The Swiss Association for Nutrition has summarized here many of the particular features of nutrition that apply to senior citizens - i.e. those of us over 65.

Defining the "Elderly" - who are they?

Depending on the selection criteria, you will find different opinions on when "old age" begins. Apart from individual differences, there are also differences associated with health status, social environment, and the other stresses of life that everyone experiences. The starting point for old age has been set at 65 years in most national and international dietary recommendations. This age is also used in Switzerland. This article is therefore directed to independent, active, mobile, older people living in their own home who are at least 65 years old.

Consideration of our own aging processes should begin as early as possible. The role of nutrition increases in importance as we get older because our health and our ability to feel good depends heavily on what and how we eat. Who doesn't want to enjoy an independent active life into ripe old age! For that reason, it's important not only to provide our bodies with foods from the different nutritional groups with the right balance of nutrients, but also to enjoy them, richly. Seniors don't require a special diet, but they do require the nutrition appropriate for old age, and this should include foods that usually suit their tastes. Nutrition also shouldn't be completely thrown out of balance by going on a restrictive diet. However, it's wise to adapt one's personal nutrition early on, in response to changing circumstances. The best formula for a healthy old age is an active lifestyle with regular bodily exercise, an abundance of social contacts, and a balanced, varied diet.

Energy Supply

Compared with the recommendations for young adults, the nutritional requirements in the elderly remain about the same, but their energy needs decrease. This means that older people should consciously select foods with a high nutritional value. These are foods that are high in vitamins, minerals, secondary plant materials, and fiber. Examples are: whole-grain products, legumes, fruits and vegetables. Energy sources such as oils, butter, cold cuts, whole-milk products, baked goods, and candy should be eaten sparingly, because they contain a lot of calories in the form of sugar and fat which can contribute to obesity.

Just as in younger years, attention must also be given in old age to maintaining a healthy body weight. According to the German/Austrian/Swiss Reference List 2000 for food intake, the average daily energy requirement for people 65 and older with a normal body mass index (BMI) should be:

• Men: 2,300 calories
• Women: 1,800 calories

You can calculate your own BMI; it's your body weight in kg divided by your body height in m .

Here's an example: a woman weighing 70 kg (154 lbs.) who is 1.70 m (5'-6") tall should divide her body weight in kg, twice, by her height in meters (70 kg ÷ 1.7 m ÷ 1.7 m = 24.2).

You can also use the HealthandAge Tool "Find Out Your BMI" given in the first link below.

According to the World Health Organization (WHO), a BMI between 18.5 and 25 is within the normal range. The BMI of the woman used in our example is with normal limits. We should certainly strive to reach this goal - but not by going on a starvation diet.

Since energy requirements decrease in old age, we must take special care to reduce our energy sources accordingly, to prevent a positive energy balance which will result in a slow but steady weight gain. In this situation, we must remember that the energy balance depends not only on caloric intake from food, but also on our physical activity. In the long term, weight increase can become a risk factor for the "diseases of civilization", such as diabetes, cardiovascular disease, and degenerative joint disease (osteoarthritis).

On the other hand, seniors can also constantly consume too little energy for various reasons - loss of appetite, or social isolation - and thereby lose weight. In such cases, energy-rich and nutritional foods should be consumed in larger quantities to prevent too great a weight loss and to bring the body weight back into a healthy range.

Hunger and thirst

Hunger and thirst as well as the senses of taste and smell can decrease in older people. It may be helpful to have outside reference points and signals to guide you (time of day, members of the household, etc.). Eating and drinking should therefore be planned. It's useful to develop an eating pattern in which several small meals are spread out over the day. The sensation of thirst can also diminish; the body's signals for lack of fluids get weaker with age. We should drink at least 1.5 liters (3 pints) of liquid a day.

The following are some tips to make it easier to reach a fluid intake of 1.5 liters (3 pints) per day:

• Place a full pitcher of lightly-spiced tea, fruit tea, or a bottle of mineral water on the kitchen table. The pitcher or bottle should be empty by nightfall.
• Drink a glass of water immediately after you get up in the morning.
• Drink a glass of water after cleaning your teeth at night.
• Mix and match diluted fruit juices as substitutes for the other drinks.
• Remember that soups and bouillon are good sources of fluid.

Warning: The volume of liquids drunk should be increased in cases of greater fluid loss (e.g. by heavy sweating, vomiting, diarrhea, etc.) Coffee, black tea, and alcoholic drinks do not count since they draw fluid from the body.

