Features of nutrition in old age. Sample menu for an elderly person Principles of nutrition for the elderly

A. Yu. Baranovsky, Doctor of Medical Sciences, Professor, Head of the Department of Gastroenterology and Dietology, North-Western State Medical University. I. I. Mechnikova, St. Petersburg, doctor of the highest category

Carrying out a large amount of therapeutic and preventive work among the population of various ages, nutritionists note that among the elderly there are many people who have fairly good health, who have retained satisfactory vigor of mind and body by retirement age, who reasonably belong to the category, albeit conditionally but healthy people. The most important thing in this regard is that the indicated category of elderly people is also interested in further maintaining their health. For them, this article has been prepared.

Rational nutrition (from lat. rationalis - reasonable) is a physiologically complete nutrition of healthy people, taking into account their gender, age, nature of work, and climatic living conditions. Rational nutrition contributes to the preservation of health, resistance to harmful environmental factors, high physical and mental performance and active longevity. Dr. Tom Spies said at the 1957 convention of the American Medical Association: "If we had enough knowledge, we could prevent or cure all diseases only with the help of proper nutrition."

What does this statement and the definition of rational nutrition have to do with elderly people, especially senile ones, who, as a rule, are burdened with certain diseases of a predominantly chronic nature? Indeed, in our time and in our country, where state policy has not yet moved from words to active actions to preserve the health of its citizens, especially of older ages, where a sense of careful and interested attitude of citizens of all ages to their health has not yet been brought up, Russians cannot call even at least a conditionally healthy nation. What in this connection can be said about the elderly and old people?

Despite the overall unfavorable picture with the health of our compatriots, the author of the article excludes for himself even the slightest possibility of a gloomy attitude towards the prospects for healthcare in Russia. The aforesaid fully applies to the gerontological contingent of the population. The most important task of every doctor, inherent in the essence of our profession, is to do everything in his power not only to treat already developed diseases, but also to preserve people's health, to ensure the preventive focus of all our activities.

Principles of nutrition for the elderly

Discussion of the problem of nutrition as an important component of a healthy lifestyle for an elderly person is extremely important when considering issues of geronto-dietology.

The nutrition of practically healthy elderly and old people is based on the following basic principles:

• compliance of the energy value of the diet with the actual energy consumption of the body;
• preventive orientation of nutrition, taking into account the possibility of preventing or slowing down the development of atherosclerosis and coronary heart disease, hypertension, diabetes mellitus, cholelithiasis, cancer, osteoporosis and other pathologies common in old age;
• compliance of the chemical composition of the diet with age-related changes in metabolism and functions of organs and systems;
• a variety of food set to ensure a balanced content in the diet of all essential nutrients;
• the use of products and dishes that have a fairly easy digestibility in combination with products that moderately stimulate the secretory and motor functions of the digestive organs, normalize the composition of the intestinal microflora;
• the correct diet with a more even distribution of food in separate meals compared to a young age;
• individualization of nutrition, taking into account the characteristics of metabolism and the state of individual organs and systems in specific elderly and old people, their personal long-term eating habits.

In order to form a correct concept of proper nutrition among the population and to work individually with patients, WHO experts created a visual and easy-to-use “nutrition pyramid”, which includes five food groups (see Fig. 1). The division of products into groups was made depending on the primary source of which nutrients they are (see Table 1).

Rice. one. food pyramid

If the average calorie content of food is 2000-2200 kcal / day, then the optimal diet (according to the food pyramid) looks something like this.

The first group (the basis of the pyramid) is the largest component (up to 40%), includes all kinds of cereals, rice, potatoes, bread and pasta. By weight, this is about 1.5 kg, but the choice of products is important: it is preferable, for example, unpolished cereals with a high content of dietary fiber or wholemeal bread.

The second group (35%) - vegetables and fruits, required in the amount of 400 g / day. This does not include canned cucumbers, tomatoes, etc. In any other form - frozen, dried, boiled - vegetables and fruits are absolutely acceptable. At the same time, it is recommended to consume both vegetables and fruits during the day.

The third group - even less significant (20% of the total) - protein, about 200 g of any food: chicken, fish, meat, eggs and alternative foods (legumes, nuts) - is quite enough for healthy functioning. It is recommended to choose foods low in fat.

The fourth group - dairy products (milk, cheese, sour-milk products), are consumed in approximately the same volume. It is also recommended to choose foods low in fat.

The fifth group - all types of fats and sweets - is the smallest, represents fats, oils, foods high in fat (sausages, fatty meat, pastries, etc.), salt, as well as sugar and foods high in sugar (sweets, sweetened drinks, syrups, etc.). The share of this group should not exceed 5%.

Portion calculation

For the convenience of calculating the diet, a system of food portions was created (see Table 1). Depending on a number of indicators - the patient's age, gender, physical activity, body weight (presence of obesity), etc. - the number of servings is modified within the specified limits.

Table 1. Sizes, composition and number of servings of products in the daily diet according to the food pyramid

Despite the apparent simplicity and approximation, the calculation of the content of the main nutrients in the diet according to the portion system is quite accurate and greatly facilitates both the work of a dietitian and the calculation of the diet by the patient himself.

The approximate content of nutrients in one serving is presented in table. 2.

Table 2. Content of Key Nutrients Per Serving

Calorie requirement

So, first of all, about the energy balance of the body. The Institute of Nutrition of the Academy of Medical Sciences of the USSR developed physiologically based norms of calorie requirements depending on the nature of professional activity, sex and age of a person.

According to the intensity of physical activity, the adult population is divided into five groups:

Group 1 - persons whose work is not associated with the cost of physical labor or requires little physical effort (knowledge workers, employees, non-working pensioners);

2nd group - workers whose work does not require great physical effort (workers in automated processes, workers in the radio-electronic industry, communications, telegraph, conductors, salesmen, etc., as well as working pensioners);

3rd group - persons whose work is associated with significant physical effort (machine operators, textile workers, transport drivers, shoemakers, postmen, laundry workers, foremen of tractor and field farming teams, catering workers);

4th group - workers of non-mechanized hard labor (casters, carpenters, construction workers, agricultural workers, metallurgists, blacksmiths);

5th group - workers engaged in especially hard physical labor (miners employed directly in underground work, steelworkers, diggers, logging workers, masons, loaders, whose labor is not mechanized).

In table. Figure 3 presents data on the daily energy requirement of an adult young and middle-aged person, based on the allocation of the above five population groups.

Table 3 Daily energy requirement of the adult population in cities and villages with developed public services, kcal

The energy costs of older people are significantly lower than the energy costs of young and middle-aged people: by an average of 21% at the age of 61-74 years and by 31% at the age of 75 years and older. The energy value of their daily diet recommended by physiologists depends on this (see Table 4).

Table 4 Approximate energy value of the daily diet for persons of older age groups

An analysis of the materials presented in the table indicates an excess of high-calorie nutrition for most elderly people in the Russian Federation, which negatively affects the aging process. Our study on the effect of excess caloric nutrition on the biological age of 186 elderly people (the age of the examined persons is 61-75 years) shows (see Fig. 2) that excessive caloric nutrition adversely affects the aging process: biological age is ahead of passport age by more than thirty %. In the control group - almost 15%.

Rice. 2. Biological age of older people (N = 186) with excess caloric intake

All food products, depending on their calorie content (per 100 g of the edible part of the product), can be divided into five groups:

1st - very high calorie content (450-900 kcal): butter, vegetable oil, nuts, chocolate, halva, puff pastries with cream, fatty pork, raw smoked sausage.

2nd - high calorie content (200-400 kcal): cream, sour cream, fat cottage cheese, cheese, ice cream sundae, meat pork, boiled sausages, sausages, meat of geese and ducks, fatty herring, saury, salmon, caviar, cereals, pasta , bread, sugar, honey, jam, marmalade, fondant sweets.

3rd - moderate calorie content (100-199 kcal): semi-fat cottage cheese, dairy ice cream, lamb, beef, rabbit and chicken meat, eggs, horse mackerel, mackerel, sardines, low-fat herring, sturgeon.

4th - low calorie content (30-99 kcal): milk, kefir, low-fat cottage cheese, cod, hake, pike perch, flounder, carp, pike, Ocean pasta, fruits, berries, potatoes, beets, carrots, green peas.

5th - very low calorie content (less than 30 kcal): zucchini, cabbage, cucumbers, radishes, lettuce, turnips, tomatoes, pumpkin, sweet peppers, cranberries, fresh mushrooms.

A decrease in calorie content (i.e., malnutrition) leads to a physiologically unjustified consumption of not only energetically significant nutrients - carbohydrates, fats, but also the proteins of the body itself, to a decrease in the mass of skeletal muscles. As a result of this, human performance decreases, immunodeficiency develops, dystrophic processes occur, and aging of the body is activated. Excessive calorie intake, as is known, leads to the deposition of fats and carbohydrates in the form of subcutaneous fat in fat depots and other organs, to weight gain and obesity, to the progressive course of aging processes.

Misconceptions of modern geronto-dietology

Very difficult situations in the body of an elderly person can occur both with a deficiency of dietary protein and with its excessive intake. In modern gerontodietology, there is a point of view that justifies the expediency of using significant protein-energy restrictions in the rational nutrition of older people (by 25-30% or more in relation to the current physiological nutritional norms for the elderly and the elderly).

