Eating Better

Bernadette Harkins (left) and Laura Abescrombia enjoy lunch, one of the three meals served daily in the Raphael House, an assisted-living residence in Rockville, Md.

When Bernadette Harkins, 89, of Rockville, Md., could no longer feed herself properly, she moved to an assisted-living residence. Today, she can enjoy three meals a day served to her and about 30 other people in their home-like communal dining room.

When Harry, 85, of Moscow, Pa., could no longer feed himself properly, he moved in with his daughter and her family. Today, with her guidance, he's eating six times a day, snacking on high-calorie, high-protein foods, and maintaining a near-normal weight.

Harry, who asked that his last name not be used, and Harkins typify many of today's older generation. Living alone in most cases, they often are unable to meet their dietary needs and are forced to make compromises.

Harry didn't know how to cook. He developed cancer, which made it even more important that he eat a well-balanced diet. Harkins knew how to cook but didn't take time to prepare adequate meals for herself.

"I would snack is what I'd do," she said. "I would think about getting a meal and then just have a cup of tea and toast. I knew I wasn't doing the right thing as far as nutrition was concerned."

Their eating problems stemmed from loneliness and lack of desire or skill to cook. Other older people may eat poorly for other reasons, ranging from financial difficulties to physical problems.

The solutions can be just as varied, from finding alternative living arrangements to accepting home-delivered meals to using the food label recently revised by the Food and Drug Administration and the U.S. Department of Agriculture. Physical activity also is important in maintaining a healthy lifestyle.

Why the Concern

Nutrition remains important throughout life. Many chronic diseases that develop late in life, such as osteoporosis, can be influenced by earlier poor habits. Insufficient exercise and calcium intake, especially during adolescence and early adulthood, can significantly increase the risk of osteoporosis, a disease that causes bones to become brittle and crack or break.

But good nutrition in the later years still can help lessen the effects of diseases prevalent among older Americans or improve the quality of life in people who have such diseases. They include osteoporosis, obesity, high blood pressure, heart disease, certain cancers, gastrointestinal problems, and chronic undernutrition.

Studies show that a good diet in later years helps both in reducing the risk of these diseases and in managing the diseases' signs and symptoms. This contributes to a higher quality of life, enabling older people to maintain their independence by continuing to perform basic daily activities, such as bathing, dressing and eating.

Poor nutrition, on the other hand, can prolong recovery from illnesses, increase the costs and incidence of institutionalization, and lead to a poorer quality of life.

[Graphic Omitted] Montgomery County, Md., residents (from left) Alta Young Poole, Henrietta Singer, Song Soonok, and Rita Ford-Wheatley line up at the Waverly House in Bethesda for a chicken dinner.

The Single Life

Whether it happens at age 65 or 85, older people eventually face one or more problems that interfere with their ability to eat well.

Social isolation is a common one. Older people who find themselves single after many years of living with another person may find it difficult to be alone, especially at mealtimes. They may become depressed and lose interest in preparing or eating regular meals, or they may eat only sparingly.

In a study published in the July 1993 Journals of Gerontology, researchers found that newly widowed people, most of whom were women, were less likely to say they enjoy mealtimes, less likely to report good appetites, and less likely to report good eating behaviors than their married counterparts. Nearly 85 percent of widowed subjects reported a weight change during the two years following their spouse's death, as compared with 30 percent of married subjects. The widowed group was more likely to report an average weight loss of 7.6 pounds (17 kilograms).

According to the study, most of the women said they had enjoyed cooking and eating when they were married, but, as widows, they found those activities "a chore," especially since there was no one to appreciate their cooking efforts.

For many widowed men who may have left the cooking to their wives, the problem may extend even further: They may not know how to cook and prepare foods. Instead, they may snack or eat out a lot, both of which may lead people to eat too much fat and cholesterol and not get enough vitamins and minerals.

Special Diets

At the same time, many older people, because of chronic medical problems, may require special diets: for example, a low-fat, low-cholesterol diet for heart disease, a low-sodium diet for high blood pressure, or a low-calorie diet for weight reduction. Special diets often require extra effort, but older people may instead settle for foods that are quick and easy to prepare, such as frozen dinners, canned foods, lunch meats, and others that may provide too many calories, or contain too much fat and sodium for their needs.

On the other hand, Mona Sutnick, Ed.D., a registered dietitian in private practice in Philadelphia, pointed out that some people may go overboard on their special diets, overly restricting foods that may be more beneficial than detrimental to their health.

