22.2 Nutrition for Older Adults: Aging Changes, Needs, Problems, and Senior Citizen Programs

The life cycle competency area includes older persons, a growing share of the Filipino population. Geriatric screening tools such as the Mini Nutritional Assessment and sarcopenia criteria are covered in the life-stage assessment section.

Changes With Aging

Psychosocial and economic factors: living alone, loss of a spouse, depression, dementia, limited income, and difficulty shopping or cooking all reduce food intake.

Nutrient Needs (PDRI 2015)

Common Nutrition Problems

• Malnutrition: from poor intake, illness, poverty, or isolation; screen regularly.
• Sarcopenia and frailty: loss of muscle mass and function. Fried's frailty phenotype counts five criteria: unintentional weight loss, self-reported exhaustion, weak grip strength, slow walking speed, and low physical activity; 3 or more criteria indicate frailty and 1-2 indicate pre-frailty. Resistance exercise plus adequate protein is the main treatment.
• Dehydration: reduced thirst and fear of incontinence; offer drinks regularly.
• Osteoporosis: calcium, vitamin D, protein, exercise, and fall prevention.
• Constipation: fiber, fluids, and activity.
• Dysphagia: after stroke or with dementia; texture-modified diets.
• Polypharmacy: many drugs affect appetite, taste, and nutrient status (for example, metformin lowers B12; diuretics change potassium).
• NCDs: diabetes, hypertension, and heart disease need diet management, but overly strict diets in frail older adults can cause malnutrition, so restrictions are often relaxed.

Meal Planning for Older Adults

• Nutrient-dense foods in smaller portions: eggs, fish, milk, legumes, vegetables, fruits.
• Small, frequent meals and snacks when appetite is poor.
• Soft, moist textures when chewing is difficult: lugaw with egg and malunggay, fish cooked in sauce, soft-cooked vegetables, mashed root crops.
• Flavor without excess salt: garlic, onion, ginger, calamansi, herbs.
• Fortified foods or oral nutrition supplements when intake is low.
• Regular fluids offered between meals.
• Social eating: family meals, community kitchens, and senior center activities improve intake.
• Food safety: older adults are more vulnerable to foodborne illness, so avoid raw or undercooked eggs, meat, and fish, and reheat leftovers thoroughly.

Example. A 75-year-old woman weighs 48 kg. At 1.0-1.2 g/kg, her protein goal is 48-58 g/day. If she eats little meat, the ND might add an egg at breakfast, milk at snack time, and tofu or fish at lunch and dinner.

Laws and Programs for Senior Citizens

• Expanded Senior Citizens Act of 2010 (RA 9994): for citizens aged 60 and older, a 20% discount and VAT exemption on specified purchases, including medicines, medical and dental services, transport, and restaurant meals, and the establishment of an Office of Senior Citizens Affairs (OSCA) in each city and municipality.
• Social pension: indigent senior citizens receive a monthly social pension, raised to ₱1,000 by RA 11916 (2022).
• National Commission of Senior Citizens Act (RA 11350, 2019): created a commission to protect the rights and welfare of senior citizens.
• Community services: senior citizen centers, home visits by health workers, influenza and pneumococcal vaccination, and NCD screening at primary care facilities.

The ND can contribute through screening at senior centers, cooking demonstrations on soft and affordable meals, home care advice for caregivers, and menu planning in residential care facilities.

Tips for caregivers of older adults:

• Serve meals at regular times in a calm, well-lit place, and eat together when possible.
• Check that dentures fit and the mouth is clean before meals.
• Offer finger foods and adaptive utensils to keep the older person feeding independently.
• Keep a water glass within reach and offer drinks every few hours.
• Watch for weight loss, leftover food, coughing during meals, and confusion, and report them to the health team.