University of Massachusetts Amherst

It's MORE Than A Meal

 

Special Nutrition Needs of Older Adults

chronic diseases

Heart Disease

Coronary heart disease involves a progressive blockage of coronary arteries that reduces blood flow to the heart. This can raise the risk of chest pain, heart attack, and death. Coronary heart disease is the leading cause of death among older adults.

If too much cholesterol circulates in the blood, it can build up in the walls of the arteries. Over time, the arteries become narrow and slow down the blood flow to the heart. Since blood carries oxygen to the heart, chest pains can occur when less oxygen is available. If no oxygen gets to the heart, a heart attack can happen.

Risk Factors for Heart Disease

  • Some risk factors are beyond control. They include age (45 or older for men; 55 or older for women) and family history of early heart disease.
  • Other risk factors can be controlled through diet and lifestyle changes. These include high blood pressure, high blood cholesterol, high LDL (“bad” cholesterol), low HDL (“good” cholesterol), cigarette smoking, diabetes, overweight, and lack of exercise.

What Do the Numbers Mean?

Different types of cholesterol and fat travel through the body.

  • LDL cholesterol (low-density lipoprotein) is called the “bad” cholesterol. It is the main cause of cholesterol build-up and blockage in arteries.
    VLDL cholesterol (very low-density lipoprotein) is also called “bad” cholesterol because it acts in much the same way as LDL cholesterol.
  • HDL cholesterol (high-density lipoprotein) is the “good” cholesterol. It prevents cholesterol from building up in the arteries; therefore, it protects against heart disease.
  • Total cholesterol is the sum of LDL, VLDL, and HDL cholesterol levels.
  • Triglyceride is a type of fat in the blood that can raise the risk of heart disease.
Ideal Levels of Cholesterol and Triglycerides to Reduce the Risk of Heart Disease
Blood Level: Aim for:
Total Cholesterol Less than 200 mg/dL

LDL Cholesterol
Low risk patients ………………………………………… Less than 160 mg/dL
Moderately high risk patients …………………………… Less than 160 mg/dL
High risk patients ………………………………………… Less than 100 mg/dL
Very high risk patients …………………………………… Less than 70 mg/dL

HDL Cholesterol More than 60 mg/dL
Triglycerides  Less than 150 mg/dL
Source: National Cholesterol Education Program Adult Treatment Panel III, 2004

Preventing and Treating  Heart Disease

To help prevent heart disease, adults should work with their health care providers to change their diets and lifestyles. A heart-healthy eating plan can help control the risk factors of high blood pressure, high cholesterol levels, overweight, and diabetes.

Serving heart-healthy meals and incorporating physical activity into the daily routine can help older adults lower their risk of heart disease. A heart-healthy eating plan provides less than 30% of calories from fat. It includes foods low in saturated fat, cholesterol, and sodium. It also includes fiber from whole grains, fruits, and vegetables.

Treating heart disease may involve a prescribed diet, medications, and a supervised physical activity program. It also may require surgery.

High Blood Pressure

Blood pressure is the force that blood exerts against the artery walls. It is measured in two numbers. The top number is systolic pressure (as the heart beats). The bottom number is diastolic pressure (as the heart relaxes between beats). Blood pressure is affected by several factors and can vary over the course of a day. Therefore, blood pressure measures should be repeated over a few days to get an accurate reading.

High blood pressure, or hypertension, is blood pressure that remains elevated for a long time. It is prevalent in older adults, and often has no warning signs or symptoms. It can be dangerous because it makes the heart overwork and raises the risk of atherosclerosis (buildup of fat in arteries). It can also lead to kidney disease or congestive heart failure. 

  Normal Blood Pressure High Blood Pressure
Systolic 120 or less 140 or higher
Diastolic 80 or less 90 or higher
Source: Your Guide to Lowering Blood Pressure, National Institutes of Health, 2003.