Digestion

Older people are more susceptible to certain digestive disorders as well as constipation, diarrhea, bloating, feelings of fullness, or loss of appetite, because the capacity of the digestive organs decreases in old age. Other causes lie in the way individuals eat: too little fiber-rich foods, lack of fluids, habitually eating too large a meal, or eating too fast. The causes may also be related to medications or diseases, as well as to personal circumstances involving stress, mental tension, or depression.

These problems can be dealt with by balanced nutrition, eating fiber-rich foods such as whole-grain products (at least one portion a day) and fruits and vegetables, and by drinking at least 1.5 liters (3 pints) of liquids. Proper chewing promotes digestion. The digestive tract is less burdened if several small meals a day are consumed, while digestive disorders such as bloating and feelings of fullness will occur less often. Exercise and abdominal massage keep the intestines moving. Causes of stress should be decreased. Simple relaxation techniques can be learned in a class. Finally, it may be helpful to discuss one's personal situation with a specialist.

Foods to counteract constipation: Foods rich in dietary fiber such as: whole-grain bread, whole rice, granolas, figs, berries, bran, vegetables. Drink plenty of fluids!

Foods to counteract diarrhea: Foods like bananas, paddy rice, black tea, blueberries, dark chocolate, white bread.

Regular protein intake

Protein deficiency can also lead to nutritional deficits. Protein is important for the development and regeneration of body cells, especially the muscles. Important sources of protein are milk and milk products, meat, fish, eggs, as well as legumes, cereals, and potatoes. It is usually helpful to give preference to lean foods and use low fat preparation methods.

Calcium is important

Milk and milk products supply the body with calcium. This helps maintain bone strength. If bones decrease in density, then osteoporosis (bone loss) develops over time. Bone degeneration is due not only to calcium deficiency but also partly to genetics. Bone loss can be slowed down by including vitamin D-rich nutrients in the diet. Also helpful is adequate outdoor exercise. Calcium requirements in the elderly are always high - about 1,000 mg a day. Two or three portions of milk or milk products a day should be consumed to obtain this amount of calcium. Other helpful items in meeting calcium requirements are calcium-fortified mineral water (about 300 mg calcium per liter, e.g. Adelbodner, Alpina, Aproz, Eptinger, Valser brands) and dark green vegetables. If you are finding it difficult to meet the daily calcium requirement through food, or if you suffer from lactose intolerance (milk-sugar sensitivity), then you should consult a specialist about obtaining a general calcium supplement.

Enriched foods and supplements

Individuals should consult with a nutrition specialist to decide whether, and which, supplements and enriched foods are useful. A balanced diet, little or no alcohol, outdoor exercise, relaxation and avoidance of tobacco provide the basis for a healthy lifestyle, and make vitamin preparations superfluous in healthy people. However, since some individual energy needs are low, it can be difficult to meet nutritional requirements even when following a healthy diet. Supplements and enriched foods provide a useful addition to a healthy diet. Such preparations can also be used selectively together with a healthy diet in very stressful situations, such as during acute or chronic illness, loss of appetite, or fatigue-associated conditions. Vitamin-rich fruit juices, for example, are often worthwhile since they help meet vitamin requirements and also supply fluids.

Eat with others and enjoy it!

Eating with others brings greater pleasure. Solitary elderly people can get together to cook and eat together. Some opportunities for this are found in dining clubs or lunch clubs, for example. Even a visit to a restaurant creates a welcome change! Every meal should be somewhat festive: dishes lovingly cooked and served up with spices and herbs spark the appetite. Nicely prepared foods awaken eating pleasure. A tastefully arranged table, a few flowers, or candles contribute to a relaxed atmosphere.

Regular exercise

Physical activity has the benefit of preventing muscle deterioration, promoting mental equilibrium, and warding off the diseases of civilization. Everyday physical exercise can be added to, or substitute for, sports like swimming, bicycling, gym work-outs, strength training, hiking, or skiing. Use the stairs instead of the elevator or escalator, go shopping on foot, take an afternoon walk through the park or by the lake, take a walk with the dog (or your neighbor), etc. Outdoor exercise builds up vitamin D from the sunshine which, along with calcium, influences bone density. For this reason, a daily outing in the fresh air shouldn't be passed up. Energy consumption is also raised by regular exercise, and this has a beneficial effect on weight. People who exercise regularly can also eat more, and this makes it easier to meet daily vitamin, mineral, and trace elements requirements.

