Food and Nutrition for Older Adults Promoting Health and Wellness
Publication Date: January 1, 2012
Last Updated: March 14, 2022
Conclusion Statements
Antioxidants and Vision
Regarding the development of A D, findings from studies of antioxi- dant intake below or above RDA levels are inconclusive. Further research is needed, given the risks of oversupplementation. (Fair, )
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The results of one large trial (Age-Related Eye Disease Study) in the United States found a beneficial effect of beta-carotene, vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper supplementation on delaying progression of advanced AMD. However, studies published since that time reported inconclusive findings. Further research is needed, given the risks of over supplementation. (Fair, )
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Antioxidants and Cognition
Although studies on healthy older adults consuming recommended levels of antioxidants generally reported no association with impaired cognitive function, studies regarding antioxidant intakes below recommended levels reported an association with cognitive decline. Research on antioxidant intakes at supplemental levels are inconclusive; conflicting results may be due to genetic factors and prior nutrient deficiencies. Further research is needed in this area. (Fair, )
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Compared with healthy older adults, intakes of all nutrients may be lower in older adults with diagnosed cognitive impairment or Alzheimer’s disease; however, it is unclear whether low levels of nutrients precede or are the consequence of cognitive impairment. In addition, antioxidant intake at supplemental levels demonstrated no difference in the delay of cognitive decline. Additional research is needed in this area. (Fair, )
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For all older adults, RDs should encourage food intake meeting the DRIs (or other recommended levels) for antioxidant vitamins and minerals and recommend a multivitamin if food intake is low. Studies regarding antioxidant intakes below recommended levels reported an association with cognitive decline; however, research regarding AMD was inconclusive. (Strong, Imperative)
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For older adults with diagnosed AMD, RDs should collaborate with others on the inter-professional team (eg, physicians, ophthalmologists, pharmacists, and other health care professionals) to determine whether an older adult would benefit from high-dose supplementation of antioxidants, because some formulations have side effects and contraindications. A systematic Cochrane review reported that the results of one large trial (Age-Related Eye Disease Study) in the United States found a beneficial effect of antioxidant (beta-carotene, vitamin C, and vitamin E), lutein/zeaxanthin and zinc and copper supplementation on delaying progression of advanced AMD. However, studies published since that time report inconclusive findings. (Strong, Conditional)
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Advise against antioxidants for treatment diagnosed cognitive impairment/Alzheimer’s dis ease. For older adults with diagnosed cognitive impairment or Alzheimer’s disease, RDs should advise against antioxidant supplementation, because it has not been shown to have an effect and some formulations have side effects and contraindications. Findings from studies of antioxidant intake above RDA levels in subjects with diagnosed cognitive impairment or Alzheimer’s disease demonstrated no difference in the delay of cognitive decline. These findings were substantiated by one systematic Cochrane review. (Strong, Conditional)
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Assessment of Overweight and Obesity in Older Adults
Research reported decreased physical function in subjects who had gained weight (20 lb) and lost weight (10 lb), as well as higher mortality rates for subjects who had unintentionally lost weight (5% to 10% of body weight over a period of 3 to 5 years) and whose weight had cycled. Studies regarding the effects of intentional vs unintentional weight loss on physical function and mortality are limited; further research is needed in these areas. (Fair, )
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In older adults, studies demonstrated that muscle mass generally decreases and fat mass generally increases over time, even when weight is stable. Subjects with greater percentage of fat mass had increased risks of disability, mobility limitations, and decreased physical function; research reported higher risks in women, with increasing body fatness compared with men. Research regarding the relationship between body composition and mortality reported conflicting results; more research is needed in this area. (Fair, )
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Studies reported that subjects with higher BMI had increased risks of disability, mobility limitations, and/or decreased physical function. The evidence linking BMI levels with mortality is mixed; most studies reported a U-shaped relationship with increased mortality at lower and higher BMI levels. However, some studies reported reduced or increased mortality at overweight, obese, and underweight BMI levels. Further research is needed regarding the effect of obesity on mortality. (Fair, )
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Studies reported that subjects with higher waist circumference (>102 cm in men, >88 cm in women) or higher waist-hip ratio, had increased risks of disability, mobility limitations, and/or decreased physical function, as well as an increased risk of mortality.