Sodium and Blood Pressure

Sodium plays a major role in controlling blood pressure, since it helps maintain fluid pressure within the blood.  For some people, consuming foods high in salt can lead to elevated sodium levels in the body, which can result in high blood pressure. 

Guidelines to Help Prevent High Blood Pressure

  • Maintain a healthy weight.
  • Include fruits, vegetables, low-fat dairy foods.
  • Choose foods with less salt and sodium.
  • Limit alcohol intake.
  • Be physically active.

Treating High Blood Pressure

Treating high blood pressure may involve following the guidelines above, along with stricter sodium restrictions. People unable to control their high blood pressure with diet and lifestyle changes alone may also require medications such as diuretics and other drugs. This may especially be true if they have a strong family history of high blood pressure.

Focus on Sodium

  • According to the Dietary Guidelines, most people should aim for less than 2,300 mg of sodium per day. This is about 1 teaspoon of salt. Older adults and people with high blood pressure should aim for less than 1,500 mg of sodium per day.
  • High amounts of sodium (as salt) are often added to processed and prepared foods.
  • Most unprocessed foods are naturally low in sodium. These include fruits; fresh or frozen vegetables; and fresh or frozen fish, fish, poultry, and meat.
  • Read food labels for sodium content. Avoid adding salt in recipes or at the table.
  • Use spices and herbs for seasonings.

Diabetes

Diabetes is a disease that affects how the body uses carbohydrates (sugars and starches) from foods. Usually, the sugars and starches that people eat are broken down into a sugar called glucose, and their blood carries the glucose to cells in the body.  A hormone called insulin helps move glucose from the blood into the cells for fuel and storage.

People with diabetes either cannot make insulin or cannot use it properly, depending on what type of diabetes they have. Either way, the glucose stays in the blood longer and cannot be used properly by the cells. The result is a high blood glucose level.

Type 2 diabetes is most prevalent in adults. The body makes insulin, but cannot use it properly. Risk factors include age over 40 years, overweight (more than 20% of ideal body weight), and having a closely related family member with diabetes. It can often be treated with diet and exercise (exercise helps muscles use glucose for energy). Treatment may also require medications.

Possible Complications

Diabetes can cause some serious problems over time. It can lead to blindness, kidney damage, heart disease, nerve damage, and other health problems. 

Signs and Symptoms

The signs and symptoms of diabetes may include:

  • Feeling hungry or thirsty all the time.
  • Urinating more than usual.
  • Feeling tired more than usual.
  • Blurred vision.
  • Cuts or bruises that won’t heal.
  • Tingling or numbness in hands and feet.

Diabetes and Older Adults

Many older adults may have type 2 diabetes without even knowing it. They may be surprised to be diagnosed with diabetes, because they haven’t noticed any symptoms or felt sick. Therefore, it is extremely important that older adults have their blood glucose checked on a regular basis.  If they have diabetes, they should see their doctor and a licensed registered dietitian to design a meal plan that best fits their needs.

Preventing Type 2 Diabetes

  • Maintain a healthy weight. 
  • Consume plenty of fiber.
  • Eat appropriate portion sizes.
  • Be physically active, if possible.

Goals for People with Diabetes

  • Follow special dietary advice from your doctor and a licensed registered dietitian.
  • Take insulin or diabetes medications if prescribed.
  • Be physically active, if possible.
  • Maintain a healthy weight.
  • Aim for blood glucose levels within the recommended range.

The chart below shows general goals for most people with diabetes who self-test their blood glucose levels. An individual’s health care team should determine specific target goals and develop a program of regular glucose monitoring to manage his/her diabetes.

Goals for Blood Glucose Control
Time of Check Whole Blood Values Plasma Values
Before meals 80-120 mg/dL 90-130 mg/dL
Bedtime 100-140 mg/dL 110-150 mg/dL
Source: If You Have Diabetes, Know Your Blood Sugar Numbers. National Diabetes Education Program, National Institutes of Health and the Centers for Disease Control and Prevention, 2002.

