As people age, numerous physical and social changes can impact their nutrition.

Lifestyle Changes
1. A change in living arrangements
2. Death of a spouse
3. Decreased income, affecting the ability to purchase food
4. Social isolation
5. Loss of the ability to drive to the store alone to buy food

Physical Changes
1. Slow metabolism and a decreased need for calories
2. Lack of chewing and swallowing ability
3. Loss of smell or taste
4. Slowed digestion
5. Diarrhea and constipation
6. Diseases such as diabetes, arthritis, and cardiac or breathing problems
7. Lack of activity

Many older adults do not take the time to plan and cook meals since they are alone. If you are a Caregiver, take the time to eat with your client and set the table so the meals look attractive to them. In a facility, have the client eat in the dining room if possible to encourage socialization and give the client something to look forward to. Encourage family members to visit during mealtime or take the client out to eat occasionally, if possible. Please remember that you can suggest healthful diet tips to your clients, but the ultimate decision of what they will eat is up to them and their family. If you have concerns about your client’s diet or the availability of foods, please call the office, and the nurse will follow up with your concerns.

The USDA food guidelines follow the FOOD GUIDE PYRAMID (see picture). Serving sizes are as follows:
1. Grains- 1 oz cereal,1/2 bagel,1/2 cup of pasta or rice, one slice of bread
2. Fruit and vegetables- ¾ cup (6 oz) juice, ½ cup fruit, 1 cup salad-type vegetables, one medium piece of fruit
3. Protein foods- 2-3 oz meat, poultry, or fish, one egg, 2 Tablespoons peanut butter,1/2 cup cooked beans
4. Dairy- 1 cup (8oz) milk and yogurt, 2 oz cheese, ½ cup cottage cheese
5. Fatty foods and sweets- use in moderation- butter, margarine, oils, and salad dressings, cakes, pies, candy, etc.

Making healthy choices is also essential. Choose fish and beans as a low-fat alternative to meat for several meals a week. Eat a variety of fruits and vegetables every day. Choose whole-grain breads and cereals. If you are choosing whole wheat bread, be sure that the ingredients clearly state’ whole wheat’; if it simply says ‘wheat,’ it is not high in fiber. Low-fat or non-fat dairy products are a healthier alternative to high-fat dairy products. Sugar and salt should be used sparingly.

Fiber is essential to provide BULK in the diet, aid in digestion, and reduce constipation. Eating at least five servings of fruits and vegetables, as well as whole-grain breads and cereals, will increase fiber intake. Eating cooked beans, peas, and lentils is a great way to increase fiber without adding fat. Vegetables and fruits are also a source of essential vitamins that are necessary in the diet.

Water is vital to health; 6 to 8 glasses of water a day are recommended. Lack of fluid intake can lead to dehydration, particularly in older people. Drinking fluids mostly in the morning and afternoon can help decrease the need for extra bathroom trips at night. Other fluids can take the place of water, but water is the best choice. Two to three cups of coffee, caffeinated tea, or cola a day should be the limit for caffeinated beverages. Decaf tea and coffee are generally considered better choices for older individuals. Proper hydration aids digestion, prevents constipation, and helps prevent urinary infections, as well as colds and the flu. It is also essential to provide your client with extra fluids in hot weather to help cool their body and keep them hydrated.

Sugar should be consumed in moderation as part of a balanced diet. Sugar has no fat, minerals, vitamins, or fiber, but it is a carbohydrate. Processed foods are a primary source of excess sugar; read labels and, if possible, choose foods where sugar is not listed among the first few ingredients. All sugars are the same; white sugar, raw sugar, brown sugar, honey, and corn syrup have the same effect on the diet. When reading labels, look for clues like dextrose, fructose, and sucrose; any ingredients that end in "ose" are sugars. People lose taste buds as they age, and they may not detect added sugar, salt, etc., so they tend to use more to achieve a better flavor in their foods. Try using other spices, such as cinnamon, and opt for sweet-tasting fruits instead of sugary sweets. People with diabetes will have special diets, ranging from those free from added sugar to specific diets tailored to their needs. Please ensure you understand the particular requirements for your client. If you have any questions, please call the office and arrange for a nurse to come out and explain them to you.

Fat has more than twice the calories per gram as carbs or proteins; each gram of fat has nine calories. A regular diet should contain no more than 30% of the calories from fat. People with heart disease or inactive adults should further reduce their fat intake to 20% of total calories. Read labels for fat content. Processed foods, also known as convenience foods, typically have higher fat contents than food you prepare yourself. Saturated fats are found in meats, eggs, dairy products, and some plant oils, such as palm and coconut oils, as well as cocoa butter. Saturated fats raise LDL “BAD” cholesterol and should be limited. Monounsaturated fats lower LDL cholesterol and should be part of a healthy diet. Sources of monounsaturated fats are olive oil, peanut oil, avocados, nuts, chicken, and fish. Polyunsaturated fats help lower your total cholesterol. Sources of polyunsaturated fats include corn, sunflower, safflower, walnut, and canola oils. In a standard 2,000-calorie diet, the total fat should be 65 g or 585 calories.

TIPS TO REDUCE FAT
1. Broil or bake food instead of frying after removing fats and skin
2. Meat portion size should be 2 -3 oz.
3. Eat more fish and poultry, and eat red meat less often
4. Eat more beans, legumes, peas, and grains
5. Try skim and reduced-fat dairy products
6. Read labels and avoid hydrogenated oils, palm and coconut oils, and cocoa butter
7. Use herbs and spices to season food instead of butter and fatty sauces

Our bodies require 500 milligrams of salt daily; most of us consume significantly more. Excess salt consumption can lead to high blood pressure, and the likelihood of developing high blood pressure increases with age. Besides salt, other sources of sodium are baking soda, baking powder, MSG, soy sauce, and prepared seasoning (read labels). Sodium is also present in high concentrations in many processed foods and canned goods. Again, read labels and look for low-sodium versions of foods and avoid processed foods. Try cooking without salt and then add salt substitutes or limit the amount of salt after the food is prepared. Many clients will be on a restricted salt diet, which is 2 grams or 2,000 mg of salt. In any diet, an excess of 2,500 mg is probably too much salt.