When you think about aging and nutrition, what comes to mind? Maybe you’re thinking about how nutrition is vital for growth and development during childhood and adolescence. Or how to meet the nutrition needs of a busy adult with bills to pay and kids to raise. Did the special nutrition requirements of the elderly pop into your head? At each stage of the life cycle, our nutrition needs change and we face unique challenges to healthy eating.

During these times of the coronavirus pandemic and months of social distancing, the needs of the elderly have been on my mind. Even under normal circumstances, older adults face numerous challenges that can get in the way of maintaining good health and quality of life. Now that many businesses and services are closed and people are self-isolating, I can only imagine how hard things have been for elderly individuals. If you’re over 55 years of age, or you have someone in your life who you care about in that age range, it’s crucial to be aware of age-related nutrition issues as well as solutions to overcome them.

Why healthy eating is important for seniors

Eating well helps you age well. Good nutrition provides your body with the energy and nutrients it needs to stay healthy and strong. It you stay healthy and strong, you’ll be able to maintain your independence for longer and enjoy a higher quality of life. A healthy diet promotes and protects health and well-being. One major benefit of a healthful diet is the prevention of muscle and bone loss, which in turn decreases the risk of falls and bone fractures. It will also keep your immune system strong, which protects you from getting sick.

In addition, nutrition can be used to prevent or lower the risk of diseases that are more common in the elderly, such as heart disease, type 2 diabetes, and osteoporosis. Even if you already have a condition, a healthy diet can slow the progression of these diseases and help manage symptoms. It’s also important for older adults to maintain a healthy weight. Being either overweight or underweight can have a negative impact on health, mobility, and independence. The quality of your diet directly and indirectly affects the quality of many facets of life.

Age-related challenges

There are numerous physical changes that take place as we age that can make healthy eating more challenging. Older adults tend to experience low appetite and/or a decreased interest in food. This could be indirectly caused by health conditions that require medications that have side effects like reduced sense of smell and taste. A dampening of the senses tends to occur with age, which affects the enjoyment of food. Many elderly folk also experience difficulties with chewing or swallowing due to neurological issues such as a stroke or Alzheimer’s disease. Reduced mobility is a major challenge faced by older adults. It affects nutrition status by making it more difficult to get to the grocery store and complete the tasks required to prepare food.

Changes in lifestyle that come with age can also make healthy eating difficult. Elderly people might have less income at their disposal to provide for their needs. They might be caring for a loved one, such as a spouse with chronic health issues. Or, they could be living alone, which is a potential barrier to health and well-being. For example, if a person is used to cooking for a large family, it can be difficult to know how to shop and cook for one. Conversely, someone living on their own may have never been the main cook in their household when they were younger. Also, eating alone can be lonely, which negatively impacts appetite and desire to eat.

These changes are significant and can be difficult to face. But it’s not impossible! With the right resources and supports, they can be overcome. For each barrier to healthy eating, there are several solutions that can help you maintain your health.

Age-specific nutrition needs

While your energy/calorie needs decrease as you age, your needs for certain key nutrients increases. Strong bones are a key factor in maintaining good health as a senior. They keep you mobile and independent. Your strong bones will help you do your grocery shopping, cooking, and baking. Calcium and vitamin D are the main nutrients that impact bone health.

Calcium

• adults over the age of 50 require 1200 milligrams of calcium per day. Older adults require more calcium to maintain their bones compared to adults aged 19-50 years (who need 1000 milligrams/day)

• milk and milk alternatives (ie: soy milk, coconut milk, etc) are great sources of calcium. Aim to get 2 or 3 servings into your diet each day

• if you don’t have a large appetite, there are ways to sneak calcium into your meals:

  • cheese can be added to pretty much everything, from sandwiches to cooked vegetables to salads

  • when making soup, stews, hot cereal, pudding, etc, substitute water with soy milk, milk, or skim milk powder

• not a fan of milk products? There are other foods that contain calcium:

