What are the nutritional requirements for older adults?

As you grow older, choosing a diet that can help you age gracefully and ward off chronic diseases can feel important. Just ask Ellen Whalley of Newton, MA, a married mother of two young adults. Whalley had always been careful about what she ate, but when her kids moved back home during the coronavirus pandemic, she relaxed some of her usual dietary rules. That meant more red meat than usual, for instance, and frequent snacking on cookies and other sweets. One day, she had an epiphany. “I’m 60! I’m not young anymore!” she recalls thinking to herself. “I have to really think about what I eat.”

Whalley now opts for less steak and more salmon, treats her sweet tooth only on rare occasions, and made other changes to create a diet built for better health as she ages. If you’re of a certain age, what should your diet look like? The answer: For the most part, your diet recommendations stay the same, but keep your eye out for certain problem areas that can affect you as you get older.

Older Americans have the healthiest diets in the United States, according to the United States Department of Agriculture (USDA), but that’s not much to brag about. In its recently updated Dietary Guidelines for Americans (produced with the Department of Health and Human Services), the USDA rated Americans’ diet quality with a “Healthy Eating Index,” which has a range of zero to 100. Overall, the typical American received a low score of 59. As a group, older adults score higher, but are still flunking, with a Healthy Eating Index of 63.

The basic rules for boosting those scores are the same for everyone, says the USDA. The foundation of your diet should be nutrient-rich foods such as fruits and vegetables, whole grains, legumes, and low- or non-fat dairy, as well as high-protein foods such as fish, lean meats and poultry, nuts, lentils, and soy products such as tofu. Limit foods high in saturated fat, sugar, and sodium. Also, limit the alcohol you drink (no more than two drinks per day for men, one drink for women).

But, as you glide past middle age, making some changes to your diet may be in order. Here are some things to consider.

If you have packed on pounds lately, it may be that you need to dial back the calories in the food you eat. “Many older adults trend towards weight gain,” says Angel Planells, a Seattle-based registered dietitian nutritionist and national media spokesperson for the Academy of Nutrition and Dietetics.

You gain weight because you consume more calories than your body needs for producing energy, and there are several reasons why this mismatch occurs in some seniors, says Planells. For starters, your metabolism -- the rate at which you burn food as energy -- slows down with age. You may also become less active over time, which reduces your fuel needs. But if you keep eating the same amount as you did in your younger days, unused fuel gets stored as body fat. But it doesn’t have to be, says Planells, who has many older clients who have avoided weight gain by staying active.

Meanwhile, about 1 in 10 seniors in the United States don’t eat enough, especially nutritious foods, a problem known as undernutrition, says geriatrician James Powers, MD, of Vanderbilt University Medical Center in Nashville. Some live in “food deserts” and lack access to well-stocked grocery stores. Others may be too frail to shop or cook for themselves. Isolation, a common experience for many older men and women, can be a factor, too: Studies show that people eat more when they dine with others, says Powers.

Losing 10 pounds or more without trying over a 6-month period is a sign of undernutrition, which can cause many health problems, such as a weakened immune system, Powers says. Dealing with undernutrition can be a challenge, he says. It may involve family members and caregivers to help find solutions, such as signing up for a community meals program.

Powers does not recommend a weight loss diet that cuts calories for anyone after age 75. “When individuals over this age lose weight, they lose muscle mass and actually do worse,” he says. They’re more likely to suffer falls, need nursing care, and have a shortened lifespan.

Not getting the right nutrients can go hand in hand with undernutrition in the elderly. Even if you eat plenty of food, you could still be missing some key nutrients, like the following:

Calcium. The recommended dietary allowance for calcium jumps from 1,000 milligrams daily to 1,200 milligrams for women after age 50. Calcium keeps bones healthy, of course, but that’s not all. “Your body needs it for the heart, muscles, and nerves to function properly, too,” Planells says, adding that calcium also plays a role in guarding against some cancers, diabetes, and high blood pressure. Dairy foods are a top source, but you can also get calcium from leafy greens and fish with bones (such as canned salmon or sardines). Or look for calcium-fortified products, which include some soy and almond beverages and orange juice.

Fiber. While the gastrointestinal (GI) tract seems to be less affected by aging than other organ systems, older men and women still have more constipation and other digestive problems. Eating high-fiber foods such as whole-grain breads and cereals, beans, fruits, and vegetables can help you avoid GI troubles.

Protein. Every cell in your body needs protein to function, but undernourished seniors often get too little from their diets, Powers says. “The body will then use its own protein stores in muscles, so that person will get weaker and weaker unless we replenish with protein.” If you don’t get enough protein, you can land yourself in the hospital. But you can boost your protein intake by drinking protein shakes, Powers says.

Vitamin B12. About 20% of older adults don’t get enough vitamin B12. That’s partly because vitamin B12 becomes harder for the body to absorb over time, Planells says. Plus living on a budget may keep some retirees from affording rich sources of this nutrient. Poultry, beef, seafood, eggs, and dairy products are all good sources of B12. Others include fortified breakfast cereals (check the Nutrition Facts label on the box) and any product that has added nutritional yeast, says Planells.

Vitamin D. The recommended dietary allowance for vitamin D rises from 600 International Units (IU) daily to 800 IU for women after age 70. Vitamin D is essential for healthy bones but may also help fight depression and have other health benefits, Planells says. Oily fish, egg yolks, and fortified foods (like breakfast cereals) are good sources.

Potassium. Older men and women are twice as likely as middle-aged adults to have high blood pressure. Maintaining normal potassium levels can help you keep your blood pressure healthy, which you can do by eating lots of fruits, vegetables, beans, and low- or non-fat dairy products.

Talk to a doctor or registered dietitian before taking dietary supplements to cover any nutrient gaps in your diet, though Powers says popping a daily multivitamin can make sense for seniors who aren’t eating a balanced diet.

Just as your hearing and vision can get worse over time, other senses can be affected, too. “Older folks can lose their sense of taste and smell,” Powers says, “and with that, there can be a decline in the pleasure of eating.” Some people may try to make up for it choosing intensely flavored foods. Too often, he says, seniors will take a heavy hand with the saltshaker or choose high-sodium dishes, which can raise blood pressure. A better idea, Powers says, is to liven up dishes with spices and herbs instead.

A hard time swallowing caused by an esophagus that’s too tight is another physical change that affects some seniors and can make eating less pleasant, Powers says. One common cause is damage to the esophagus caused by acid flowing upward from the stomach, known as gastroesophageal reflux (GERD). Treating GERD with a type of drug called a proton pump inhibitor such as omeprazole or lansoprazole can often relieve the problem, Powers says, though sometimes an outpatient procedure is needed. But simply switching to softer foods, alternating bites with plenty of fluids, and eating more slowly can ease the hard time you have with swallowing, too, he says.