Common health problems in old age

Constipation

Constipation is a common problem in older people, affecting one in five in this age group. Most at risk are those who have a poor diet and who take little exercise. Adequate intake of fiber and fluids should be promoted, as well as some physical activity if possible. Sources of fiber include wholegrain cereals, wholemeal flour and bread, wholegrain rice, pulses, fruit and vegetables. If there are chewing difficulties, vegetables can be pureed to produce soups and fruit pureed to produce drinks. The addition of pure bran to foods is not recommended because it can interfere with the absorption of several minerals. Regular meals and snacks can help to ensure a good nutritional intake. Laxatives should not be the treatment of choice.

Anemia

Iron-deficiency anemia is common in older people, particularly those in residential care, where 52% of men and 39% of women have been reported to have low hemoglobin levels (Finch et al.,
1998). This may be a result of poorer absorption of iron, e.g. the consumption of tea was high among the group with low hemoglobin levels and the tannins in tea inhibit the absorption of non-haem iron. Furthermore, gastric disorders are more common in older people, which can also interfere with efficient iron absorption or result in blood loss. The best food sources of iron are those containing iron in the haem form. Non-haem sources of iron can also make a useful contribution to overall intake.

Diabetes

Around 1.4 million people in the UK currently suffer from diabetes. Between 75% and 90% of cases have type 2, or non-insulin-dependent diabetes, and 10–25% have type 1, or insulin-dependent diabetes. Dietary treatment of diabetes no longer involves the restriction of carbohydrate foods. Diabetic diets today are based on healthy eating principles. This
means following a diet that is low in fat and high in carbohydrate, particularly complex carbohydrate. Intake of concentrated sources of sugars, such as sugary foods or drinks, should be limited, however. The use of special diabetic products should not be necessary. Regular meals and snacks should be encouraged. Physical activity should be promoted where possible and, if a person is overweight, advice to lose weight may be appropriate.

Overweight and Underweight

Overweight and obesity affect a significant proportion of older people. In the Diet and Nutritional Survey of people aged 65 years and older, it was found that among free-living participants 67% of men and 63% of women were either overweight or obese (Finch et al., 1998). The corresponding figures for those living in residential care were 46% and 47% for men and women, respectively. Some overweight older people, particularly those who have reduced mobility or osteoarthritis, may wish to lose weight. It is important, if reducing energy intake, to ensure that the diet is still properly balanced and provides sufficient vitamins and minerals to meet requirements. Any weight loss should be slow and gradual, at a rate of about 1–2 lb/week.


Underweight, on the other hand, poses a greater risk to the health of older people than being overweight. This is a problem that is more prevalent in those living in residential care, where in the survey of people aged 65 years underweight. The corresponding figures for those living in the community were 3% for men and 6% for women, respectively. Being underweight in old age has been shown to correlate with shorter survival. Predisposing factors to malnutrition have been identified as living alone, being housebound, not having regular cooked meals, being on supplementary benefits, being of a lower social class, suffering from depression, having low mental test scores, having poor dentition, having chronic bronchitis or emphysema, having had a gastrectomy, experiencing swallowing difficulties, smoking and having alcohol problems. These risk factors do not necessarily indicate the need for intervention, but should be viewed as potential danger signs.

Heart disease and stroke

Coronary heart disease and stroke are significant causes of death and ill-health. They cause almost 115 000 deaths each year in England. Strokes caused over 54 000 deaths in 1997, most of which were in people over the age of 75 years. Any strategy that limits the prevalence of these conditions will improve life expectancy and quality of life in older people. General healthy eating advice applies equally to older people, e.g. consuming a low-fat, high carbohydrate diet that is rich in fruit and vegetables. Consumption of oil-rich fish is also recommended, at least one portion a week. Only for very old or frail people is this advice sometimes inappropriate; these people should be encouraged to eat whatever they can

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