NUTRITIONAL NEEDS OF THE OLDER ADULT

1. Calories - 1500-2000 kcal/day to maintain ideal weight; 12% of calories from protein sources; 50-60% of calories from carbohydrates; 20-30% of calories from fats.


2. High fiber - prevent or alleviate constipation and dependence on laxatives.


3. Sodium - 3-4 g/day according to cardiac and renal status.


4. Fats - limit to help retard the development of cancer, atherosclerosis, obesity, and other diseases.


5. Fluids - 6-8 glasses/day.


6. Common deficiencies: calories; calcium; folic acid; iron; thiamine; vitamins A, B₁₂, C, and D; niacin; zinc.


7. Factors contributing to food preferences:
1. Physical ability to prepare, shop for, and eat food.
2. Income.
3. Availability of food if dependent on others.
4. Food intolerances.


8. Nutrional table provides interventions for common eating problems in the older adult.

RELIGIOUS CONSIDERATIONS IN MEAL PLANNING

1. Orthodox Jews:
   1. Kosher meat and poultry.
   2. No shellfish, eels, or pork products.
   3. Milk and dairy products cannot be consumed with meat or poultry; requires separate utensils.
   4. No eggs with a blood spot may be eaten. Eggs may be used with either meat or dairy meals
2. Conservative and Reform Jews: dietary practices may vary from religious laws.
3. Muslims: no pork or alcohol.
4. Hindus: vegetarians (cows are sacred).
5. Seventh-day Adventists:
   1. Vegetarianism is common (lacto-ovo).
   2. No shellfish or pork products.
   3. Avoid stimulants (coffee, tea, other caffeine sources).
   4. No alcohol.
6. Mormons: no coffee, tea, or alcohol.

SPECIAL DIETS

1. Low-carbohydrate diet-ketogenic: low carbohydrate, high fat; dumping syndrome: low carbohydrate, high fat, high protein.
2. Gluten-free diet-elimination of all foods made from oats, barley, wheat, and rye; used for celiac disease.
3. High-protein diet-lean meat, cheese, and green vegetables.
   1. Nephrotic syndrome (may also be on lowsodium diet).
   2. Acute leukemia (combined with high-calorie and soft-food diets).
   3. Neoplastic disease.
4. Low-protein diet:
   1. Usually accompanied by high-carbohydrate diet and normal fats and calories.
   2. Renal failure, uremia, anuria, acute glomerulonephritis.
5. Low-sodium diet:
   1. Heart failure.
   2. Nephrotic syndrome.
   3. Acute glomerulonephritis (varies with degree of oliguria).

