Food and Nutrition for Older Adults

Executive Summary of Recommendations (2012)

Executive Summary of Recommendations

Below are the major recommendations and ratings for the Academy of Nutrition and Dietetics Food and Nutrition for Older Adults Promoting Health and Wellness Recommendations. More detail (including the evidence analysis supporting these recommendations) is available on this website to Academy members and EAL subscribers under Major Recommendations.

To see a description of the Academy Recommendation Rating Scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here .

The Food and Nutrition for Older Adults Promoting Health and Wellness Recommendations are listed below. (Note: If you mouseover underlined acronyms and terms, a definition will pop-up.)

Nutrition Assessment
FNOA: Considerations for Weight Management in the Older Adult
Regardless of age, the registered dietitian (RD) should consider the following when assessing the need for weight management through modifications in dietary intake and physical activity in older adults:
- Classification of overweight or obesity
- Presence of comorbidities
- Physical function
- Cognitive function
- Attitude toward longevity
- Lifestyle
- Personal choice
- Quality of life.
While studies have demonstrated varying associations between assessment indicators of overweight or obesity and physical function and mortality in the older adult, the need for weight loss should be based on input from the physician or geriatrician, RD, qualified exercise specialist and other members of the health care team and will ultimately be the personal decision made by the older adult.
Fair

Imperative
FNOA: Use Multiple Assessment Indicators for Classification of Overweight/Obesity
Regardless of age, the RD should use more than one of the following assessment indicators when classifying overweight or obesity:
- Weight change (and weight history)
- Current (and past) weight, height and BMI
- Waist circumference
- Body composition.
More than one assessment indicator should be used, due to the potential limitations of each indicator in the older adult, such as gender and ethnic differences in their application. In addition, studies demonstrated that muscle mass generally decreases and fat mass generally increases over time, even when weight is stable.
Fair

Imperative
Nutrition Intervention
FNOA: Encourage DRI for All Older Adults
For all older adults, the registered dietitian (RD) should encourage food intake meeting the Dietary Reference Intakes (or other recommended levels) for antioxidant vitamins and minerals and recommend a multi-vitamin if food intake is low. Studies regarding antioxidant intakes below recommended levels reported an association with cognitive decline, however research regarding age-related macular degeneration was inconclusive.

Strong

Imperative
FNOA: Collaborate with Others Regarding Treatment of Diagnosed Age-Related Macular Degeneration
- For older adults with diagnosed age-related macular degeneration, the RD should collaborate with others on the inter-professional team (such as physicians, ophthalmologists, pharmacists and other healthcare professionals) to determine whether an older adult would benefit from high-dose supplementation of antioxidants, as some formulations have side-effects and contraindications.
- Studies have found a beneficial effect of antioxidant (beta-carotene, vitamin C and vitamin E), lutein/zeaxanthin and zinc and copper from diet or supplementation on delaying progression of advanced age-related macular degeneration. However, other studies report inconclusive findings.
Strong

Conditional
FNOA: Advise Against Antioxidants for Treatment of Diagnosed Cognitive Impairment/Alzheimer's Disease
- For older adults with diagnosed cognitive impairment or Alzheimer's Disease, the RD should advise against antioxidant supplementation, as it has not been shown to have an effect and some formulations have side effects and contraindications
- Findings from studies of antioxidant intake above recommended dietary allowance (RDA) levels in subjects with diagnosed cognitive impairment or Alzheimer's Disease demonstrated no difference in the delay of cognitive decline. These findings were substantiated by one systematic Cochrane review.
Strong

Conditional
FNOA: Screen for USDA and OAA Program Eligibility
The registered dietitian (RD) should screen all older adults for eligibility (or refer for screening) in United States Department of Agriculture (USDA) programs and the Older Americans Act Nutrition Service Program and identify potential barriers to participation, such as disability, functional impairment, attitude toward program utilization and income level. Research reported racial and ethnic differences in program participation, as well as in subjects with vision or hearing difficulties, special dietary needs, functional limitations or disabilities.

Fair

Imperative
FNOA: Encourage Participation in USDA and OAA Programs
The RD should encourage eligible older adults to apply for and participate in the following United States Department of Agriculture (USDA) and Older Americans Act (OAA) programs:
- United States Department of Agriculture (USDA)
  - Supplemental Nutrition Assistance Program (SNAP)
  - Senior Farmer's Market Nutrition Program (SFMNP)
  - Child and Adult Care Food Program (CACFP)
  - Emergency Food Assistance Program
  - Commodity Supplemental Food Program (CSFP).
- Older Americans Act (OAA) programs
  - OAA Congregate Nutrition Program
  - OAA Home Delivered Nutrition Program.
Research reported that participation in USDA and OAA programs improved food and nutrient intake, increased fruit and vegetable consumption, stimulated interest in healthy foods, improved quality of life and improved nutritional status. However, some subjects felt that they did not need food assistance and some participants did not know that they were eligible or how to apply.
Fair

Conditional