Review of the Nutritional Status in Older Adult Population
Department of Food Technology, Nutrition and Food Science (Campus of Lorca), University of Murcia. Lorca (Murcia), Spain
Department of Nutrition and Food Science. University of Granada. Campus of Cartuja s/n. 18071. Granada, Spain
Department of Health Sciences. Catholic University of Avila. Avila, Spain
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
Academic Editor: Noelia González Gálvez
Special Issue: Older People, Health, Functionality and Physical Activity
Received: November 07, 2022 | Accepted: February 21, 2023 | Published: February 27, 2023
OBM Geriatrics 2023, Volume 7, Issue 1, doi:10.21926/obm.geriatr.2301224
Recommended citation: Latorre JA, Abellán C, López-Moro A, Giménez-Blasi N, Conde-Pipo J, Mariscal-Arcas M. Review of the Nutritional Status in Older Adult Population. OBM Geriatrics 2023; 7(1): 224; doi:10.21926/obm.geriatr.2301224.
© 2023 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
1.1 Demographic Data and Determinants of Poor Nutritional Health in the Spanish Older Adult Population
The increase in life expectancy and, in some countries, the low birth rate is leading to accelerated growth in the percentage of older adult people, increasing the aging of the population . Individuals are reaching ages unthinkable in previous eras, and the number of octogenarians has increased significantly .
In the case of Spain, the number of people over 65 has doubled in less than 40 years. Current data show that the population over 65 is around 20%, with over 9 million people, of which approximately 30% are octogenarians. In this sense, and according to projections made by the INE (i.e., Spanish “Instituto Nacional de Estadística”), it is estimated that by 2050 the number of people over 65 years of age will be over 30% of the population (almost 13 million). The number of octogenarians will reach over 4 million .
Of all the physiological changes that occur during aging, the greatest is due to changes in the musculoskeletal system, which loses up to 15% of its fat-free mass. Compared to men in their 20s and 30s, those in their 70s and 80s have about 11 kg less muscle and 10 kg more fat. Losing 11 kg of muscle over 50 years equates to 227 g per year, so individuals may not notice this, because weight remains relatively stable .
Losses of fat-free mass leave older people with fewer mineral, muscle and water reserves to draw on when needed. After the age of 70, weight begins to decline. Age-associated changes in body composition are related to lower levels of physical activity, food intake and hormonal changes .
On the other hand, certain senses such as sight, taste, smell and hearing deteriorate and thus prevent people from enjoying the details of life in the same way . Thus, visual acuity is lost about vision, colors are not easily distinguishable, vision in poorly or brightly lit places becomes difficult, spatial perception (movement and speed) is complicated and difficulties in focusing on distances occur, increasing the reaction time to visual stimuli.
Hearing acuity is also lost, with difficulty perceiving high frequencies and distinguishing background noises, confusing consonant recognition and not detecting warnings. Impairment of taste and smell also occur, affecting the choice of foods, with preferences for those with a stronger aroma and sweet taste.
In terms of general health, complications at the digestive level are common among the older population, including decreased saliva production, jaw wear and loss of teeth in the mouth, decreased peristalsis and acid production in the esophagus and stomach, decreased absorption of nutrients in the small intestine, changes in digestive transit in the large intestine and decreased pancreatic function. At the cardiovascular level there is a decrease in vascular elasticity, with consequent hypertension, as well as a decrease in gas exchange and cough reflex at the respiratory level. In addition, there is impaired renal function and decreased number of neurons, with possible memory and motor coordination failures .
1.2 Food and Nutrition in Spain
The diet in Spain has changed significantly over the last 40 years, moving away in part from the traditional model of the Mediterranean Diet. However, there are still higher intakes of bread, vegetables, fruit, pulses, fish and vegetable oils than in other European countries. This is one of the conclusions included in the "White Paper on Nutrition in Spain," published by the Spanish Nutrition Foundation (FEN) in collaboration with the Spanish Agency for Food Safety and Nutrition (AESAN) . According to recent studies, we consume more fatty meats, sausages and foods rich in simple sugars than recommended. On the other hand, the consumption of cereals, derivatives, vegetables and pulses has decreased, implying an unbalanced calorie profile. Furthermore, the mean salt consumption in Spain is 9.9 g/day, double the current World Health Organisation (WHO) recommendation of a maximum of 5 g per day . The evolution of the pattern of food consumption in Spain is similar to that in the rest of the world's industrialized countries. Thus, from 1950 until well into the first decade of the 2000s, the mean consumption of Kcal/day has been increasing . Furthermore, there is an incorrect distribution of macronutrients, with a greater contribution of proteins and lipids to total daily energy, to the detriment of carbohydrates.