COMMON THERAPEUTIC DIETS

1. Clear-liquid diet
   1. Purpose: relieve thirst and help maintain fluid balance.
   2. Use: postsurgically and following acute vomiting or diarrhea.
   3. Foods allowed: carbonated beverages; coffee (caffeinated and decaffeinated); tea; fruit-flavored drinks; strained fruit juices; clear, flavored gelatins; broth, consommé; sugar; popsicles;
   4. commercially prepared clear liquids; and hard candy.
   5. Foods avoided: milk and milk products, fruit juices with pulp, and fruit.
2. Full-liquid diet
   1. Purpose: provide an adequately nutritious diet for patients who cannot chew or who are too ill to do so.
   2. Use: acute infection with fever, gastrointestinal upsets, after surgery as a progression from clear liquids.
   3. Foods allowed: clear liquids, milk drinks, cooked cereals, custards, ice cream, sherbets, eggnog, all strained fruit juices, vegetable juices, creamed vegetable soups, puddings, mashed potatoes, instant breakfast drinks, yogurt, mild cheese sauce or pureed meat, and seasonings.
   4. Foods avoided: nuts, seeds, coconut, fruit, jam, and marmalade.
3. Soft diet
   1. Purpose: provide adequate nutrition for those who have trouble chewing.
   2. Use: patients with no teeth or ill-fitting dentures; transition from full-liquid to general diet; and for those who cannot tolerate highly seasoned, fried, or raw foods following acute infections or gastrointestinal disturbances, such as gastric ulcer or cholelithiasis.
   3. Foods allowed: very tender minced, ground, baked, broiled, roasted, stewed, or creamed beef, lamb, veal, liver, poultry, or fish; crisp bacon or sweetbreads; cooked vegetables; pasta; all fruit juices; soft raw fruits; soft breads and cereals; all desserts that are soft; and cheeses.
   4. Foods avoided: coarse whole-grain cereals and breads; nuts; raisins; coconut; fruits with small seeds; fried foods; high-fat gravies or sauces; spicy salad dressings; pickled meat, fish, or poultry; strong cheeses; brown or wild rice; raw vegetables, as well as lima beans and corn; spices such as horseradish, mustard, and catsup; and popcorn.
4. Sodium-restricted diet
   1. Purpose: reduce sodium content in the tissues and promote excretion of water.
   2. Use: heart failure, hypertension, renal disease, cirrhosis, toxemia of pregnancy, and cortisone therapy.
   3. Modifications: mildly restrictive 2 g sodium diet to extremely restricted 200 mg sodium diet.
   4. Foods avoided: table salt; all commercial soups, including bouillon; gravy, catsup, mustard, meat sauces, and soy sauce; buttermilk, ice cream, and sherbet; sodas; beet greens, carrots, celery, chard, sauerkraut, and spinach; all canned vegetables; frozen peas; all baked products containing salt, baking powder, or baking soda; potato chips and popcorn; fresh or canned shellfish; all cheeses; smoked or commercially prepared meats; salted butter or margarine; bacon; olives; and commercially prepared salad dressings.
5. Renal Diet
   1. Purpose: control protein, potassium, sodium, and fluid levels in body.
   2. Use: acute and chronic renal failure, hemodialysis.
   3. Foods allowed: high-biological proteins such as meat, fowl, fish, cheese, and dairy products- range between 20 and 60 mg/day. Potassium is usually limited to 1500 mg/day. Vegetables such as cabbage, cucumber, and peas are lowest in potassium. Sodium is restricted to 500 mg/day. Fluid intake is restricted to the daily urine volume plus 500 mL, which represents insensible water loss. Fluid intake measures water in fruit, vegetables, milk, and meat.
   4. Foods avoided: cereals, bread, macaroni, noodles, spaghetti, avocados, kidney beans, potato chips, raw fruit, yams, soybeans, nuts, gingerbread, apricots, bananas, figs, grapefruit, oranges, percolated coffee, Coca-Cola, Orange Crush, sport drinks, and breakfast drinks such as Tang or Awake.
6. High-protein, high-carbohydrate diet
   1. Purpose: corrects large protein losses and raises the level of blood albumin. May be modified to include low-fat, low-sodium, and low-cholesterol diets.
   2. Use: burns, hepatitis, cirrhosis, pregnancy, hyperthyroidism, mononucleosis, protein deficiency due to poor eating habits, geriatric patients with poor food intake, nephritis, nephrosis, and liver and gallbladder disorders.
   3. Foods allowed: general diet with added protein. In adults, high-protein diets usually contain 135-150 g protein.
   4. Foods avoided: restrictions depend on modifications added to the diet. These modifications are determined by the patient’s condition.
7. Purine-restricted diet
   1. Purpose: designed to reduce intake of uric acid-producing foods.
   2. Use: high uric acid retention, uric acid renal stones, and gout.
   3. Foods allowed: general diet plus 2-3 quarts of liquid daily.
   4. Foods avoided: cheese containing spices or nuts, fried eggs, meat, liver, seafood, lentils, dried peas and beans, broth, bouillon, gravies, oatmeal and whole wheats, pasta, noodles, and alcoholic beverages. Limited quantities of meat, fish, and seafood allowed.
8. Bland diet
   1. Purpose: provision of a diet low in fiber, roughage, mechanical irritants, and chemical stimulants.
   2. Use: gastritis, hyperchlorhydria, functional GI disorders, gastric atony, diarrhea, spastic constipation, biliary indigestion, and hiatus hernia.
   3. Foods allowed: varied to meet individual needs and food tolerances.
   4. Foods avoided: fried foods, including eggs, meat, fish, and seafood; cheese with added nuts or spices; commercially prepared luncheon meats; cured meats such as ham; gravies and sauces; raw vegetables; potato skins; fruit juices with pulp; figs; raisins; fresh fruits; whole wheats; rye bread; bran cereals; rich pastries; pies; chocolate; jams with seeds; nuts; seasoned dressings; caffeinated coffee; strong tea; cocoa; alcoholic and carbonated beverages; and pepper.
