When Does Old Age Begin?

<The boundary between seniors and old people has shifted over the years. Some people are deemed old because they are grandparents—even at forty-five. Others become old when they retire, regardless of age or circumstance. Despite getting a seniors’ discount at age 50, or 60 or 65, some folks don’t fit the definition because of their mindset, Social Security or not. Now that Social Security eligibility in the United States is headed toward 70 and a whole lot of folks are still working, old age might never be attainable. The physical and mental changes can sneak up on us, though. Wrinkles and liver spots, gray hair (if you have hair), reduced lung capacity and voice changes wrought by loss of elasticity are signs of aging. But the mental changes, namely forgetfulness and full-blown dementia, are the more frightening. Depressed mood is common.

Because “out of sight is out of mind” may be truer than we like to think, grandma and grandpa may be among the forgotten, especially if they live more than a few hours distant from the rest of the family. If still a couple, the septuagenarian or octogenarian pair might fare quite well. But if left alone, by death or incapacitation, faring well might be history. Those over age 75 may not be as helpless as they were a decade ago, but their nutrition status is probably the same—miserable. Were it not for assisted living facilities or equivalent communal arrangements, or for home care organizations, or even for dedicated family, many seniors would be categorically undernourished or malnourished. One reason is being alone at the table. The isolated person waits for hunger to drive him to eat, often being satisfied with a bowl of high-carb-low-protein cereal, a can of super-salty soup, or a questionably prepared frozen something. Being alone, regardless of age, has been likened to smoking fifteen cigarettes a day (Cresswell, 2010).

Geriatrics is not the same as gerontology, the latter being the study of the aging process itself, which looks at the psychological and biological aspects. Geriatrics is a sub-specialty of adult medicine that focuses on the aged, which is a time of life determined more by need than by years. An aged body will show a decline in organ systems, some of which can be blamed for choices made earlier in life, including smoking, sedentary lifestyle and poor dietary habits. It’s possible that these can be overcome by quitting, moving and choosing foods wisely.

Nutrient deficiency is common in the elderly because of several factors:  reduced food intake, lack of variety, medications that cause nutrient depletions, financial insecurity, poor oral condition, loss of gustatory sensation, and other dreadful conditions, among which are an uncaring family and a desolate social life. There are some things a single senior can do to help ensure more wholesome intake. Eating away from the kitchen, as on a porch or patio, might excite appetite. Setting the table with a placemat and flowers to brighten things up can make a difference. Inviting neighbors or sharing cooking time helps to encourage mindful eating. The bottom line is that nutrition is a major determinant in aging well because it promotes health and functionality.

Meals have often added a sense of security and meaning to life. That’s hard to get when alone. A single who is sedentary also has a reduced energy need. If a comparable reduction in energy intake is not made, body fat will increase, partly because of choosing foods that are energy-dense instead of nutrient-dense.  This concern requires closer attention than at any other time of life.

Dehydration is a form of malnutrition that is a major problem among those over eighty. Blunted thirst sensation is partly the cause, but so too are medications, cognitive decline and fear of incontinence. Besides constipation, cognitive decline can worsen and death can result from inadequate hydration.

Without enough protein, frailty, lowered immune function and impaired wound healing are issues to face. The RDA of 0.8 grams of protein per kilogram of body weight still holds true in old age. In fact, a little more protein can help to prevent sarcopenia, the wasting of muscle mass attributed to aging. Up to twice as much is still healthy.

The depression that is known to accompany bereavement causes malnutrition and leads to unfavorable outcomes. Loss of appetite in such a situation is common, but the encouragement to eat by a caring family or empathic social network can stave off negative consequences.  Measurement of depressive symptoms using accepted diagnostic tools indicate that as many as forty percent of seniors fit the category, with a considerable number being malnourished, the two states being reciprocal (Ahmadi, 2013) (Mokhber, 2011).

Maintaining nutrition homeostasis is a challenge in the elderly to begin with. Those who are homebound by choice or by chance don’t realize their dietary needs. Some don’t care. But it’s necessary to provide enough protein to maintain tissue integrity, muscle mass and immune function.  We mistakenly think that old age translates to limited kidney function and that protein will unnecessarily tax kidneys. That’s not always the case, especially if hydration is adequate. Someone needs to be there to lead the parade. Loneliness is a complex response to lack of company or to feelings of being disconnected. It can occur even in a household filled with people. As odd as it may sound, loneliness interferes with good health by increasing susceptibility to viral attacks and by intensifying inflammatory responses to stressors (Jaremka, Aug 2013, Jul 2013). The prospect of eating alone reduces appetite, but the opposite is true. Being with family and friends is the best appetite stimulant for the elderly.

Ahmadi SM, Mohammadi MR, Mostafavi SA, Keshavarzi S, Kooshesh SM, Joulaei H, Sarikhani Y, Peimani P, Heydari ST, Lankarani KB. Dependence of the geriatric depression on nutritional status and anthropometric indices in elderly population. Iran J Psychiatry. 2013 Jun;8(2):92-6.

Adam Cresswell, Health editor Isolation as harmful as smoking 15 a day The Australian. July 29, 2010 http://www.theaustralian.com.au/news/health-science/isolation-as-harmful-as-smoking-15-a-day/story-e6frg8y6-1225898190216#sthash.5x6gP5ky.dpuf

Drewnowski A, Warren-Mears VA. Does aging change nutrition requirements? J Nutr Health Aging. 2001;5(2):70-4.

Greeley A. Nutrition and the elderly. FDA Consum. 1990 Oct;24(8):24-6, 28.

Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, Kiecolt-Glaser JK. Loneliness promotes inflammation during acute stress. Psychol Sci. 2013 Jul 1;24(7):1089-97.

Johansson L, Sidenvall B, Malmberg B, Christensson L. Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home. J Nutr Health Aging. 2009 Dec;13(10):855-61.

Johansson Y, Bachrach-Lindström M, Carstensen J, Ek AC. Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study. J Clin Nurs. 2009 May;18(9):1354-64.

Mokhber N, Majdi M, Ali-Abadi M, Shakeri M, Kimiagar M, Salek R, Moghaddam PA, Sakhdari A, Azimi-Nezhad M, Ghayour-Mobarhan M, Soluti S. Association between Malnutrition and Depression in Elderly People in Razavi Khorasan: A Population Based-Study in Iran. Iran J Public Health. 2011;40(2):67-74.

Roe DA. Geriatric nutrition. Clin Geriatr Med. 1990 May;6(2):319-34.

Seiler WO, Stähelin HB. Special aspects of malnutrition in geriatrics. Schweiz Med Wochenschr. 1995 Feb 4;125(5):149-58.

Wham CA, Teh RO, Robinson M, Kerse NM. What is associated with nutrition risk in very old age? J Nutr Health Aging. 2011 Apr;15(4):247-51.