  • almonds

  • sesame seeds

  • greens: broccoli, bok choy, spinach

  • figs

  • white, navy, and baked beans

  • sardines and salmon

• if you’re not getting enough calcium-rich foods in you diet, speak to a healthcare professional (ie: doctor, registered dietitian, nurse practitioner). It may be in your best interests to take a calcium supplement

Vitamin D

• vitamin D is made by your body when your skin is exposed to sunlight. Some of our vitamin D needs can be met by spending time outside. However, too much sun exposure can lead to sunburns and increases the risk of skin cancer. Also, in northern areas (such as Canada), the amount of sunshine in the winter months is too low for our bodies to make enough vitamin D

• it’s important to eat foods that contain vitamin D:

  • fatty fish: salmon, herring, sardines, tuna, mackerel

  • egg yolks

  • beef liver

  • cow’s milk is fortified with vitamin D. Some brands of yogurt are as well. You can find out whether a product contains vitamin D by checking the nutrition facts label

  • fortified milk substitutes (ex: soy, almond, pea, coconut). Milk substitutes aren’t always fortified with vitamin D. Check the label to be sure

• it can be hard to get outside if you’re elderly, and even then, it’s important to wear sunblock when you’re in the sun. On top of that, it’s difficult to get enough vitamin D from your diet alone. That’s why Health Canada recommends that older adults take a daily vitamin D supplement:

  • adults 50+ years of age should take 400 IU vitamin D3 each day

  • adults 70+ years of age should take 800 IU vitamin D3 each day

  Side note: IU stands for International Units. It’s the unit of measurement used for vitamin D.

The elderly tend to eat smaller amounts of food and may have difficulty getting nutrient-rich foods because of financial- or health-related reasons. As a result, there is a tendency for the elderly to develop deficiencies in protein, iron, and B vitamins - especially vitamin B12. These nutrients are required for many systems in the body, but perhaps the most relevant is the immune system. Nutrient deficiencies can weaken the immune system, which can makes you prone to infection and causes recovery from illness to take longer.

Excellent sources of these nutrients include:

• red meat

• poultry

• fish

• eggs

• legumes (beans, peas, lentils)

• tofu

• nuts

• seeds

If you eat a variety of foods from each food group, that will help ensure you’re getting enough of the above nutrients. Also, if your ability to get fresh foods is limited, frozen, canned, and dried foods are all great options to help you meet your nutrition needs.

Weight changes and appetite issues

Weight changes can have a major impact on the health and well-being of older adults. If an elderly person becomes overweight/obese, this can make it a lot more difficult for them to be mobile and care for themselves. Being overweight or obese also increases the risk of developing health issues. For example, it can cause high blood pressure, which in turn increases the risk of heart attack and stroke.

Being underweight can be just as detrimental. If an elderly person is not meeting their energy and protein needs, this causes them to lose muscle mass, which decreases mobility and the ability to be independent. Underweight older adults are more likely to get infections because the immune system can’t function properly when the body is malnourished. Recovery from sickness and injury is also slower, for the same reason.

Becoming either overweight or underweight has negative outcomes on the health of the elderly. That’s why weight maintenance (ie: preventing weight gain and weight loss) is the priority when it comes to maintaining health. Keeping track of your weight on a monthly basis is a great way to monitor your health and notice weight changes before they get out of hand. If you notice your weight increasing, you can try being more physically active, watch your portion sizes, and/or limit foods that are high in fat and sugar. If you’re experiencing unwanted/unnecessary weight loss, it could be due low appetite or decreased desire to eat.

What to do about low appetite:

• if you’re a smoker, try to quit! Smoking decreases appetite and dampens your senses of smell and taste. If you stop smoking, your appetite will increase and you’ll enjoy your food more!