9. Low-fat, cholesterol-restricted diet
   1. Purpose: reduce hyperlipidemia, provide diet ary treatment for malabsorption syndromes and patients having acute intolerance for fats.
   2. Use: hyperlipidemia, atherosclerosis, pancreatitis, cystic fibrosis, sprue, gastrectomy, massive resection of the small intestine, and cholecystitis.
   3. Foods allowed: nonfat milk; low-carbohydrate, low-fat vegetables; most fruits; breads; pastas; cornmeal; lean meats; unsaturated fats such as corn oil; desserts made without whole milk; and unsweetened carbonated beverages.
   4. Foods avoided: remember to avoid the five C’s of cholesterol—cookies, cream, cake, coconut, chocolate; whole milk and whole-milk or cream products, avocados, olives, commercially prepared baked goods such as donuts and muffins, poultry skin, highly marbled meats, shellfish, fish canned in oil, nuts, coconut, commercially prepared meats, butter, ordinary margarines, olive oil, lard, pudding made with whole milk, ice cream, candies with chocolate, cream, sauces, gravies, and commercially fried foods.
10. Diabetic diet
    1. Purpose: maintain blood glucose as near normal as possible; prevent or delay onset of diabetic complications.
    2. Use: diabetes mellitus.
    3. Foods allowed: choose foods with low glycemic index; composed of 45-55% carbohydrates, 30-35% fats, and 10-25% protein. Foods are divided into groups from which exchanges can be made. Coffee, tea, broth, bouillon, spices, and flavorings can be used as desired. Exchange groups include: milk, vegetables, fruit, starch/ bread (includes starchy vegetables), meat (divided into lean, medium fat, and high fat), and fat exchanges. The number of exchanges allowed from each group is dependent on the total number of calories allowed. Nonnutritive sweeteners (aspartame) if desired. Nutritive sweeteners (sorbitol) in moderation with controlled, normal-weight diabetics.
    4. Foods avoided: concentrated sweets or regular soft drinks.
11. Acid and alkaline ash diet
    1. Purpose: furnish a well-balanced diet in which the total acid ash is greater than the total alkaline ash each day.
    2. Use: retard the formation of renal calculi. The type of diet chosen depends on laboratory analysis of the stones.
    3. Acid and alkaline ash food groups:
       1. Acid ash: meat, whole grains, eggs, cheese, cranberries, prunes, plums.
       2. Alkaline ash: milk, vegetables, fruit (except cranberries, prunes, and plums).
       3. Neutral: sugars, fats, beverages (coffee and tea).
    4. Foods allowed: all the patient wants of the following.
       1. Breads: any, preferably whole grain; crackers; rolls.
       2. Cereals: any, preferably whole grain.
       3. Desserts: angel food or sunshine cake; cookies made without baking powder or soda; cornstarch pudding, cranberry desserts, custards, gelatin desserts, ice cream, sherbet, plum or prune desserts; rice or tapioca pudding.
       4. Fats: any, such as butter, margarine, salad dressings, Crisco, Spry, lard, salad oils, olive oil, etc.
       5. Fruits: cranberries, plums, prunes.
       6. Meat, eggs, cheese: any meat, fish, or fowl, two servings daily; at least one egg daily.
       7. Potato substitutes: corn, hominy, lentils, macaroni, noodles, rice, spaghetti, vermicelli.
       8. Soup: broth as desired; other soups from foods allowed.
       9. Sweets: cranberry or plum jelly; sugar; plain sugar candy.
       10. Miscellaneous: cream sauce, gravy, peanut butter, peanuts, popcorn, salt, spices, vinegar, walnuts.
    5. Restricted foods: no more than the amount allowed each day.
       1. Milk: 1 pint daily (may be used in other ways than as beverage).
       2. Cream: ⅓ cup or less daily.
       3. Fruits: one serving of fruit daily (in addition to the prunes, plums, and cranberries); certain fruits listed under Foods avoided, following, are not allowed at any time.
       4. Vegetables, including potatoes: two servings daily; certain vegetables listed under Foods avoided, following, are not allowed at any time.
    6. Foods avoided:
       1. Carbonated beverages, such as ginger ale, cola, root beer.
       2. Cakes or cookies made with baking powder or soda.
       3. Fruits: dried apricots, bananas, dates, figs, raisins, rhubarb.
       4. Vegetables: dried beans, beet greens, dandelion greens, carrots, chard, lima beans.
       5. Sweets; chocolate or candies other than those listed under Foods allowed, preceding; syrups.
       6. Miscellaneous: other nuts, olives, pickles.
12. High-fiber diet
    1. Purpose: soften stool; exercise digestive tract muscles; speed passage of food through digestive tract to prevent exposure to cancer-causing agents in food; lower blood lipids; prevent sharp rise in blood glucose after eating.
    2. Use: diabetes, hyperlipidemia, constipation, diverticulosis, anticarcinogenic (colon).
    3. Foods allowed: recommended intake about 6 gram crude fiber daily: all bran cereals; watermelon, prunes, dried peaches, apple with skin; parsnips, peas, brussels sprouts; sunflower seeds.
13. Low-residue (low-fiber) diet
    1. Purpose: reduce stool bulk and slow transit time.
    2. Use: bowel inflammation during acute diverticulitis or ulcerative colitis, preparation for bowel surgery, esophageal and intestinal stenosis.
    3. Foods allowed: eggs; ground or well-cooked tender meat, fish, poultry; milk; mild cheeses; strained fruit juice (except prune); cooked or canned apples, apricots, peaches, pears; ripe bananas; strained vegetable juice; canned, cooked, or strained asparagus, beets, green beans, pumpkin, acorn squash, spinach; white bread; refined cereals (Cream of Wheat).

