The elderly need more protein and vitamin D than other adults. Malnutrition is a widespread problem that may be difficult to reverse. Greater awareness of creating new and customized products may be key to improving the quality of life for many.
Despite considerable individual differences, there are many common issues which affect people who reach an advanced age. Here we will give an overview of the most commonly shared issues concerning food and eating among the elderly, various challenges and what opportunities we have for addressing some of them.
Who are “the elderly”? The “elderly” as a group can be said to include two or three generations. The World Health Organization (WHO) stipulates that you are elderly at the age of 65, and old from the age of 80. However, the bodily processes that can create problems with food and eating can start as early as when you are 50, so it might be useful to be aware of the potential challenges before they occur.
Common food-related issues among the elderly
- Lower energy demand
- Decreased appetite
- Loss of muscle
- Chewing and swallowing difficulties
Needing more proteins
Many elderly have an increased need for proteins in their diet, as muscle loss (sarcophagi) is a natural part of the aging process. The normal need for protein per kilogram of bodily weight per day is 0.8-1 grams for adults, but increases to 1-1.2 grams for people over the age of 65. From the age of 65, proteins should account for 15-20 percent of one’s energy intake.
Protein demand increases further in the event of illness, and many elderly people have multiple diagnoses. An insufficient protein intake over time leads to weakened muscles and an impaired general condition, or can cause other ailments and diseases.
Getting your protein needs covered can be a challenge as overall energy demand decreases in the elderly, and many lose their appetite because of this or for other reasons.
It may be necessary to eat protein-enriched foods or to change your eating pattern to ensure that your protein needs are met. As a precaution, more protein should be added to your diet from the age of 50 onwards. Physical activity such as weight-training also plays an important role in maintaining muscle mass.
In Norway we often eat fish or meat for dinner, so dinner often becomes the main meal for meeting our protein needs. However, if you have a greater need for protein, it is important that you also have more protein for breakfast, lunch and when snacking.
Examples of protein-rich foods
- Unprocessed meat or fish (including on bread)
- Dairy products (such as cheese, skyr, kesam, cottage cheese, sour cream or Greek yogurt, or protein-enriched milk (Styrk))
- Eggs or egg-based products
- Other sources:
- Vegetables generally contain low levels of protein, but legumes such as beans, chickpeas and soy-based products are excellent sources of vegetable protein.
- Nuts also contain a relatively high level of protein, but since they are also rich in fats, the intake should be limited if you are a normal weight or are overweight.
- There is also protein in flour and cereal products.
Tips for getting enough protein in your diet
- Add extra sandwich fillings to your usual slices of bread, such as cold cuts, eggs, fish (such as tomato mackerel) or cheese.
- You could also add eggs or cottage cheese when baking bread, or make waffles (or cakes) with extra eggs or dairy products.
- Another option if you require additional protein is to buy protein powder and mix it into the food, but be aware that the addition of protein powder can affect the food’s taste and consistency.
Greater need for vitamin D
The elderly also have an increased need for vitamin D. Other than that, their vitamin, mineral and fibre needs are largely equal to that of adults, but as their overall energy demand is lower, the food they eat should be more nutrient-dense.
Key sources of Vitamin D:
- Exposure to sunlight
- Cod liver oil, fatty fish and roe/caviar
- Several dairy products such as some types of white cheese and milk are also enriched with vitamin D
Many elderly people suffer from a reduced appetite, making them eat less than before. There may be several causes for this, such as a slower metabolism or reduced feeling of hunger due to physiological changes, illness, or major social upheavals in life such as losing one’s life partner or moving into a care home. Many also have a reduced sense of taste or smell with age, which makes the food become bland and lack flavour, and can affect their appetite and ability to enjoy meals.
Tips for an increased appetite
- Try to dine with someone you are comfortable with. If you live alone, you could visit family members or attend day centres or activities for the elderly to eat with others. This, as well as physical activity, can help increase your appetite.