"My advice for a 60-year-old person might be 'watch your fat' but for an 80-year-old who's underweight, I'd say, 'eat the fat, get the calories,' " Sutnick said.

Physical Problems

Some older people may overly restrict foods important to good health because of chewing difficulties and gastrointestinal disturbances, such as constipation, diarrhea and heartburn. Because missing teeth and poorly fitting dentures make it hard to chew, older people may forego fresh fruits and vegetables, which are important sources of vitamins, minerals and fiber. Or they may avoid dairy products, believing they cause gas or constipation. By doing so, they miss out on important sources of calcium, protein and some vitamins.

Adverse reactions from medications can cause older people to avoid certain foods. Some medications alter the sense of taste, which can adversely affect appetite. This adds to the problem of naturally diminishing senses of taste and smell, common as people age.

Other medical problems, such as arthritis, stroke or Alzheimer's disease, can interfere with good nutrition. It may be difficult, if not impossible, for example, for people with arthritis or who have had a stroke to cook, shop, or even lift a fork to eat. Dementia associated with Alzheimer's and other diseases may cause them to eat poorly or forget to eat altogether.

Money Matters

Lack of money is a particular problem among older Americans who may have no income other than Social Security. According to 1994 U.S. Census Bureau data, nearly 12 percent of people 65 and over are below the average poverty level for their age group. In 1994, the poverty level for a person 65 and over was $7,108 a year.

According to the 1994 data, the mean annual income for people 65 and over was $16,709, almost $10,000 less than what they earned on average between ages 55 and 64.

Lack of money may lead older people to scrimp on important food purchases-for example, perishable items like fresh fruits, vegetables and meat- because of higher costs and fear of waste. They may avoid cooking or baking foods like meats, stews and casseroles because recipes for these foods usually yield large quantities.

Financial problems also may cause older people to delay medical and dental treatments that could correct problems that interfere with good nutrition.

[Graphic Omitted] Avis Taylor digs into a Waverly House meal. The site is one of 18 in Montgomery County where older people who live anywhere in the county can share a noon meal provided by the county' Area Agency on Aging.

Food Programs

Many older people may find help under the Older Americans Act, which provides nutrition and other services that target older people who are in greatest social and economic need, with particular attention on low-income minorities. According to the U.S. Administration on Aging, which administers the Older Americans Act, the nutrition programs were set up to address the dietary inadequacy and social isolation among older people.

Home-delivered meals and congregate nutrition services are the primary nutrition programs. The congregate meal program allows seniors to gather at a local site, often the local senior citizen center, school or other public building or a restaurant, for a meal and other activities, such as games and lectures on nutrition and other topics of interest to older people.

Available since 1972, these programs, funded by the federal, state and local governments, ensure that senior citizens get at least one nutritious meal five to seven days a week. Under current standards, that meal must comply with the Dietary Guidelines for Americans and provide at least one-third of the Recommended Dietary Allowances for an older person. Often, people receive foods that correspond with their special dietary needs, such as no-added-salt foods for those who need to restrict their sodium intake or ground meat for those who have trouble chewing.

Other nutrition services provided under the Older Americans Act are nutrition education, screening and counseling.

While these nutrition programs target poor people, they are available to other older people regardless of income, according to Jean Lloyd, a registered dietitian and nutrition officer with the Administration on Aging. Although no one is charged for the meals, older people can voluntarily and confidentially donate money, she said.

The meals provide not only good nutrition, but they also give older people a chance to socialize- a key factor in preventing the adverse nutritional effects of social isolation.

For those who qualify, food stamps are another aid for improving nutrition. Under this program, a one-person household can receive up to $115 a month in food stamps to buy most grocery items.

For the homebound, grocery-shopping assistance is available in many areas. Usually provided by non-government organizations, this service shops for and delivers groceries to people at their request. The recipient pays for the groceries and sometimes a service fee.

In some communities, private organizations also sell home-delivered meals.

Other Assistance

Family members and friends can help ensure that older people take advantage of food programs by putting them in touch with the appropriate agencies or organizations and helping them fill out the necessary forms. Some other steps they can take include:

• looking in occasionally to ensure that the older person is eating adequately
• preparing foods for and making them available to the older person
• joining the older person for meals.

In some cases, they may help see that the older person is moved to an environment, such as their home, an assisted-living facility, or a nursing home, that can help ensure that the older person gets proper nutrition.

Whatever an older person's living situation, proper medical and dental treatment is important for treating medical problems, such as gastrointestinal distress and chewing difficulties, that interfere with good nutrition. If a medication seems to ruin an older person's taste and appetite, a switch to another drug may help.

