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Nutrition - Dr Rosemary Stanton

Well known nutritionist and long term valley resident shares her knowledge.

 

February 2014 - nutrition for the 'elderly'

The term ‘elderly’ was once used for anyone aged over 65. As someone well past that age, I don’t feel elderly and actually feel pretty much the same as when I was younger – although the mirror tells a different story!

In establishing dietary recommendations, elderly people have also been defined as anyone over 65, but in the most recent review of Australia’s Dietary Guidelines, we realised the term was inappropriate.

The need for some nutrients changes at different stages of life, but there’s little correlation between changing needs and age 65. For women, especially, some things change after menopause when we need less iron (no more pregnancy or blood loss from menstruation) and more calcium (although that’s grounded more in hope of maintaining bone density than in evidence it will be effective). Most men and women also need fewer kilojoules as they grow older and that starts from about age 30, or earlier in those whose physical activity falls.

The 2013 Dietary Guidelines replaced references to ‘elderly’ people and directed the emphasis to the differing needs of the ‘frail aged’. That’s also hard to define and can occur at varied ages. Early features include slowed or unsteady gait, muscle weakness and loss of muscle bulk, reduced mobility and falls.

For most people in their 60s and early 70s, the main aim should be to stay as active as possible. This reduces muscle loss and also allows you to eat more without gaining extra body fat. Avoiding excess body fat, especially round the middle and upper body, is important not only because it’s associated with increased risks of type 2 diabetes, heart disease, strokes and several common cancers, but because it impedes the ability to be active. Carrying too much weight also increases the chances of back and knee problems.

However, there’s no need (or advantage) in being ultra thin. Indeed if you’re likely to reach your late 80s and 90s, when the absorption of food can decrease, it makes sense not to be too thin. The healthy weight range is a reasonable guide for most older people. (Calculate it by dividing your weight (in kilograms) by your height (in metres) squared. The ideal is between 18 and 25, but closer to 25 is not a problem for those past their mid 70s.

 

Need for specific nutrients

In theory, nutrients that may need attention in those in their mid 70s include protein as well as vitamins riboflavin (vitamin B2), B12 and D. Almost all Australians get more than enough protein and riboflavin is usually amply supplied.

As a check, protein is found in fish and other seafood, lean meat, poultry, legumes, eggs, nuts and grains as well as milk, cheese and yoghurt. If you use a cereal or nut milk, check the label and choose one with at least 3g of protein/100 mL. Some make that grade; others don’t. For the frail aged who may have dental or other problems that make chewing difficult, malted milk drinks are an excellent source of protein.

Riboflavin is widely distributed in foods with dairy products being top sources. It’s also found in seafood, meat, chicken, mushrooms, nuts and Vegemite. Vegetables provide some too, especially broccoli.

Vitamins B12 and D are the nutrients needing most attention as absorption decreases with age.

 

Vitamin B12

Vitamin B12 is found only in animal products, including meat, fish, poultry, milk, cheese and yoghurt. Claims it is in mushrooms overlook the fact that the quantity is small and varies with the growing medium. Comfrey and spirulina are often touted as sources of B12, but the form they contain is not absorbed by humans (of any age). Those who avoid all animal products will need a supplement of this vitamin.

Problems with vitamin B12 arise because it needs a substance secreted by the stomach for its absorption. This factor can decrease with age. Fortunately, a higher dose of vitamin B12, easily obtainable from an oral supplement, can help overcome the lower absorption.

If you take a vitamin B12 supplement, make sure you do not take one containing folic acid (the synthetic form of folate). The natural folate present in vegetables is not a problem and the folic acid added to bread flour also supplies amounts that are safe. A high intake of folic acid is only likely from a supplement. In its natural form in green vegies, legumes, beetroot, cauliflower, wholegrains and nuts, it’s entirely safe (and desirable).

 

Vitamin D

This vitamin, usually obtained from the action of sunlight on skin, is needed for the body to absorb calcium. Because vitamin D is actually a hormone that takes part in many other biochemical reactions in the body, some people have assumed it’s a cure-all. Sadly, studies are not showing the guessed at benefits, but it is important for bone health.

If you’ve had a blood test for vitamin D, note that a recent study found the tests had misclassified between one in five and one in three people as deficient. The different results depended on the laboratory and the type of measurement used. Testing has sold a lot of supplements, but a new examination of these shows very little benefit. Incidentally, costs of vitamin D testing have gone from $1.3 to over $140 million in the last 10 years.

The ideal source of vitamin D is to expose skin, for example the arms, to sunlight for an average of about 10 minutes a day. However, the absorption process is less efficient in some older people (including those over 60) and they may need twice as long. Because vitamin D is stored in body fat, those who have higher levels of fat may also need more. Fortunately, daily exposure isn’t necessary because the vitamin is stored, so an hour in the garden or out walking twice a week will usually provide ample quantities. Because of the high risk of skin cancers and melanoma, before 11am or after 3pm are the best times.  ­