Nutrition in old age: what is important?

The body changes as we age: the proportion of muscle and water in the body drops. This coincides with an increase in the proportion of body fat. But the need for nutrients like vitamins and minerals is roughly the same as before, if not more. Maintaining a balanced diet in advanced age positively impacts your health and well-being: it supports key bodily functions and helps you stay fit and active.

Healthy people who are above the age of 60 should ideally refer to the Swiss Society for Nutrition (SSN)’s food pyramid. There are additional recommendations for age-specific nutrition when it comes to calories, fluids and nutrients.

Calorie requirements in old age

In old age, bodily functions such as our metabolism are slower than they are at a younger age. The amount of calories required drops. The following table shows how many calories people need for moderate activity at different ages:

Tip: in addition to age, gender and activity play a key role in how many calories a person needs. The SSN provides a calorie calculator that factors in all the key points. 

Fluid requirements in old age

As we age, thirst decreases, and our kidneys no longer function as well as they did before. That’s why ensuring adequate fluid intake is especially important when it comes to maintaining a healthy diet in old age. The SSN recommends drinking at least one to two litres a day. This supports physical and mental performance. Water and unsweetened tea are best.

Nutrient requirements in old age

Unlike calorie requirements, the need for nutrients remains as high as ever in older age, if not higher. The SSN recommends the following:

• Calcium: calcium is essential for strong, healthy bones. Since the body increasingly loses bone density in old age, adequate calcium intake becomes more important than ever. It plays a key role in the prevention and treatment of osteoporosis (bone loss). Adults should ideally consume 1000 mg. This can be achieved by eating or drinking dairy products: a glass of milk contains roughly 240 mg of calcium, while a tub of yoghurt contains about 200 mg. Some pulses and green vegetables are rich in this nutrient too: 200 g of cooked haricot beans contains roughly 130 mg of calcium, while 120 g of raw broccoli contains 112 mg of calcium.
• Vitamin D: vitamin D helps the body to absorb calcium, thereby contributing to healthy bone structure. In old age, the body produces roughly four times less vitamin D than in younger years. Since most foods contain limited vitamin D, specialists recommend that men and women aged 60 and above get 20 mg of vitamin D a day in the form of food supplements.
• Protein: proteins are essential to muscles and bones – but they also support our immune defences. As we age, the body needs more protein than before. For those older than 65, daily protein requirements amount to roughly 1.0 gram per kilogram of body weight. Foods that are particularly high in protein include dairy products (e.g. milk, yoghurt, quark, cottage cheese), lean meat, fish and egg and pulses (e.g. lentils, chickpeas, haricot beans), tofu or oats.

Loss of appetite in old age has various causes:

• Impaired vision: if vision deteriorates significantly, dishes might stop looking as appetising – the saying “a feast for the eyes” doesn’t quite ring true anymore.
• Dental and swallowing problems: another reason people eat less in old age is difficulty chewing or swallowing. This diminishes the pleasure in eating.
• Reduced sense of taste and smell: as we age, our sense of taste and smell decreases. This makes eating less appealing and reduces the appetite.
• Gastro-intestinal problems: at times, these can result in our favourite dishes not being tolerated as well as usual, unsettling and negatively influencing the appetite.
• Dependency on others: elderly people often depend on others when they eat. Some are ashamed of this and would rather skip meals.
• Medication: Some medications lead to a loss of appetite. These include chemotherapeutic drugs, sedatives and antibiotics.
• Certain illnesses: having depression is one potential reason an elderly person might have no appetite. In such cases, those affected often lack the motivation to eat. Loneliness in older age may intensify this. Likewise, dementia, tumours and gastro-intestinal diseases can have an impact on the appetite.

What can you do about loss of appetite in older age? 

Loss of appetite is often a source of strain for the elderly. The good news is that there’s a lot they can do to regain pleasure in eating and make nutrition more enjoyable again:

• Eating mindfully stimulates enjoyment. Try to consciously perceive smells and aromas. This relaxes and enhances the taste experience.
• Aesthetic dishes look more appealing and stimulate the appetite.
• Vibrant and varied dishes with different colours make food more appealing, even if your vision isn’t as good as it once was.
• Fresh fruit, vegetables and herbs boost the appetite and create a more intense taste experience.
• Disperse several smaller meals throughout the day. This makes it easier to eat and supplies you with a steady stream of important nutrients.
• If you’re experiencing dental issues or swallowing difficulties, soft or puréed dishes like soups and stews make eating easier. This will eliminate the fear of swallowing.
• Seek company: eating alone significantly reduces the motivation to cook and takes the pleasure away from eating. Eating with other people helps to boost the appetite and turns eating into a pleasant experience.
• Exercise, ideally in the fresh air, stimulates the appetite. It also counteracts muscle and bone loss, boosts your circulation and lifts your mood. 