A review of basic diet principles may help improve nutrition. Explaining to older people the importance of good nutrition in the later years may motivate them to make a greater effort to select nutritious foods.

Look to the Label

The food label can help older people select a good diet. Revamped in 1992, the label gives the nutritional content of most foods and enables consumers to see how a food fits in with daily dietary recommendations.

Some of the information appears as claims describing the food's nutritional benefits: for example, "low in cholesterol" or "high in potassium." Understrict government rules, these claims can be used only if the food meets certain criteria. This means that claims can be trusted. For example, a "low-cholesterol" food can provide no more than 20 milligrams (mg) of cholesterol and no more than 2 grams of saturated fat per serving. A high-potassium food must provide at least 700 mg of potassium per serving.

Less common but also helpful are label claims linking a nutrient or food to the risk of a disease or health-related condition. So far, FDA allows only eight of these claims because they are the only ones supported by scientific evidence. One claim links sodium, a nutrient found in salt and used in many processed foods, to high blood pressure. On the food label, this claim would read something like this:

"Diets low in sodium may reduce the risk of high blood pressure, a disease associated with many factors."

More in-depth information is found on the "Nutrition Facts" panel on the side or back of the food label. This information is required on almost all food packages. Unlike before, this nutrition information is easier to read because it appears in bigger type and is usually on a white or other neutral contrasting background, when practical.

Some nutrition information also may be available for many raw meats, poultry and fish and fresh fruits and vegetables at the point of purchase. The information may appear in brochures or on posters or placards.

Physical Activity

Besides diet, physical activity is part of a healthy lifestyle at any age. It can help reduce and control weight by burning calories. Moderate exercise that places weight on bones, such as walking, helps maintain and possibly even increases bone strength in older people. A study published in the Dec. 28, 1994, Journal of the American Medical Association found that intensive strength training can help preserve bone density and improve muscle mass, strength and balance in postmenopausal women. In the study, subjects used weight machines for strength training.

Also, scientists looking into the benefits of exercise for older people agree that regular exercise can improve the functioning of the heart and lungs, increase strength and flexibility, and contribute to a feeling of well-being.

Any regular physical activity is good, from brisk walking to light gardening. Common sense is the key. But, before a vigorous exercise program is started or started after a long period of rest, a doctor should be consulted.

Taking time out for exercise, using the food label to help pick nutritious foods, taking advantage of the several assistance programs available, and getting needed medical attention can go a long way in helping older people avoid the nutritional pitfalls of aging and more fully enjoy their senior years.

Paula Kurtzweil is a member of FDA's public affairs staff.

To learn more about the food label and nutrition for older people, write for these publications:

* Using the New Food Label to Choose Healthier Foods. FDA, 5600 Fishers Lane (HFE-88), Rockville, MD 20857. Ask for publication number (FDA) 94-2276.

* Healthy Eating for a Healthy Life. AARP (American Association of Retired Persons) Fulfillment, 601 E. St.5 N.W., Washington, DC 20049. Ask for publication by title and stock number D15565.

To learn about meal programs for senior citizens in your area, call the Administration on Aging's Elder Care Locator, (1-800) 677-1116.

For information about food stamps, contact your county's food stamp office listed in the blue pages of the telephone book. To find a registered dietitian in your area, call the National Center for Nutrition and Dietetics Consumer Nutrition Hotline, (1-800) 366-1655.

[Graphic Omitted]

The Nutrition Facts panel is the place to go for more complete nutrition information.

Start at the top with serving size information. Serving sizes are:

• given in both household and metric units
• uniform across product lines so you can more easily compare the nutritional qualities of similar foods
• close to the amounts people really eat (although they're not recommended amounts).

Be sure to look at %Daily Values on the right. They show how a serving of food fits in with current recommendations for a healthful diet. A high percentage means the food contains a lot of a nutrient. A low percentage means it contains a little. The goal is to choose foods that together give you about 100 percent a day.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Food and Drug Administration FDA on the Internet: http://www.fda.gov/

We hope you found this reprint from FDA Consumer magazine useful and informative. FDA Consumer, the magazine of the U.S. Food and Drug Administration, provides a wealth of information on FDA-related health issues: food safety, nutrition, drugs, medical devices, cosmetics, radiation protection, vaccines, blood products, and veterinary medicine. For a sample copy of FDA Consumer and a subscription order form, write to: Food and Drug Administration, HFI-40, Rockville, MD 20857.