Hypoglycemia in People with Diabetes

Hypoglycemia is low blood sugar. It can occur in someone with diabetes who is taking medications. Be alert to the signs and symptoms, which include feeling weak, feeling hungry, sweating more, or having sudden changes in heartbeat. Immediately test the blood glucose level of a person with these symptoms. If his/her glucose level is below 70 mg/dL, the person should immediately consume one of the following:

  • 1/2 cup fruit juice
  • 1/2 cup regular soft drink (not diet or sugar-free)
  • 5 or 6 pieces of hard candy
  • 1 or 2 teaspoons of sugar or honey
  • 2 or 3 glucose tablets

After 15 minutes, retest the blood glucose level and see if it has returned to a more acceptable level. After the blood glucose level stabilizes, offer the person a snack if it will be at least 1 hour until the next scheduled meal.

Diabetes Meal Plan

Following a proper meal plan is important in controlling blood glucose levels. Along with exercise and medications (insulin or oral diabetes pills), eating well-balanced meals in the correct amounts can help keep blood glucose levels as close to normal as possible.

A diabetes meal plan tells how much and what kinds of food a person can eat at meals and snack times. It should fit in with the person’s schedule and eating habits.  There are many ways to follow a diabetes meal plan. Examples are following the USDA Pyramid, rating your plate, exchanges lists, and carbohydrate counting.  Check with your participant’s heath care provider for individual recommendations.

Tips for Feeding Participants with Diabetes:

  • Follow scheduled eating times.  Serve meals and snacks at about the same time each day to maintain a consistent supply of sugar in the blood.  Eating too much food at one time can raise blood glucose to dangerous levels. Skipping a meal can cause the blood glucose to drop too low, resulting in hypoglycemia.
  • The Idaho Plate Method provides a quick and easy way to know how much space each food group should occupy on a dinner plate (fill ½ of the plate with bright, colorful vegetables, ¼  of the plate with a starchy food, and the other ¼  with a protein food).     You can order this guide from the Idaho DCE Plate Method, PO Box 441, Rexburg, Idaho 83440-0441, website www.platemethod.com, phone 208-624-7279.
  • See the next page for a sample diabetic menu with different amounts of food at different calorie levels. Observe how small changes or additions in foods bring the menu up to a higher calorie level. Note that serving sizes and food items are not necessarily those creditable by CACFP.
  • Check with the participant’s healthcare provider for individual recommendations.

Sample Diabetic Menu

NOTE: This is only a sample of a menu for people with diabetes. It is NOT designed specifically for your program’s participants with diabetes. Serving sizes and food items shown below are not necessarily creditable by CACFP. Any meal or menu substitutions that vary from CACFP regulations require documentation from a medical authority.

MEAL AND FOODS
DAILY CALORIES
  1600 1800 2000 2200
Breakfast        
Orange juice ¾ cup ¾ cup ¾ cup ¾ cup
Oatmeal ½ cup ½ cup ½ cup ½ cup
Whole-wheat toast 1 slice 1 slice 2 slices 2 slices
Margarine/butter 1 tsp 1 tsp 1 tsp 1 tsp
Skim milk ½ cup ½ cup ½ cup 1 cup
Morning Snack        
Graham cracker squares 3 squares 3 squares 3 squares 3 squares
Orange 0 1 orange 1 orange 1 orange
Lunch        
Vegetable soup 1 cup 1 cup 1 cup 1 cup
Tuna sandwich / sandwiches        
Water-packed tuna ½ cup ½ cup ½ cup ¾ cup
Low-fat mayonnaise 1½ Tbsp 1½ Tbsp 1½ Tbsp 2 Tbsp
Tomato slices 2 slices 2 slices 2 slices 3 slices
Whole-wheat bread 2 slices 2 slices 2 slices 3 slices
Apple 1 apple 1 apple 1 apple 1 apple
Skim milk ½ cup ½ cup ½ cup ½ cup
Afternoon Snack        
Muffin 1 muffin 1 muffin 1 muffin 1 muffin
Skim milk ½ cup 1 cup 1 cup 1 cup
Dinner        
Chicken breast (skin removed) ½ breast ½ breast ½ breast ½ breast
Baked potato 1 potato 1 potato 1 potato 1 potato
Margarine / butter 1 tsp 1 tsp 1 tsp 1 tsp
Carrots and peas ½ cup ½ cup ½ cup ½ cup
Green salad 1 cup 1 cup 1 cup 1 cup
Low-fat dressing 2 Tbsp 2 Tbsp 2 Tbsp 2 Tbsp
Grapes 15 grapes 15 grapes 15 grapes 15 grapes
Oatmeal cookies 0 0 2 cookies 2 cookies
Water 1 glass 1 glass 1 glass 1 glass
Evening Snack        
Gingersnap cookies 3 cookies 6 cookies 6 cookies 6 cookies
Banana 1 banana 1 banana 1 banana 1 banana
Skim milk 1 cup 1 cup 1 cup 1 cup

