Physical Fitness for Elders Part 1: Food

Editor’s Note: Physical fitness is the last topic of Diana Boufford’s series of articles describing Comprehensive Geriatric Fitness. She has so much information to share on physical fitness that we’ve divided the article into 3 pieces: this one on food and two more to follow, one on exercise and one on laughter and restorative medicine. Other articles in the series cover the overall topic of Comprehensive Geriatric Fitness, as well as four other types of fitness:

• Emotional Fitness
• Social Fitness (along with specific exercises to build social fitness)
• Spiritual Fitness
• Family Fitness

What does research tells us about the relationship between what elders eat and their overall well-being?

Diet: Sometimes Too Much

According to Dr. John Ratey, “We are in danger of eating ourselves to death and killing our brains in the process.”

This is a sobering statement. Unfortunately, the data back it up. The US National Health and Nutrition Examination Study (NHNES) of 11,145 people revealed that adults over the age of 60 had higher levels of abdominal obesity and hypertension than any other age group tested, except those 80 years and older whose levels of abdominal obesity and hypertension are even higher. The NHNES goes on to say,

“Nutrition plays a significant role in prolonged health and health promotion throughout the life course. Owing to relationships identified between nutritional intake and mild cognitive impairment, depression, physical deterioration, and quality of life, promotion of successful aging and older adults should include healthy dietary practices.”

If you want to experience a long healthy life with a sound mind, be mindful of what you put into your mouth.

I have so often seen people who have allowed themselves to become very thick in the waist through sedentary lifestyles and poor eating become morbidly obese as they grow older. Then they required aides to help them walk, change their clothing, transfer into a shower, and bathe. These people have become crippled by excessive weight.

However, change is within reach. A good friend of mine once told me that human beings can do almost anything very well for short amounts of time. It is the consistent effort over a long period of time that is challenging. He taught me that making small, consistent changes in diet and exercise on a day-to-day basis is the most effective way to overcome habitual, self-destructive lifestyle practices.

So with this suggestion in mind, I started increasing my water intake. At that time in my life I was drinking far too much coffee and not enough water. So I slowly introduced a glass of water with each meal, and eventually, one glass of water in between. Over time this became a natural routine. Now I drink between six and eight glasses of water every day. I’ve applied this principle of small consistent change to both my exercise routines and my food intake. Changes can become sustainable and relatively easy to maintain with this method.

The Mediterranean Diet

The Mediterranean diet consists largely of fruits, vegetables, olive oil, and fish, with small amounts of red meat and dairy products and a moderate amount of wine consumed with meals. Depp, Martin, and Jeste say that the Mediterranean diet raises the likelihood of successful aging. It has been associated with decreased mortality and a reduction in cardiovascular and chronic diseases, as well as a decline in the incidences of Alzheimer’s disease. The Healthy Aging and Body Composition Study sampled 3,075 older adults between the ages of 70 to 79 and found that those who conform to the Mediterranean diet showed the least amount of decline in mobility over an eight-year period. They also showed a slower decline in cognitive functioning. The study also shows that higher adherence to the Mediterranean diet showed a lower risk of mild cognitive impairment (MCI), a precursor to Alzheimer’s disease and other dementias.

My mother came to me last winter concerned about how high her weight had become. At only 5 feet tall, she was tipping the scales at over 140 pounds. She complained of difficulty walking and how much her back hurt. These physical complaints were slowing her down. I told her about the newest research regarding the Mediterranean diet.

The first thing she said was, “I can’t drink wine because I am on too many medications.” After acknowledging that this was true, I suggested that she start eating lots of fruits and vegetables and stop eating starches, sugars, breads, and pastas and increase her water consumption in order to start losing weight.

That was February 2013. It is now July 2013. My mother just informed me that she’s down to 123 pounds, what she considers her ideal weight, and she is feeling very healthy. These changes did not occur solely as a result of the changed diet. She also exercised daily. For more on exercise for the elderly, watch for my next article.

