Nutrition in the elderly is difficult due to many disease conditions associated with this age group. In this document, I am going to consider a hypothetical situation where an 87 year old, called Joe, who has many conditions requiring the right choice of foods. He weighs 240 lbs. and is 5'11" tall. The article primarily talks about nutrition in an elderly man. Joe has very bad knees and is not able to get around without his walker. He is not very stable when he walks and macular degeneration of his eyes has made it so he can not shop or prepare foods for himself. Joe has been told by his doctor that he needs to control his discretionary allowance of calories and watch is calorie intake as he is a borderline diabetic. Joe has high blood pressure, a family history of CVD, and high Cholesterol. His last blood work run by the doctor shows he is low on Vitamin B12 and Vitamin D. Joe is not allergic to any foods and can eat most things with the exception of some foods such as nuts, coconut, apples, bagels, and raw vegetables due to the difficulty in chewing. The doctor has suggested that if he can not control his cholesterol he will need to be put on medication. I will calculate Joe's Body Mass Index (BMI) and state the reference range. The types and amount of foods that should be taken by Joe will be looked at. A list of foods that are low in Cholesterol, good source of Vitamin B12, Vitamin D, low in salt, low in fat, and low in sugar will be provided. A diet for Breakfast, Lunch and Dinner for two days will be provided. I will also write the insights and suggestions regarding this article.
Key words: nutrition in an elderly man, Body Mass Index (BMI)
Hypothetical Joe
The Body Mass Index (BMI) can be defined as a standardized estimate of an individual's relative body fat calculated from his or her height and weight (Peters, 2009). There are two methods of calculating the BMI. It can be calculated as BMI=weight in kg/height in m2 or BMI=weight in lbs multiplied by 703/height in inches2. In the case of Joe, BMI=240*703/(12*5+11)2 which is 168720/712, thus 33.47kg/m2. According to the chart in Nutrition Now, Brown, E. Judith, since Joe is 5'11" he should weigh less 172 lbs for him to be in the healthy weight range. He is overweight.
Joe is inactive since he has a bad knee and has difficulty walking around. Thus according to the Food Guide Pyramid, he should reduce the total amount of food taken. He should relatively take more grains, vegetables, milk and fruits. He should reduce meat and reduce fats and oils even further. For elderly people, the Food Guide Pyramid should highlight specific selections within each food group category to emphasize foods with a high ratio of nutrients to energy (nutrient density) to ensure adequate nutrient intakes, and should be narrowed to reflect lowered energy needs (Russell, Rasmussen, Lichtenstein 1999). Foods high in fat and sugar should be avoided. Joe should take a variety of foods that are nutrient dense. Whole grain foods should be fortified with nutrients to reduce the total amount of food taken. Cereals taken by Joe can be fortified with folate. Folate fortification may also benefit the elderly by lowering blood homocysteine levels, resulting in a potential reduction in risk of homocysteine-related cardiovascular disease (Russell et al, 1999). Green leafy vegetables provide folic acid, Vitamin A, vitamin C and roughage (fiber). Cruciferous vegetables like kale provide antioxidants phytochemicals. Whole yellow, orange or red fruits provide a wide range of vitamins. Only low fat dairy products should be taken. A variety of chewable, low fat meat, chicken, fish, beans, eggs and nuts is important. Fiber is contained in the foods of four of the building blocks of the Food Guide Pyramid (grains, fruits, vegetables, meat-legumes groups) and is an important dietary component in the elderly, primarily for prevention of constipation, diverticulosis and diverticulitis (Brodribb 1980). Fluid intake should be emphasized since thirst sensation in the elderly is reduced. He should take at least two liters of water per day.
