Eating a varied and balanced diet is important for good health and wellbeing in later life. Although the obesity crisis is known as one of the foremost public health challenges, malnutrition at the other end of scale is often overlooked as a serious issue. Around 1 in 10 people over the age of 65 in the UK are malnourished or are at risk of malnutrition.¹

Here are the eight common myths when it comes to nutrition for older adults.

Myth 1: It’s normal to lose weight with age

The Malnutrition Task Force found that 36% of over-60s think that weight loss in later life is a normal part of ageing, whilst 75% have never worried about themselves or another older person unintentionally losing weight.2 In fact, it is not fine to lose weight with age without trying. Unplanned weight loss in older age should be treated as an alarm bell of malnutrition or other serious conditions such as cancer, dementia and liver disease.

Myth 2: Losing your appetite in later life is not a serious issue

Loss of appetite in later life can be a warning sign of malnutrition or other serious conditions, and help should be sought sought from a healthcare professionals such as GP, a dietitian, or from social prescribing. Malnutrition can make someone more likely to get ill or have a fall, slow down recovery time from illness or surgery, increase complications and in very extreme cases even cause death.³

Myth 3: Older adults need fewer nutrients than younger adults

Older adults may need less calories than younger adults due to age-related muscle loss and reduced activity.⁴ However, these changes can be variable among individuals. A review by Dorrington et al suggested that older adults have higher requirements for protein, calcium, folate, vitamin B12 and fluid but similar for all other macro and micronutrients compared with the general population.⁵

Myth 4: Older adults do not need to worry about becoming overweight or obese

Being slightly overweight in older age may be protective. The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosis of malnutrition recommends BMI 22kg/m² as the lower cut-off for adults over-70s.⁶ Obesity is linked with age-associated muscle wastage which can affect functional status in older adults. Micronutrient deficiencies are more common in overweight or obese adults than those with healthy weight.⁷ A balanced diet packed with all nutrients accompanied by appropriate exercise intervention is needed.

Myth 5: A low-fat low-sugar diet is better for older adults

Dietary needs change throughout the lifecycle. Despite popular health beliefs, a low-fat low-sugar diet may not be suitable for older adults who have lost weight unintentionally or have poor oral intake. Food is not just about providing nutrients but also enjoyment and connecting people together.

Myth 6: Adding cream and butter to food is the best way to fortify it

There has been a tendency in the past for oral nutrition support to mainly focus on increasing energy intake (using high fat and sugar ingredients such as cream and butter) rather than on increasing intake of all nutrients. However, it is better to use nutrient-dense ingredients (providing variety of nutrients including protein and micronutrients, as well as energy) such as skimmed-milk powder, eggs, nuts, nut butter and cheese.⁸

Myth 7: Drinking less fluid is a good way to prevent toilet visits

Older adults may be reluctant to drink fluids to reduce toilet visits, especially during the night. However, it has been shown that restriction of the overall fluid intake does not reduce urinary incontinence frequency or severity.⁹ It is important to drink enough fluid each day to keep the bladder healthy and prevent urinary infection. 

All fluids count except alcohol of more than 4% abv. Although caffeine is a mild diuretic (may cause the need to urinate), drinking caffeinated beverages like tea and coffee does not cause dehydration (fluid loss in excess of the volume taken).

Myth 8: Eating three proper meals a day is better for older adults

Eating regularly is essential for helping older adults live well and remain independent as they age. However, eating three full meals a day can be a struggle if there is a loss of appetite or if they find cooking too difficult or time-consuming. Smaller but more frequent meals with snacks in between and well-chosen ready meals can be just as beneficial.

Everyone has individual requirements and it is about finding what is right for them.

Dove Yu, RD, ANutr

Senior Specialist Dietitian (Nutrition Support/Palliative Care)
PR Officer at BDA Older People Specialist Group @BDA_olderpeople

Dove is passionate about person-centred care, nutrition education and research.
She has experience in nutrition support in both acute and community settings
and is interested in food art and different food cultures.

Twitter@: doveyu_RD
Instagram: doveyu_dietitian

References

1. Russell CA and Elia M (2014). Nutrition Screening Surveys in Hospitals in the UK, 2007–2011. A report based on the amalgamated data from the four Nutrition Screening Week surveys undertaken by BAPEN in 2007, 2008, 2010 and 2011. Available from: http://www.bapen.org.uk/pdfs/nsw/bapen-nsw-uk.pdf  [Accessed 10th Feb 2022]
2. BAPEN (2017). Weight loss in later life not a normal part of ageing. Available from: https://www.bapen.org.uk/news-and-media/news/weight-loss-in-later-life-not-a-normal-part-of-ageing [Accessed 10th Feb 2022]
3. BAPEN (2018). Introduction to Malnutrition - What are the consequences of malnutrition? Available from: https://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition?start=2 [Accessed 17th Feb 2022]
4. Shimokata H and Kuzuya F (1993). Ageing, basal metabolic rate and nutrition. Nihon Ronen Igakkai Zasshi. 30(7): 572-6. Japanese. doi: 10.3143/geriatrics.30.572. PMID: 8361073
5. Dorrington N, Fallaize R, Hobbs DA, Weech M and Lovegrove JA (2020). A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK. The Journal of nutrition. 1; 150(9): 2245-56
6. Cederholm T, Jensen G, Correia M, Gonzalez M, Fukushima R, Higashiguchi T et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Journal of Cachexia, Sarcopenia and Muscle. 2019; 10(1): 207-217
7. Astrup A and Bugel S (2018). Overfed but undernourished: recognising nutritional inadequacies/deficiencies in patients with overweight or obesity. International Journal of Obesity.
8. NICE. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. NICE guideline [CG32] [Internet]. 2006 [cited 29 March 2021]. Available from: https://nice.org.uk/guidance/cg32 [Accessed 17th Feb 2022]
9. Welsh Government (2019). Food and nutrition in care homes for older people. Available from: https://gov.wales/sites/default/files/publications/2019-12/food-and-nutrition-care-homes-older-people-drinking-and-importance-hydration-residents.pdf [Accessed 17th Feb 2022]