• do some form of exercise, like walking, before meals

• talk to your healthcare provider about any medications you’re on to see if they might be causing appetite problems or changes in your sense of taste. It might be possible to try a different medication that doesn’t affect your appetite as much

• eat small, frequent meals or snacks (every 2 or 3 hours) instead of trying to eat 3 large meals each day

• make every bite count by eating foods that are high in energy and protein:

  • add 3.25% milk or skim milk powder to soups, cold & hot cereals, milkshakes, scrambled eggs, pudding, and pancakes

  • top cold & hot cereal, yogurt, ice cream, toast, salads, and pancakes/waffles with nuts/seeds/nut butters

  • put cheese or cheese sauce on vegetables, potatoes, sandwiches, and eggs

  • eat canned tuna or salmon in a sandwich, on crackers, or in a salad

  • other ingredients you can add to boost the calories of a meal or snack include honey, jam, cream, and any type of oil

What you can do if you don’t feel like eating:

• when you eat alone, take some extra steps to make your meal more enjoyable:

  • try a new recipe

  • choose a comfortable place to eat

  • play your favourite music

  • set the table with nice place mats and flowers

  • eat your meal outside

  • watch TV or read a book while you eat

  • go to your favourite restaurant for your meal or order take-out

• make your meals interesting:

  • try different spices and herbs to add flavour

  • fill your plate with foods with different textures

  • change the temperature of the foods you’re eating. For example, eat a cold sandwich for lunch one day and have some hot soup on another day

• eat with others. If you eat your meals with others, you can enjoy their company. People tend to eat more when they’re in good company:

• join a cooking club or lunch group in the community

• invite your family over for a meal

• eat with a neighbour

• have a potluck with your friends

• many community centres have community kitchens that are available for anyone to use. If you make a visit to a community kitchen, you’ll meet new people and might even make a new friend

• free lunches are often offered on a monthly or even weekly basis at community centres or you local Royal Canadian Legion

Hydration

People of all ages need to drink fluids to prevent dehydration. However, in the elderly, dehydration can have serious consequences. The confusion, dizziness, and fatigue that often result from dehydration can lead to falls and other accidents. Another consequence of dehydration is urinary tract infections (UTIs), which the elderly often suffer from. This is significant because infections can also cause symptoms that affect safety, like confusion, dizziness, and fatigue. Staying hydrated will help your body function properly and your mind think clearly.

In addition, hydration can improve the symptoms of several health issues. For example, drinking fluids helps relieve constipation, a problem commonly faced by older adults. Additionally, if you have diabetes and struggle with high blood sugars, drinking fluids throughout the day may help. This is because drinking more liquid causes increased urination, so your body will eliminate more sugar.

One of the physical changes we go through as we age is a decreased sense of thirst. This can be problematic because you might not feel thirsty even though your need to drink fluids has not decreased. One major reason older adults suffer from dehydration is that their senses aren’t telling them they are thirsty, so they don’t drink enough liquids. To stay hydrated, it’s important to drink regularly throughout the day whether you feel thirsty or not.

To meet your body’s hydration needs, drink 9 - 12 cups of fluid/day (ie: 2 - 3 litres/day). You can get your fluids from:

• water

• coffee or tea

• juice - choose 100% juice, with no added sugars

• milk

• fortified milk alternatives (ex: soy milk)

• soup - choose varieties with lower amounts of salt

• fruit and vegetables such as watermelon, oranges, cucumber, tomato, etc

*Try to limit the sugar and salt in your liquids since too much sugar and/or salt can cause dehydration.

If you’re having trouble meeting your fluid needs, try these tips:

• have a source of fluid from the above list at each meal and snack

• drink a glass of water when you first wake up in the morning

• have teatime (or coffee time) every afternoon

• keep a full water bottle or glass nearby throughout the day

Chewing and swallowing issues

Some older adults have trouble biting, chewing, and/or swallowing. This issue is caused by damage to the nervous system (ex: stroke, head injury, dementia) or the physical structures involved in swallowing (ex: cancers of the head and throat; chronic reflux disease). Chewing and swallowing issues can negatively impact health because they can lead to a fear of eating and the avoidance of many foods.

If you or an older adult you know experience coughing or choking while eating or drinking, talk to a healthcare professional. A doctor, dietitian, or speech-language pathologist can assess the cause of the issue and help find solutions to eat safely. If you have problems with your teeth, gums, or dentures, talk to a dentist. They’ll figure out how to help you bite and chew properly again.