Point of view - the occurrence of "mild stress"

So, in the laboratory of V. N. Nikitin, in an experiment, it was found that with a limited diet, neurohumoral regulation changes significantly: the concentration of the pituitary hormone corticotropin and the hormone of the adrenal cortex corticosterone increases in the blood, the concentration of thyroid-stimulating hormone, thyroxine, insulin decreases. Dieted animals differed from controls in mating ability - it lasted up to 33-36 months compared to the usual 20-28. According to V. N. Nikitin (1999), the mechanism of action of the diet on the body is associated with the occurrence of “soft stress”, under which many life processes proceed differently.

Point of view - increasing the efficiency of metabolic processes

Animal studies led by V. V. Frolkis (1992) showed that limiting the caloric content of food consumed by 20-60% causes a prolonging effect. Food at the same time should be qualitatively complete (vitamins, microelements). Transferring young mice to feeding every other day increased lifespan by 17%. The transfer of older animals led to an increase in life expectancy by 30%. An increase in life expectancy was also observed when “older” mice were transferred to a diet. An association has been found between the age at which animals start dieting and life expectancy. If the body begins to lack calories, as well as protein, then it turns on an adaptive reaction, which consists in slowing down or increasing the efficiency of metabolic processes. According to the author, with a slow metabolism, it is easier to satisfy the need for calories and protein. Moreover, the slower or more economical the exchange, the longer the organism lives. It should be noted that we are talking about experimental material, examples and conclusions of which some nutritionists are trying to use today, unconsciously extrapolating the results of the experiment to humans.

"Humanization" of experimental data

It is very important to emphasize that there is some optimal amount of dietary restriction. Indeed, even experimental data show that at first, as the calorie content of food decreases, the life span of mice progressively increases, and then this does not lead to further growth and even increases mortality. And from these positions, the conclusion of some experimenters and representatives of the so-called alternative medicine is absurd (V. V. Bezrukov, 2000; V. I. Dontsov, 2005; G. I. Valdenberg et al., 2001 and others): the fewer calories and protein in food, the longer life.

Of course, there is a scientifically proven physiological limit to the reduction of protein in food and its calorie content. It is important to emphasize again and again that the greatest care must be taken when transferring experimental data to humans. After all, life should be not only long, but also full. A lot of work is needed to "humanize" the experimental data, to find the optimum dietary effects. A simple, formal transfer of the results of experiments from animals to humans is unacceptable!

Human Research

The fundamental need to revise a number of nutritional norms is evidenced by data on the relationship between nutritional characteristics and human diseases. Long-term follow-up of members of the so-called anti-coronary club in New York showed that low-calorie (1600 kcal) and low-fat diets (10% of energy consumption) reduced coronary heart disease by 3.5 times. The Kiev Institute of Gerontology found that the degree of atherosclerotic disorders in older people with a daily caloric intake of 1600-2100 kcal is significantly less than those whose diet was 2650-3100 kcal.

We have conducted studies that included a long-term comprehensive clinical observation of 224 elderly people (61-75 years old) of both sexes who are on different diets in terms of protein and energy content. The materials showed that a long-term decrease in the calorie content of the diet and the protein content in it by 25% or lower in relation to the physiological norm for this age group led already after 6 months to the appearance of signs of protein-energy deficiency in the elderly, a noticeable decrease in muscle mass, quantitative depression of a number of indicators of the immune system (especially the total number of lymphocytes, mainly due to T-lymphocytes) and the general reactivity of the body. But the most demonstrative in the study, in our opinion, are the results concerning the dynamics of the biological age of the surveyed contingents (see Fig. 3).

Rice. 3. Biological age of older people (N = 224) with protein-energy malnutrition

It turned out that a long-term protein-energy deficiency in the diet of elderly people led to a fairly pronounced advance of their biological age in relation to the passport (calendar) in comparison with the control group. This allows us to speak unequivocally about the stimulating effect on the aging process of the nutritional deficiency of the diets of the elderly and the need to comply with the above described principles and quantitative characteristics of rational nutrition.

Compliance with the requirements for a healthy diet for older people

As another argument in favor of the physiological significance of compliance with the existing requirements for a healthy diet for older people, we present the results of another fragment of our "geronto-dietological" study. They reflect the main indicators of the quality of life of the examined elderly people who are long-term on diets of various contents and fulfillment of rational requirements for the use of daily diets (see Fig. 4).

Rice. 4. Dependence of the quality of life of the elderly on the nature of nutrition

Designations: OZ - general health; FF - physical functioning; Zh - viability; PZ - mental health; SF - social functioning.

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It has been established that the irrational nutrition of the elderly, in contrast to those who competently comply with most of the prescribed requirements for the chemical composition of rational nutrition and methods of its application, contributes to the deterioration of almost all the main indicators of the quality of life of the examined persons. This was all the more clearly demonstrated against the background of the results of a medical and sociological survey of the population of St. Petersburg, carried out by A. A. Novik et al. (1999, 2002). The most significant negative impacts of inadequate nutrition in older people are noted in assessing their physical condition, as well as social functioning.

Nutritional balance for the elderly

Let us characterize the nutritional features of elderly and senile people in more detail.

How much protein?

The question of the protein composition of the diet in the elderly and senile age has not been unambiguously resolved. In an aging body, the synthesis of hormones, various protein structures is reduced, the regeneration process is slowed down, the synthesis of enzymes, including those that break down protein-lipid complexes, does not proceed as fast as in younger people. The process of digestion and assimilation of meat proteins is very complex, while the activity of digestive enzymes is reduced in old age. At the same time, the breakdown of proteins and their loss by the body increase. At the same time, it has been established that food restriction, a decrease in the protein composition of the diet, which lowers immune activity at a young age, causes the opposite effect in older people: the activity of cellular and humoral immunity factors increases. Therefore, in old age, it is advisable to reduce the protein rate to 1 g per 1 kg of body weight, which will not allow the development of protein-energy deficiency processes, but will not activate catabolism.

It is important to ensure the optimal proportion between animal and vegetable proteins in the diet is 1:1. At the same time, among proteins of animal origin, preference should be given to proteins of fish and especially milk. The most useful is river fish (perch, pike, carp), and from marine fish - cod varieties. The amount of fish in the diet should be brought up to 75 g / day.

An elderly person can afford 2-3 eggs per week, preferably soft-boiled, or in the form of an omelette, or as an addition to meals.

Meat "overloads"

Meat and, to a lesser extent, fish (ivasi, sardines and some other varieties) are rich in purine bases - a source of uric acid formation in the body, which contributes to the occurrence of hyperuricemia with the formation of uric acid diathesis and gout. Therefore, meat "overloads" are very difficult for the elderly to tolerate.

Purine bases are converted into broths when meat, poultry or fish are cooked. This is one of the reasons for the undesirable use of concentrated broths in the diet of the elderly.

Another reason for the restriction of meat in old age is the appearance in the body of an excess amount of products of nitrogenous origin (azotemia) due to the weakening of metabolic processes. In addition, fatty meats contain a significant amount of cholesterol.

The foregoing allows us to recommend that older people limit the consumption of meat and meat products. It is advisable to arrange fasting days 1-2 times a week, and on the remaining days, use a meat dish once in the diet (100 g in finished form). It is preferable to cook meat, fish dishes, as well as poultry dishes in boiled form.

The benefits of dairy products

Older people are recommended to enter into the diet up to 30% of proteins due to dairy products. This is primarily cottage cheese, the amount of which in the daily diet can be 100 g. If possible, low-fat cottage cheese should be preferred as it has less calories and has a higher protein content.

Cheeses are included in the diet. In amounts of 10-20 g, any kind of cheese may be allowed for elderly and old people. However, we should not forget that cheese, one of the main suppliers of calcium, at the same time contains a lot of fat, cholesterol and salt. It is better to choose mild and unsalted varieties.

With good tolerance, milk should be present in the diet of an elderly person (300-400 g / day). In old age, a decrease in the activity of digestive enzymes increases the likelihood of poor tolerance to fresh milk (flatulence, rumbling, diarrhea). Tolerability improves when drinking boiled milk or adding it in small amounts to tea, coffee. Fermented milk products are especially useful - kefir, yogurt, acidophilus. Their positive effect is mainly due to the presence of lactic acid bacillus, which maintains the normal composition of the intestinal microflora, which prevents the development of putrefactive processes in the intestine and improves the antitoxic function of the liver. It is recommended to consume 200 g of kefir or other fermented milk products daily, preferably in the evening, before going to bed. Can be added to kefir 1 tbsp. l. vegetable oil, stirring it well.

50% - vegetable proteins

Vegetable proteins should make up half of the protein portion of the diet. They are mainly represented by cereals and legumes. However, these products are poorly tolerated, causing increased gas formation, belching, heartburn, rumbling, and upset stools. Only green peas or green beans are usually added to the diet as a side dish in small quantities. In addition to being poorly tolerated, a major reason for restricting legumes is their high purine content.

Of the cereals, buckwheat and oatmeal are the most useful. Adding milk to these cereals brings their amino acid composition closer to the optimal one. With good tolerance, millet and barley porridges are included in the diet. Rice is limited due to its fixing action. Semolina is recommended for those patients who, for one reason or another, need a sparing diet.

