Nutrition Considerations for The Elderly

Maximizing Quality of Life

This article is about ageing population, their common age-related problems, nutritional implications and suggestions on implementing nutritional changes including supplements.

Defining Elderly

People between 50 and 60 are considered pre-elderly, above 60 are considered as elderly, and above 85 are considered very-elderly. United Nations Report of 2015 about Ageing Population says that “The number of people aged 60 and older worldwide is projected to more than double in the next 35 years, reaching almost 2.1 billion people. Most of this growth will come from developing regions of the world, although the oldest old, who are more than 80 years of age, are the fastest growing segment of the population in developed regions.”

Therefore to improve quality of life we have recommendations and emphasize that prevention is the key for improvement, and people don’t have to act on recommendations only when they become elderly.

Common Age Related Problems

• Sarcopenia
• Low bone mineral density and osteoporosis
• Age-induced weight loss
• Age-related cognitive decline and risk of neurodegenerative diseases

Sarcopenia

Sarcopenia is defined as “A syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death. Risk factors for sarcopenia include age, gender and level of physical activity.”

It starts with lowering of muscle-mass and is called pre-sarcopenia. With age muscle-mass, muscle strength and performance all go down. Muscle mass starts declining by ~1% per year from the peak.

Why is sarcopenia an issue?

Research says that sarcopenic individuals are over three times more likely to fall during a follow-up period of 2 years relative to non-sarcopenic individuals. We are well aware of the obvious negative consequences of falls such as injury & fractures (especially if BMD is low). Moreover, falls are also associated with greater functional decline, physical activity restriction and social withdrawal, anxiety and depression etc. There is a research finding that those who have experienced a previous fall are 2.8 times more likely to fall again

Mechanism behind Sarcopenia

Basal rates of muscle protein synthesis (MPS) & muscle protein breakdown (MBP) are unchanged with healthy ageing.

Sarcopenia is due to many factors including a loss of motor neurons and muscle fibers, type II fiber atrophy anabolic resistance (i.e. less muscle protein synthesis after protein ingestion, resistance exercise and insulin) and impaired muscle regeneration.

Nutritional Intervention

Protein and Leucine

Adequate Protein at Each Meal is recommended. Ensure adequate essential amino acids (EAAs) with each meal. Ageing muscle is less sensitive to lower doses (~6.7g) of EAAs (26% leucine), but Leucine enrichment (41% leucine) rescues the response. High doses (10–15g) of EAAs stimulate MPS to a similar extent as the young.

In one research, in elderly women one ‘adequate’ protein dose is found to be superior to 4 smaller doses in elderly women. Adequate was found to be 79% of protein in one meal (1.3g/kg FFM – Fat Free Mass) and by smaller doses it meant protein intake spread equally over 4 meals (approx. 0.4g/kg FFM each meal), This resulted in higher rates of MPS and improved muscle retention.

Fish Oil

Fish oils increases muscle sensitivity in 65+ year olds. Omega-3 supplementation approximately doubled the muscle phospholipid omega-3 fatty acid content and there was increased activation of mTOR in supplemented group. mTOR (mammalian target of rapamycin) is a member of the phosphatidylinositol 3-kinase-related kinase family of protein kinases. mTOR links with other proteins and serves as a core component of two distinct protein complexes, mTOR complex 1 and mTOR complex 2, which regulate different cellular processes.

Research papers have been published about benefits of fish oil:

• 2g/day fish oil supplementation for 90 days augmented increases in muscle strength & functional capacity in elderly women
• 4g EPA/DHA for 6 months increased muscle mass and strength (slowing the normal decline in muscle mass and function)
• 3g/day fish oil supplementation for 18 weeks augmented increases in muscle function and quality in older women

Creatine

Creatine in combination with resistance training (RT) increased lean mass and strength more than RT alone. Creatine supplemented groups have shown lower incidence of sarcopenia.

Meta-analysis supports a role for creatine supplementation in older adults. This helps in enhanced muscle mass gain, enhanced strength and enhanced functional performance.

Practical Recommendations

• Resistance Exercise
• Adequate protein (and leucine) at each meal to account for anabolic resistance: 0.4 – 0.6g/kg
• Fish oil supplementation: 2 – 12g/day
• Creatine supplementation: 5g/day taken with food that is insulinogenic

Osteoporosis

Osteoporosis is a skeletal condition that occurs when the body loses too much bone, makes too little bone, or both. It is characterized by decreased density (mass/volume) of normally mineralized bone”. With ageing, the balance shifts in a negative direction, favoring greater bone resorption and less bone formation. Osteoporosis means “porous bone.”

It is most common in post-menopausal women. It is also common in the female athlete triad/eating disorders.

Why is osteoporosis an issue?

As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.

Nutritional Recommendations

Calcium

• Recommended Nutrient Intake (RNI) for 50+ Males – 1000mg/day
• Recommended Nutrient Intake (RNI) for 50+ Females – 1200mg/day

Hyperparathyroidism causes release of calcium from the bones, it is caused by calcium and vitamin D deficiency.

It has also been found that increasing calcium intake from dietary sources increases BMD by a similar amount to increases in BMD from calcium supplements.

Vitamin D

Vitamin D is required for osteoblast genesis and bone formation. 35%–90% of the institutionalized elderly are estimated to be vitamin D deficient.

Research on effect of Vitamin D on BMD has shown significant benefit. Vitamin D3 Supplementation (400IU) slightly decreases PTH secretion and increases bone mineral density at the femoral neck.

