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Chapter 11. Healthier Older Adults

	"I walk, garden, and do housework. Exercise keeps me limber. Most people don’t think I’m my age." — Vivian, age 78

If you’re an older adult or perhaps playing a vital role in taking care of aging parents or grandparents, there are some nutrition and physical activity considerations to keep in mind. Getting older doesn’t mean that our quality of life or desire to be our best is any different. In fact, we usually become more aware of our health as we age. Healthful habits can help older adults enjoy daily activities, stay mobile, and be independent. Anytime is a good time to start healthy habits, no matter how old we are.

So, if you are a little older…you can still be healthier. Eating a balanced diet of nutrient- packed foods applies to all of us, but for older adults, a healthy eating plan may require a little more planning. If you have health problems or take medication regularly, it may be important to check with your health care provider for advice about changing your diet or physical activity level.

Fiber, more important than ever   |    Fats and your heart
The relationship between sodium and potassium   |    Keeping your food safe
Bringing it together   |    You can! Be active.   |    What is strength training and why do it?

Fiber, more important than ever

We’ve talked about how a healthy diet includes fiber-rich foods, such as fruits, vegetables, and whole grains, that offer many health benefits including protection against heart disease. Another benefit is that fiber promotes regularity. Constipation may affect older adults for many reasons—from taking certain medications to drinking less fluid.

How much fiber do you need? The recommended dietary fiber intake is 14 grams per 1,000 calories consumed. So, the more calories you eat, the more fiber your body needs. Now, figure out your fiber needs from your estimated calorie needs in your Personal Profile.

Good sources of dietary fiber include: cooked dry beans and ready-to-eat bran cereal or shredded wheat; pears and berries; dried prunes, figs, and dates; and cooked green peas, Brussels sprouts, sweet potatoes, and spinach (see appendix B-8). For a 2,000-calorie diet, you will need 2½ cups of vegetables (a source of fiber and other nutrients) each day. Consuming at least 3 or more ounces of whole grains can reduce the risk of several chronic diseases and may help with weight maintenance.

	Older adults should pay special attention to certain nutrient needs. For example: Many people over 50 years old have reduced absorption of vitamin B12. Therefore, they should consume vitamin B12 from fortified foods or a dietary supplement.10 Older adults tend to need more vitamin D to help maintain bone health. Drinking vitamin D-fortified fat-free or low-fat milk, or fortified orange juice, is a good way to get your vitamin D.11 Since constipation may affect up to 20 percent of people over age 65, older adults should consume foods rich in dietary fiber and drink plenty of water. Lifestyle changes can prevent or delay the onset of high blood pressure and can lower elevated blood pressure. These changes include increasing potassium intake, reducing salt intake, eating an overall healthful diet, engaging in regular physical activity, and achieving a healthy weight.

Fats and your heart

Many of us, especially if we are older, have been told to eat less fat. Fat can impact the health of our heart and arteries in positive and negative ways, depending on the type of fat. All the more reason to stay away from saturated fats, trans fats, and cholesterol. Eating too much saturated and trans fats, the type of fats that are solid at room temperature, may increase the risk of heart disease. Saturated fats can be found in animal-based products such as milk and milk products, butter, meat, and poultry. And eating too much cholesterol, a fatty substance found only in animal-based products, may also increase the risk of heart disease. It’s important to eat less than 10 percent of your calories from saturated fats.

For example, if you aim to eat 2,000 calories per day, your daily allowance of saturated fat would be less than 200 calories or 20 grams—which equals 100% Daily Value (DV) for saturated fat. And, remember, this is a limit, not a goal, meaning you do not need to achieve your DV for saturated fat! Furthermore, you should keep trans fats (often found in cakes, cookies, crackers, pies, and breads) as low as possible, and eat less than 300 milligrams per day (mg/day) of cholesterol.

Maybe you are someone who has an elevated LDL (bad) cholesterol level. Definitely, you should follow your health care provider’s advice. Those of us with elevated cholesterol may be advised to decrease our calories from saturated fat to less than 7 percent of total calories—which is about 16 grams or about 80% DV—and less than 200 mg/day of cholesterol. It’s critical to find out what’s right for a Healthier You.

Now, a few words about making wise fat choices: an immediate change you can make is to eat monounsaturated and polyunsaturated fats found in fish, nuts, and vegetable oils to reduce saturated fat calories in your diet. In fact, to help reduce the risk of heart disease, some evidence suggests eating approximately 2 servings of fish per week (a total of about 8 ounces) for people who have already had a heart attack. It may reduce their risk of death from cardiovascular disease. For more information on fats and using the Nutrition Facts label to help choose them wisely, turn to chapter 8, "Fats, Added Sugars, and Salt,".

The relationship between sodium and potassium

Nearly all of us eat too much salt (sodium). As a matter of fact, on average, the more salt we eat, the higher our blood pressure—and most of the salt we eat comes from processed foods, not necessarily from the salt shaker. Surprised? Eating less salt is an important way to reduce the risk of high blood pressure, which may in turn reduce the risk of heart disease, stroke, congestive heart failure, and kidney damage.