The shift away from the Mediterranean dietary pattern may have health implications, mediated by losses in balance, variety, adequacy, antioxidant content, vegetable weight and cultural aspects that have traditionally been hallmarks of the Mediterranean dietary pattern. This deterioration of the traditional feeding pattern in Spain is shown in many important research studies, such as PREDIMED-Plus or ANIBES [9,10,11].
Cardiovascular disease is the leading cause of death and disability in Western countries, accounting for 1 in 3 deaths in the United States and 1 in 4 in Europe. In 2013, 9 of the top 25 risk factors for this potential loss of life years were related to poor dietary habits.
Cardiovascular disease development is related to several risk factors, such as high blood pressure, dyslipidaemia, type 2 diabetes, smoking and a sedentary lifestyle. The first three are closely related to the type of diet and often to excess weight. Therefore, effective nutritional interventions, smoking cessation and regular physical activity are crucial in reducing these events’ incidence or recurrence. Epidemiological evidence indicates that adherence to the Mediterranean Diet is generally associated with reductions in the risk of cardiovascular disease .
1.3 Nutritional Risks in the Older Adult Population
Preventive nutrition services should address health promotion and disease prevention with a focus on healthy eating and physical activity to reduce the progression of chronic diseases, and maintain functionality and quality of life in the face of disability and dependency.
There are several factors related to nutritional risk in this sector of the population (advanced age, illness, polipharmacy, functional disability, social isolation, depression, etc.), which are closely related to inadequate food and nutrient intakes.
The nutritional requirements at risk for this population sector and their approach can be summarised in Table 1.
In the older population, nutritional care is not limited to disease management and medical nutritional treatment. However, it has broadened to focus more on healthy lifestyle and disease prevention, where improved nutrition and increased physical activity become crucial.
More than any other age group, the older population requires health and nutrition information and is willing to change to maintain their independence and quality of life. They often need help to improve their self-care behaviors and want to know how to eat healthier, exercise safely and be motivated .
2. Material and Methods
A narrative literature review was conducted to determine the nutritional status and risk in the Spanish older adult population. Three databases were searched, and although the articles included in this review were selected from the search results in the PubMed and Google Scholar databases, no usable results for this research could be found among the Science Direct results, despite the large number of them.
An initial general search was conducted to give context to the research topic. The search for articles in these databases was carried out using the keywords "nutrition," "Mediterranean diet," "requirements," “health" and "Elderly," using the boolean operator "and."
Following this, more specific research objectives were set, seeking to address the current health Status and body composition of the Spanish elderly population (The keywords used were: Older Adult Health Status Spain); malnutrition figures and energy and nutrient intake profiles in the Spanish Older population (The keywords used were: Nutritional Status Older adult Spain) and food intake and adherence to the traditional Mediterranean diet pattern in the older population (The keywords used were: Nutritional Status older adult Spain); and the nutritional Status of the Spanish older population (The keywords used were: Nutritional Status older adult Spain, Nutritional Status older adult Spain).
The reading of the titles found in the databases was followed by a first selection based on whether the title provided sufficient information to cover the focus of the selected topic. Some main filters bounded the choice of articles and references: Year of publication: Articles published in the last 10 years (from 2012 to 2022), place of research: Articles carried out in Spain, language of publication: Articles in English or Spanish, study subjects: Older population over 65 years of age, type of publication: Research articles, reports and briefings, availability: Results were limited to only those articles that were published in full text.
2.2 Selection Criteria
Repeated or duplicate articles in the different databases were eliminated. The abstract submitted for the remaining articles were read using the following inclusion and exclusion criteria for their selection or discarding:
2.3 Inclusion Criteria
Studies dealing with the health status of the old population. Studies relating dietary intake based on the Mediterranean Diet. Studies that identify the nutrients and energy intake of our older population.
2.4 Exclusion Criteria
Reviews of the subject or articles that are not complete. Studies include patients with other degenerative pathologies, chronic diseases or age ranges under 60 years. Opinion articles, commentaries or economic studies.
