Extension Programming to Educate the Elderly about Nutrition

An important issue for the Cooperative Extension System is to assist families with responsibility for dependent elderly by promoting use of community-based programs and resources. This study compared self-perceived problems of life quality and diets of participants in Title III congregate and home-delivered meal programs. The purpose was to generate ideas for collaborative education efforts between Extension and government-sponsored elderly nutrition programs using self-assessed nutrition and life quality issues of the clientele.

Thirty-one self-selected volunteers from the Meals-On-Wheels and congregate meal programs in Logan, Cache County, Utah completed three-day food records and a validated quality of life questionnaire (McKenzie & Jacobsen, 1988) designed for self-evaluation of physical, psychological, and food consumption problems. Average daily intakes of calories, protein, fat, fiber, vitamins, and minerals were computed and compared to national recommendations (Chernoff, 1991). Forty-eight percent of the subjects were congregate meal participants; 52% utilized Meals-On-Wheels; and 65% were female. Ages ranged from 59-91 years, with a sample mean of 76 years, 72 years for males, and 77 years for females.

Meals-On-Wheels participants reported a greater number and severity of physical problems than congregate meal participants. The two groups were not different in self-perceived psychological or consumption problems or overall quality of life. Males reported fewer psychological problems and a higher overall quality of life than females.

Mean nutrient intakes did not differ between the home-delivered and congregate meal groups, but overall sample averages of some nutrients were low (Table 1). Caloric intake was 92% of recommended levels. Intakes decreased with increasing age and declining life quality scores. Energy requirement may decline naturally with age and increased longevity may be related to lower body weight. Even so, it is difficult to consume adequate essential nutrients when caloric intake is limited. The sample average protein intake was 138% of standard and decreased with age even though requirement does not. Optimal dietary protein and appropriate exercise minimize age-related loss of muscle mass and strength. Dietary fiber was less than the recommended 25 grams per day. Low fiber intakes may contribute to constipation, diverticular disease, diabetes, and hyperlipidemia.

Sample mean intakes were low for vitamin B-6, folacin, and zinc. Vitamin B-6 requirement may increase with age. Diets of the very old and sick may be especially deficient, and estrogens used to treat osteoporosis may increase the need for vitamin B-6. Older people tend to maintain adequate folate status despite low intakes, but alcohol and prescription drug use can compromise their folate status. Some zinc deficiency symptoms resemble common problems of the elderly, such as declines in taste acuity, wound healing, and immune response. But, prolonged therapeutic doses to correct low zinc status can lead to copper deficiency and impaired immune function.

Disease prevention and health promotion efforts for the elderly must consider the special needs and risk factors of this clientele. Physical problems of the home-bound elderly do not necessarily influence their psychological outlook or dietary status. Congregate meal participants readily accept nutrition education that is interactive, immediately applicable, and appropriate to their knowledge level. Home-bound elders receiving Meals-On-Wheels may be equally receptive to nutrition education efforts. Many older people rely entirely on their physicians for nutrition and health advice, but others may not consult health professionals due to limited finances, mobility, and geographic isolation. The higher incidence of psychological problems and lower life quality reported by women in this study may be due to longer life spans and solitary living which are important risk factors for disease and disability. Extension agents may be the best resource to evaluate self-perceived problems of the elderly and to coordinate community agencies and organizations, educational and research institutions, health-care systems, and public policy-makers. The synergistic effect of these activities can lead to improved nutritional health and life quality while reducing long-term, health-related costs of older people in our communities.

Chernoff, R. (Ed.). (1991). Macronutrient requirements for elderly persons in geriatric nutrition: The health professional's handbook. Gaithersburg, MD: Aspen.

McKenzie, P. F., & Jacobsen, H. N. (1988). The University of North Carolina Institute of Nutrition quality of life scale for the elderly. Currents, IV(1), 22-29.