Nutrition of the elderly: helping them to grow old gracefully

70% of ageing is explained by the environment, only 30% by the genes. This is to say how important the role of nutrition is and a healthy lifestyle are in growing old.

Ageing: an embrittlement but not a disease

To grow old gracefully, without pathology or handicap, by maintaining one's physique and cognitive faculties is a true challenge for medicine when the role to be played by nutrition proves to be important.

"The optimal nutrition represents one of the modifiable factors easiest to change ageing and especially to prevent bad ageing thanks to targeted strategies, at the forefront of which stands the identification of risk patients with nutritional pathologies, explains Dr. Monique Ferry, geriatrist and nutritionist. Physiological changes related to ageing itself, loss of appetite, early satisfaction or reduction of taste, can indeed modify the feeding of the elderly and weigh on their nutritional status. "
Ageing itself should not be regarded as a disease, but simply as an embrittlement compared to the possible disease from a pathology.

A kind of Ageing, the quality of which is not only based on genes: heredity explains indeed only 30% of ageing, while 70% are related to the environment. A figure which underlines how much the way of life is important.

Hydration is often badly estimated

Hydration of the elderly remains the first point to supervise
  • Drink one liter for the needs of the body and food brings the remaining one liter.
  • A reduction in food intakes is frequently noticed among the elderly; it is linked to a decrease in hydration

Units of hydration

To support the everyday practice of dieticians and nutritionists, Monique Ferry recommends the use of units of hydration.
  • A yoghurt is equivalent, in term of hydration, to a glass of water.
  • The priority must be given to a well hydrated nutrition, in particular rich in fruit and vegetables.
  • To offer attractive drinks such as fruit juices

Proteins: increase the quantity!

It is fundamental to control and preserve muscle mass.
  • Eat proteins like meat, eggs, dairy products and fish
  • Maintain a physical activity with at least thirty minutes of daily walk
  • If the protein intake decreases, then occurs a re-synthesis at the detriment of certain tissues, in particular the muscles. However, the reduction in the muscle mass by sarcopenea, reduction in the muscle mass, represents a risk factor of embrittlement for the old subject.
  • It is necessary to eat varied food, without monotony, main cause of the aggravation of the physiological reduction of the taste.

Encourage the elderly to move

For Monique Ferry, "to make an elderly move, you need to make him eat... and not to hold an opposite reasoning of the type "She eats little because she remains seated all day".

After the age of 70, the elderly need energy intakes higher by 20% than those in their thirties because of a less good metabolic output of food. The share of proteins in this total must thus be increased.

A study showed that many people among those who had aged well were those who had spontaneously increased the proportion of their protein contributions in their rations to reach the level of advised intake.

Very useful recommendations

Some simple things can help:
  • a spoon of powdered milk in the yoghurt or soup
  • A pinch of Gruyere on dishes
  • An egg added to mashed potatoes
  • A small pot of condensed milk in a gratin.

It is not possible to ask an elderly to consume double cheese or meat ration, because volume causes rapid satiety among the elderly. It is thus advisable to increase the energy density of usually consumed food.

1.500 Kcal/day: a daily minimum caloric intake

1500 Kcal/day represents the minimal calories contribution of an elderly.

Not to lose weight

Medicine ingestion, catabolising pathologies which increase the anorectic cytokine production, loss of appetite because of less activity of the neurotransmitters orexigenes (neuropeptide Y, ghreline)... represent risk factors of weight loss.

Any weight loss not recovered is at the origin of bad ageing, the addition of these small losses ending up generating many complications.

No diet after 70

Diets should be proscribed after 70, except perhaps sodium free diets which can be followed, for a limited period, on medical prescription.

And this, even for a diabetic patient whose limited appetite causes a difficulty in covering daily requirements, including carbohydrates.

At the end of a meal, they can even enjoy a sweet "pleasure", since the latter will not brutally increase glycaemia.

Diet and cholesterol

Caution for the patients presenting little hypercholesterolemia :

A preventive diet with respect to cholesterol has a meaning between 30 and 70. For this age, it is absolutely necessary to banish restrictive diets.

Weigh regularly the elderly

It is necessary to weigh systematically the elderly, just as measuring blood pressure, to react very quickly to a loss of weight.

It is also necessary to get information about the weight of the previous years, to be careful with a pair of baggy trousers around the waist or an elderly woman who seems lost in her dress...

One kilo lost will be extremely difficult to regain, even more if the weight loss goes back to a few months.

Experiments show that the elderly grow old gracefully when, at this age, the BMI is between 23 and 27 .

To support anabolism, it is as far as possible necessary to increase the protein consumption in the morning and at midday.

Precautions when a diet remains essential

If a diet is really essential, for a prosthesis for example or in the event of a person who is seriously overweight, the elderly should not lose weight. When the problem of weight arises because of a hip or knees prosthesis, the loss should not exceed 10% of the initial weight, and this, only on long term, i.e. at least a year.

The elderly not only risks malnutrition and a muscular loss which will handicap rehabilitation, but also a rapid regain of fat reserves during this rehabilitation, when the diet is not restrictive any more.

Vitamines and rock salt

We should not neglect vitamins and minerals , whose necessary level can only be reached, in particular to provide cognitive and immunising functions, if the daily food supply reaches 1.500 kcal/d, also comprising essential fatty acids, such as omegas 3.
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