Good Nutrition Essential for Healthy Aging

Fran Lowry

May 08, 2019

"Healthy eating is one key determinant of health, and as geriatricians, we can provide patients with the tools they need to maintain their health," said Marissa Black, MD, at the American Geriatrics Society 2019 Annual Scientific Meeting in Portland, Oregon.

For seniors, eating well can be a challenge. They might live in a neighborhood with plenty of fast-food chains but no grocery store, they might be unable to drive to a distant grocery store, they might be unable to afford good-quality food, and they might have trouble eating because of ill-fitting dentures.

Marissa Black

The list goes on and on, said Black, from the VA Puget Sound Healthcare System and the University of Washington in Seattle.

Geriatricians are not expected to be experts in nutrition, but they should know the basics. They also need to know what resources are available in their community, and how to use social workers and dieticians appropriately, she told Medscape Medical News.

A good geriatric assessment includes a dietary and nutritional assessment, she added.

"When geriatricians take a medical history, they should ask about things like dentures: Are they poorly fitting? Is it difficult to chew?" she explained. They should also ask whether the patient has difficulty swallowing or whether he or she has undergone any surgeries that impair nutrient absorption, which declines with age.

And then "they should ask about medications." Metformin is a common medication, said Black, but it interferes with vitamin B₁₂ absorption. Polypharmacy can also be an issue in older people: "Is the patient on more than five drugs? Could that be interfering with their diet?"

Questions about daily living should also be part of the assessment, she said: "Who does the cooking? Who does the shopping? Where do you shop? What are meal times like? Do you eat alone? What is a typical day like for you? What do you eat and drink over the course of the day?"

Motivational interviewing techniques — using of reflective listening, asking for permission to give advice, and displaying empathy and cultural sensitivity — can be a good way to engage patients, she explained, because it enlists them as "collaborators in their care."

It has been demonstrated that there is a direct correlation between motivational interviewing and behavior change (Am J Prev Med. 2010;39:321-328).

Nutritional advice can be a component of a medical recommendation, Black said.

Patients should be encouraged to maintain a healthy weight, to focus on nutrient-dense food, and to eat mono- and polyunsaturated fat, nuts, seeds, cold-water fish (such as tuna and sardines), whole-grain carbohydrates, fiber, and adequate protein.

"Protein is extremely controversial," said Black.

Ideally, adults should eat least 0.8 grams of protein per kilogram of body weight daily, so a person who weighs 160 pounds (73 kg), should eat at least 58 g daily.

This is a broad-population recommendation, she noted. "When it comes down to it, you have to tailor your care to the patient in front of you."

Food Insecurity Among Seniors

Food insecurity in older adults is a huge issue, said Black. "Helping to screen for it so that we can do something about it is really important. There are programs out there, but you have to look for them."

One is the Healthy Teaching Kitchen program from the Department of Veterans Affairs, which is designed to teach veterans and their families healthy cooking skills. Classes of six to eight people meet once a week for 2 hours during the 6-week program and learn about nutrition, grocery shopping, cooking together, and eating together.

"The fifth class is about going to the grocery store and making a healthy meal for four people for under $10. Participants are always skeptical, but many are able to do that," Black reported. "We've gotten wonderful feedback; people really enjoy the classes.

Even people not experiencing food insecurity need to eat with other people sometimes, "so it's also about congregating," she added.

The VA has been screening for food insecurity for more than 2 years, and there are 119 teaching kitchens at VA centers across the country. Geriatricians interested in setting up their own teaching kitchen program can get information from Nutrition and Food Services at the VA, she said.

"It's a good way to do nutrition education because, clearly, the current model — a one-on-one really fast office visit — isn't working," said Black.

Not Enough Dieticians

"What we eat contributes to both disease and wellness," said session moderator Kathryn Daniel, PhD, RN, from the College of Nursing and Health Innovation at the University of Texas at Arlington.

But despite the obvious importance of good nutrition, only about 19 hours of an entire 4 years of medical school is dedicated to nutrition, she told Medscape Medical News.

"In nurse practitioner programs, social work programs, and registered nurse programs, it's probably even less than that," she reported, which accounts for the heavy reliance on registered dieticians.

Unfortunately, there are not enough dieticians to meet the need, so clinicians need to know basic information about and recommendations for healthy eating and nutrition.

"There are a lot of challenges that come with aging," Daniel pointed out. Dentition can affect the ability to chew and changes in the gut can affect the absorption of nutrients.

However, "if you give up completely on healthy eating, you will shorten your life," she said.

Black and Daniel have disclosed no relevant financial relationships.

American Geriatrics Society (AGS) 2019 Annual Scientific Meeting. Presented May 3, 2019.

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