Nuitrition programs help independent and homeless senior citizens, as well as those eating government-subsidized meals, maintain their health and diet : Nutrition and Aging

Joan and Bob, both 65, live in a posh Beverly Hills home where a butler-cook prepares sensible, nutritious meals for the couple and their dinner guests according to the guidelines established by Joan. She is a knowledgeable, nutritionally conscious eater and tries to reduce use of fats, sodium and calories in their diet. Joan and her husband are in excellent health. They not only watch their weight and know how to manage their diet, but exercise daily by playing tennis, taking long walks or swimming. The prognosis for a healthful, long life? High.

Emil Le Beau, 65, a retired chemist living in Leisure World in Laguna Hills, has lived alone for several years. A cardiovascular problem some years back turned him on to exercise as a life style activity. He now jogs daily, avoids fats, sodium, sugar and cholesterol, eats no desserts and cooks his own casseroles to help control his diet. When he eats out, the menu includes fish.

Senior Exxie Jones, a native of Kentucky who loved fried chicken and pot roast and gravy, discovered she had high cholesterol and triglyceride levels along with being overweight. A nutrition class at Leisure World, where she lives, helped her change her ways. Now she walks two miles, rides a stationary bicycle for 30 minutes and takes an aerobic class every weekday. She’s feeling much better now, calls up a friend to join her for dinner and is living a good life.

But Joan, Bob, Emil and Exxie are rarities among the 20 million-plus seniors living in this country.

There is Hanna K., one of the many estimated 35,000 homeless in the city, who hunts for her meals in garbage cans and street curbs. Her nutritional status is poor. Prognosis for good health longevity, dim.

Roy Swarthout, 77, is slightly better off. He eats haphazardly, sometimes stopping at the Union Rescue Mission in downtown Los Angeles for a meal. While the meals, in general, leave much to be desired nutritionally, they do provide nourishment to the 1,500 participants daily. His nutritional status is also poor. And it will continue to be poor.

Then there is Frank Yamada, 73, who has been a daily participant of a government nutrition program commonly referred to as Meals On Wheels in Little Tokyo since the federal government allocated funds nine years ago through the Older Americans Act for persons 60 years and older. His meals, to which he contributes $1, are ethnically satisfying and nutritionally sound. But the Little Tokyo site stands in jeopardy of extinction if allocations are not increased.

The nutrition picture of the elderly is, at best, precarious, as far as existing programs and health status go.

From a practical point of view, length of life of human societies is basically determined by diet and climate, prevention and treatment of infections, level of sanitation and level of housing, according to Dr. Jerzy Meduski, assistant professor of neurology at USC School of Medicine.

There are 20 million persons older than 65 living in the United States, give or take 3 to 4 million, making up 11% of the total population. It is expected that by the year 2030 the elderly population will double, with the population of persons older than 75 growing at the fastest rate. The challenges facing the nation and each individual in maintaining high health status are enormous. The question is, are the challenges being met?

Although improved health care and nutrition education systems in the past 10 years have staved off the horrendous effects of the chronic killer diseases among middle and old age groups, nutritional surveys measuring the dietary intakes of nutrients of the elderly have suggested that nutritional deficiencies exist in at least 50% of the elderly population living independently, with the homeless and those on low or fixed income at greatest risk.

So far, several population studies have found that intakes of certain vitamins, protein and calories fall well below the Recommended Dietary Allowances, but it is not clear how these findings correlate to disease or death rates.

The four leading causes of death in the United States are diseases of the heart, cancer, cerebral vascular lesions and accidents. The elderly are at greatest risk for arteriosclerotic heart disease, and cancer occurs most frequently in the 60- to 65-year-old age group. The elderly are also at highest risk of accidents.

“All humanitarian considerations aside, the cost of taking care of the elderly is going up all the time. Anything one can do to increase quality and decrease morbidity will have a good effect on society and family resources,” said Stanley Gershoff Ph.D., dean of Tufts University School of Nutrition.

During 1975, of the $103 billion spent on the nation’s heath care, 29% or about $30 billion went to the health care of the elderly, according to a report in the American Journal for Clinical Nutrition.

While nutrition is believed to be a factor in at least some of the age-related disorders and may help in the treatment of these disorders, how nutrition might modulate the aging process is yet unknown.

In the aging process, each individual seems to break down at different rates. Life span is greatly influenced by several factors: genetic traits, positive and negative effects of environment--such as climate--food and life style, according to Meduski.

There are several major changes in the body that come with age, which reduce the ability of the organ system to function effectively.

According to Meduski, there is a decrease in function of the multicomponent systems (basal metabolic rate, blood pressure, water and others); cardiovascular systems (cardiac output and total peripheral resistance); respiratory system (maximum breathing rate); urinary system; nervous system, and muscle strength.

Decreased Metabolic Efficiency

These physical malfunctions lead to loss of teeth, lack of coordination, physical weakness and disability, vision problems, immobility and digestion discomfort. There is a loss of sense of taste and smell. Anorexia and decreased metabolic efficiency are also involved, according to Dr. Harold H. Sandstead, director of the U.S. Department of Agriculture Human Nutrition Center on Aging at Tufts University.