Norm of bread

The source of vegetable protein is bread, it is highly recommended to introduce rye bread into the daily diet. It is better to use wholemeal bread or bread with bran. Rye bread is more complete in terms of amino acid composition. Along with other cereals, rye bread is a source of vitamin B, minerals and fiber. In cases where rye bread causes heartburn or other symptoms of dyspepsia, enhancing fermentation processes, it is better to use it dried.

Bread made from wholemeal flour or bran, promoting bowel movement, improving its motor activity, does not give discomfort. Elderly people are recommended to consume up to 300 g of bread per day. Half of the daily allowance should be performed at the expense of bran bread, from wholemeal flour or rye.

Fat ratio

The amount of fat in the diet of older people should be moderate. A limit on the amount of fat in the diet is set - 70-80 g, and for people over 75 years old - 65-70 g.

It is very important to observe a certain ratio between animal and vegetable fats. At the same time, one should strive to increase the proportion of vegetable oils in the diet to half the total amount of fat. But this measure must be carried out carefully. Often there are cases when the desire to achieve high therapeutic efficacy from the use of this product is ensured by its uncontrolled increase in the diet to quantities that cause only a violent laxative effect, adversely affecting the patient's health.

The introduction of the required amount of vegetable oil is dictated primarily by the prevalence of polyunsaturated fatty acids in it. These acids are not synthesized in the body. The second very important component of vegetable oils are phosphatides (lecithin) and the third - phytosterols. Together, all these biologically active substances have a beneficial effect on cholesterol metabolism.

With a deficiency of vegetable oils and their component - phospholipids - liver steatosis can form with metabolic disorders corresponding to this condition. Vegetable oils contain tocopherols, which have an antioxidant effect. These substances neutralize free radical reactions, improve DNA metabolism, reducing degenerative changes in organs during aging.

The good choleretic effect of vegetable oils is of great importance for the elderly in connection with the bile stasis syndrome typical of this period. We must not forget about the laxative effect of vegetable oils, which is also very important in old age.

Among animal fats, butter should take the main place in the rational nutrition of the elderly. It refers to milk fats, the most easily digestible. Its beneficial properties are also determined by the presence of vitamin A. Usually, 15 g of butter per day (along with cooked food) is recommended, adding it just before serving the dish. It should be borne in mind that butter is resistant to heat treatment.

Elderly people need to limit the introduction of cholesterol. 300 mg of cholesterol per day is considered acceptable.

Restriction of carbohydrates in the diet of elderly and senile people

The amount of carbohydrates in the diet of elderly and senile people is limited. This is dictated primarily by the overall reduction in energy costs. Carbohydrates should be about 300 g in the daily diet. It is advisable to limit carbohydrates mainly due to simple sugar and sweets, while vegetables, fruits and grains should be in sufficient quantities in the diet.

less sugar

You should beware of excess sugar, which can lead to an overstrain of the pancreas, contribute to the development of diabetes, and adversely affect the functions of the liver and biliary tract. In elderly and senile people, an excess amount of sugar increases the concentration of triglycerides, low-density lipoproteins and increases the level of cholesterol in the blood, contributing to the same excess accumulation of fat mass. Elderly people are recommended to consume 30-50 g of sugar and sweets per day. Preference should be given to fruits, berries or honey, where sugars are represented mainly by fructose.

More dietary fiber

It is advisable to increase the intake of complex carbohydrates containing fiber, pectin, etc., which are currently united by the term "fibrous food substances (dietary fiber)". Fiber and pectin substances are almost not absorbed. Due to their physical and chemical properties, they have the ability to adsorb food and toxic substances and improve the bacterial content of the intestine.

Especially important is the regulating effect of dietary fiber on bowel emptying and pressure reduction in it. Activation of motor activity of the intestine, normalization of stool under the influence of dietary fiber seem to be a real measure for the prevention of diverticulosis and malignant neoplasms. In addition, dietary fiber helps lower blood cholesterol and bile levels. There are indications of a relationship between the occurrence of dental caries and an insufficient amount of dietary fiber in the diet. For the elderly, the amount of fiber should be 25-30 g / day.

The role of vitamins in the diet of elderly and senile people

Vitamins and minerals in the diet of elderly and senile people deserve special attention. In older people, vitamin deficiency can develop due to metabolic disorders characteristic of age, when the processes of absorption of vitamins suffer to a large extent. In addition, when the composition of the microflora changes, its ability to synthesize vitamins also suffers. At the same time, saturating the body of old people with vitamins is especially important, since vitamins C, P, groups B, E and others serve as stimulants and regulators of oxidative processes.

Mention should be made of the selective effect of vitamins C and P on the permeability of the vascular wall, and the positive effect of vitamin C on cholesterol metabolism. Providing vitamin A, which has a specific effect on the condition of the skin, mucous membranes and organs of vision, is especially important for the elderly. The wide spectrum of action of B vitamins makes it necessary to include them in the diet of the elderly.

A nutritious diet that is recommended for older people, enriched with grains and fresh fruits, usually allows you to enrich the diet with vitamins. But even in the summer and autumn seasons, when there is an abundance of vegetables and herbs, fruits and berries in the diet, older people need to additionally inject vitamin preparations.

Potassium, copper, chromium, iodine, etc.

Although the need for minerals is relatively small, it is not always easy to provide them to the elderly. With age, there is an accumulation in the body of some of them and a decrease in others. The content of potassium, copper, chromium, iodine, iron, and some others is falling, while zinc, lead, sodium, and a number of others are increasing. The problem of calcium has not been solved. As you know, the aging body is able to accumulate calcium in the wall of blood vessels. At the same time, calcium deficiency is often one of the causes of senile osteoporosis. Insufficient iron content leads to iron deficiency anemia.

Serious attention in elderly patients deserves a change in the ratio of potassium and sodium in favor of an increase in the latter. A tendency to fluid retention, a negative effect on the cardiovascular and urinary systems is a direct consequence of electrolyte shifts. Therefore, you should select foods rich in minerals that are deficient for the body. Ideal foods that combine low sodium with high potassium are vegetables and fruits. Dried fruits are very rich in potassium: prunes, apricots, raisins, dried apricots. Vegetables should be consumed without adding salt, with vegetable oil or a small amount of sour cream. The amount of table salt in the diet of patients who have reached the elderly and senile age should not exceed 3-5 g / day.

The introduction of seaweed and other seafood (shrimp, scallops, squid) into the diet not only reduces iodine deficiency, but also improves lipid metabolism, reduces blood clotting activity, providing an anti-sclerotic effect.

Half a liter of liquid

The amount of liquid in the diet of the elderly and old people should correspond to the physiological need - 1.5 liters per day. It is recommended to include juices, compotes, rosehip broth, weak tea with milk and lemon in the diet. Fluid restriction in the elderly is performed only when indicated. It is advisable to avoid strong coffee or tea. But many people have become accustomed to these drinks throughout their lives. To deprive them of a completely traditional cup of coffee or a glass of strong tea is unwise. It can be advised to drink coffee with chicory or milk, no more than 1 cup per day; tea - with lemon or milk.

In old age, changes in the chewing apparatus may occur. Hence, there are requirements for the choice of products and methods of culinary processing. Preference should be given to foods and dishes that are easily digested and easily absorbed. Meat in chopped form, fish, cottage cheese are more easily exposed to the action of digestive enzymes. From vegetables, preference should be given to beets, carrots (fresh, mashed), zucchini, pumpkin, cauliflower, tomatoes, mashed potatoes. Of the fruits, all sweet varieties of berries and fruits, citrus fruits, apples, black currants, lingonberries are recommended. Cabbage should be limited in the diet, as it enhances fermentation processes.

With severe disorders of digestive activity, exacerbation of gastritis, cholecystitis, colitis, all food is given in a pureed form, or a diet corresponding to this disease is prescribed.

The temperature of the food matters, it should not be too hot and not too cold.

Intake rates for key nutrients

Table 5 Essential Nutrient Requirements for Older People (WHO, 2002)

In table. 6 shows an approximate daily set of products for the elderly, which is designed taking into account their gender and age.

Table 6 Approximate daily set of products for the elderly and old, g

Dietary diversity in the diet of the elderly

In the diet of the elderly, of course, any food should be present, and the diet should be mixed, varied. It is not recommended to exclude favorite dishes from the diet and replace them with food that the old person has never eaten.

As with other age groups, the elderly should receive a varied diet using the four main food groups of the food pyramid. The American National Institute on Aging recommends that the diet of older adults include:

• At least twice a day milk (or low-lactose dairy products such as old hard cheeses and yogurt).
• Twice a day high protein foods (lean meat, poultry, fish, eggs, legumes, nuts, peanut butter).
• Four times a day fruits and vegetables, which should include citrus fruits (or citrus juice) and vegetables with dark green leaves.
• Four times a day bread orproducts from cereals, whole grains or fortified.

The diet of the elderly

An important section of adequate nutrition for older people is the observance of an appropriate diet (the time and number of meals, the intervals between them, the distribution of the diet according to energy value, chemical composition, food set and weight).

Regular food intake, the exclusion of long intervals between them, the exclusion of heavy meals ensures the normal digestion of food and prevents overstrain of all body systems involved in the absorption of nutrients.