Chewing and swallowing issues can be dealt with by choosing softer foods and/or changing the way you prepare foods. You can add gravy or other sauces to your meals to help soften and moisten food. Thicker liquids are sometimes easier to swallow, such as cream soups and milkshakes. Try chopping, mashing, and/or pureeing foods with a fork, blender, or food processor. Trying different food textures will help you know what you’re able to safely eat so you can meet your nutrition needs.

Here are some examples of texture-modified foods from each food group:

• grains: mashed or boiled potato, pasta, oatmeal, cream of wheat, cream of rice

• meat & alternatives: eggs, peas, lentils, canned fish, ground meats

• milk & alternatives: yogurt, pudding, ice cream, custard

• vegetables & fruits: well-cooked vegetables, canned vegetables and fruits, pureed vegetables and fruits

Shopping

There are several barriers older adults may face when trying to do grocery shopping. You might not have the financial resources, transportation, or physical ability to get groceries.

Do you have a tight budget? Here a few suggestions:

• do your shopping on the senior discount day at your local store

• try shopping online. Prices can be cheaper online than they are in-store

• buy food with a family member or friend and split the cost

• there are many places that offer a free meal and some socialization. Try visiting a community kitchen, senior centre or recreation centre, your local Royal Canadian Legion, or a church in your area

• choose cheaper options from each food group:

  • vegetables & fruit: cost-effective fresh produce includes carrots, potatoes, oranges, and bananas. Frozen produce is usually cheaper than fresh.

  • meat & alternatives: dried/canned beans, canned fish, eggs, tofu, cheaper cuts of meat (blade, flank, pork shoulder, stewing meats)

  • grains: pasta, rice, oatmeal, cornmeal, creamed wheat, creamed rice

  • milk & alternatives: powdered milk; store brands of yogurt and cheese (ex: No Name, President’s Choice) tend to be lower in price

Having trouble getting to the grocery store?:

• share a taxi to the store with a friend and split the cost

• a quick Google search can help you find volunteer services in your community that offer support with grocery shopping. These services may offer a ride to the store or may even provide food delivery services

• try shopping online and get your groceries delivered to you

If your ability to get groceries is limited for financial and/or physical reasons, it’s important to stock up on non-perishable items for the times you’re not able to go to the store. Make a checklist of these items to help you remember what to purchase when you’re able to buy groceries:

• peanut butter

• skim milk powder

• canned vegetables and fruit

• canned/jarred pasta sauce

• canned fish

• beans and lentils

• pasta

• rice

• oatmeal

• bread, which can be frozen for later

• frozen meat and poultry

• frozen vegetables and fruits

Cooking

As people age, it can be harder to cook for themselves due to mobility issues or low energy levels. You might also find it difficult to cook for just 1 or 2 people if you’re used to cooking for an entire family. In addition, adults over the age of 60 are at higher risk of food poisoning. Precautions must be taken in the kitchen to prevent food-related illness.

If you’re having difficulties cooking, try some of these tips:

• prepare meals and snacks when you have the most energy:

  • chop vegetables, etc for later use

  • cook meals ahead of time and store them in the fridge or freezer. You can eat these meals when you’re too tired to cook

  • make one of these quick and healthy snacks:

    • applesauce or other fruit puree

    • popcorn

    • cheese and crackers

    • fresh or canned fruit

    • hard-boiled eggs

    • hot or cold cereal

    • yogurt with fruit

    • milk and oatmeal cookies

    • toast and peanut butter

    • canned soup

    • trail mix

    • veggies and dip

• make recipes that have just a few ingredients and/or require little to no cooking

• buy bagged salads or pre-chopped vegetables

• buy frozen, ready-to-eat dinners. Look for options that offer 10 grams or more of protein and try to pick meals that are lower in salt

• if you’re having trouble getting around your kitchen or using appliances and utensils, ask you doctor to refer you to an occupational therapist. They’re experts at helping people complete activities of daily living independently. They might recommend special devices that are easier to use or make modifications to your kitchen to make cooking simpler

• have your meals delivered through services such as Meals on Wheels

• consider moving to a home where meals are provided for you

Finding it hard cooking for one? Make a larger amount of a recipe and eat it over the next couple days. Or portion it out into containers and freeze it to be eaten another time. Check out whether there is a lunch club or other group meal programming in your community. You could also find a friend or family member to alternate cooking days with. That way, you can share the task of making meals. You’ll also get to try each other’s recipes and maybe learn about different food traditions.

