieving adequate intake for older adults can be challenging especially due to age-related changes such as reduced appetite, changes in food preferences, taste changes and lack of interest in food. Firstly, make sure you regularly consume meals throughout the day, try eating every 2 hours or similarly consuming 3 meals and 3 mid-meal snacks a day. Placing meals on a small plate can help with those who experience reduced appetite and lack of interest as opposed to placing large meals in front of an individual, which can often overwhelm them and result in reduced intake. Making or offering nourishing drinks and desserts like a glass of milk, milkshakes, yoghurt and custards are a great way to improve an individual’s protein, calcium and energy intake. For more advice and personalised strategies to help your or a loved one’s individual needs see an APDf or more information.

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