Older, Eating Better
When Bernadette Harkins of Rockville, Md., could no longer
feed herself properly, she moved to an assisted-living residence.
Today, she can enjoy three meals a day served to her and about
30 other people in their home-like communal dining room.
When Harry of Moscow, Pa., could no longer feed himself properly,
he moved in with his daughter and her family. With her guidance,
he ate six times a day, snacking on high-calorie, high-protein
foods, and maintaining a near-normal weight.
Harry (who asked that his last name not be used) and Harkins
typify many of today's older generation. Living alone in most
cases, they often are unable to meet their dietary needs and
are forced to make compromises.
Harry didn't know how to cook. He developed cancer, which
made it even more important that he eat a well-balanced diet.
Harkins knew how to cook but didn't take time to prepare adequate
meals for herself.
"I would snack is what I'd do," she said. "I
would think about getting a meal and then just have a cup of
tea and toast. I knew I wasn't doing the right thing as far
as nutrition was concerned."
Their eating problems stemmed from loneliness and lack of
desire or skill to cook. Other older people may eat poorly for
other reasons, ranging from financial difficulties to physical
The solutions can be just as varied, from finding alternative
living arrangements to accepting home-delivered meals to using
the food label developed by the Food and Drug Administration
and the U.S. Department of Agriculture. Physical activity also
is important in maintaining a healthy lifestyle.
Why the Concern?
Nutrition remains important throughout life. Many chronic
diseases that develop late in life, such as osteoporosis, can
be influenced by earlier poor habits. Insufficient exercise
and calcium intake, especially during adolescence and early
adulthood, can significantly increase the risk of osteoporosis,
a disease that causes bones to become brittle and crack or break
But good nutrition in the later years still can help lessen
the effects of diseases prevalent among older Americans or improve
the quality of life in people who have such diseases. They include
osteoporosis, obesity, high blood pressure, diabetes, heart
disease, certain cancers, gastrointestinal problems, and chronic
Studies show that a good diet in later years helps both in
reducing the risk of these diseases and in managing the diseases'
signs and symptoms. This contributes to a higher quality of
life, enabling older people to maintain their independence by
continuing to perform basic daily activities, such as bathing,
dressing and eating.
Poor nutrition, on the other hand, can prolong recovery from
illnesses, increase the costs and incidence of institutionalization,
and lead to a poorer quality of life.
The Single Life
Whether it happens at age 65 or 85, older people eventually
face one or more problems that interfere with their ability
to eat well.
Social isolation is a common one. Older people who find themselves
single after many years of living with another person may find
it difficult to be alone, especially at mealtimes. They may
become depressed and lose interest in preparing or eating regular
meals, or they may eat only sparingly.
In a study published in the July 1993 Journals of Gerontology,
researchers found that newly widowed people, most of whom were
women, were less likely to say they enjoy mealtimes, less likely
to report good appetites, and less likely to report good eating
behaviors than their married counterparts. Nearly 85 percent
of widowed subjects reported a weight change during the two
years following a spouse's death, as compared with 30 percent
of married subjects. The widowed group was more likely to report
an average weight loss of 7.6 pounds (3.4 kilograms).
According to the study, most of the women said they had enjoyed
cooking and eating when they were married, but as widows, they
found those activities "a chore," especially since
there was no one to appreciate their cooking efforts.
For many widowed men who may have left the cooking to their
wives, the problem may extend even further: They may not know
how to cook and prepare foods. Instead, they may snack or eat
out a lot, both of which may lead people to eat too much fat
and cholesterol and not get enough vitamins and minerals.
At the same time, many older people, because of chronic medical
problems, may require special diets: for example, a low-fat,
low-cholesterol diet for heart disease, a low-sodium diet for
high blood pressure, or a low-calorie diet for weight reduction.
Special diets often require extra effort, but older people may
instead settle for foods that are quick and easy to prepare,
such as frozen dinners, canned foods, lunch meats, and others
that may provide too many calories, or contain too much fat
and sodium for their needs.
On the other hand, Mona Sutnick, Ed.D., a registered dietitian
in private practice in Philadelphia, points out that some people
may go overboard on their special diets, overly restricting
foods that may be more beneficial than detrimental to their
"My advice for a 60-year-old person might be 'watch your
fat' but for an 80-year-old who's underweight, I'd say, 'eat
the fat, get the calories,'" Sutnick says.
Some older people may overly restrict foods important to good
health because of chewing difficulties and gastrointestinal
disturbances, such as constipation, diarrhea and heartburn.
Because missing teeth and poorly fitting dentures make it hard
to chew, older people may forego fresh fruits and vegetables,
which are important sources of vitamins, minerals and fiber.
Or they may avoid dairy products, believing they cause gas or
constipation. By doing so, they miss out on important sources
of calcium, protein and some vitamins.
Adverse reactions from medications can cause older people
to avoid certain foods. Some medications alter the sense of
taste, which can adversely affect appetite. This adds to the
problem of naturally diminishing senses of taste and smell,
common as people age.
Other medical problems, such as arthritis, stroke or Alzheimer's
disease, can interfere with good nutrition. It may be difficult,
if not impossible, for example, for people with arthritis or
who have had a stroke to cook, shop, or even lift a fork to
eat. Dementia associated with Alzheimer's and other diseases
may cause them to eat poorly or forget to eat altogether.
Lack of money is a particular problem among older Americans,
who may have no income other than Social Security. According
to 2001 U.S. Census Bureau data, the median annual income in
that year for people 65 and over was $14,152. More than 10 percent
of people that age had an income below the average poverty level
for their age group, defined as $8,980 a year.
