The aging population is the fastest growing generation, called “baby boomers”, and signs indicate that in the future, there will be a greater need for nutritional programs and policies in order to prevent hunger among the elderly. The elderly population is at a heightened risk of suffering from malnutrition or under-nutrition. Many must make difficult choices on a daily basis, such as: how to meet their needs, or how to obtain the items they need. Often times, the elderly lack sufficient amounts of food items due to lack of finances or transportation and/or proper preparation equipment and tools. There are many programs at the government, non-profit, and private levels that seek to address these issues and provide assistance with meeting nutritional needs but, they are about to be overwhelmed with requests and applications.
Defining the Elderly Population
The elderly are described as being age 65 and older, however, the aging population can further be defined by assigning categorical labels which define each sub-set of the elderly. Riley & Riley (1986) first describes that there are the “young-old” which is comprised of those individuals ages 65-74; Followed by the “old-old”, which are classified as those whom are between the ages of 75-84; Lastly, there are the “oldest-old” which are those people age 85 and over (as cited in, Hooyman & Kiyak, 2011, p. 7).
Photo Credit: U.S. Census Bureau/U.S. Administration on Aging
Although there are many people who may “feel” as though they are younger, or are actually physically healthier than those in a lower age range, the terms listed above use an individual’s chronological age as the identifying terms for the populations addressed in this paper. Racial and ethnic groups can also be used to define a set of the aging population for the purpose of this paper. Minority ethnic groups (as a whole) are expected to grow faster than their Caucasian cohorts over the next decade. (Ferrini & Ferrini, 2008) Race directly correlates to identifying who the elders with nutritional needs are, as a greater proportion of minority elderly live in poverty. Gender also plays a role in identifying those with the greatest nutritional needs, as well as marital status, health, income, and living arrangements.
In short, being elderly can be a direct social determinant of hunger, malnutrition, and under-nutrition, which means there are far more people suffering from hunger in all categories of the elderly population, than other age groups in the U.S.
Nutritional Needs of the Elderly
The Recommended Daily Allowances (RDA) is a standard which guides individuals with making their food choices. The RDA was developed by the Food and Nutrition Board working under the Institute of Medicine for the National Academy of Sciences (Ferrini and Ferrini, 2008). While caloric requirements diminish with age, the actual intake needed varies on an individual basis. As people age, body fat increases, muscle mass decreases, and metabolic rate gradually reduces as elders become less active. This means that they do need slightly less caloric intake than younger people, but the vitamin, mineral and micro-nutrient levels needed, do not change as people age (Ferrini and Ferrini, 2008. pg 313).
There are exceptions however to the needs of the elderly. Some older people remain highly-active and require more caloric intake than the less mobile elderly. Elders are also at higher risk for dehydration due to having less body water composition, therefore requiring the elderly to consume additional water intake. Proteins and carbohydrates are just as important in old age as it is in the younger years, when the body is still growing. Protein is used in the growing body to form muscle and aid in overall growth, but also aids in the healing process from injury, surgery and helps fight illness (Ferrini and Ferrini, 2008). This is what makes it so important in the elderly diet. Carbohydrates in the form of complex carbohydrates are essential for providing vitamins and minerals, as well as to reduce a high-calorie diet. Lastly, fiber is beneficial in high amounts due to its disease fighting and prevention properties. Many diseases, especially chronic disease, can be aided with a high-fiber diet. Diabetes, colon cancer, diverticulitis, heart disease, and high blood pressure may be averted or reversed with a high fiber diet. This is an obvious benefit to the aging population as they are at a higher risk for chronic diseases. Many elderly people do not meet these guidelines or needs. They do not sufficiently meet the recommended servings, according to the USDA Center for Center for Nutrition Policy and Promotions “Food Pyramid” guidelines for daily consumption.
Photo Credit: Tufts University/AARP
Factors That Affect the Nutritional Practices of the Elderly Population
Many people make the mistake of assuming that elders require less nutritional or caloric intake than younger generations. The elderly are consuming less, but not because they require less; it is because they cannot afford to buy, or are not able to obtain the necessary amount. The elderly population is disproportionately at a much higher risk for under-nutrition and malnutrition than other groups. Much of this can be attributed to a variety of factors including economic status, psychological or physiological well-being, and social or personal factors (Wold, 1999, p. 101). According to Wold (1999), 15% to 50% of the elderly population suffers from malnutrition or poor nutrition, with an even higher risk of inadequate nutritional intake. (p. 101)
Economic status plays a major role in nutrition. One must have the funds available to be able to purchase food. A vast majority of the oldest population lives solely on Social Security, and therefore must often make difficult decisions regarding their finances. A common theme among the elderly is choosing between bills, and medication, or food. Nord (2011) states:
One in four of the food-insecure elderly households were food insecure to the extent that one or more household members were hungry, at least some time during the year, because they could not afford enough food.