The bibliographic searches described above yielded more than 7000 articles between the two databases. The application of the eligibility and exclusion criteria reduced this number to 21 scientific papers, 7 of which served to answer more than one specific question. The research results are described below in Tables 2, 3 and 4 dedicated to the 3 research questions. Each table shows the main characteristics of the articles collected for the bibliographic review, such as author, year and country of publication, type of article, the methodology followed and the main results presented.
We can see as results of the different BMIs in each article, with overweight and obesity, as well as the reflection of different pathologies referred to the study population, from Diabetes Mellitus 2, dyslipidemia, chronic diseases, depression, heart problems, respiratory diseases and the consumption of drugs (Table 2).
We observed many cases of malnutrition, as well as inadequate nutrient intakes, where dietary recommendations are not met in terms of the percentages of macronutrients, micronutrients and recommended daily portions in the research population (Table 3).
This research work has been developed to establish the nutritional status of older adults in the Spanish population. In order to answer this question, aspects of special relevance for the determination of this nutritional status were addressed, such as the general state of health of the older adults, their body composition and of course their intakes, reflected in the form of compliance or non-compliance with the recommendations both in terms of energy and nutrients, and in the general pattern of food intake and its relationship with the diet that is traditionally followed by them, the Mediterranean Diet.
4.1 Body Composition and Health Status in the Older Adult Population
Maintaining an adequate nutritional status is a preventive element against complications and diseases. In older adults, nutrition has different conditioning factors due to decreased physical activity, decreased thirst, loss of teeth and alterations in taste and smell, which result from aging. In addition, other non-physiological conditions influence the maintenance of appropriate nutritional status, such as functional limitations that impede food preparation, social circumstances, etc. The association of chronic diseases, which increases with age, further increases the nutritional deterioration of individuals. In addition, socio-economic hardship in certain vulnerable groups can exacerbate undernutrition in older adults with illness .
Among the selected scientific papers, BMI values ranging from 4 to 33 kg/m2 represent levels of overweight and obesity in the older adult population [5,13,14,15,16,17,18,19,20]. These values are much higher than those defined as optimal by nutritional guidelines.
A high percentage of subjects participating in the different studies present cognitive deterioration, an aspect that usually leads to the onset of different pathologies such as arterial hypertension, dyslipidemia, diabetes mellitus, cancer, dementia or other pathologies that originate or develop at this stage of age, being risk factors that increase and condition the state of health [5,14,15,16,17,18,19,20,21,22].
The geriatric assessment uses different scales to detect frail older adults, some of which address the nutritional status assessment.
4.2 Energy Intake, Nutrient Intake and Malnutrition
Early diagnosis of malnutrition in primary care is important to prevent its progression through effective interventions. Thus, it is known that a good nutritional status could reduce the number of hospitalizations, increase longevity and improve the quality of life of this population .
About energy intake, the study of the different studies present in the results reveals that only in one of the articles did the participating population comply with the dietary recommendations established for the older adult population. In the rest, diets over 2000 kcal/day are highlighted, which implies high energy intakes, an aspect that can lead to episodes of obesity in certain cases [5,13,23,24,25,26,27].
In terms of nutrient intake, the recommendations of the SEGG (Spanish Society of Gerontological Geriatrics) recommend that the energy intake of the main macronutrients should be distributed as follows: 60% carbohydrates, less than 30% fat, 15% protein, adequate fiber content (20-35 g), vitamins, minerals (calcium 1,200 mg) and fluid intake around 30-35 mL/kg/day . Studies can reflect high amounts of fat, reaching 36-37% and in other cases stable amounts of protein of around 13-18% [13,24,25,26,27]. As has been proven throughout the different bibliographic searches, the MNA is the most widely used instrument for assessing nutritional status as it is a validated tool, simple and quick to use in institutionalised patients.
Among the studies reviewed to estimate the occurrence of malnutrition, this appeared in approximately 3-4% of the subjects and it is noteworthy that in a high percentage we found the risk of malnutrition [5,17,18,19,20,21,22]. Illness-related malnutrition impacts quality of life, contributing to frailty and dependence and leading to vulnerability in older adults. It reduces autonomy, limiting or making tasks such as shopping, carrying bags, preparing food or even eating impossible.
4.3 Food Intake and Adherence to the Mediterranean Diet
About the eating habits of older adults, the data provided by the "Food and Nutrition Guide for our Adults" shows that the diet should include a wide variety of fruit, vegetables and pulses, due to their high fiber, vitamin (antioxidants) and mineral content.