Parathyroid hormone (PTH), also called parathormone or parathyrin, is a hormone secreted by the parathyroid glands that regulates the serum calcium concentration through its effects on bone, kidney, and intestine.

Practical Recommendations

• Exercise and physical activity. Particularly weight-bearing or resistance exercise
• Adequate dietary calcium. 1200mg/day for 50+ females. 1200 mg can be had from 170 grams of whole milk or 170 grams of Greek yoghurt or 50 grams of canned sardines or 110 grams of spinach.
• Optimize Vitamin D levels

Age Induced Weight Loss

Significant changes in bodyweight of more than 4% per year has been found to be an independent predictor of mortality. Even moderate declines of 5% or more over three years is predictive of mortality in older adults.

Why is weight loss common in the elderly?

Reduction in energy intake due to:

• Alterations in taste and smell
• Greater satiation after a meal
• An increase in circulating concentrations of CCK
• Delayed gastric emptying
• Dental problems (poorly fitting dentures)
• Dementia, depression or other psychiatric disorders
• Side effects of certain medications
• Reduced motivation/ability to prepare food
• Frequent illnesses/infections
• As a result of an impaired immune system
• Increased incidence of dysphagia

Practical Recommendations

• Meal-prep or meal delivery services
  • Meals marketed for elderly are often inadequate
  • Consider logistics e.g. fresh vs frozen meals
• Energy-dense meals and snacks
  • Low volume
  • Lower fiber
  • Higher in fat
• Considerations for snacking frequency
  • Are snacks compromising energy (and protein) intake at meals?
• Liquid calories
  • Whole milk/whey
  • Fruit juice and smoothies
• Reduce caffeine intake
• Encourage palatable foods
  • As long as they do not displace nutrient-dense meals
  • Make healthy, nutritious foods more palatable
  • Add sauces
  • Add salt
• Maintaining / introducing optimal hydration strategies is important
  • Prompt through water bottles filled with palatable fluids e.g. sugar-free squashes, caffeine-free teas
    Elderly are at increased risk of dehydration. Reduction in renal function reduces responsiveness to antidiuretic hormone (ADH).  ADH binds to receptors on cells in the collecting ducts of the kidney and promotes reabsorption of water back into the circulation. In the absence of antidiuretic hormone, the collecting ducts are virtually impermeable to water, and it flows out as urine.Less ‘thirst’ or drive to drink can often lead to dehydration.

Cognitive Decline & Neurodegenerative Diseases

Conceptual reasoning, attention, memory & processing speed all decline gradually with ageing

Neurodegenerative diseases associated with ageing:

• • Alzheimer’s
  • Parkinson’s Disease
  • Amyotrophic Lateral Sclerosis

Glucose Control has been found to be related to Degenerative Diseases.

• • Diabetes mellitus almost doubles the risk of dementia
    • 81% of patients with Alzheimer disease had either type 2 DM or impaired fasting glucose measurements
  • Glycation and advanced glycation end (AGEs) products contribute to the ageing process and age related diseases as well as diabetic complications
  • Type 3 Diabetes has been found to be related to Alzheimer’s disease which results from resistance to insulin in the brain.

Practical Recommendations

Fish Oil

A commonality across Alzheimer’s and Parkinson’s is significantly decreased levels of n-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid (DHA) in the brain.

• • Oxidative stress and inflammation, which are common characteristics that lead to neuro degenerations, are processes that can be modulated by n-3 PUFAs such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Early supplementation with n-3s may convey the most significant benefit in treating or preventing Neurodegenerative diseases

Creatine

Creatine has Neuro protective effects.

• • Ageing is associated with low levels of Creatine & Phosphocreatine (PCr), also known as creatine phosphate.
  • Better memory has been found in supplemented vegetarians.
  • 24 weeks of supplementation did not improve cognitive function or emotional parameters in older women
  • 1 week supplementation significantly improved cognitive tasks in elderly.

Conclusion

Increase in protein intake results in:

• • Improved immune status
  • Improved wound healing
  • Weight management (client-specific)
  • Improved bone health
  • Muscle mass maintenance/prevention of sarcopenia
  • Protein distribution, type and bolus should be considered

Recommendation: At least one protein serving per day that is 0.4 – 0.6g/kg. More often likely being more preferable. Or >2.2g Leucine.

Recommended Supplements:

• • Fish Oils – 2000mg – 12000mg per day
    • Cardiovascular health
    • Joint health (arthritis)
    • Anabolic resistance
    • Immunity
  • Vitamin D – Dose to maintain optimal levels
    • Bone health & fracture risk
  • Multivitamin – Consider calcium content
    • Immunity & bone health
  • Creatine – 5g per day
    • Cognitive health
    • Sarcopenia

It is never too late to start implementing nutritional changes. Protein intake should be a key focus. Protein isn’t just about preventing sarcopenia.

Supplementation can be very helpful with many age-related disorders and diseases.

Please contact me Abhinav to discuss and learn what I and my team AbhiFit in Dubai, UAE can do for the elderly through nutrition and personal training.

Please also contact me to learn about our nutrition and personal training services for kids to adults in Dubai, UAE to achieve your muscle gain, strength gain, fat loss and figure / physique transformation goals.

Many female and male clients including kids, teens, adults and elderly people have greatly benefited from Abhinav’s strong experience as a top personal trainer and nutritionist in Dubai, UAE. You can see some of his client transformations here.

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