A well balanced diet composed of diverse foods is the goal for healthy eating to provide a variety of nutrients required.  Five nutrients that older adults may need to pay extra attention to are water, protein, fiber, calcium (and vitamin D), and vitamin B12.

Water

Why is water important?

As we age, thirst sensation is reduced as is the kidney’s ability to conserve water.  In addition, there is a reduction in the amount of water the body stores.  As a result, older adults need more conscious consideration of their hydration status as they may become dehydrated quicker.  Risks of suboptimal hydration status include constipation, increased risk of falls, urinary tract infections, drug interactions or side effects, and increased confusion.  For those with diabetes mellitus, reduced hydration status can also affect blood sugar control.  

Some medications can also impact hydration status. Extra attention is warranted to replace any excessive fluid losses from illness (diarrhea, vomiting, fever) or activity.

How much water is needed?

While fluid requirement may vary depending on diagnoses and activity, it is the general recommendation for older women to drink 1.6 L/d and older men to drink 2.0 L/d.

There are some health diagnosis that impact fluid requirements, consult your health care provider to understand how your diagnosis may affect your fluid requirements.

How can I improve the intake of water?

To help older adults consume fluids ensure fluids are readily accessible, provide verbal prompts, encourage foods with high water content (soup, fruit, vegetables, yogurt), and consider sharing a drink over a visit.  

Protein

Why is protein important?

As we age, starting around 30 years old, our muscle mass declines at a rate of 3-8% per decade, the rate of decline accelerates after 60 years of age.  This involuntary loss of muscle can result in reduced strength and function and ultimately ability and independence.  Adequate intake of protein and energy (calories) are important to minimize muscle loss, stimulate muscle growth to contribute to maintaining functional ability.  Protein is the building block for muscle.  With insufficient calories consumed the body will use its muscle mass for energy further contributing to muscle loss.  There is added benefit to prevent muscle loss (as well as bone density) with resistance exercise when combined with adequate intake of energy and protein.  

Protein needs may increase with any illness or inflammation.

Older adults are at increased risk for suboptimal protein intake because of increased need, reduced appetite, dentition, difficulty swallowing (dysphagia), limited income, and self-restriction.  

How much protein is needed?

Protein requirements will vary based on age, activity, and health diagnosis. There is ongoing research suggesting baseline protein requirement for older adults is greater than younger adults. For adults, the current recommended protein intake is 0.8 g/kg/d however, the current research is suggesting at least 1.0-1.2 g/kg protein per body weight for adults over the age of 65 years. For example, for a 150 lbs (68 kg) woman over 65 years of age, the recommended protein intake would be 68 – 82 grams protein per day; for a 180 lbs (82 kg) man over the age of 65 years of age, the recommended protein intake would be 82 -98 grams protein per day.

There are some health diagnosis that impact protein requirements, consult your health care provider to understand how your diagnosis may affect your protein requirements.

How can I improve the intake of protein?

The most commonly known source of protein is animal meat however there are other foods that are high in protein that are worth exploring, more economical, and may be easier to consume.  Consider legumes (beans, peas, and lentils), nuts, nut butters, and eggs. Try to incorporate a protein-rich food at each meal and snack.

While most foods are a combination of nutrients, some common foods that are considered to be higher in protein include:

• 75 g (2.5 oz) serving of meat provides approximately 20-25 grams of protein
• 1 large egg provides approximately 6 grams of protein
• 1 cup (250 ml) milk provides approximately 8 grams of protein
• 125 ml (127 g) beans provides 6-9 grams of protein
• 1.5 oz of nuts provide approximately 6-9 grams of protein
• 1 cup lentils provide approximately 19 grams of protein
• 2 tbsp of peanut butter provides approximately 7 grams of protein
• 3/4 cup Greek yogurt provides approximately 16 grams of protein
• 3/4 cup of yogurt provides approximately 9 grams of protein

Fiber

Why is fiber important?

Fiber can help lower cholesterol, manage blood sugars, feed healthy gut bacteria, and keep stool soft and regular.  There are two types of fiber: soluble and insoluble.  Soluble fiber dissolves in water to form gel.  Insoluble fiber does not dissolve in water but will rather absorb water (and other materials) to form stool.  Both types of fiber are valuable. Fiber can increase the feeling of fullness which could reduce overall intake.

Older adults are at increased risk of not consuming adequate fiber because of dentition, reduced appetite, difficulty swallowing, limited income, and dexterity for food preparation.

How much fiber is needed?

For older adults the recommended intake is 21 grams per day for women and 30 grams per day for men.  

How can I improve the intake of fiber?

Dietary fiber is found in whole grain products, fruits, vegetables, legumes, nuts and seeds.  Eating a balanced diet with a variety of foods will help meet fiber requirements.  

It is prudent when increasing fiber intake to do so slowly and also increase fluid intake.  

Calcium (and Vitamin D)

Why is calcium and vitamin D important?

Calcium and vitamin D are crucial to prevent and delay progression of osteoporosis. Vitamin D helps your body absorb calcium. Other nutrients involved in bone health are vitamin K, protein, vitamin A, and magnesium.  

Advancing age results in altered absorption of calcium, loss of calcium and bone.  Recommended calcium intake increases for older men and women but increases earlier in life for women because of accelerated bone loss during menopause.  

How much calcium and vitamin D is needed?

Women over the age of 50 years and men over the age of 70 years are recommended to have 1200 mg of calcium.

Vitamin D requirements for men and women 51-70 years of age is 600 IU and for men and women over the age of 70 years it is 800 IU per day.

How can I improve the intake of calcium and vitamin D?

Food sources of calcium include dairy products, green leafy vegetables, some nuts and seeds. While most foods are a combination of nutrients, some common foods that are considered to be higher in calcium include:

• 1 cup (250 ml) cow’s milk provides approximately 309 mg of calcium
• 1/2 cup (125 ml) cottage cheese provides approximately 73 mg of calcium
• 3/4 cup Greek yogurt provides approximately 175 mg of calcium
• 3/4 cup of yogurt provides approximately 300 mg of calcium
• 30 grams of cheddar cheese provides approximately 225 mg of calcium
• 1/2 cup greens (kale, spinach, collard greens) provides approximately 95-160 mg of calcium.
• 1.5 oz of almonds provides approximately 145 mg of calcium

Vitamin D is more challenging to get from food and supplementation may be beneficial to discuss with a health care professional. Food sources of vitamin D included fatty fish (salmon, trout, tuna, mackerel), egg yolk, and fortified foods (margarine, milk).

Vitamin B12

Why is vitamin B12 important?

Vitamin B12 is involved in brain and nerve cell development, cell metabolism, red blood cells production, and DNA production.  

Vitamin B12 is of concern in older adults because of its reliance on a protein called intrinsic factor for absorption. Intrinsic factor declines with age.

Low vitamin B12 levels can cause muscle weakness, trouble walking, difficulty thinking, memory loss, fatigue, swollen inflamed tongue, tingling sensation in hands, legs, or feet

How much vitamin B12 is needed?

The daily recommended intake vitamin B12 is 2.4 micrograms.

How can I improve the intake of vitamin B12?

The body cannot make vitamin B12 so we need to meet get vitamin B12 from food. Vitamin B12 can be found in food from animal products: meat, poultry, dairy, eggs. Plants do not make vitamin B12 so people following a vegetarian or vegan diet pattern are at high risk of vitamin B12 deficiency if they are not consuming foods fortified with vitamin B12. Ensuring intake of good food sources of vitamin B12 and considering supplementation with your health care provider can help older adults meet their vitamin B12 requirements.