With physiological aging, the functions of the digestive organs are moderately reduced, and the adaptive capabilities are significantly limited, so large food loads may be unbearable for them. Recommended 4 meals a day:

• 1st breakfast - 25% of the daily energy value of the diet;
• 2nd breakfast or afternoon snack - 15-20%;
• lunch - 30-35%;
• dinner - 20-25%.

At night, it is desirable to consume sour-milk drinks or raw vegetables and fruits. On the recommendation of doctors, it is possible to include fasting days (cottage cheese, kefir, vegetable, fruit), but not complete fasting. For diseases of the elderly and old people, a 5-time diet is desirable:

• 1st breakfast - 25%;
• 2nd breakfast - 15%;
• lunch - 30%;
• dinner - 20%;
• 2nd dinner - 10% of the daily energy value of the diet.

Features of geronto-dietetics

For healthy elderly and old people, there are no prohibited foods and dishes, but if only more or less preferred. Passion for any one or group of food products is unacceptable, since even their high nutritional value cannot compensate for the defects of one-sided nutrition.

Physiologically, the transition of older people from the usual diet to strict vegetarianism, eating only raw food, separate meals and other non-traditional methods of human nutrition is not justified. The preference of certain foods for the elderly and old people is explained by the requirements for their rational nutrition in terms of energy value and the chemical composition of food rations, and the preventive focus of geronto-dietetics.

Rational nutrition of the elderly is an effective factor in maintaining human health, preventing diseases, and prolonging life. At the same time, the effectiveness of the healing effect of rational nutrition can be optimal only in the unity of the application of other factors of a healthy lifestyle for an elderly person: maintaining feasible physical and mental activity corresponding to the age and gender of a particular person, alternating it with good rest, including sufficient rest. sleep, stress prevention, compliance with basic sanitary and hygienic requirements at home and in professional activities, maintaining sexual activity and regular sexual life as long as possible, etc.

It should be noted that numerous works of gerontologists, nutritionists, physiologists, and clinicians have proven the mutually reinforcing effect of all the components of a healthy lifestyle, without exception, which should be led by all doctors, including, of course, nutritionists.

Based on age classification, people over 50 are divided into three groups:

• people of mature age - 50 - 60 years.
• elderly people - 61 - 74 years.
• people of senile age - 75 years and more.

Aging is a natural process, biologically natural. It is based on a slowdown in a number of physiological and biochemical reactions, a decrease in resistance to external influences, etc.

There is a weakening of all body systems, including the digestive system.

1. Decreased motor and excretory functions of the stomach. Such changes are typical for 80% of people over 50 years old.
2. The acidity of gastric juice and its digestive capacity decrease, which causes the development of putrefactive microflora in the intestine, and negatively affects the digestion process.
3. Decreases two to three times the speed in the small intestine. Possible deterioration in absorption and.
4. There are age-related changes in the pancreas, in the salivary glands, in the liver.

But first of all, the work of the cardiovascular system worsens in the elderly. Atherosclerosis arises and develops: a disease in which there is a thickening of the walls of blood vessels, loss of their elasticity and the appearance of fragility.

However, the aging process can be accelerated or slowed down with the help of nutrition. Principles of rational nutrition in old age:

1. Limit your diet to avoid overeating.
2. Ensure a high biological usefulness of the diet.
3. Implement anti-sclerotic orientation.

After 50 years, the diet corresponds to 2500 - 2600 kcal per day, the consumption of fats and sugar is limited.

for older people especially important. Since at this time the adaptability of the organism decreases, which can cause inconsistent work, which ensure the relative constancy of nutrients in the blood.

for the elderly prevents the progression caused by the aging process, the enzymatic and excretory functions of the digestive glands. Recommended four meals a day, eating at the same time, which contributes to high digestibility.

An increase in the frequency or number of meals lowers the excitability of the food center and reduces appetite. If there is a tendency to obesity and increased appetite, it is advisable to eat five times a day. The same diet is justified for people of senile age.

1. 25 - 30% - for the 1st breakfast, 15 - 20% - for the 2nd breakfast, 40 - 45% - for lunch, 10 - 15% - for dinner.
2. 25% (600 - 700 kcal) - for the 1st breakfast, 15% (300 - 400 kcal) - for the 2nd breakfast, 35% (900 - 1000 kcal) - for lunch, 25% (600 - 700 kcal) - for dinner.

If there is a tendency to obesity and an increase in the frequency of meals, a relatively even distribution of the energy value of the diet throughout the day is recommended, or additional meals are provided - compote, kefir or fruit between meals (lunch and dinner) and before going to bed.

Rational organization nutrition for the elderly has a beneficial effect on metabolism (metabolism), supports performance and health.

According to the age classification, the population over 60 years old is divided into two age groups: the first - 60-74 years old, the second - over 74 years old.

The aging process is a slow accumulation of age-related changes that manifest themselves at all levels of the body. The changes and causes that form aging include: a decrease in daily energy consumption, a decrease in redox processes, the prevalence of dissimilation processes over assimilation processes, the presence of degenerative atrophic processes in the body, as well as a weakening of the functions of the digestive apparatus - a decrease in the acidity of gastric juice, disorders of the pancreas and liver.

Changes in the gastrointestinal tract affect the digestion and absorption of nutrients. A decrease in the acidity of gastric juice can be the cause of the development of vitamin B12 deficiency - anemia. In the elderly, there is a deterioration in the absorption of calcium and vitamin D, which leads to thinning and a decrease in bone density - a disease of osteoiosis.

In old age, the elasticity of the walls of blood vessels decreases, which leads to the development of hypertension.

When organizing the nutrition of the elderly, it is necessary to take into account all the changes that occur in the body.

Since there is a need for some restriction of the amount of food, especially at one meal, there are problems with providing the diet with biologically active nutrients.

In the diet of the elderly, it is necessary to include nutritional substances with anti-sclerotic and lipotropic properties.

It is necessary to include foods rich in fiber in the diet in order to remove excess cholesterol and stimulate intestinal motility.

Of great importance in the nutrition of people in this category is the enrichment of the diet with fermented milk products, the most important part of which is lactic acid, which has biological activity. Lactic acid also inhibits the development of putrefactive and some pathogenic bacteria. With the help of fermented milk products, it is possible to limit the formation of putrefactive microbes in the intestines of harmful substances involved in the development of atherosclerosis.

Need for nutrients

. For the elderly, in accordance with the physiological norms of food needs (1991), the amount of protein for men under 75 years old is 68 g, over 75 years old - 61 g per day. For women - 61 and 55 g, respectively. In terms of 1 kg of body weight, the need for protein is 1-1.3 g. It is unacceptable to include an excess amount of protein, which leads to the development of atherosclerosis and strain of the liver and kidneys.

. In the diet of the elderly, low-fat dairy and fish products, as well as seafood are recommended.

The need for fat in older people corresponds to 77 and 65 g for men and 66 and 57 g for women. The proportion of vegetable fats should be at least 30% to provide the body with polyunsaturated fatty acids. The inclusion of oleic and linolenic fatty acids (olive oil, seafood, linseed and hemp oils) in the diet reduces blood viscosity, prevents thrombosis, and reduces the risk of cardiovascular diseases. Foods high in fat should be excluded from the diet.

. Carbohydrates, as the main source of energy, should be 50-55% of the total calorie intake. The daily requirement for carbohydrates is 335 and 280 g for men and 284 and 242 g for women. The proportion of simple sugars in the elderly should not exceed 10-15% of the total amount of carbohydrates, since their excess leads to an increase in cholesterol synthesis in the liver, an increase in blood sugar and a risk of cancer. For people in this category, it is recommended to include in the diet a sufficient amount of fiber and other complex carbohydrates. A sufficient amount of dietary fiber in the diet helps to stimulate intestinal motility, the formation of beneficial intestinal microflora, and the prevention of cancer.

. In the nutrition of the elderly, vitamins are of particular importance, especially those that have anti-sclerotic, hypotensive (lower blood pressure), lipotropic and antioxidant effects.

Among these vitamins, vitamins B 6 , PP, folic acid, vitamin E, β-carotene can be distinguished. In old age, it is necessary to constantly maintain the physiological level of vitamin C in the body, as it increases redox processes, normalizes metabolism, slowing down the aging process, has a lipotropic effect, and helps the absorption of iron.

In old age, cases of polyhypovitaminosis (deficiency of several vitamins) are often noted.

To compensate for vitamin deficiency, it is necessary to provide the body with a balanced diet, in some cases it is recommended to use vitamin complexes.

Minerals. With age, a large amount of minerals, especially Ca salts, accumulate in the human body. They are deposited in the walls of blood vessels, joints, disrupting their motor ability. Along with this, the concentration of minerals decreases in some tissues. Often in older people, there is a slight release of calcium from the bones.

With insufficient intake of calcium from food, if its absorption is disturbed, a decrease in bone density and mass occurs, which leads to osteoporosis. The need for calcium in the elderly is 1000 mg per day.

In old age, especially in women, iron deficiency is noted. In old age, dehydration of the body is possible, caused by a lack of fluid or sodium intake.

Diet. In connection with the decrease in the functions of the digestive tract, it is necessary to adhere to 4-5 meals a day at a strictly defined time, to exclude long breaks between meals.

Physiological norms of needs for basic nutrients and energy for elderly and senile people are presented in Table. one.