“The positive effects on memory function associated with a brain-healthy diet may be as effective (or even more effective over time) than those achieved with current FDA-approved medications.” Richard Isaacson, M.D., an Alzheimer’s disease specialist, who says that a good diet is one that is high in fruits, vegetables, and whole grains, and low in dairy, saturated fat, and refined sugar (a.k.a. the Mediterranean diet). (Quote taken from AgingCare.com)

DIET: Sometimes Too Little

On the other side of the coin, we have people who do not eat enough to fuel their bodies. Often I see seniors eating minimal amounts of food. They may have lost their appetites or no longer enjoy culinary delights.

Possible reasons are many, and one must conduct a thorough assessment to figure out which apply to a particular case. Is it depression? Do they have dental problems which make chewing difficult or painful? Are there swallowing difficulties or choking hazards? Is it the quality of the food? All of these need to be explored to ensure there are no contributing factors influencing the lack of zest for food. Consider consulting with a dietitian to discuss types of food that might appeal or to discuss the way portion size affects appetite. A speech language pathologist, can evaluate a person for swallowing difficulties that may make eating a frightening experience.

When all other possible causes have been ruled out and the person is quite content with a low food intake, then optimizing the quality of the diet can ensure that they get all the nutrients needed to sustain health and energy. For instance, sweet potatoes have more nutrients than white potatoes, rice, or pasta. Dark colored fresh vegetables such as rappini or spinach are preferable to corn and carrots, which are high in sugars, or iceberg lettuce, which has virtually no nutritional value, or frozen vegetables. Try a Google search for “Nutrient dense foods” for more suggestions.

Fresh fruits and vegetables are great for people with teeth that allow them to bite, chew, swallow and digest them. But what about people who require minced or puréed foods? Many will lose their appetites just seeing the brown goop on their plates. It does not have to be this way. In Ontario, Baycrest Health Sciences teamed up with George Brown College’s culinary students and issued a challenge, “Reinvent the puree.” They had a cook-off to create new foods to appeal to people in long-term care that had eating and swallowing difficulties. It was an innovative and successful learning experience for all involved, and the partnership continues. The results were documented in a recent issue of Canadian Nursing Home.

Small servings can seem more palatable to people who aren’t very interested in eating. Along with several other suggestions, nurse Angela Morris suggests small frequent meals for elders who are turning away from food.

Too much or too little. Neither contributes to ongoing health. Just enough of the right kinds of food can help elders preserve brain power, muscle mass, overall health, and independence.

 

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REFERENCES

Acquista, A. & Vandermolen, L. A. (2006). The Mediterranean Prescription: Meal Plans and Recipes to Help You Stay Slim and Healthy for the Rest of Your Life. Ballantine Books.

Canadian Nursing Home, (2013). Summer Issue, 24 (2), 4-6. Journal webpage.

Depp, C. A., Martin, A. S., & Jeste, D. V. (2013, Winter) Successful Aging: Implications for Psychiatry. Focus, XI (1). Abstract.

Depp, C. A. (2013). Successful Aging: Implications for Psychiatry Research. Webcast. It looks like it is possible to create a guest account to view the webcast.

Emling, S. (2013). Mediterranean Diet Appears To Boost Aging Brain Power, Study Says. Huffington Post.

Martínez-Lapiscina1, E. H., Clavero, P., Toledo1, E., Estruch, R., Salas-Salvadó, J., San Julián, B., Sanchez-Tainta1, A., Ros, E., Valls-Pedret, C., & Á Martinez-Gonzalez, M. (2013). Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology and Neurosurgical Psychiatry. doi:10.1136/jnnp-2012-304792. Abstract.

Maurer, R. (2012). The Spirit of Kaizen: Creating Lasting Excellence One Small Step at a Time. New York: McGraw-Hill.

Morris, A. (2011). 7 ways to whet an appetite.

Ratey, J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain. New York: Little, Brown and Company.

Shahar, D. R., Houston, D. K., Hue, T. F., Lee, J. S., Sahyoun, N. R., Tylavsky, F. A., Geva, D., Vardi, H., & Harris T. B. (2012). Adherence to Mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults. Journal of American Geriatric Society, 60(10), 1881-1888. doi: 10.1111/j.1532-5415.2012.04167.x. Abstract.

Photo Credits from Compfight with a Creative Commons license
Water with lemon courtesy of Redwood 1 (Rob)
Fruits and vegetables courtesy of jalb
A little bit of delicious food courtesy of ulterior epicure