One of the physical changes that happens with age is the immune system has a harder time protecting the body from food poisoning. On top of that, if you have a chronic disease like diabetes or kidney disease, that makes it even more difficult to fight off infection. Here are some important precautions to take to prevent food-related illness:

• avoid raw or under-cooked eggs, meat, and poultry

• cook food to the proper internal cooking temperature. You can find a temperature chart here:

  https://www.canada.ca/en/health-canada/services/general-food-safety-tips/safe-internal-cooking-temperatures.html

• make sure your fridge temperature is 4 degrees Celsius (40 degrees F) or lower. Your freezer should be - 18 degrees Celsius (0 degrees F) or lower

• do not leave food out at room temperature for longer than 2 hours

• eat leftover food from your fridge within 2 - 4 days

  *label containers of leftovers with the date so you can track how long they’ve been in your fridge

I hope that this blog post helped you find some solutions to challenges you or someone you know might be facing. To finish things off on a tasty note, I’m going to share my meatloaf muffin recipe with you. Meatloaf freezes well and goes great with pasta, rice, and bread. You can enjoy this recipe with tomato sauce, gravy, or cheese sauce. These muffins are also an excellent source of protein, iron, and B vitamins. There are even some veggies in there!

Meatloaf Muffins

Yield: approx. 12 muffins

Ingredients

1 tablespoon oil

1 medium yellow onion, minced

2 large carrots, finely chopped

1 or 2 cloves of garlic, minced

optional: 1 jalapeno pepper, minced

1.5 pounds ground beef (or pork, chicken, turkey, etc)

1/2 cup canned crushed tomato

1/2 cup rice flour (any type of flour will work here)

1 egg, beaten

1 tablespoon soy sauce

1 tablespoon tomato paste

1 tablespoon Dijon mustard

1 teaspoon vinegar

1 teaspoon salt

1 teaspoon dried oregano

pepper, to taste

toppings: tomato sauce, ketchup, gravy, cheese sauce

(side note: the green topping in the picture is Caesar salad dressing mixed with mashed avocado)

Instructions:

1) Preheat the oven to 350 F.

2) Heat the oil in a pan over medium-high heat. Add the onion, carrots, and garlic and cook until they start to become tender (5-7 minutes). *If you cook the veggies until they’re completely soft, they’ll become mushy by the time the muffins are done baking.

3) Set the veggie mixture to the side to cool. While it’s cooling, combine all the remaining ingredients in a large bowl. Once the veggies are cool, add them to the mixture.

4) Place muffin liners into a muffin tin or spray the tin with cooking spray. Divide the meatloaf mixture between the 12 wells, filling each one to the top.

5) Bake for 30 minutes. You might need to rotate the muffin tin midway through if the muffins are not browning evenly.

6) Remove the muffins from the tin and enjoy a couple with the vegetable and grain of your choice for a balanced meal. You can transform your muffins into cupcakes by adding toppings!

Please speak to a doctor or registered dietitian if you have questions about your nutritional needs or those of someone in your care.

References

Canada’s Food Guide. (2019) “Healthy eating for seniors”. Government of Canada. <https://food-guide.canada.ca/en/tips-for-healthy-eating/seniors/> Accessed April 28, 2020.

Health Canada. (2019) “Food safety for adults ages 60 and over”. Government of Canada. <https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/food-safety-adults-ages-60-over.html> Accessed April 28, 2020.

Keller & Wdoniak. (2012) “A guide to healthy eating for Older Adults”. EatRight Ontario. <http://www.unlockfood.ca/eatrightontario/media/ero_pdf/en/seniors/older-adult-guide.pdf> Accessed April 28, 2020.