Table 1. Norms of physiological needs for nutrients and energy for the elderly and senile

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Therapeutic nutrition for major acute and chronic diseases

Features of nutrition of the elderly and old people

Old age is a hereditary programmed phenomenon. Physiological, normal old age is not complicated by any sharp painful (pathological) process, it is the old age of practically healthy elderly (60-74 years old) and old (75-90 years old) people. Pathological, premature old age is complicated by diseases. Even with physiological old age, there are shifts in metabolism and the state of organs and systems of the body. However, by changing the nature of nutrition, it is possible to influence the metabolism, adaptive (adaptive) and compensatory capabilities of the body and thus influence the pace and direction of the aging process. Rational nutrition in old age (gerodietetics) is an important factor in the prevention of pathological deposits on physiologically regular aging. The basics below gerodietetics must be taken into account when organizing medical nutrition for the elderly and old people, i.e. in the practice of geriatrics - the treatment of diseases in old age.

The values ​​of nutritional and energy requirements recommended for the elderly and old people are given in Table 3 and Table 7 of the section "Physiological norms of nutrition for various groups of the adult population". The energy requirement of the body in old age decreases due to a decrease in the intensity of metabolic processes and limitation of physical activity. On average, the energy value of the diet at 60-69 years old and 70-80 years old is 80 and 70%, respectively, of that at 20-40 years old. Some older people tend to overeat.

The aging body is especially sensitive to excess nutrition, which not only leads to obesity, but more than at a young age, predisposes to atherosclerosis, hypertension, coronary heart disease, diabetes mellitus, cholelithiasis and urolithiasis, gout, etc., and ultimately contributes to premature aging.

On average, the energy value of the daily diet for older men and women should be 9.6 and 9.8 MJ (2300 and 2100 kcal), respectively, and for the old - 8.4 and 8 MJ (2000 and 1900 kcal). The energy value of the diet is limited by sugar, confectionery and flour products, fatty meat products and other sources of animal fats.

For older people who carry out physical activities at work or at home, the indicated energy requirement may be increased. The control of energy compliance of nutrition with the needs of the body is the stability of body weight.

In old age, the intensity of self-renewal of proteins decreases, which determines the decrease in the need for proteins. However, insufficient intake of proteins exacerbates age-related changes in metabolism and, more quickly than at a young age, leads to various manifestations of protein deficiency in the body.

The daily protein requirement for older men and women is on average 70 and 65 g, respectively, and for the old, 60 and 57 g, respectively. Animal proteins should make up 50-55% of the total protein. As sources of animal proteins, dairy and fish products of low fat content, non-fish seafood are desirable. The meat of animals and birds is moderately limited.

Excessive intake of proteins negatively affects the aging body, causes excessive stress on the liver and kidneys, and contributes to the development of atherosclerosis.

Milk fats, which are easily digestible, contain lecithin and fat-soluble vitamins, can make up to 1/3 of all dietary fats. In old age, peasant, sandwich and especially dietary butter is more useful than ordinary butter.

At least 1/3 of the fat should be vegetable oils (20-25 g per day). Unrefined vegetable oils are preferred, in which there are more substances important for the elderly and old people, such as phosphatides, sitosterol, vitamin E, as well as vegetable oils in their natural form (in salads, vinaigrettes, cereals), and not after heat treatment.

Fatty acids of vegetable oils have a positive effect on the metabolism, in particular cholesterol, in the aging body. However, excessive consumption of vegetable oils is impractical due to their high energy value and the possibility of accumulation of unsaturated fatty acid oxidation products in the body. For individual meals, the amount of fat with a high content of unsaturated fatty acids, including butter, should not exceed 10-15 g.

In the diet limit cholesterol, but do not exclude foods that are both rich in it and anti-atherosclerotic substances (lecithin, vitamins, etc.), such as eggs, liver.

Dietary fiber is necessary to stimulate the motor function of the gastrointestinal tract and bile secretion, as older people often have constipation and congestion in the gallbladder. Dietary fiber helps to remove cholesterol from the body.

Easily digestible carbohydrates are limited in the diet, primarily sugar, confectionery, sweet drinks. Their content should not exceed 15% of all carbohydrates (at one time - up to 15 g), and with a tendency to obesity - 10%. This is due to an age-related decrease in carbohydrate tolerance, in particular due to changes in the insular apparatus of the pancreas, increased formation of fat and cholesterol due to easily digestible carbohydrates, and their adverse effect on the functions of the cardiovascular system of the elderly.

Partially, sugar can be replaced with xylitol (15-25 g per day), which has a sweet taste and has a mild laxative and choleretic effect. From easily digestible carbohydrates, lactose and fructose (dairy products, fruits, berries) should prevail.

In old age, both oversaturation of the body with certain minerals and their insufficiency is possible. For example: calcium salts are deposited in the walls of blood vessels, joints and other tissues. With a calcium deficiency in food or an excess of nutrients, its absorption worsens (fitins of cereals and legumes, oxalic acid, fats), calcium is excreted from the bones. This, especially against the background of a lack of proteins, can lead to senile osteoporosis.

The body's need for elderly and old people in calcium is 0.8 g, and in phosphorus - 1.2 g. It is advisable to increase the amount of magnesium to 0.5-0.6 g per day, given its antispastic effect, the ability to stimulate intestinal motility and bile secretion , normalize cholesterol metabolism.

With a sufficiently high potassium content in the diet (3-4 g per day), the amount of sodium chloride should be moderately limited to 10 g per day, mainly by reducing the consumption of salty foods. This is of particular importance with a tendency to increase blood pressure.

With hypertension, the diet should contain less than 10 g of salt (see "Nutrition for hypertension"). The need for iron is 10-15 mg per day, regardless of gender. If the diet is dominated by grains and low in meat, fish, fruit, and berries, this amount of iron may be deficient.

It should be borne in mind that iron deficiency anemia is often noted in old age, especially in diseases of the gastrointestinal tract. In addition, with physiological old age, bone marrow iron reserves decrease and the efficiency of iron incorporation into erythrocytes decreases.

With physiological aging, the metabolism of a number of vitamins changes, but these changes do not indicate an increased need for vitamins. However, some elderly and old people have vitamin deficiencies due to poor nutrition or impaired absorption of vitamins. In diseases, vitamin deficiency in the body occurs in old age faster than at a young age.

The need for practically healthy elderly people in vitamins is presented in Table. 7 of the section "Physiological nutritional norms for various groups of the adult population." It is necessary to focus on providing vitamins at the expense of their natural sources - food. This does not exclude additional vitaminization, in particular with vitamin C in the winter-spring period, as well as periodic intake of multivitamin preparations (decamevit, undevit, etc.) in small doses - 1 tablet per day. In diseases, these doses are increased. Excess intake of vitamins is harmful to the aging body.

The main principles of the diet of the elderly and old people are regular meals, the exclusion of long intervals between them, the exclusion of heavy meals. This ensures normal digestion and prevents overstrain of all body systems that ensure the absorption of nutrients.

With physiological aging, the functions of the digestive organs are moderately reduced, but the adaptive capabilities are significantly limited, so large food loads may be unbearable for them.

For healthy elderly and old people, there are no forbidden foods, but only more or less preferred ones. Passion for any one or group of food products is unacceptable, since even their high nutritional value cannot compensate for the defects of one-sided nutrition.

Physiologically, the transition of older people from their usual diet to vegetarianism, eating only raw food, etc. is not justified. The "Methodological recommendations for organizing nutrition for the elderly and senile" developed by the Institute of Nutrition and the Institute of Gerontology offers a list of foods and dishes for the elderly and old people.

Bread and flour products: wheat and rye bread, better than yesterday's baking, bread with the inclusion of bran, soy flour, phosphatides (lecithin) and seaweed; crackers, cookies. Sweet dough is limited.

Soups: vegetarian, vegetable (shchi, beetroot, borscht), fruit, cereals. Low-fat meat and fish broths no more than 2-3 times a week.

Meat, poultry, fish: low-fat varieties, mainly boiled, possibly with subsequent frying, baked and chopped (cutlets, dumplings, meatballs). Non-fish seafood (squid, mussels, etc.), in particular stewed or baked with vegetables, salads with vegetables, etc.

Dairy products: all types are widely recommended, preferably low fat (milk, fermented milk drinks, from buttermilk and whey, semi-fat and low-fat cottage cheese, cheeses of low fat content and salinity). Limit cream, sour cream, fatty cottage cheese, salty and fatty cheeses.

Eggs: up to 2-4 per week. Soft-boiled, milk-protein omelets, in dishes. Limit egg yolks.

Cereals: cereals, casseroles, puddings from various cereals in combination with milk, cottage cheese, dried fruits, carrots. Limit rice, pasta, legumes.

Vegetables: A variety of raw and cooked. Dishes from vegetables and seaweed (salads, vinaigrettes, side dishes) are widely recommended. Spinach and sorrel limit.

Snacks: low-fat types of boiled sausages and sausages, hams, mild cheeses, boiled fish in aspic, lightly salted or soaked herring, seafood, vegetable salads and vinaigrettes with vegetable oil. Limit smoked, salty, spicy snacks, caviar, canned snacks.

Fruits, sweet dishes, sweets: various fruits in any form - raw, dry, baked, mashed potatoes, kissels, compotes, jelly, etc. Milk jelly, kissels. Dessert dishes are semi-sweet or on xylitol. Instead of sugar, honey is desirable. Limit sugar, confectionery, especially cream, chocolate, ice cream.