Special considerations

If cooking is a problem, ready-to-eat dishes may be helpful. A frozen pizza or ravioli from the frozen foods section of the store tastes good and can be prepared instantly; these products only need to be baked or warmed up. The wide selection available allows variety and has something for every taste. A crisp salad or fresh fruit for dessert may be added to the prepared foods to create a complete meal.

See your dentist if you have chewing problems, and in the meantime enjoy julienne fruits and soft cooked vegetables!

Problems with food shopping arise if mobility is limited, but meal delivery service can be used, and restaurants are increasingly prepared to make deliveries.

Nutritional recommendations for the elderly

Many factors affect our nutritional behavior: individual needs and wants, daily moods, social environment, physical activity, current selection of available foods, advertising, etc. In addition, each person has individual nutritional requirements. The following recommendations ensure (in the form of a balanced and varied diet) an adequate supply of energy, nutrition, and protective elements, and therefore represent a healthy eating pattern. They are directed at the healthy older "average person" with normal physical activity - in other words a person with average energy and nutritional requirements. Exceptions must be made for sick older people. Likewise, the listed amounts and portions refer to average sizes.

Note: words in italics and bold text are particularly important for people with a propensity for or existing obesity.

Fats and Oils
Daily consumption: 2 teaspoons (10 g) vegetable oil with a high proportion of monounsaturated, unheated fatty acids (e.g., canola oil, olive oil) in salad dressings for example.

Maximum daily consumption: 2 teaspoons (10 g) grease or oil (e.g., peanut oil or refined canola and olive oil) in food preparation.

Daily consumption: at most 2 teaspoons (10 g) spreadable fat (butter or margarine) on bread.

Pastries/Snacks
Enjoy them in moderation; at most 1 small portion daily (e.g., 1 scoop of ice cream, 1 bar of chocolate, 1 piece of cake, 1 handful of chips, a half handful of salted nuts).

Meat, Fish, Eggs, Legumes
Weekly consumption: 2-4 meals of one portion of meat (1 portion = 80-120 g). More is unnecessary, less is no problem.

Weekly consumption: at most one meal of cured meats such as ham, sausage or bacon in place of meat.

Monthly consumption: at most one meal of innards such as liver, kidney, tripe, sweetbreads (1 portion = 80-120 g).

Weekly consumption: 1-2 portions of fish (1 portion = 100-120 g).

Weekly consumption: 1-3 eggs, including processed eggs, e.g., in baked goods, soufflés, or cream sauces.

Weekly consumption: 1-2 portions of legumes and legume products such as lentils, chickpeas, Indian beans (1 portion = 40-60 g, dry weight), tofu (1 portion = 100-120 g).

Milk and Milk Products
Daily consumption: 2-3 portions of milk products (1 portion = 0.2 L milk or 1 cup of yogurt or
30 g hard cheese or 60 g soft cheese; 1 portion contains about 250 mg calcium).

Grain Products and Potatoes
Daily consumption: eat at least 3 portions of starchy foods such as bread, potatoes, rice, cereals or pastas, . The portion depends on the amount of physical activity.

Fruits
Daily consumption: 2-3 portions of fruit, raw if possible (1 portion = 1 apple, 1 banana, 3 plums or a bowl of berries).

Vegetables
Daily consumption: 3-4 portions of vegetables, one of which should be raw, e.g., as a dip vegetable or a mixed salad (1 portion = 100 g raw or 150-200 g cooked vegetables, 50 g leafy green or
100 g mixed salad).

Alcoholic and Nonalcoholic Drinks
Drink at least 1.5 liters of liquid per day, preferably unsweetened and nonalcoholic drinks such as calcium-rich mineral water (> 300 mg calcium per liter).

Attention: Make up for large losses of fluids (e.g., due to heavy sweating) by increasing your liquid intake.

Nutrition for the elderly - a checklist

• Maintain a steady weight (BMI under 25), lose excessive weight (BMI > 30)
• Drink a sufficient amount of liquids
• Eat one protein-rich food daily
• Eat plenty of fruits and vegetables and whole-grain products
• Keep up regular physical activities

Source

Schweizerische Vereinigung für Ernährung / The Swiss Association for Nutrition (SAN). Merkblätter zur Ernährung, Vol. II. Main Editor: Herr Hansjörg Ryser, Bern.Website at : http://www.sve.org/english/index.html

Links

• Find Out Your BMI
• Nutrients in Produce Linked to Better Health in Seniors
• Dining Ambiance Spurs Appetite in Seniors
• Are Older Folk at Risk of Vitamin D Deficiency?
• Convenience Foods