University of Wisconsin - Extension

Between 8 and 16 percent of Americans age 65 and older (between 2.5 and 4.9 million) do not have regular access to a nutritionally adequate, culturally compatible diet. And as the population of older adults is expected to increase from 33 million in 1994 to 70 million by the year 2030, even more older adults could be at risk of inadequate nutrition.

"Federal programs to combat hunger reach only a third of older adults in need," says Betsy Kelley, University of Wisconsin-Extension outreach specialist and a registered dietitian.

"Poverty is a strong indicator of malnutrition risk. Almost 20% of older adults are poor or close to the poverty line, and older women experience nearly twice the poverty rate of older men."

Kelley says factors that contribute to the risk of malnutrition in older adults include hunger, poverty, inadequate food intake, social isolation, depression, dementia, dependency, disability, problems with oral health, chewing and swallowing problems, presence of acute or chronic diseases or conditions, multiple medications, and advanced age.

An evaluation of the Elderly Nutrition Program of the Older Americans Act indicates that 67% to 88% of participants are at moderate to high nutritional risk. Staff and volunteers at community-based programs, such as congregate meals and home-delivered meals, are observing serious nutrition-related problems among older adults, especially among those who are homebound and in frail health.

One survey found almost two-thirds of respondents had a weight outside the healthful range, and 18% to 32% had involuntarily gained or lost 10 lb. within the 6 months before the survey.

The U.S. Department of Agriculture (USDA) surveyed Americans' nutrition between 1994 and 1996 using a Healthy eating Index. The study found as age increases, there is a small but gradual increase in the percentage of elderly with scores in the "poor" range. Among the elderly, HEI scores decrease as income decreases, indicating a greater risk for a poor diet among those with less income.

"The survey found that older adults appear to be eating a variety of different foods, so emphasis should be put on trying to have older adults eat enough foods high in nutritional value," Kelley says. "Milk and fruit groups had the lowest scores and are especially important to emphasize. The results may be influenced by factors such as physical limitations, depression and chronic disease."

The survey found older Americans made major changes in their diets between 1977 and 1994. They ate less red meat, eggs, and sugars and sweets, and ate more legumes, grains and fruit in 1994 than they did in 1977. These changes meant they consumed less fat, saturated fat, cholesterol, zinc and sodium and more vitamins A and C, folate, fiber, and calcium.

"However, their intake of energy, dietary fiber, vitamins B6 and E, calcium, magnesium and zinc were still lower than recommendations," Kelley says. "Decreases in milk consumption and increases in soft drinks and fruit drinks are a concern because of the implications for bone health. Also of concern is low intakes of zinc and dietary fiber."

The study's authors recommend that older adults be encouraged to eat more servings from the fruit, vegetables, grain, milk and meat groups to improve their overall dietary quality. They suggest that their low energy intake is preventing older adults from getting enough balance in their diet to meet their vitamin and mineral needs.