Sauces and spices: dairy, vegetable broth, fruit, tomato. Citric acid, vinegar, vanillin, cinnamon, allspice, bay leaf, spicy vegetables - in moderation. Limit horseradish, mayonnaise, exclude meat, fish, mushroom sauces, mustard.

Drinks: weak coffee and tea, it is possible with milk, coffee drinks, fruit, vegetable and berry juices, fruit drinks, rosehip and wheat bran decoctions. Kvass and carbonated drinks are limited.

Fats: various types of cow butter - limited (3-5 g per serving) for sandwiches and dressing ready meals. Limited - lard and margarine. Lamb, beef, cooking fats, it is desirable to exclude. Vegetable oils are widely used - for salads, vinaigrettes, marinades, in dishes, etc.

When organizing meals for the elderly and old people who are in social security institutions, they are guided by the norms of the food set.

Local features may necessitate the replacement of some products with others, but similar in chemical composition. It is advisable to replace meat with fish, dairy products with cottage cheese, milk with kefir, eggs with fish, cheese, cottage cheese, one type of vegetable with others available, etc.

You should not replace cereals with legumes, which are poorly digested at this age. The specified food set is close to the requirements of a balanced diet for the elderly and old people and contains about 75-80 g of fat, 330-350 g of carbohydrates; 9.2-10 MJ (2200-2400 kcal). The grocery set provides the need for minerals and vitamins, with the exception of vitamin C.

For diseases of the elderly and old people who require therapeutic nutrition, one should be guided by the existing recommendations on the dietary therapy of specific diseases, but with changes in the energy value, chemical composition and food set of therapeutic diets, taking into account the considered principles of nutrition in physiological old age. For example, with peptic ulcer in diet No. 1, dairy products, fish and egg whites are preferred as sources of animal protein due to some decrease in the digestive capacity of the digestive system in old age.

Egg yolks are limited in the diet to 3-4 per week, by reducing the amount of butter, refined vegetable oils are increased, which are added to fish, vegetable dishes, low-fat kefir (5-10 g per glass).

With the so-called "senile" gastric ulcer, there is a reduced secretion of gastric juice, so it is advisable to change diet No. 1 in the direction of a somewhat less strict chemical sparing.

In elderly and old people with peptic ulcer, treatment with "greens" is sometimes justified - 3-4 meals a day before the main meal of raw, well-chopped vegetables and fruits (carrots, cabbage, lettuce, apples, etc.) with the addition of vegetable oils.

In chronic pancreatitis, the protein content of diet No. 5p should be reduced from 110-120 g to 80-100 g. This also applies to other diets with a recommended increase in protein. With obesity in the elderly and old people, diet No. 8 and 8a is indicated, but not No. 8o.

With long-term, non-progressive and moderate obesity (grade 1), there is no need for special diets. However, with concomitant diabetes mellitus, which in older people often occurs due to a decrease in tissue sensitivity to insulin (see "Nutrition for Diabetes"), it is necessary to reduce excess body weight.

It is very important to change the diet in drug therapy of the elderly and old people (see "Peculiarities of therapeutic nutrition in drug therapy"), taking into account the characteristics of the response of the aging organism to drugs and a decrease in their excretion due to age-related changes in the kidneys. If sick elderly and old people can be assigned a common table, then instead of diet No. 15, diet No. 10c is most desirable.

Any organism is subject to aging - a natural process of changes affecting all spheres and levels of life. Life after 80 years is always accompanied by physiological signs and psychological problems that are mandatory for this age. Not only genetic predisposition affects how young we look and feel well, having stepped over the milestone of 80 years. There are other factors that we will focus on in this article.

As we age, the changes that occur in the body become more and more obvious. The nervous, endocrine, cardiovascular, musculoskeletal and other systems can no longer work at full capacity, thousands of different cells die every day, the elasticity and elasticity of blood vessels, muscles, and connective tissues are lost.

After 80 years, our body functions worse and worse. The heart works more slowly, the blood moves through the blood vessels less actively, the kidneys, liver, and digestive system function worse. Age-related changes affect muscles, joints, bones, they become less mobile and more fragile.

The processes occurring inside the body are reflected in the appearance of a person: the skin loses its elasticity and firmness, becomes flabby, becomes covered with wrinkles, age spots appear, hair turns gray and becomes rarer, teeth fall out.

Old age is called the age of contemplation and tranquility. And yet, despite the natural decline in physical activity, life after 80 years should not be considered as an insurmountable obstacle to walking at a fresh age, communicating with family and friends. Many people, having crossed the threshold of 80 years, continue to lead a busy life, take care of themselves, prefer to remain active. Their well-being largely depends on relationships with relatives, the atmosphere in the family, food and care.

In the elderly and senile age, almost everyone begins to develop psychological problems. Here are their reasons:

Important mental functions of the body are significantly reduced, memory, attention, the ability to think and analyze are weakened.

Increased stress caused by the loss of friends, loved ones, disability.

Weakens the ability to adapt.

Self-esteem decreases, as awareness of one's advanced age comes.

There is less and less communication, time spent alone, on the contrary, more, there is no interest in modern life.

Very often, older people and old people prefer to live in the past, their memories.

There may be depressive states, thoughts of suicide, which are caused by a lack of life prospects, exacerbated diseases, uselessness of the family, fear of imminent death.

It is worth noting that such psychological problems can begin much earlier, already from the age of 40-50.

The following physiological features are characteristic of senile age:

The functions of the body are reduced, the work of internal organs and tissues is disturbed.

Muscles become weaker, bones become more fragile, joints begin to ache, vision and hearing deteriorate.

Chronic diseases are on the rise. Doctors say that almost every elderly person suffers from at least five diseases that have a chronic course, accompanying and reinforcing each other. Since the endocrine and immune systems function worse in old age, frequent relapses of existing diseases occur.

The most typical for this age are diseases such as sclerosis, senile amyloidosis, prostatic hyperplasia, osteoporosis, dementia, etc.

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work out stress

Short-term nervous shocks (quarreled with superiors, cut off while driving on the road) can be useful, because they force the body to mobilize, activate hidden reserves, and make a decision faster. However, in a situation where stress becomes a system, continues for a long time, the body is not able to cope with it.

Accumulating stress hormones (such as cortisol, norepinephrine, adrenaline) have a very aggressive effect on the cardiovascular, endocrine, nervous system, etc. Despite the fact that nature provides ways to remove stress hormones, any system that is in a state of constant stress, begins to malfunction, which in turn leads to the emergence of various pathological syndromes and diseases.

Very effective ways to get rid of stress are exercise and tears. After a sports workout, most of us experience a pleasant muscle fatigue and a feeling of peace. Yes, and the folk proverb that if you cry, it will become easier, there is a physiological justification. Stress hormones leave the body in most cases in two ways: they are washed out by tear fluid and “burn out” in actively working muscles.

As you know, naturally emotional peoples live the longest. For example, the average life expectancy of the French is 80 years, it is they who celebrate centennial anniversaries more often than others. Among our closest neighbors, Caucasians are long-livers. And for us, the best way to deal with stressful situations is sport. At the same time, to achieve the effect, training should be daily and last at least 40 minutes (cardiologists talk about this time of physical activity).

In order to continue to lead an active life after 80 years, you should take care of yourself, do not overeat. Extra pounds are more dangerous for the male body than for the female. In overweight people, under the influence of the aromatase enzyme, the male hormone testosterone is converted into the female hormone estrogen. Both hormones are needed by both men and women, but their quantity and ratio is essential.

With an excess of adipose tissue, estrogen levels rise significantly, which leads to hypogonadism in men. The flip side of this process is the cessation of testosterone production. That is why in very obese men one can observe a very weighty chest. In general, such a hormonal imbalance can lead to the development of metabolic syndrome, diabetes and heart problems.

The human body is restored during a night's sleep. With chronic lack of sleep, the appearance worsens, the immune system weakens, excess weight may appear and the development of various diseases. However, sleeping more than 10 hours a day is also unhealthy. Studies conducted at Harvard University have shown that in this case, the quality of sleep deteriorates, memory problems arise.

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Nutrition is of great importance for slowing down or accelerating the aging process of the body. After 80 years, for a full life, you should adhere to the following principles of rational nutrition:

Avoid overeating.

The diet must be complete.

It is worth adhering to the anti-sclerotic orientation of nutrition.

Starting from the age of 50, it is necessary to ensure that the energy value of the food consumed is 2500–2600 kcal per day, it is necessary to limit the consumption of fats and sugar.

For a full life after 80 years, diet is of particular importance. With age, the body's adaptability becomes lower, which can cause disruptions in the work of regulatory mechanisms that ensure the relative constancy of nutrients in the blood.

With the help of proper nutrition, disturbances in the enzymatic and excretory functions of the digestive glands can be prevented. You should adhere to four meals a day, eat food at the same time whenever possible, which will contribute to its high digestibility.

It should be noted that by increasing the frequency or number of meals, it is possible to reduce the excitability of the food center and reduce appetite. That is, if a person after 80 years of age is prone to overweight, it would be more expedient for him to switch to five meals a day.

25-30% for the first breakfast, 15-20% for the second breakfast, 40-45% for lunch, 10-15% for dinner.