- For those who have a weakened sense of smell or taste, adding more spice to their food can help – but they should be mindful of their salt intake.
- Cooking dishes with different textures, or making sure that the food looks appealing, can also help stimulate the appetite.
- If you are a light eater and/or have a low weight, it is important to eat regularly and add snacks to meet your daily nutritional needs.
Food is abundant in Norway. Nonetheless, up to 60 per cent of residents at care homes and patients living in an institution do not get proper nourishment. This is also a challenge for many older people living at home. Malnutrition can worsen existing health conditions, slow down healing and recovery processes, make you more susceptible to infections, increase the risk of falling, impair mobility, increase the risk of depression, increase the risk associated with surgical interventions and cause nonspecific symptoms that can be misinterpreted.
Malnutrition is not only bad for individuals, but has also major economic consequences for society at large. The effects of malnutrition can lead to more inpatient days and increased costs of treatment.
Malnutrition is treated with food and providing proper nutrition, and prevention is by meeting individual dietary needs. Personalized or customized food is therefore an important measure for meeting the “elderly boom” in the years to come. We need to develop a greater focus on nutrition among the elderly, both in terms of prevention and treatment of malnutrition.
Enriching food for malnourished people
- Cases of malnutrition can be treated by enriching the person’s food with both proteins and fats. Enriching food with fat is the simplest means, as it has little impact on its consistency and taste compared to protein enrichment. Enriching foods with fat can be done by adding nutrient-dense products such as butter, cream or cooking oil to the food. Nuts or nut butters are another good source of fat.
Chewing and swallowing difficulties
Many elderly people have difficulties chewing and/or swallowing food due to reduced saliva production, poor dental health or weakened muscles of the jaw and throat (dysphagia). The many manifestations of dysphagia means that we need to be able to provide food with a consistency adapted to each individual suffering from it – from those who need easy-to-chew food to those who can only ingest fluids.
Those with have severe chewing and swallowing difficulties struggle to both eat and eat enough. Without customised meals, eating can be a significant issue which can lead to malnutrition.
It’s not just older people who have problems with chewing and swallowing. Dysphagia can also result from damage to the central nervous system (due to strokes, tumours or Parkinson’s) or other injuries to the mouth or throat, for example from surgical interventions or radiotherapy.
Practical tips for when chewing is difficult
- If chewing food is difficult, you can boil potatoes and other vegetables for longer than usual. Fish has a more delicate texture than meat, and is easier to eat for many. You could also mash vegetables or fish lightly with a fork and make meat easier to chew by cooking it for longer, preferably at lower temperatures. “Pulled” or slow-cooked meat products are examples of meat that has been cooked for a long time, making it extremely tender.
- If you have problems with low saliva production which makes food feel dry in the mouth and difficult to chew, then adding sauces can make it easier to chew food. Acid, for example from lemon juice or in vinaigrettes, can stimulate saliva production. Bread can be problematic for people with chewing difficulties or low saliva production. Nutrient-dense waffles, French toast, nutritious porridge or dinner products can be good options.
More people will need to live at home
People over 60 years are more likely to be hospitalized than other age groups. Since malnourished people are at higher risk of disease combined with a poorer general heath, they are often unable to live at home for longer periods of time after hospital admissions or treatments. They tend to end up as “revolving door patients” who are moved between institutions and treatments. This is bad for the patient and costly for society. We currently have around 40,000 nursing home spaces in Norway.
Since nursing home spaces are costly, the number of spaces is unlikely to increase in the years to come, which means the elderly have to be able to live independently at home for longer. That makes it even more important to develop food products that are adapted to the needs of this group of people in terms of extra protein, vitamin D, various textures and nutrition-dense foods.
It is crucial that the elderly are aware of the fact that their nutritional needs differs from the rest of the population, so that they can call for more products which are developed to their needs. The food industry needs to regard this group as a distinct consumer group with their own purchasing power. We food scientists are working to help the food industry develop more tasty, nutritious food products with different textures, customized to a wider variety of dietary needs, are introduced to the market.