Fish consumption should be higher than meat consumption and 3 to 4 eggs per week. Dairy consumption should reach 3 servings per day, following the food pyramid recommendations that highlight the Mediterranean Diet .
With the results obtained, we can highlight a variety of population that complies and does not comply with the dietary recommendations, obtaining a greater or lesser adherence to the Mediterranean Diet. 53% of the population met the recommendation for fruit consumption, 11% for vegetables, 79% for olive oil, 73% for cereals, 88% for fish, white meat, eggs, nuts and legumes. 81% complied with the recommendation for red meat and intake .
In another article, the percentages of the population that complied with the consumption recommendations were: 67% for vegetables, 33% for fruit, 63% for olive oil, 69% for protein foods, and 24.1% for pulses .
In general, there are better results for the percentage of subjects complying with protein intake recommendations and worse results for plant-based foods [14,26,28,31]. However, one study reported interesting results with high frequencies of compliance for cereals, fruits, legumes, dairy products and olive oil (>70%) and lower frequencies for vegetables (30%) and protein foods (55%) .
In contrast, in another article  there was low compliance with the recommendations in the consumption of whole grains (6.7%), fruit (15%), and nuts (30%). There was high consumption of olive oil (98.3%), legumes (86.7%) and eggs (88.3%), but analyzing the total results, adherence to the Mediterranean Diet was 51.7% of the sample . It is worth noting that 76% of the population of the different articles we have analyzed, as I have shown, comply with the objectives set for a healthy state of health and daily adherence to a Mediterranean Diet . 24% of subjects do not have a healthy lifestyle, which can be associated with poor education in habits or poor personal nutrition.
4.4 Clinical and Practical Implications
In aging adults, nutritional care is not limited to disease management and medical nutritional treatment, but has broadened to focus more on healthy lifestyle and disease prevention.
Without an increased emphasis on improving diets and eating habits, it is not possible to achieve a better quality of life as we age, thus leaving a huge field where nutritionists and other healthcare colleagues have a great job to do to make the lives of our older adult population longer and healthier.
Limitations of the work and suggestions for future research. The main obstacles encountered in the development of the current study were the scarcity of articles that meet our specific objectives in the Spanish population. Much information was found about this pathologies and research projects in different fields. However, developing them about nutrition and original food in our country is essential.
Food is a constant action developed by mankind, it has been evolving and with it, always has the door open to new research to develop new methods or other techniques to learn how to help the older adult population to have a better nutritional status and improve the day to day to contribute to the pathologies that are original in this stage of life.
The older adult population presents a multitude of pathologies that are treated with drugs. In addition to these drugs, dietary optimization would promote a better quality of life. Most older adults adhere to the traditional dietary patterns of the Spanish population, resulting in a reasonably good state of health. There is a small percentage of the older adult population in a state of malnutrition but a large percentage at risk, indicating that nutritionists still have much work to do with this sector. The Mediterranean Diet is a benchmark in dietary patterns whose adherence by this part of the population leads to better aging. Cognitive deterioration means that older adults suffer a great loss of quality of life and must be alleviated in an interdisciplinary way, with the essential participation of nutritional advice. The body mass index is often high, many people have a diet very high in calories and added to the incompatibility of the development of activity can result in the appearance of obesity in the older adult population. Intake of fiber, calcium, vitamin D and protein in the correct amounts is essential to keep the older patient in the best condition.
This paper will be part of Alejandro Lopez-Moro's doctoral thesis. Being completed as part of the “Nutrition and Food Sciences Program” at the University of Granada. Spain. Authors would like to thank the Poncemar Foundation of Lorca Campus (Lorca, Murcia, Spain) for their support.
The study was designed by JAL, NG-B and MM-A; data were collected and analysed by CA, JC-P and AL-M; data interpretation and manuscript preparation were undertaken by CA, JA-L, AL-M, NG-B, JC-P and MM-A.
This study was funded by FEDER-ISCIII PI14/01040 by the Counselling of Economic Transformation, Industry, Knowledge and Universities-Junta de Andalucía (P18-RT-4247) and by The High Council for Sports (CSD), Spanish Ministry of Culture and Sport (RED RDFD “Functional Sports Dynamometry” Ref. 06/UPB/22). This research was supported by an FPU grant from the Spanish Ministry of Universities to Alejandro Lopez-Moro (FPU20/00210).
All authors reviewed and approved the manuscript. None of the authors had a conflict of interest.
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