NB: contact your doctor if you suffer from a lasting loss of appetite. 

Malnutrition in old age is often associated with a loss of appetite and/or its triggers. Triggers might, for instance, include certain medications, illnesses or certain life circumstances. Experts differentiate between two forms of malnutrition:

• Quantitative malnutrition: those affected do not get enough calories in their diet in old age and fail to supply their body with enough energy.
• Qualitative malnutrition: those affected do eat enough but are still malnourished. This is because their diet is not balanced and lacking in various essential nutrients.

NB: quantitative and qualitative malnutrition can occur simultaneously too. 

What can you do about malnutrition in old age? 

If age-related malnutrition is suspected, it is essential that medical advice be sought. A doctor will be aware of the potential causes and knows the best course of action you should take, be it as an affected individual or as a relative. In many cases, specialist nutrition counselling for the elderly is the best option. Experts in nutrition counselling provide tailored dietary recommendations to treat elderly malnutrition in a targeted manner. This list provides you with an overview of potential nutrient deficiencies that might be experienced in old age and shows what you can do to address these:

• Iron deficiency: elderly individuals deficient in iron should adopt a diet rich in red meat and liver. These contain particularly high levels of iron, and iron from animal products is particularly well absorbed by the body. Good plant-based sources of iron include pulses, nuts, seeds, vegetables and herbs. Adopting an iron-rich diet is one partial means of treating an iron deficiency. This also serves as an effective way of treating iron-related anaemia in old age. However, it’s not always possible to fix an iron deficiency through diet alone. In certain cases the body cannot absorb sufficient amounts of iron. Likewise, some medications can sometimes lead to an iron deficiency. Your doctor will know what to do in such cases.
• Calcium deficiency: calcium is important for bones. Calcium-rich foods include cow’s milk, yoghurt, gouda and green vegetables like broccoli or leafy spinach.
• Vitamin D deficiency: the body produces vitamin D with the help of sunlight. However, in older age, it produces four times less of this than in younger years. That is why experts recommend taking vitamin D through food supplements, in consultation with a doctor. Salmon, sardines, mushrooms and eggs provide an added boost to vitamin D intake.
• Protein deficiency: people above the age of 60 often do not get enough protein. A protein-rich diet in old age includes milk, yoghurt, quark and cottage cheese, among other things. Meat, fish and pulses contain a lot of protein too. Fortunately, a protein-rich diet is another way of boosting muscle development in old age. That’s because your body needs protein to build and maintain muscle.

There is a close correlation between age-related loss of appetite, malnutrition and weight loss. The most common causes of weight loss in older age are physical ailments and changes that affect the appetite, but depression may also be a potential trigger.

So is weight loss in older age normal? As a general rule, you should speak to your doctor if you are over the age of 65 and have unintentionally lost more than 5% of your body weight within three months. The same applies if you have a BMI (Body Mass Index) of less than 20. Both can be an indication of serious illnesses like diabetes, Parkinson’s or dementia.

What can you do to prevent weight loss in old age?

A balanced diet plays a crucial role when it comes to weight deficiency in old age. Protein-rich foods are especially important here: they can help to prevent age-related muscle loss. Meals for the elderly should ideally be rich in foods like meat, fish, milk, cheese, eggs and pulses (e.g. lentils, chickpeas and peas). One particularly effective way that the elderly can ensure an adequate supply of nutrients is by eating several small nutrient-rich meals dispersed throughout the day. This is because many elderly individuals are unable to eat large portions.

Following the recommendation of a medical specialist, calorie-rich nutritional supplements can be effective in countering weight deficiency in old age. Nutritional supplements are available in the form of drinks and come in various different flavours.

A tailored and nutrient-rich diet can boost health and quality of life in old age. In some cases it may be worth seeking the assistance of a doctor or a dietitian for this. Age-specific nutrition combined with sufficient exercise and social interaction can help older people to remain active.