Adapted from Diabetes and Your Diet: Using the Dietary Guidelines for Americans as a Guide to Healthy Eating; University of Wisconsin Extension – Cooperative Extension, publication NCR 576, 2004.

Osteoporosis

Osteoporosis is a gradual process of bone loss that results in weak, brittle bones. It is a major cause of bone fractures of the hip, spine, and wrist. Every year, over 25 million people in the United States are afflicted with this disease.  Osteoporosis is called a “silent disease” because often people are not diagnosed until they have broken a bone. As people get older, the risk of osteoporosis increases. 

Who Has the Greatest Risk for Osteoporosis?

Women make up 80% of people with osteoporosis. Women are especially at risk if they:

  • Are past menopause.
  • Have a small body frame.
  • Have a family history of osteoporosis.
  • Are Caucasian or Asian.
  • Don’t exercise (since exercise leads to stronger bone).
  • Eat diets low in calcium and vitamin D.
  • Smoke or drink more than 3 glasses of alcohol per day.

Older men are also at risk for osteoporosis.

Maintaining Bone Health

Osteoporosis can be prevented or delayed by consuming vitamin D and calcium and taking part in regular physical activity.  Following the CACFP pattern and offering milk with each meal will help provide calcium and vitamin D.

  • Older adults need 1,200 mg of calcium each day.  Low-fat milk, cheese, and yogurt are great sources of calcium. 
  • Older adults also need vitamin D to help their bodies absorb calcium. Vitamin D is found in fatty fish and fortified milk.
  • Calcium supplements with vitamin D may be a necessary addition to the meal plans of older adults who do not consume enough calcium-rich foods and vitamin D-fortified milk. 
  • Physical activity, especially weight-bearing exercise such as walking, lifting, or dancing, can strengthen bones and actually reverse the effects of osteoporosis.
Food Sources of Calcium
The following foods are good sources of calcium:
Amount of Calcium Food Source
350-375 mg 1 cup milk
1 cup soy milk, calcium-fortified
300-350 mg 3 oz sardines, with bones
200-225 mg 1 slice (1 oz) Swiss cheese
1 slice (1 oz) Cheddar cheese
125-150 mg  1 cup cottage cheese
1 cup baked beans
1 piece pumpkin pie (1/8 of 9” pie)
100-125 mg 1 slice (¾ oz) American cheese
½ cup vanilla pudding
50-100 mg 1 cup cooked broccoli
1 cup ice cream
1 cup soy milk, unfortified
Source: USDA National Nutrient Database for Standard Reference, Release 17 (2004)

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Developed for the Massachusetts Department of Education Child and Adult Care Food Program by the University of Massachusetts Extension Nutrition Education Program. Permission is hereby granted by the Massachusetts Department of Education to copy any or all parts of this document for non-commercial educational purposes. The Massachusetts Department of Education, an Affirmative Action employer, is committed to ensuring that all of its programs and facilities are accessible to all members of the public. We do not discriminate on the basis of age, color, disability, national origin, race, religion, sex, or sexual orientation.

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