On a social level, living alone, failure to adapt to a new environment, income loss and susceptibility to food fads often occur. “Psychological malfunctions may cause depression, anxiety and a sense of isolation. A sedentary life style contributes to obesity, which can lead to increased risks of chronic illnesses, such as diabetes, high blood pressure and heart disease,” said Sandstead.

So far, survey data reveal that many elderly individuals in the United States are eating poorly, although much of the data is incomplete. Relatively little has been done to determine what the acceptable nutritional norm for the elderly is, much less assess it, according to Jean Mayer Ph.D., president of Tufts University, one of the few scientific institutions studying data to determine the nutrition requirements for older individuals.

“Data we do have on the elderly is based on much younger people,” said Mayer.

According to Mayer, requirements for the elderly for some nutrients may be the same as for the younger adults while higher for other nutrients because of the inability of the body to absorb nutrients, an occurrence inherent in the aging process.

“It is likely that some requirements go down because of slower metabolism. It is possible that some go up because of malabsorption. It’s likely some nutrient requirements will stay the same. That’s what our research is all about,” said Mayer.

Guidelines Questioned

Some experts question the accuracy of the RDA as a nutritional guideline for the elderly because the RDAs were set for healthy persons, not necessarily taking into account the requirements that may occur because of disease, infections and physical trauma often experienced by the elderly.

One study involving six men ages 63 to 77 showed that the energy needs were about 500 calories greater than the RDA. Elderly individuals who are active may require even higher energy intakes than younger adults to maintain normal body weight, whereas sedentary individuals may require lower intakes of energy.

The RDA for protein is also controversial. Some scientific investigations suggest that protein requirements are higher than established by the RDA because elderly persons need more protein to maintain nitrogen balance than do younger individuals. Other scientists think that the elderly require less protein.

Some other recent surveys show that the average elderly diet tends to be low in the B vitamins (thiamine, riboflavin, folate and B-6). B-vitamin deficiency has been associated with isolation, alcoholism and boredom, which are prevalent among the elderly.

The RDA for calcium set at 800 milligrams per day for those 51 and older may also be off. Studies suggest that about a fourth of females of all ages in the United States take in less than 300 milligrams. It appears that 1,200 milligrams of calcium are necessary for those with osteoporosis to maintain calcium balance. It is well known that calcium absorption decreases with age, causing a serious bone deficiency disease that affects 25% of all American women older than 65. A decrease in physical activity, stress, drugs and estrogen deficiency are among factors contributing to osteoporosis, a crippling and often mortal disease.

Dysfunction of Immune System

Zinc intake ranging from 7 milligrams to 13 milligrams daily among the elderly is below the RDA of 15 milligrams, indicating zinc deficiency does exist in some elderly. Low zinc levels are associated with poor wound healing and dysfunction of the immune system, according to a report in the American Clinical Journal of Clinical Nutrition. Risk of zinc deficiency is increased in elderly persons who have problems absorbing nutrients, or renal or alcoholic liver cirrhosis problems, according to the report.

Anemia is a major problem among the elderly, according to Mary Bess Khors Ph.D., registered dietitian with the Department of Nutritional and Medical Dietetics at the University of Illinois. Dietary intake of iron by persons 56 to 75 years of age seems to be adequate, meeting the RDA for 10 milligrams iron per day. However, nutritional surveys indicate that the elderly tend to decrease intakes of meat, which is an excellent source of heme iron, while increasing their consumption of cereals. Fiber and phosphate (or phytate) content in cereals tend to reduce rather than aid iron absorption. Because the degree of absorption of iron influences the requirement for the mineral, more study is needed to determine the requirements for iron. Adequate intake of vitamins A and C has been associated with increased longevity. However, vitamin A and C levels have shown to be low among the elderly in certain geographic locations. Absorption of these vitamins may be hampered by laxatives, often used by the elderly.

Folate intake seems to be adequate for most elderly persons, but certain groups, such as low-income groups, alcoholics and those on certain medications may encounter deficiencies in this mineral.

It is believed that diet can play an important role in improving patient status.

The standard advice to the elderly veers toward a balanced diet that is somewhat high in complex carbohydrates, such as fruits, vegetables and grains, and less meat and fats.

Complex Carbohydrates

Mayer recommends reducing fat intake to 30% of calories, saturated fat to 10% of the calories and cholesterol to 300 milligrams. He recommends increased consumption of complex carbohydrates and use of natural rather than refined sugar. “Foods high in refined sugar often contain few nutrients and extra calories. On the other hand, complex carbohydrates from whole grains, fresh fruits and vegetables are rich in vitamins and minerals. And they contribute fiber, which helps prevent constipation,” he states in a recent report.

A common dietary problem among elderly is consuming too much salt, which is associated with high blood pressure, thus increasing the risk of stroke and heart disease. The elderly should also eat at least two servings of dairy products, preferably the low-fat variety of milk, yogurt and cheese to ensure an adequate calcium intake.

According to Meduski, science is still building new theories. “Aging as the area of study is now ready for valid experimental approaches, and the results of these will help to elucidate basic aspects of the process. . . . Research work in the field of aging will require the achievements of pharmaceutical sciences, regulatory biochemistry and the nutritional sciences,” he said.