Other lifestyle changes may prevent or delay getting high blood pressure. These include eating more foods rich in potassium, losing excess weight, being more physically active, and eating an overall healthy diet.

A diet rich in potassium helps to counterbalance some of sodium’s harmful effects on blood pressure. You may need to consult your health care provider for advice on how much sodium and potassium you should get, but in general, older adults should aim to consume no more than 1,500 mg/day (about 60% DV on the food label) of sodium, and meet the potassium recommendation of (4,700 mg/day) by eating potassium-rich food. When choosing packaged foods, check the sodium content on the Nutrition Facts label. Use the percent Daily Value (% DV) discussed in chapter 8, "Fats, Added Sugars, and Salt," to help limit your sodium intake. Older adults should not exceed about 60% DV for sodium for the day.

Keeping your food safe

Did you know that, every year, an estimated 76 million people in the United States become ill from food that contains harmful bacteria? Older adults are at higher risk. Perhaps, foodborne illness has affected you, and you did not even recognize the common symptoms—an upset stomach, diarrhea, a fever, vomiting, abdominal cramps, and dehydration. It can also result in more severe illness, such as paralysis and meningitis, or even death.

It’s important that older adults, people with weakened immune systems, and individuals with certain chronic illnesses pay extra attention and carefully follow food safety advice. Here are simple steps that you and your family can take to minimize the risk—four key words: clean, separate, cook, and chill. See part IV, "Play it Safe With Food,", for details on each step, as well as proper temperatures to keep food safe when you store it, thaw it, prepare it, cook it, serve it, and save leftovers. Older adults should be particularly careful.

In addition, older adults need to avoid eating or drinking raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, and raw sprouts.

Bringing it together

We’ve talked a lot about the healthy eating plan: getting a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and equivalent milk products; including lean meats, poultry, fish, legumes (dry beans and peas), eggs, nuts, and seeds; and balancing calorie intake with calorie needs. Each major food group provides a variety of nutrients, so it’s important to include all food groups in your daily eating plan.

	MY JOURNEY TO LIVING A HEALTHIER LIFESTYLE by Regina D. Coles from Atlanta, Georgia At the age of forty, my health was something that I took for granted. I was 165 pounds and I wore a size 16. I was eating whatever I wanted to eat without any thought of how my eating habits were affecting my health. I failed to get regular physical exams during this time because I felt fine and I saw no reason to schedule regular doctor’s office visits. However, all of that changed with an office visit that I scheduled with a new physician. He explained to me what cholesterol and heart disease were, as well as other health problems that develop as we age. My test results indicated a cholesterol level of 304, and my blood pressure was elevated as well as my sugar level. I was shocked to learn that all of this was going on at the same time, and I was determined that I was going to follow the lifestyle changes that my doctor recommended. He added that making these changes would lead to a healthier and happier way of living. My doctor advised me to begin an exercise program that I could enjoy so that I could remain motivated enough to stick with it. The next day, I began to run on a nearby high school track. When I first began, I ran only as far as I felt comfortable running, then I would stop and start to walk. I gradually increased my distance to 3 miles. I always made sure that I had plenty of water to drink after my run. The next change I had to make was my diet. When my doctor explained the changes that I had to make, I thought he was joking. It turns out that he was quite serious. He recommended chicken and fish, which had to be broiled or baked without the skin. I could eat lean cuts of beef twice a week prepared the same way as the skinless chicken and fish. I also had to learn to eliminate some of the fat from my foods. I became conscious of how much fat I was consuming. I also began to read the labels on the food I bought and began making better choices. Of course, I complained because I missed my old way of preparing my meals. You see, I loved fried fish and chicken and fresh collards, turnips, cabbage, and green beans prepared with salt pork. I must admit that I was truly amazed when, at the end of 6 weeks, I noticed that I was actually losing weight as a result of my lifestyle change. I realized 6 months later that this new lifestyle change would become a permanent way of living because one of the benefits was my changed attitude toward life. I began to develop a positive attitude toward life. I also became more outgoing and ready to face new challenges. After 1 year, my blood pressure drastically declined and so did my sugar level. My weight returned to normal, and I learned to enjoy my new way of eating. I looked and felt younger, and I noticed that I had more energy. Of course, I’ve faced some illnesses along the way, some more serious than others. Last year, I experienced an illness that was potentially fatal. I was told by my doctor that my survival was possibly due to the diet and exercise changes that I had made many years ago and maintained throughout the years. By the time I became an older American, I was celebrating a new body with a transformed mind. I feel that the changes that I was determined to make in my younger years have greatly affected my health and appearance today. Thanks to the lifestyle changes that I made nearly 30 years ago, today I feel great and I am blessed to be an active, healthy, and productive older American.