Lack of money may lead older people to scrimp on important
food purchases--for example, perishable items like fresh fruits,
vegetables and meat--because of higher costs and fear of waste.
They may avoid cooking or baking foods like meats, stews and
casseroles because recipes for these foods usually yield large
Financial problems also may cause older people to delay medical
and dental treatments that could correct problems that interfere
with good nutrition.
Many older people may find help under the Older Americans
Act, which provides nutrition and other services that target
older people who are in greatest social and economic need. The
program focuses particular attention on low-income minorities
and rural populations. According to the U.S. Administration
on Aging, which administers the Older Americans Act, the nutrition
programs were set up to address the dietary inadequacy and social
isolation among older people.
Home-delivered meals and congregate nutrition services are
the primary nutrition programs. The congregate meal program
allows seniors to gather at a local site, often the local senior
citizen center, school or other public building or a restaurant,
for a meal, plus health screenings, exercise, or recreational
Available since 1972, these programs, funded by the federal,
state and local governments, ensure that older people get at
least one nutritious meal five to seven days a week. Under current
standards, that meal must comply with the Dietary Guidelines
for Americans and provide at least one-third of the Recommended
Dietary Allowances for an older person. Often, people receive
foods that correspond with their special dietary needs, such
as no-added-salt foods for those who need to restrict their
sodium intake or ground meat for those who have trouble chewing.
Other nutrition services provided under the Older Americans
Act are nutrition education, screening and counseling.
While these nutrition programs target poor people, they are
available to other older people regardless of income, according
to Jean Lloyd, a registered dietitian and the national nutritionist
with the Administration on Aging. Although no one is charged
for the meals, older people can voluntarily and confidentially
donate money, she says.
The meals provide not only good nutrition, but they also give
older people a chance to socialize--a key factor in preventing
the adverse nutritional effects of social isolation and a way
of keeping people actively and socially engaged.
For those who qualify, food stamps are another aid for improving
nutrition. Under this program, a one-person household receives
an average of $44 per month in food stamps to buy most grocery
For the homebound, grocery-shopping assistance is available
in many areas. Usually provided by nongovernment organizations,
this service shops for and delivers groceries to people at their
request. The recipient pays for the groceries and sometimes
a service fee.
In some communities, private organizations also sell home-delivered
Family members and friends can help ensure that older people
take advantage of food programs by putting them in touch with
the appropriate agencies or organizations and helping them fill
out the necessary forms. Some other steps they can take include
- looking in occasionally to ensure that the older person
is eating adequately
- preparing foods and making them available to the older person
- joining the older person for meals.
In some cases, they may help see that the older person is moved
to an environment, such as their home, an assisted-living facility,
or a nursing home, that can help ensure that the older person
gets proper nutrition.
Whatever an older person's living situation, proper medical
and dental treatment is important for treating medical problems,
such as gastrointestinal distress and chewing difficulties,
that interfere with good nutrition. If a medication seems to
ruin an older person's taste and appetite, a switch to another
drug may help.
A review of basic diet principles may help improve nutrition.
Explaining to older people the importance of good nutrition
in the later years may motivate them to make a greater effort
to select nutritious foods.
Look to the Label
The food label can help older people select a good diet. The
label gives the nutritional content of most foods and enables
consumers to see how a food fits in with daily dietary recommendations.
Some of the information appears as claims describing the food's
nutritional benefits: for example, "low in cholesterol"
or "high in vitamin C." Under strict government rules,
these claims can be used only if the food meets certain criteria.
This means that claims can be trusted. For example, a "low-cholesterol"
food can provide no more than 20 milligrams of cholesterol and
no more than 2 grams of saturated fat per serving.
Less common but also helpful are label claims linking a nutrient
or food to the risk of a disease or health-related condition.
These claims are supported by scientific evidence. One claim
links whole grain foods to risk of heart disease and cancer.
On the food label, this claim would read like this:
"Diets rich in whole grain foods and low in total fat,
saturated fat, and cholesterol may reduce the risk of heart
disease and some cancers."
More in-depth information is found on the "Nutrition
Facts" panel on the side or back of the food label. This
information is required on almost all food packages. This nutrition
information is easy to read and is usually on a white or other
neutral contrasting background.
Some nutrition information also may be available for many
raw meats, poultry and fish, and fresh fruits and vegetables
at the place of purchase. The information may appear in brochures
or on posters or placards.
Besides diet, physical activity is part of a healthy lifestyle
at any age. It can help reduce and control weight by burning
calories. Moderate exercise that places weight on bones, such
as walking, helps maintain and possibly even increases bone
strength in older people. A study published in the Dec. 28,
1994, Journal of the American Medical Association found
that intensive strength training can help preserve bone density
and improve muscle mass, strength and balance in postmenopausal
women. In the study, subjects used weight machines for strength
Also, scientists looking into the benefits of exercise for
older people agree that regular exercise can improve the functioning
of the heart and lungs, increase strength and flexibility, and
contribute to a feeling of well-being.
Any regular physical activity is good, from brisk walking
to light gardening. Common sense is the key. But, before a vigorous
exercise program is started or resumed after a long period of
inactivity, a doctor should be consulted.
Taking time out for exercise, using the food label to help
pick nutritious foods, taking advantage of the several assistance
programs available, and getting needed medical attention can
go a long way toward helping older people avoid the nutritional
pitfalls of aging and more fully enjoy their senior years.