Summer 2016

Ready, Set, Go!

Baby boomers will face many barriers to good nutrition as they age. It’s time to get prepared

By Julie Flaherty

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Getting older creates obstacles to eating well at the very time that it’s most important to do so. Photo: Kathleen Dooher

Good food has always been a priority for Vyrl Robinson. As a child, she spent summers on her mother’s farm, where she learned to harvest and “put up” fruits and vegetables. She learned to cook for a crowd as the youngest of 10 children. When she and her husband built their house in Burlington, Massachusetts, she planted a large garden and made her own preserves.

Now 79 and widowed, Robinson still loves fresh produce, but she’s retired and lives on a fixed income, which makes it hard to justify the expense. So she was one of the best customers at the free weekly farmers market that the Burlington Council on Aging organized last year. She liked to try out new vegetables when the market provided interesting recipes—that’s how she discovered her taste for baked kale. “It’s just like eating potato chips,” she said. “They are crunchy like that.”

Getting older creates obstacles to eating well at the very time that it’s most important to do so.

But Robinson doesn’t think she’ll make it back to the farmers market this year. She has back problems and emphysema and has had more than one heart attack. And with both her knees in need of replacement surgery, she has started using a walker (“I tried so hard to get off it,” she said), which makes the eight steps down to the street from her house a new barrier. So she relies a bit more on the Meals on Wheels delivered to her door. It’s a big help, although they do tend to cook the broccoli more than she likes.

Robinson’s story highlights a widespread, though little recognized, problem in seniors: malnutrition. Getting older creates obstacles to eating well at the very time that it’s most important to do so. When seniors don’t eat enough, don’t eat the right foods or lose the ability to absorb certain nutrients, it can cause physical decline or exacerbate pre-existing conditions. Now, nutrition researchers at Tufts are joining a nationwide effort to address the problem, including educating baby boomers about the importance of diet long before they are living alone or dealing with physical limitations. “The idea is that providing people in their 60s with a concept of how to eat will prepare them when their lifestyles change in their 80s,” said Simin Nikbin Meydani, director of the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts.

Needs Change

Your body changes significantly as you age, a process that calls for changes in how you eat. For one thing, your muscle mass starts to shrink—a decline that actually begins in your 30s—and your metabolism will slow down, which means you’ll need fewer calories than you once did. At the same time, your nutrient needs will stay the same or even increase. Your body may begin to have trouble absorbing certain nutrients, such as B12 and magnesium, so every bite will need to provide that much more nourishment.

“When you are younger, you don’t think it’s a big deal: You have a cup of tea, a bagel, that’s it,” said Shirley Chao, director of nutrition for the Massachusetts Executive Office of Elder Affairs, who received her Ph.D. from the Friedman School in 2008. But as you get older, the need for nutrient-rich foods becomes a big issue.

“You have to think of the immune system as a factory. The factory needs to be ready as soon as it is attacked to produce all kinds of defensive mechanisms.”

And what if you don’t get enough? Malnourished seniors may lose weight, get tired or become anemic. They are more likely to have diminished muscle strength—a prime risk factor for falls—and wounds that fail to heal properly. A 1995 study looked at a sample of patients admitted to an intensive care unit and found that 43 percent of them were malnourished; they were more likely to have complications and longer hospital stays than other patients.

With age, the immune system starts to malfunction, which means optimal nutrition is particularly important for fighting off illness when we get older, said Meydani, who also heads the HNRCA’s Nutritional Immunology Lab. “You have to think of the immune system as a factory,” she said. “The factory needs to be ready as soon as it is attacked to produce all kinds of defensive mechanisms. And in order to produce those defensive weapons, it needs to have protein, essential amino acids, essential fatty acids, all kinds of micronutrients.” Infections can also diminish your appetite and decrease the body’s ability to metabolize nutrients, further decreasing the immune system’s arsenal. “It becomes a vicious cycle,” Meydani said.

For decades, officials have recognized malnutrition as a problem among older Americans. But with the eldest baby boomers turning 70 this year, there is a sense of urgency to find out just how bad the problem is. Lawmakers in Massachusetts and Ohio, for example, are considering legislation that would create commissions to gather data on the nutrition status of seniors and look for ways to prevent malnutrition. That may be smart public policy, because it’s more than the seniors themselves who feel the effects of poor nutrition. A recent study published in the Journal of Parenteral and Enteral Nutrition estimated that the national cost of treating illnesses related to malnutrition (anything from heart disease to depression) was $157 billion a year.