Foods low in cholesterol include mainly plant product e.g. green beans, green leafy vegetables, kale, onions, Irish potatoes, sweet potatoes, tomatoes, broccoli and celery. Whole fruit rather than Juice is preferred e.g. apples, cranberries and grapes. Most legumes are their products are low in cholesterol e.g. bean soup, cold bean salad, hunus sandwich, black bean dip. Grains like bran cereals, brown rice, oats, whole wheat bread. Psyllium seeds, egg white and red meat substitutes like poultry whose skin has been removed and fish are also low in cholesterol. Fat free milk, cheese and yoghurt are important because they also provide other essential nutrient like calcium. Snacks low in cholesterol include, dried fruits, bread sticks, melba toast, soda crackers, rye crisp, pretzels, etc (http://www.womenfitness.net/top_10_cholesterol_foods.htm)
Sources of vitamin B12 include lambs liver (other animal livers have vitamin B12), kidneys, eggs, fish and cheese. Strict vegetarians and people deficient of intrinsic factor need vitamin B12 injections every 3 months. (http://www.yourhealthbase.com/vitamin_B12.html)
Sunshine is the main source of vitamin D. But also, milk is a good source of vitamin D(Duyff, P.462). Fortified milk and cereals are also available.
Foods low in sodium include beverages like fruit drinks, non calorific soda, coffee and tea, breads and cereals that are whole grain, cakes, cookies, and doughnuts cereals like granola, shredded wheat puffed rice or wheat and low salt crackers, pasta like spaghetti and rice, dairy products e.g. low salt types of cheese, ice cream, shakes and milk, all types of fresh fruits and vegetables, frozen vegetables and fruits, canned low sodium vegetables unprocessed fish, meat and poultry, eggs, peanut butter and some unsalted snacks. (http://www.buzzle.com/articles/foods-low-in-sodium.html)
Most of the foods that are low in cholesterol are also low in fats and they have been previously been listed. Foods that are low in sugar include Fruits like bananas, plums, apples, pears, peaches, cherries, strawberries, prunes, grapefruits, oranges and fresh juices from these fruits, vegetables like avocados, spinach, lettuce, cucumbers, cauliflower, broccoli, celery, carrots and yams, whole grains like whole grain pasta, wheat bread and whole grain pitas, daily foods like milk, yoghurt, and ice cream that are all low fat products, legumes like peanuts, beans, lentils, soy beans and black eyed peas. Proteins like beef, chicken, turkey, eggs and fish are low sugar foods but they have high levels of fat(http://www.livestrong.com/article/26872-list-low-glucose-foods/)
Foods which could be good for Joe include green leafy vegetables(they may be cooked if he can eat raw), onions, Irish potatoes, sweet potatoes, tomatoes, broccoli, celery, fresh juice but whole fruits are preferred of apples, strawberry, orange, cranberries and grapes, egg white, beans or bean soup, bran cereals, brown rice, oats, fat free milk, cheese and yoghurt, vitamin D fortified milk, lambs liver(or any other liver), kidney, poultry whose skin has been removed and fish, coffee and tea with very little or nor sugar, bananas, wholegrain bread with low sugar. Prepared foods for Joe should be whole grain, or fresh vegetables and fruits or juice. When shopping for Joe, the food labels should show low sugar, low fat, low cholesterol, whole grain or fortified with vitamin D.
Joe should use this diet. Day 1: Breakfast; Irish potatoes, tea with very little or nor sugar,
Bananas, egg white, fresh grape juice
Lunch; wholegrain bread, green leafy vegetables (may be cooked), vitamin D fortified fat free milk,
chicken whose skin has been removed.
Supper; liver (especially lamb's), broccoli, brown rice, fat free yoghurt, bananas, fresh whole oranges.
Day 2:
Breakfast; fresh strawberry juice, coffee with very little or nor sugar, sweet potatoes,
Lunch; beans, bran cereals, fish, fat free cheese, fresh apple juice
Supper; oats, green leafy vegetables with onions and tomatoes, bananas, egg white, wholegrain bread fresh cranberries
I have gained many insights from this project like it is easy to manage body weight and related diseases by first carefully choosing the diet, foods with low risk for diseases associated with arteries and heart are readily available and can be sweet.
I suggest that Joe be encouraged to do more exercises. He can use his hands to lift things up and down if his knees are bad. He should be taken outdoors once in a while for sunshine for Vitamin D. If after all these he does not lose weight to below 172lbs, then he should be started on lipid lowering drugs.