(Nord, 2011. Para. 2)
The cost of food items also hinders the elderly population’s ability to purchase the proper foods needed to sustain an adequate diet. Many of the protein-rich foods are more costly than the cheaper processed carbohydrate alternatives. Food items such as fresh fruit and vegetables cost significantly more than canned counterparts. Food items frequently come in family-size proportions which can make it difficult for elderly shoppers seeking to find affordable foods in smaller quantities. They often must purchase more food than they can eat before it expires. Also, should a person purchase certain types of foods, such as dairy, meat, and fresh foods, they need to be stored properly in refrigerated environments. Not only does food need to be store properly, but it must be prepared properly as well.
Many of the elderly have a high-level of difficulty paying for their food items, but a large majority of those often have more trouble preparing the food items. Food preparation requires mobility, reflexes, as well as the use of senses such as smell, taste, and touch. As people age, their senses often become less sensitive and dwindle in accuracy. This can make it difficult for them to tell when food is going bad, or has already expired. Additionally, it can also make it difficult to taste whether, or not, it is cooked thoroughly. Aside from the food safety issue while preparing, it is also dangerous for the elderly living alone, who may be frail, to be operating hot appliances when preparing meals. Preparing is essentially impossible for someone who cannot stand, or stand for long periods of time. This causes problems in food preparation, as well as in getting to the store to purchase the food in the first place.
The number of elderly people that have mobility problems creates a major issue in proper or adequate nutrition. The oldest populations, especially the oldest old, often do not drive. This makes it very difficult to obtain food for homebound, or disabled elderly. Should the elderly be able to drive, and shop for themselves, they still may face obstacles in their shopping experience. Some may have a hard time reading labels with small print, others may find it difficult to reach items, and a few may find it too strenuous to push a cart through the entire store once they have arrived. (Wold, 1999)
There are a fair number of programs to assist these people. Meals on Wheels Association of America Foundation (MOWAAF), is one such program that can assist these elders. Another growing trend is call-in orders and delivery by the grocery stores and larger chains stores, as well as community volunteer shoppers. There are also a number of growing farmers markets made available to the aging population to offer them a less costly alternative to fresh fruits, vegetables, and organically grown foods sold in stores.
Health and Eating Habits of the Aging Population
Some of the reasons for the high-level of malnourishment (or undernourishment) can also be applied to the eating habits of the elderly. While food preference may be a form of an eating habit, other more important habits like medical or health related ones are much more significant determinants of poor nutrition. Factors such as health or medical reasons, medication side effects, sickness, dentures, pain, and fatigue of chewing contribute a higher risk of poor nutritional intake (Wold, 1999). Age related conditions, chronic disease, and acute conditions lead to choices in food purchases and/or consumption. Sensory changes, mental health, joint disease, and hearing loss to name a few may be factors in food choice. Chronic conditions such as diabetes, chronic obstructive pulmonary disease, arthritis, HIV/AIDS, and heart disease may also be major factors in nutritional issues in the elderly population. Lastly, acute conditions such as gum disease, influenza, dehydration, infections and pneumonia have dire affects on nutrition in addition to the other causes. All of these health issues may be determinants of poor nutrition, malnutrition, malnourishment, as well as weight changes, organ failure, bone density loss, nerve damage, weight loss, muscle mass deterioration, sensory loss, etc. (U.S. Administration on Aging, 2007. P. 4 [Figure 4]).
In general, people whom are in pain or ill, typically do not eat well as a side effect, therefore a majority of the elderly population does not receive adequate nutrition due to their health concerns. Physical activity also plays a role in disease prevention by preventing certain health problems from arising in the first place.
Obesity causes a number of complications and aggravates a host other ailments. Obesity in the older population is often associated with a lifetime of obesity, or due to a slowing metabolism which results in “creeping weight” over the years as they age. Either way, it is a serious problem which can lead to many other chronic health issues, which are often highly preventable. For the purpose of this paper, obesity in old age is not addressed as a hunger issue, other than in the other complications it causes in other areas, but rather in the nutritional health issues which lead to diet inconsistencies, weight loss, bone loss, and muscle loss; that ultimately result in malnourishment, malnutrition, and hunger.