New Challenges

So what causes malnutrition in seniors? To begin, there are financial constraints. A recent AARP Foundation survey of people ages 50 and older who live below 200 percent of the poverty line found that two in five had cut down on food or nutritious meals in the prior year, because they couldn’t afford them.

But it is not just low-income Americans who are at risk, Chao said.  “People are surprised when they see Meals on Wheels going to well-to-do communities,” Chao said. “What they don’t understand is that when you get old, you face the same problems regardless of income.” According to the U.S. Census Bureau, more than 38 percent of people ages 65 and over had at least one disability in 2010, with the most common involving walking, climbing stairs and doing errands. That makes chores like shopping and cooking impossible for many.

“If you go to your physician, they will weigh you and check your heart, but they are not measuring your nutritional status.”

Then there’s the fact that eating itself may no longer be as pleasurable for seniors. Medications can affect the ability to smell and taste, as does aging itself. Meydani points to studies showing a close correlation between loss of smell and illness and death in older adults. And the act of eating can become more difficult, thanks to lost teeth that make chewing arduous, or arthritis that makes handling a knife painful. Just as challenging for many seniors is that a meal may no longer be a social experience. That’s because even as more people are living independently for longer periods—Chao said that there are more than 150 Massachusetts centenarians still living in their communities, an unprecedented number—many of them are doing so alone. Isolation, depression and just not caring to cook for one person can lead to many seniors simply not making nutrition a priority. “They have tea and toast in the morning; then for lunch and supper they just sort of get by,” Chao said. “That’s the hidden malnutrition.”

However widespread it may be in society, and however great its cost, malnutrition still too often goes unnoticed. “If you go to your physician, they will weigh you and check your heart, but they are not measuring your nutritional status,” Meydani said.

Small Changes

To celebrate Older Americans Month in May, the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts partnered with the Age-Friendly Boston project to give local senior citizens a tutorial on healthful grocery shopping. Participants walked together from Chinatown to the Boston Public Market, where they met the vendors and hunted for items shown on the new MyPlate for Older Adults. Photo: Kathleen Dooher

Senior advocates are pushing for changes that could help address this silent epidemic. Meydani would like to see doctors monitor their patients’ bloodwork for signs of malnutrition, and hospitals use a standardized system for keeping track of nutrition status. The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, could make it easier for seniors to use the SNAP benefits that are available to them (only two in five seniors who are eligible currently enroll).

To help seniors make good eating choices, HNRCA scientists recently released an updated version of MyPlate for Older Adults, an infographic that provides a simple, pictorial guide to a healthy diet (see “A Healthy Meals Cheat Sheet,” page 21). A recent survey conducted by the AARP Foundation, which sponsored and partnered with the HNRCA on the MyPlate project, found that while interest in eating nutritious foods increases with age, understanding of what’s on a nutrition label declines. “There is a real need to fill that gap and ensure older adults have the knowledge and resources they need when they are choosing what to eat,” said Alex Lewin-Zwerdling, a senior adviser for the AARP Foundation.

As MyPlate makes clear, better nutrition doesn’t have to involve a major diet overhaul. Even small changes, such as switching from salads made with iceberg lettuce to ones with nutrient-rich spinach, could make a difference in overall health. “Tea and toast can turn into a bowl of oatmeal with a banana,” Chao said. “It’s just as easy to make.”

“Maybe it is time to have a senior lifestyle aisle,” in the same way that stores have aisles dedicated to organics and babies.

To spread the word, HNRCA researchers recently helped the Harvard Pilgrim Health Care Foundation create a booklet, “Healthy, Delicious Food at Every Age,” which highlights how seniors can shop for, cook and even grow nutritious food; the publication also describes some of the most common food and drug interactions. Researchers in the HNRCA’s Nutrition, Exercise Physiology and Sarcopenia Laboratory also worked with three Boston senior centers to create the Fit-4-Life program, which combines nutrition education with instruction on aerobic and mobility exercises.