FOOD LIST FOR READY REFERENCE IN MENU PLANNING

1. High-cholesterol foods - over 50 mg/100 gram portion: beef, butter, cheese, egg yolks, shellfish, kidney, liver, pork, veal.
2. High-sodium foods - over 500 mg/100 gram portion: bacon - cured, Canadian; beef - corned, cooked, canned, dried, creamed; biscuits, baking powder; bouillon cubes; bran, added sugar and malt; bran flakes with thiamine; raisins; breads - wheat, French, rye, white, whole wheat; butter, cheese - cheddar, Parmesan, Swiss, pasteurized American; cocoa; cookies, gingersnaps; cornflakes; cornbread; crackers - graham, saltines; margarine; milk - dry, skim; mustard; oat products; olives - green, ripe; peanut butter; pickles, dill; popcorn with oil and salt; salad dressing - blue cheese, Roquefort, French, Thousand Island; sausages - bologna, frankfurters; soy sauce; tomato catsup; tuna in oil.
3. High-potassium foods - more than 400 mg/100 gram portion: almonds; bacon, Canadian; baking powder, low-sodium; beans - white, lima; beef, hamburger; fruits, fruit juices; bran with sugar and malt; cake - fruitcake, gingerbread; cashew nuts; chicken, light meat; cocoa; coffee, instant; cookies, gingersnaps; dates; garlic; milk - skim, powdered; peanuts, roasted; peanut butter; peas; pecans; potatoes, boiled in skin; scallops; tea, instant; tomato puree; turkey, light meat; veal; walnuts, black; yeast, brewer’s.
4. Foods high in B vitamins
   1. Thiamine: pork, dried beans, dried peas, liver, lamb, veal, nuts, peas.
   2. Riboflavin: liver, poultry, milk, yogurt, wholegrain cereals, beef, oysters, tongue, fish, cottage cheese, veal.
   3. Niacin: liver, fish, poultry, peanut butter, whole grains and enriched breads, lamb, veal, beef, pork.
5. Foods high in vitamin C: oranges, strawberries, dark-green leafy vegetables, potatoes, grapefruit, tomato, cabbage, broccoli, melon, liver.
6. Foods high in iron, calcium, and residue
   1. Iron: breads - brown, corn, ginger; fish, tuna; poultry; organ meats; whole-grain cereals; shellfish; egg yolk; fruits - apples, berries; dried fruits - dates, prunes, apricots, peaches, raisins; vegetables - dark-green leafy, potatoes, tomatoes, rhubarb, squash; molasses; dried beans and peas; peanut butter; brown sugar; noodles; rice.
   2. Calcium: milk - dry, skim, whole, evaporated, buttermilk; cheese - American, Swiss, hard; vegetables - kale, turnip greens, mustard greens, collards; tofu.
   3. Residue: whole-grain cereals - oatmeal, bran, shredded wheat; breads - whole wheat, cracked wheat, rye, bran muffins; vegetables - lettuce, spinach, Swiss chard, raw carrots, raw celery, corn, cauliflower, eggplant, sauerkraut, cabbage; fruits - bananas, figs, apricots, oranges.
7. Foods to be used in low-protein and low-carbohydrate diets
   1. Low protein (these proteins are allowed in various amounts in controlled-protein diets for renal decompensation): milk - buttermilk, reconstituted evaporated, low-sodium, skim, and powdered; meat - chicken, lamb, turkey, beef (lean), veal; fish sole, flounder, haddock, perch; cheese - cheddar, American, Swiss, cottage; eggs; fruits - apples, grapes, pears, pineapple; vegetables - cabbage, cucumbers, lettuce, tomatoes; cereals - cornflakes, puffed rice, puffed wheat, farina, rolled oats.
   2. Low carbohydrate: all meats; cheese - hard, soft, cottage; eggs; shellfish - oysters, shrimp; fats - bacon, butter, French dressing, salad oil, mayonnaise, margarine; vegetables - asparagus, green beans, beet greens, broccoli, brussels sprouts, cabbage, celery, cauliflower, cucumber, lettuce, green pepper, spinach, squash, tomatoes; fruits - avocados, strawberries, cantaloupe, lemons, rhubarb.
8. Food guide pyramid - guide to daily food selection
   1. Fats, oils: use sparingly.
   2. Milk group: two to three servings.
   3. Meat group: two to three servings.
   4. Fruit group: two to four servings.
   5. Vegetable group: three to five servings.
   6. Bread/cereal group: 6 to 11 servings.