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Regardless of age, RDs should consider the following when assessing the need for weight management through modifications in dietary intake and physical activity in older adults: classification of overweight or obesity, presence of comorbidities, physical function, cognitive function, attitude toward longevity, lifestyle, personal choice, and quality of life. Although studies have demon strated varying associations between assessment indicators of overweight or obesity and physical function and mortality in older adults, the need for weight loss should be based on input from a physician or geriatrician, RD, qualified exercise specialist, and other members of a health care team and will ultimately be the personal decision made by the older adult. (Fair, Imperative)
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Use multiple assessment indicators classification overweight/obesity. Regardless of client age, RDs should use more than one of the following assessment indicators when classifying overweight or obesity: weight change (and weight history), current (and past) weight, height and BMI, waist circumference, and body composition. More than one assessment indicator should be used, due to the potential limitations of each indicator in older adults, such as sex and ethnic differences in their application. In addition, studies demonstrated that muscle mass generally decreases and fat mass generally increases over time, even when weight is stable. (Fair, Imperative)
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OAA Programs Evidence Evaluation
For older adults who participate in OAA programs, nutrition-related outcomes include improved food and nutrient intake, increased consumption of fruits and vegetables, or improved nutritional status. Limited research also reported improved outcomes related to food security or socialization, improved outcomes related to multivitamin supplementation, improved knowledge in food safety and nutrition, and increased physical activity among older adults participating in OAA programs. Continuing research on nutrition-related outcomes related to participation in OAA programs is needed.
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Limited research reports the importance of addressing racial, ethnic and religious concerns to increase program accessibility and participation by minority older adults. In addition, studies report that program participation decreases when meals do not meet the dietary recommendations for older adults and for those following therapeutic diets. Further re- search on accessibility and participation in OAA programs is needed.
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USDA Evidence Evaluation
Limited research of older adults who participate in USDA programs report increased calcium intake, improved access to fresh produce, increased fruit and vegetable consumption, stimulated interest in healthy foods, and improved quality of life. Further research on nutrition-related outcomes related to participation in USDA programs is needed. (Weak)
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Research reports race and ethnic participation in USDA programs is needed.
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RDs should screen all older adults for eligibility (or refer for screening) in USDA programs and the OAA Nutrition Services Program and identify potential barriers to participation, such as disability, functional impairment, attitude toward program use, and income level. Research reported racial and ethnic differences in program participation, as well as in subjects with vision or hearing difficulties, special dietary needs, functional limitations, or disabilities. (Fair, Imperative)
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Encourage participation in US DA and OAA programs. RDs should encourage eligible older adults to apply for and participate in the following USDA and OAA programs: USDA—SNAP, Senior Farmer’s Market Nutrition Program, Child and Adult Care Food Program, Emergency Food Assistance Program, Commodity Supplemental Food Program; OAA—OAA Congregate Nutrition Program, OAA Home Delivered Nutrition Program. Research reported that participation in USDA and OAA programs improved food and nutrient intake, increased fruit and vegetable consumption, stimulated interest in healthy foods, improved quality of life, and improved nutritional status. However, some subjects believed they did not need food assistance and some participants did not know that they were eligible or how to apply. (Fair, Conditional)
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Recommendation Grading
Overview
Title
Food and Nutrition for Older Adults Promoting Health and Wellness
Authoring Organization
Academy of Nutrition and Dietetics
Publication Month/Year
January 1, 2012
Last Updated Month/Year
April 2, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide evidence-based recommendations on three topics related to food and nutrition for older adults promoting health and wellness.
Inclusion Criteria
Female, Male, Older adult
Health Care Settings
Ambulatory, Hospital, Long term care
Intended Users
Psychologist, optometrist, dietician nutritionist, dentist, nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Assessment and screening, Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D018529 - Nutritional Support
Keywords
nutrition, geriatric, preventative care