25% (600–700 kcal) for the first breakfast, 15% (300–400 kcal) for the second breakfast, 35% (900–1000 kcal) for lunch, 25% (600–700 kcal) for dinner.

With a tendency to overweight and an increase in the number of meals, it is necessary to distribute the energy value of the diet relatively evenly throughout the day or provide additional meals (for example, kefir or fruit) in the intervals between lunch and dinner and before bedtime.

To continue to lead an active life, people after 80 years the following principles should be followed:

Fish and meat dishes, as well as the main amount of fats, are consumed in the morning and afternoon.

For dinner, you should give preference to dairy products, exclude salt and extractives.

According to the methods of cooking, stewing or boiling, including steaming, is most suitable for older people. Fatty, fried, spicy dishes, marinades and sauces are best excluded from the diet.

Maintaining the anti-sclerotic orientation of nutrition involves the limited use of foods containing cholesterol, easily digestible carbohydrates (confectionery, sugar and jam), foods high in vitamin D, nitrogenous extractives, and salt.

One of the main places in the diet of a person who has reached 80 years of age should be given to side dishes and vegetable dishes: salads seasoned with vegetable oil, cabbage, potatoes, tomatoes, cucumbers, pumpkins, zucchini, parsley, dill, in small quantities beans, beans, mushrooms , peas, spinach.

Of the drinks, tea, weak coffee, tea with milk, fruit, berry and vegetable juices are most preferable.

It is very important to ensure that the diet is varied.

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Anti-aging hobbies

A very effective way for older people to maintain an active lifestyle, youth and well-being after 80 years are walking (provided they are regular and maintain a certain rhythm).

Having mastered the computer, you will look younger in the eyes of your own grandchildren, they will be proud of their grandmother, who does not lag behind modern life even after 80 years. You should not limit your interests to culinary sites and social networks, you can explore useful programs, for example, creating photo albums, editing photos, and doing home accounting. Using a computer, you can read books, listen to music, watch movies and TV shows, write memoirs, and make purchases in online stores.

Life after 80 years will sparkle with new colors if you let in such a useful activity as home floriculture. You can start with unpretentious indoor plants or grow salad greens on the windowsill. If you've never done this before, it's best to buy a couple of inexpensive, low-maintenance plants and fit them into your new schedule.

You can create comfort by knitting, sewing, weaving, making souvenirs, painting furniture, decorating with mosaics. In any home there are old things that can be shredded and sewn into a new bedspread, chair covers or sofa cushions.

Another traditional hobby for those over 80 is cooking. Age is not an obstacle to mastering new recipes for first and second courses, pastries and desserts, homemade preparations and frosts, which are then so pleasant to pamper your loved ones.

In our life and today, such types of needlework as knitting, embroidery, macrame, beading remain relevant. In shops for needlewomen you can find ready-made paintings with embroidery patterns - there is no need to draw and translate - you will get the most interesting creative part. Needlework kits already include threads or beads.

You can make your life more interesting after 80 by learning how to sew toys for your grandchildren from nylon socks or good-natured tilde rag dolls. It will be somewhat more difficult to master felting from wool, but this type of needlework will allow you to create real masterpieces: toys, jewelry, hats.

If you have enough perseverance, you should try something completely new in life, for example, the art of kanzashi - beautiful ribbon flowers are suitable for decorating clothes, interiors, and even for making designer jewelry.

Based on age classification, people over 50 are divided into three groups:

• people of mature age - 50 - 60 years.
• elderly people - 61 - 74 years.
• people of senile age - 75 years and more.

Aging is a natural process, biologically natural. It is based on a slowdown in a number of physiological and biochemical reactions, a decrease in resistance to external influences, etc.

There is a weakening of all body systems, including the digestive system.

1. Decreased motor and excretory functions of the stomach. Such changes are typical for 80% of people over 50 years old.
2. The acidity of gastric juice and its digestive capacity decrease, which causes the development of putrefactive microflora in the intestine, and negatively affects the digestion process.
3. The rate of absorption of nutrients in the small intestine decreases two to three times. Possible deterioration in the absorption of fats and carbohydrates.
4. There are age-related changes in the pancreas, in the salivary glands, in the liver.

But first of all, the work of the cardiovascular system worsens in the elderly. Atherosclerosis arises and develops: a disease in which there is a thickening of the walls of blood vessels, loss of their elasticity and the appearance of fragility.

However, the aging process can be accelerated or slowed down with the help of nutrition. Principles of rational nutrition in old age:

1. Limit your diet to avoid overeating.
2. Ensure a high biological usefulness of the diet.
3. Implement anti-sclerotic orientation.

After 50 years, the energy value of the diet corresponds to 2500 - 2600 kcal per day, the consumption of fats and sugar is limited.

Mode nutrition for the elderly especially important. Since at this time the body's adaptability decreases, which can cause inconsistent work of regulatory mechanisms that ensure the relative constancy of nutrients in the blood.

Proper nutrition for the elderly prevents the progression caused by the aging process of the enzymatic and excretory functions of the digestive glands. Recommended four meals a day, eating at the same time, which contributes to high digestibility.

An increase in the frequency or number of meals lowers the excitability of the food center and reduces appetite. If there is a tendency to obesity and increased appetite, it is advisable to eat five times a day. The same diet is justified for people of senile age.

1. 25 - 30% - for the 1st breakfast, 15 - 20% - for the 2nd breakfast, 40 - 45% - for lunch, 10 - 15% - for dinner.
2. 25% (600 - 700 kcal) - for the 1st breakfast, 15% (300 - 400 kcal) - for the 2nd breakfast, 35% (900 - 1000 kcal) - for lunch, 25% (600 - 700 kcal) - for dinner.

If there is a tendency to obesity and an increase in the frequency of meals, a relatively even distribution of the energy value of the diet throughout the day is recommended, or additional meals are provided - compote, kefir or fruit between meals (lunch and dinner) and before going to bed.

1. Eat fish and meat dishes, as well as the main amount of fat in the daytime and in the morning.
2. During dinners, it is worth excluding foods containing a large amount of salt and extractives, and choosing dairy products, since it weakens the work of the gastric glands during sleep. Dairy products during the hours of night sleep do not change the activity of physiological systems. And salty, meat and fish dishes can adversely affect the cardiovascular and respiratory systems: blood pressure, pulse rate and respiration remain at the same level and sometimes increase instead of decreasing.
3. Elderly people in nutrition should give preference to stews and boiled dishes, vegetarian soups. It is necessary to reduce the consumption of fried and very fatty, spicy foods, marinades, sauces, as they lead to an overstrain of the digestive glands. An important role is played by the appearance of food, its smell and taste, as it contributes to a more active release of digestive juices, respectively, better digestion and assimilation.
4. Anti-sclerotic orientation involves limiting the use of foods that contain cholesterol (offal, egg yolks, brains), easily digestible carbohydrates (confectionery, sugar and jam), foods rich in vitamin D, nitrogenous extractives, with a significant amount of salt. It is necessary to include in the diet foods rich in fiber (rye bread with bran, crackers, unbread cookies), vitamins, potassium and magnesium salts, as well as vegetable oil. Low-fat lamb, beef, turkey, pork are recommended as meat products, mostly in the form of baked and boiled dishes. Fish should also be low-fat, including soaked low-fat herring once a week.
5. Side dishes and vegetable dishes should take a special place: salads with vegetable oil and vinaigrettes, cabbage, potatoes, tomatoes, cucumbers, pumpkin, zucchini, parsley, dill, beans, beans, mushrooms, peas, spinach in a small amount.
6. The norm of fat in the diet should be 70 - 80 g, including 1/3 - vegetable oil. If there is a tendency to obesity, you need to reduce the consumption of flour and cereal products, sweets, sour cream, ghee and butter.
7. Dairy products are recommended: low-fat cheeses, low-fat cottage cheese and dishes from it, yogurt, kefir, acidophilus.
8. As drinks, it is worth giving preference to tea, weak coffee, tea with milk, fruit, berry and vegetable juices.
9. A variety in the diet is necessary, the abuse of any food group is unacceptable.

Rational organization nutrition for the elderly has a beneficial effect on metabolism (metabolism), supports performance and health.

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How few people die simply of old age, having lived in good health for 100 years or more! They are written about in newspapers and on TV. Most people die from various diseases. Among the most common causes of death are cardiovascular and oncological diseases. Proper nutrition is an indispensable condition for longevity, maintaining efficiency, vigor.

In old age, a person should take more care of his diet than in previous periods of life. WHY? Physiology answers this question.

To stay healthy in old age, you need at least a little understanding of how to eat right. When examining the lifestyle of centenarians in different regions of the planet, much in common was revealed:

• The daily diet of the elderly and old people contains about 50 g of protein, 30 g of fat, 300 g of carbohydrates, which is about 1700 kilocalories per day.
• Centenarians consume very little sugar and sweets, broths and first courses on broths.
• A lot of fresh and dried herbs, onions, garlic, red peppers, vegetables and fruits, nuts, a large number of dishes from beans, corn and other legumes.
• Fats are predominantly vegetable.
• Meat - boiled lean goat meat, lamb, beef, poultry.
• Thirst is often quenched with water, buttermilk, curdled milk and other fermented milk products.
• Their diets contain a high content of vitamin E and other antioxidants (vitamins C, P, PP, sulfur-containing amino acids, selenium).