At the same time, Chao said that many nutrition programs, senior centers and councils on aging across Massachusetts have started offering classes on cooking for one or shopping with nutrition in mind.

Businesses also have a role to play. Chao said that many seniors have trouble finding the quantities and prices they want at the supermarket: They might not have use of, say, a large bag of potatoes, but they still want to get the bulk discount. “Maybe it is time to have a senior lifestyle aisle,” she said, in the same way that stores have aisles dedicated to organics and babies.

Such a section, with small packages of precut vegetables or the like, may be on the horizon. “The private sector is becoming more and more interested in identifying solutions for older adults and healthy eating, in part because it is a huge market opportunity,” said Lewin-Zwerdling. That could mean foods that are formulated with seniors’ nutritional needs in mind, and easy-to-open packaging with easy-to-read labels.

Meanwhile, public health officials would like to see more seniors as engaged as Vyrl Robinson. Shopping and cooking may be harder than they used to be, but she still cares about what she eats. She recently made vegetable soup from scratch and shared it with a neighbor. “You don’t want to live on sandwiches,” she said.


FREE AND FRESH, FOR SENIORS ONLY  

They say that it stretches their food budget farther because their produce is covered for the week. And most report that they are eating more vegetables.

But just as important, the free weekly farmers market put on by the Council on Aging in Burlington, Massachusetts, offers senior citizens a whole lot of social engagement. “For some, it’s their only outing for the week,” said Marge McDonald, director of the council.

All the food at the market comes from the New Entry Sustainable Farming Project, an initiative of the Friedman School and other partners that trains beginning farmers and helps them sell their crops through the World PEAS Food Hub. In 2008, World PEAS began offering free or subsidized fresh produce to those in need, many of them older adults. Last year, the project supplied more than $90,000 worth of free produce to 14 programs in Massachusetts, including the Kit Clark Senior Center in Dorchester, Somerville/Cambridge Elder Services and councils on aging in Burlington, Peabody and Arlington.

Devin Ingersoll, the food-access facilitator at New Entry, says that project organizers weigh the specific challenges that seniors face in eating well. For instance, cooking can be difficult for this population, so project organizers include lots of foods that can be eaten raw, such as blueberries, apples, lettuce and cherry tomatoes. They’re also mindful of the dietary restrictions that can accompany old age, so kale, that nutritional powerhouse, is offered only sporadically, as its high vitamin K content can interfere with blood-thinning medication.

The success of the program reflects something the AARP Foundation discovered when it surveyed people ages 50 and over about what would help them eat more nutritious foods. The most popular response was “ways to find affordable fruits and vegetables” where they live.


 

myplate2_16_250A HEALTHY MEALS CHEAT SHEET

Many seniors want to eat well; they just don’t know where to start. To help, scientists at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts have just released the latest version of MyPlate for Older Adults, a simple, easy-to-follow diagram for nutritious eating. It is based on the 2015-2020 Dietary Guidelines for Americans, and its overarching advice could apply to adults of any age. But the graphic and accompanying website provide tips and reminders that are particularly suited to the needs and concerns of seniors.

As a person gets older, “one needs to be a little more careful about choosing food. The amount of nutrients per calorie should be relatively high,” said Alice H. Lichtenstein, director of the HNRCA Cardiovascular Nutrition Laboratory and the Gershoff Professor at the Friedman School.

Lichtenstein, who served as vice chair of the 2015 Dietary Guidelines Advisory Committee, said that one of the goals of creating the new infographic was to let seniors know that they have options. Getting to the store regularly for fresh produce may be difficult for those who no longer drive, or who “may be reluctant in the winter to go out,” Lichtenstein said. That’s why the modified graphic gives equal prominence to frozen fruits and vegetables, as well as to low-sodium canned versions, which have longer shelf-lives.

The graphic also acknowledges that seniors may no longer be cooking for a big family, or even a spouse. “With a bag of prepeeled carrots or frozen broccoli, you can snip it open and just take out a single serving,” she said.

The MyPlate for Older Adults points out that cheese and yogurt have something in common with fish, eggs, poultry and nut butter. “We moved them into the protein quadrant because dairy is an excellent source of high-quality protein,” Lichtenstein said.

Julie Flaherty, the editor of this magazine, can be reached at julie.flaherty@tufts.edu.

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