Aside from economic factors deterring elders from receiving proper nutritional consumption, disease is just as prevalent as a determinant of hunger among the elderly. Psychological factors such as delirium, schizophrenia and other paranoid disorders, dementias, depression, alcoholism, anxiety disorders, and Alzheimer’s disease all have a major effect on the elderly and their ability to be self sufficient, including feeding themselves and making sure they are getting the proper nutrients to be healthy. These types of diseases are often associated with weight loss, lethargy, isolationism, confusion, and even suicide. The most common treatment of these disorders is primarily medication, and psychotherapy or counseling. While counseling may have great affects on those suffering, medication use in old age often just adds another complication to an already aggravated situation. The elderly often have numerous medications to “keep up with”, but when these types of medications are added, it may exacerbate the same issues that they are treating.
Other diseases which may be serious and can lead to hunger issues are those of elderly in the most critical health care situations. Older people whom are recipients of tube feedings, or are bed-ridden are at a higher risk for malnutrition. Hunger is a serious side effect in these cases. Often times the person may not even be able to communicate. Bed sores among the weakest old persons complicate things further and creates an environment for infection, in which proper nutrition is needed in order to overcome and heal. Tube-fed individuals are often getting the minimum requirements to sustain life, and have a difficult time getting all the nutrients that the body requires.
Programs, Initiatives and Organizations that Address Hunger
A growing need for services in the elderly communities across the United States is growing momentum. As the ‘Baby Boomers’ come of age they will become the fastest growing population in the U.S. This calls for a greater need for services to address the needs of the elderly, and in particular, assist them with nutritional needs. Many initiatives have already been taken to help quell the growing epidemic of elderly hunger, and those initiatives have enormous effects on the communities in which they serve, but a greater force is needed to counteract the rapidly increasing aging population.
The cost of food, housing, energy, and medical care creates a great burden on the elderly and programs such as the DHHS Administration on Aging, United States Department of Agriculture, Meals on Wheels Association of America Foundation, local food shelters, area grocers and chain stores, as well as volunteer groups and other private and non-profit organizations have all developed programs, initiatives, policies, or collaborations to help fight hunger among the elderly population.
For seniors who cannot afford food items, or are low income and live below the poverty line, food stamps are available to those seeking assistance. SNAP benefits as they are called, can supplement the cost of food for seniors at risk for hunger. Meals on Wheels delivers food direct to the doorsteps of elderly people in need. Local food shelters have set up transportation services for elderly to be able to attend functions at their locations, and special farmers markets have been established in communities across the nation in order for the elderly to be able to obtain more fresh fruits and vegetables at a cheaper cost and in lower volumes than the larger stores offer. Some grocery chains and small businesses offer call-in service where the elderly can call in an order ahead of time and come pick it up, or have it delivered to them. Also, many communities now have volunteer neighborhood programs in which people drive to the store, and do the shopping for an elderly neighbor or person in their community, and then delivers it to their house for them. Many senior centers across the country hold social events for the elderly to address hunger and proper nutrition in the form of community breakfasts, brunches, lunch, or dinners.
Additional initiatives to combat hunger issues in the elderly population are through social government programs such as Social Security (SS), Supplemental Security Income (SSI), Medicare, Food Stamps, and other legislature such as the Older Americans Act (OAA). These are categorized as entitlement programs which are provided by the government. With the exception of Social Security and Medicare, which are guaranteed to anyone whom has reached a certain age, other entitlements have requirements that must be met in order to qualify. To be eligible for Social Security or Medicare, a person only needs to meet the age requirement. Eligibility for these other programs, however, are need-based and an applicant must fall under certain income guidelines to be approved.
(Note: The above graph shows how the government can automatically deduct funds from your social security retirement to pay back your student loans. Start saving, paying, and planning for this NOW! Something to think about when budgeting for living expenses in retirement.)
Public policies to address the social needs of the elderly have been in place since the 1930’s, with the first official measure taken with the development of the Social Security Act in 1935. Since this time there have been a number of policies, institutions, organizations, amendments, advisory boards, commissions, conferences, grants, and legislation developed; all which seek to address the needs and social problems of the elderly population.
A few of the most critical developments over the last few decades include the Older Americans Act 1965, National Institute on Aging establishment in 1974, Nursing Home Reform Act of 1987, and the Family and Medical Leave Act in 1996 (Hooyman and Kiyak, 2011. pg 697. Table 16.2). Much has been done to make sure that the elderly population does not get neglected in the policymaking arena, but with the rapidly growing population of elders in the last decade, and only more to reach retirement age in the coming decade, a strain is being placed on the existing policies and systems which will require more adjustments to programs and social policies.