Nutrition and Aging

The diet of older adults can be influenced by a variety of factors. Generally, older adults have reduced caloric requirements. One may either eat less or thrive on more foods with lower nutritional value.34 Gustatory and olfactory acuity may be diminished, making foods less appealing because they do not taste or smell as they once did. There may be oral health problems, such as a poor dentition, ill-fitting dentures, or periodontal disease that makes chewing more difficult. Impaired motor abilities can make getting to the grocery store, meal preparation, or feeding oneself complicated. Medications and disease can affect appetite and gastrointestinal motility. Many times older adults are on fixed incomes and may choose foods that cost less and are easy to prepare and potentially less nutritious. Older adults who live alone may not eat regularly or healthfully.34

When a diet is not well balanced, nutritional deficiencies can occur. Softer foods may be chosen when chewing function is impaired due to one or more oral health problems. This usually results in decreased protein consumption that can contribute to a zinc deficiency. The older adult must have an adequate amount of fluids, or cardiac function and/or dehydration can result. Many times dehydration causes confusion in the older adult. Many may not get sufficient exposure to sunlight, leading to a reduced synthesis of vitamin D in their skin. Calcium levels may fall due to medications, a reduced consumption of dairy products, limited physical activity, combined use of alcohol and antacids, and hormonal factors. Deficiencies in vitamin B complex, vitamin C, and folic acid are also common among older adults. Pernicious anemia is most frequently seen in the older population as a result of malabsorption of vitamin B12.62 Oral symptoms associated with this and other deficiencies are listed in Table IV.34

Nutritional counseling for the older adult is of utmost importance. Some older adults may not be aware of healthful nutritional habits and the probability that they could enhance their quality of life by the foods they eat. Nutrition for older adults should focus on preventing diseases such as atherosclerosis, anemias, osteoporosis, and dental caries. With nutritional guidance, an older adult should be able to make a connection between dietary deficiencies and lowered resistance to disease and premature aging.60 Nutritional counseling should not only provide the older adult with helpful dietary suggestions, but it also should be an opportunity for dental hygienists to become familiar with a patient’s way of life.

Nutritional intake is usually considered to be synonymous with oral food and fluid intake. However, that is not always possible, especially for institutionalized dependent older adults in a hospital or hospice setting. Upon proper consent, enteral nutrition may be initiated if oral intake is not possible after three to five days and the gastrointestinal tract is functional. This type of feeding is considered advantageous because it is more cost effective, fewer complications arise, GI mucosal integrity is maintained, and both the patient and caregiver can easily care for the external stoma.34 The patient and caregivers need to know that daily oral plaque control measures must be performed because bacteria continues to colonize even in the absence of food intake.34