Overeating should be avoided

especially with a sedentary lifestyle. Diet 4-5 times a day (according to the principle: eat more often, but little by little to kill the feeling of hunger). The distribution of products should be approximately the same so as not to overstrain the gastrointestinal tract. This is especially important for those suffering from angina pectoris, in whom a full stomach can provoke pain in the heart.

It is necessary to limit the consumption of animal fats rich in saturated fatty acids. At the same time, the share of products containing vegetable fats rich in polyunsaturated fatty acids, phospholipids and vitamin E should be increased. The fat content should not exceed 50-70 g, the share of vegetable oil 30-40%. It is advisable to gradually replace animal fats in the diet with low-calorie margarines, with a fat content of up to 60%, as has long been customary in the West.

Easily digestible carbohydrates (sucrose, glucose), which also contain a lot of calories and, conversely, enrichment with foods with dietary fiber (fiber). Fiber, which is part of grains, vegetables and fruits, eliminates constipation, promotes “burning” of excess fat, excretion of cholesterol, regulates glucose levels (thus preventing diabetes), and prevents the development of tumors of the gastrointestinal tract. Leguminous crops are among the most ancient and are the basis of the nutrition of the population of the entire globe, in Europe it is wheat, rye, barley, oats, etc., in America - corn, beans, in Asia - rice, soybeans. They are the main source of vegetable protein and carbohydrates, fiber, and B vitamins.

Be careful with diets that prohibit bread, cereals, potatoes. Lack of fiber leads to indigestion. Hypovitaminosis B1, B2, B6 - to dysfunction of the central nervous system (irritability, weakness, memory loss, depression, fatigue), skin problems (dryness, peeling, hair loss). Therefore, bread (especially from wholemeal flour), cereals, potatoes should be consumed several times a day. Vegetables and fruits should be consumed 400-500 g per day, preferably fresh and grown in the place of residence. Boiled and stewed, as well as frozen vegetables, fruits and berries are also useful. Avoid fried foods.

To a greater extent due to meat and to a lesser extent - milk. Meat products are an important source of protein and iron. At the same time, meat products contain a sufficiently large amount of saturated fatty acids, which increases the risk of developing hypercholesterolemia and CVD. Therefore, meat products with a high fat content should be replaced with lean meat, poultry, fish, legumes, which contain less saturated fat.

A complete rejection of animal products is no less harmful than their excess consumption. With prolonged vegetarian nutrition, there is a decrease in immunity, anemia, increased fatigue, weakness, headaches, dry skin, hair loss, decreased spermatogenesis and sexual activity in men (zinc deficiency, vitamins A and B12, which are found only in animal products). The best option: meat - 1-2 times a week, fish - 2-3 times a week, eggs - once or twice a week and dairy products every day.

are an important source of calcium and protein. Calcium is especially necessary for the elderly. You should eat low-fat milk and low-salt dairy products, while calcium and protein remain in the same amount. Many foreign nutritionists believe that milk is good for children under 3 years old, but not for an adult. Because in a person older than 30 years, milk sugar - lactose - does not break down.

At the same time, many Russian nutritionists do not agree with this. In their opinion, milk is indispensable for people over 50 as a source of calcium (but you need to drink it constantly, then there will be no indigestion of milk in the stomach). Apparently, both are right. It is now well established that the amount of the enzyme responsible for the breakdown of milk decreases with age, but this process is individual. And therefore, for some adults, milk can really harm, for someone, on the contrary, it will be useful. The same nutritionists argue that milk is not a drink, but a complete food, and they should not quench their thirst and drink food with milk: it blocks the normal secretion of gastric juice. It is advisable to drink milk on an empty stomach in small sips. When milk is drunk quickly and in large quantities, it coagulates into large flakes and is more difficult to digest. The combination of milk with bread is considered successful.

reduces the activity of enzymes (lipases) that promote the digestion of fats, and increases the permeability of the vascular wall. Therefore, its consumption should be limited to 5 g per day. To eat less salt, use seasonings from herbs (dill, parsley, cumin, green onions, garlic, mint, etc.). They give the dishes aroma and peculiar taste, but most importantly, they facilitate digestion.

necessary at any age, but in an elderly person the need for them is higher. And why? Because he absorbs them worse. It is difficult to list all the diseases that their lack can cause. Vitamins stimulate redox processes and therefore improve the processes of processing fats and cholesterol in the body, preventing them from accumulating (vit C, E, P, B6, PP, A). Vitamins C and P, in addition, strengthen the walls of arteries, reduce their permeability to cholesterol. Even a small deficiency of vitamin C can lead to serious consequences - mortality from cardiovascular diseases among those who receive about 50 mg of ascorbic acid per day is 15% higher than those who receive twice as much. Vitamin C helps prevent anemia. The fact is that it greatly increases the absorption of iron contained in animal products. In practice, this means that if you eat meat, liver, yolk (i.e., foods rich in iron), then add as much greenery as possible to them, and then the absorption of iron will increase by 3-4 times. Vitamin C, as well as vitamin P, is found in many fruits and vegetables, but is stored for the longest time in cabbage, citrus fruits, and sweet peppers.

When a person has “third teeth”, i.e. prostheses, he tries not to eat raw vegetable salads, but prefers vegetable purees. Because of the “tender” stomach and the already not quite healthy liver, he refuses black bread. And as a result, there is not enough thiamine (vitamin B1) in the food, and although the elderly lady says: “I must have sclerosis, I forget everything,” memory impairment is not necessarily caused by sclerotic changes, but perhaps a lack of vitamin B1.

Such an unpleasant detail of appearance as fan-shaped wrinkles above the upper lip appears with a lack of vitamin B2 (riboflavin).

Lack of vitamin B3 (niacin, or vitamin PP) can cause symptoms similar to neurasthenia.

With a lack of vitamin B6, atherosclerosis develops faster.

Vitamin B12 increases resistance to oxygen starvation, lowers cholesterol levels in the blood, and with age it becomes more and more effective (for example, at 50-60 years old, this vitamin does not help as much as at 70 and older).

The source of most B vitamins (except vitamin B12) are cereals, wholemeal bread, bran, seeds, nuts, legumes.

Vitamin B12 is found in animal products - liver, meat, fish, egg yolk, seafood.

Vitamin E plays a very significant role in the processes of formation of new and in prolonging the life of old cells in the human body, promotes the absorption of vitamins A and D. It has been proven that vitamin E slows down aging. There is an opinion that “flowers of old age”, i.e. age spots on the skin do not appear in old age if there is enough vitamin E in the body.

Food should contain a sufficient amount of foods rich in trace elements: calcium, magnesium, copper, chromium, zinc, iodine.

Calcium needed for normal bones. It is especially important for women, because. they are 5 times more likely than men to suffer from osteoporosis. Dairy products are a source of calcium. Cheeses contain the most calcium, but cottage cheese and sour-milk products are recommended for older people, because cheese is poorly digested. There is a lot of calcium in powdered milk, so it can be added to dough, minced meat, meatballs, etc.

Thanks to magnesium people suffer less from sclerosis, tolerate stress more easily, kidney stones and hemorrhoids appear less often. A lot of magnesium in buckwheat, oatmeal, millet, peas, beans.

Iodine activates the breakdown of cholesterol (found in seafood).

Selenium prevents the development of cancer - its source is seafood, especially herring, crabs, lobsters, yolk, offal, barley (barley, barley groats), yeast, wheat bran. Simple carbohydrates (sweet and starchy foods) interfere with the absorption of selenium.

Zinc participates in the processes of bone formation, affects the condition of the skin, makes us more resistant to stress, colds. Men need this trace element more, since in old age it prevents the development of prostatitis and prostate cancer (in the young it promotes spermatogenesis). Rich and affordable sources of zinc include herring, mackerel, oatmeal, mushrooms, wholemeal bread, and garlic.

It is better to get all the substances necessary for the body with food. But in old age, there is often a need for additional intake of vitamins and trace elements. Separate vitamins, as a rule, are produced in therapeutic doses and are used only as prescribed by a doctor for various diseases. For the purpose of prevention, it is advisable to purchase a vitamin complex in a pharmacy, preferably with microelements.

Our doctors believe that Russian drugs are no worse than imported ones. At the same time, Western manufacturers insist on the opposite. However, there is simply no serious scientific evidence confirming the correctness of either side. So make your own choice.

Of the domestic preparations for people of senile and elderly age, the most effective are “Dekamevit” and vitamin-mineral complexes “Complevit” and “Kvandevit”. They should be taken 1 tablet per day, preferably all year round.

In old age, you should reconsider some of your eating habits and remember that foods such as milk, cottage cheese, kefir, fish, wholemeal bread, buckwheat and oatmeal, a variety of vegetables, fruits, including raw ones, dried fruits, greens , sea cabbage and other seafood, vegetable oils, must be eaten daily; others - meat, eggs, caviar, sweets, honey, confectionery and flour products, chocolate, cocoa, coffee, tea - should be consumed in limited quantities. Refractory fats (lamb, beef, lard), duck, goose, fatty meats, brains, internal organs of animals, smoked meats should be consumed occasionally and in small quantities. And, of course, the abuse of alcoholic beverages and overeating is completely unacceptable.

For clarity, we give an approximate grocery set of preventive orientation.

Proper nutrition in adulthood