Aging

EVIDENCE SUPPORTS GOOD NUTRITION FOR ACTIVE HEALTHY AGING

Older Americans Food Habits Short Change Their Health
Substantial numbers of older adults, particularly the very old, minority, and low-income persons, consume less than one-third of the recommended intakes for key nutrients.  Food intake has been shown to decline by about 1100 calories per day in older men and 700 calories per day in older women.  Similar declines in intakes of B-complex vitamins, calcium, zinc, and Vitamin E are widespread.  Nutrient shortages in older adults increase the risk of protein-calorie malnutrition and adversely affect chronic disease outcomes.  In an aging body, as is true with any machine, chronic fuel shortages (inadequate intake of calories and nutrients) limit function and impair longevity and quality of life.  Dietetics professionals are uniquely qualified to help older adults access and improve food intake.  J Gerontol A Biol Sci Med Sci 2001;56(2):65-80.

Dietitians Help Older Adults Eat Well

The diets and nutritional status of community-residing adults aged 70+ years who had reduced levels of functioning were improved through in-depth personalized nutrition counseling. After counseling, intakes of fruits, vegetables, and dairy increased, as did blood concentrations of carotene.  J Am Dietetic Association, Oct 2002.

Good Nutrition Prolongs Independence and Quality of Life

Common chronic conditions that contribute most to functional disability in older adults are often nutrition-related: obesity, cardiovascular diseases, hypertension, stroke, cancer, diabetes, kidney diseases, and osteoporosis.  About 30 million people live with these diseases, costing $300 billion annually - 1/3 of U.S. health care expenditures.

The Institute of Medicine found that nutrition interventions are effective in managing and treating dyslipidemias, hypertension, heart failure, diabetes, and kidney failure.  For example, medical nutrition therapy (MNT) improves lipid profiles to prevent cardiovascular disease, reduces blood pressure in older adults with hypertension, improves functional status, quality of life, and prevents readmissions and length of hospital stay for those with heart failure, delays progression of kidney disease, and is effective in controlling blood glucose for those with diabetes. Nutrition services would save $52 to $168 million for older adults with hypertension, $54 to $164 million for dyslipidemias, and $132 to $330 million for diabetes.

Individuals with higher serum levels of other carotenoids, such as lutein and zeaxanthin, have a significantly reduced risk for age-related macular degeneration.  (ODS Abstract).  Of approximately 8 million people at risk for age-related eye diseases, 300,000 could be saved from vision loss in the next five years with nutrition supplementation. (The Age-Related Eye Disease Study. Arch Ophthalmol. 2001;119:1417-1436).

Over half of older adults have calcium and vitamin D deficiencies.  Osteoporosis occurs in about 10 million older Americans.  The National Osteoporosis Foundation estimates 1.5 million osteoporotic fractures occur annually.  Studies show that daily supplementation with calcium and vitamin D significantly reduce the incidence of fractures.  In 1995, hip fractures in older adults cost over $8 billion.  While these costs are expected to double by 2015, the predicted cost of avoiding hip fractures with nutrition treatment for all Americans over age 65 is only $33,000. (IOM report on The Role of Nutrition in Maintaining Health in the Nation’s Elderly)

Recent studies show that consuming adequate amounts of various fruits and vegetables, including blueberries and spinach, can reduce age-related losses in motor function and cognition. Treatment of older adults with mild to moderate Alzheimer’s disease with vitamin E supplementation slows cognitive decline and delays institutionalization. (ODS abstract) Supplementation with vitamin E may also reduce risk for coronary heart disease. (ADA Position Paper on nutrition, aging, and the continuum of care)

Nursing Home care improved by Good Nutrition

Up to 85 percent of the nearly 1.6 million residents in American nursing homes have protein undernutrition or involuntary weight loss (1).  Good nutritional status is associated with lower susceptibility to infections (1,2), including pneumonia and urinary tract infections which are the #2 and #14 reasons that Medicare recipients are admitted to hospitals (cost per discharge $11,561 and $9,673, respectively.) (3). Well-nourished residents also have a lower death rate associated with co-existing illnesses (1,2).  Nursing home residents who gain weight have generally favorable outcomes (1). The National Citizen’s Coalition for Nursing Home Reform found that registered dietitians were the key to the delivery of adequate nutrition and hydration in nursing homes (2).  Research shows that the more time spent by dietitians in nursing homes, the less time residents spend in hospitals (4).

  1. American Medical Directors Association. Clinical Practice Guidelines: Altered Nutritional Status. 2002, American Medical Directors Association.
  2. Malnutrition and dehydration in nursing homes: key issues in prevention and treatment. National Citizens’ Coalition for Nursing Home Reform. June 2000, p 24.
  3. Medicare short-stay hospital DRGs ranked by discharges fiscal year 2000. Source: CMS/OIS Sept 2002 http://www.cms.gov/researchers/pubs/datacompendium Accessed 1/30/03.
  4. Impact of dietitians on quality of care in 16 nursing homes in East Central Indiana. J Am Diet Assoc. 1993;93:73.
Nutrition care reduces pressure ulcer development

The National Pressure Ulcer Long-Term Care Study identified nutrition variables associated with pressure ulcer development in nursing homes.  Implementation of a quality improvement initiative has proved successful in sustaining a significant reduction in pressure ulcer rate in nursing homes (10 percent vs. 2 percent). The economic model shows an increase of $0.51 in prevention costs per at-risk resident per day and a decrease of $2.01 in treatment costs per day. The nutrition protocol had the greatest cost-effectiveness and highest return on investment for facilities compared to four other treatment methods. (J Am Geriatrics Society, Nov 2002)