Nutrition in Older People

Key points

• In the UK, life expectancy has doubled over the last 200 years and now around 16% of the population is aged over 65 years. 

• General nutrient requirements and healthy eating guidelines apply to older people. However, energy requirements fall with advancing age due to a decrease in basal metabolic rate and often decreased levels of physical activity.

• The ability to synthesise vitamin D by the skin decreases with age. Older people are therefore recommended to take a supplement containing 10?g of vitamin D daily as well as regularly eating food sources of the vitamin (for example oily fish and fortified breakfast cereals).

• Some older people in the UK, especially those living in institutions, have been found to have low intakes and/or low blood levels of a range of micronutrients.

• Good nutrition and regular physical activity play a protective role in a number of age-related conditions including cardiovascular disease and cognitive decline and can help to protect oral and dental health, and bone and joint health in later life.

• Both malnutrition and obesity are prevalent in the older population. Malnutrition is more prevalent in older people living in institutions, whereas overweight and obesity are more prevalent in free-living adults.

An ageing population

In the UK, life expectancy has doubled over the last 200 years, and now around 10 million of the population is aged over 65 years (16% of the population). Within the older age group, even greater population growth has been seen among those aged 85 years and over.

Unfortunately, these extra years added to our lifespan are not necessarily ‘healthy’, and this has a detrimental impact on the quality of life of older people.

Energy requirements

For healthy people, energy requirements decrease with advancing age. This is due to changes in body composition; a decrease in lean body tissue (muscle) and an increase in fat tissue. This means that, for a given bodyweight, older people tend to have less muscle and more fat, leading to a fall in basal metabolic rate (BMR). Many people also become less active as they get older. In the UK (as in other countries) the estimated average requirement (EAR) of energy for older adults has been set at a lower level than for younger adults.

Dietary recommendations

In the UK, dietary recommendations for fat, carbohydrate and dietary fibre are the same for older people as for the rest of the population and similar healthy eating guidelines apply.

There are, however, specific recommendations for vitamin D for older people. Vitamin D is synthesized in the skin via the action of sunlight. But older people typically go out of doors less than younger age groups and their skin is less efficient at producing vitamin D from sunlight. It is therefore recommended that all adults over the age of 65 take a supplement containing 10?g of vitamin D daily and regularly eat foods containing vitamin D (e.g. oily fish and fortified breakfast cereals). 

Cognitive decline and stroke

Stroke, dementia, Parkinson’s disease and depression are common diseases affecting the brain of older people and they can have a severe impact on a person’s quality of life and independence. High intakes of sodium (salt), fat, energy and alcohol are linked with high blood pressure, which is a major risk factor for cognitive decline and stroke.

There is now some evidence that fatty acids in the diet may be important in determining the risk of developing dementia. Some emerging research suggests a protective role for omega-3 fatty acids.

Low status of folate, vitamin B₁₂ and vitamin B₆ has been associated with elevated levels of homocysteine, which is linked with increased risk of stroke and an increased risk of dementia. Low vitamin B₁₂ status affects 5-10% of people over the age of 65 years and low folate status affects 16% of older people living in institutions, so it is important that steps are taken to improve deficiencies in dietary intake of these vitamins.

Physical activity is thought to have a protective role against cognitive decline in later life; but results have not yet been adequately supported by data from randomised controlled trials.

Bone and joint health

It is estimated that 1 in 3 women and 1 in 12 men over the age of 55 years will suffer from osteoporosis in their lifetime. Adequate intakes of calcium and vitamin D are key to ensure that optimum peak bone mass is attained in early adulthood and to reduce postmenopausal bone loss and prevent osteoporotic fractures.

Low vitamin D status has also been shown to increase risk of falls. Vitamin D insufficiency is widespread in older people in the UK, particularly among those in residential care (see table 1). People aged 65 years and over should take a vitamin D supplement (10?g), and eat food sources such as oily fish, and fortified breakfast cereals.