	Special Considerations For those of you 65 years of age and older, there are some important things to consider when it comes to physical activity: The most important thing to do is to become less sedentary. Use a gradual or stepwise approach. Focus more on moderate activity than achieving high levels of activity. Try to spend time on both strength training and cardio or aerobic activities, rather than just focusing on one or the other. Perform balance exercises to reduce your risk of fall and injury. To maintain the range of motion necessary for daily activities, perform activities that maintain or increase flexibility. Good to do: If you have a chronic condition, manage your risk of injury by working with a health care provider to develop an activity plan.

For older adults, every day it’s important to eat:

• fiber-containing foods
• vitamin B₁₂-fortified foods, such as fortified cereals, or take the crystalline form of vitamin B12 supplements
• vitamin D-fortified foods, such as fortified milk or orange juice, which are important for calcium absorption and can reduce the risk of bone loss.

In general, older adults should get enough foods that contain calcium, potassium, fiber, magnesium, and vitamins A, C, D, and E, without eating too many foods high in calories, saturated and trans fats, cholesterol, added sugars, and salt (sodium).

We’ve already talked about some adjustments to make to our diets. Now, let’s quickly review how this fits into your daily calorie needs based on "My Personal Profile," or if you are caring for older adults, take a moment to figure out their range.

For example, a 60-year-old, sedentary woman should aim for 1,600 calories per day, while a 60-year-old, sedentary male should aim for 2,000 calories per day.

When increasing the amount of fruits, vegetables, and legumes you eat, be sure to eat them in place of less nutritious foods, not in addition to them, if weight control is part of your goal. Next, let’s work in some physical activity.

You can! Be active.

Many older adults may feel that they are too tired to be physically active or that they have earned their rest. However, physical activity is a critical part of a healthy lifestyle, and for older adults, physical activity may take on even more meaning. Continuing to live independently—doing the things that you enjoy—can be linked to being active. Increasing your heartbeat, strengthening your muscles, and increasing your flexibility contribute to physical fitness and the ability to do everyday activities like climbing the stairs, shopping for groceries, and visiting with family and friends.

	"Physical activity is like a savings account. The more you put in, the more you get out of it!" — Earl, age 62

Older adults may want to consult with their health care provider, if they have certain chronic diseases or are taking medications, before starting vigorous physical activity. Let’s also clear up a misconception—that older adults should not participate in physical activity because of a risk of falls or injury. Actually, the opposite is true. Sedentary older adults have a higher risk of falls and regular physical activity may reduce their risk. Research also shows that regular physical activity can promote psychological well-being and can aid in reducing feelings of mild-to-moderate depression and anxiety. On a day that you’re feeling a bit tired, down, or stressed, consider taking a brisk walk around your neighborhood or at the mall. Start small, have a positive attitude, build up to more vigorous activities, and continue to enjoy all that life has to offer you!

Let’s get into the nitty gritty…for adults ages 65 and older, here’s what science tells us to do:

• At a minimum, do moderately-intense cardio or aerobic activity for at least 30 minutes per day, most days of the week.
  AND
• At a minimum, do strength-training exercises, 2 days per week.

Moderate activity: Intensity is relative to your level of fitness. For some older adults, moderately-intense physical activities include:

• walking briskly
• biking at a casual pace
• dancing (ballroom, line dancing, jazz, or tap)
• water aerobics
• golfing without a cart
• light gardening/yard work such as raking or pushing a power lawn mower
• actively playing with children
• doubles tennis.

Vigorous activity: For some older adults, vigorously-intense physical activities include:

• jogging
• swimming laps
• singles tennis
• heavy yard work.

What is strength training and why do it?

We’ve talked about this in chapter 10, "Making Physical Activity Part of a Healthier You," because it’s important for all adults regardless of age. But it’s worth repeating. Strength-training exercises are resistance exercises that increase the strength of your muscles, help maintain the integrity of your bones, and may improve your balance, coordination, and mobility. Both strength training and cardio or aerobic activities are important. In particular, strength training helps develop and maintain a healthy skeleton and muscle mass.

A few examples of strength-training exercises are:

• digging in a garden
• chopping wood
• using a push lawn mower
• bicep curls
• yoga (some types are more strengthening than others)
• leg lifts
• squats.

What is balance training? Some exercises improve your balance and strength at the same time. If you are at risk of falling, you should include balance exercises as part of your strength-training activities. Some examples include:

• rising up and down on your toes while standing and holding a stable chair or countertop
• walking a straight line heel to toe
• side leg raises while standing and holding onto a chair
• knee flexions (while standing and holding onto a chair, bend knee so your foot lifts behind you)
• hip flexions (while standing and holding onto a chair, raise knee toward chest).

Remember: You can do it. It’s time well spent to help give you more time, extra quality years to spend with your family and friends enjoying life!

¹⁰ Older adults should meet their vitamin B₁₂ needs by eating foods fortified with vitamin B₁₂, such as fortified cereals, or by taking the crystalline form of vitamin B₁₂ in supplements.

¹¹ For example, an older adult could get adequate daily vitamin D from 3 cups of milk (300 IU), 1 cup of vitamin D-fortified orange juice (100 IU), plus 600 IU from vitamin D supplements.

CHAPTER 12 >

Table of Contents     |     Dietary Guidelines for Americans 2005
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion