New Dietary Guidelines Include Focus on Older Adults

The latest Dietary Guidelines for Americans (DGAs) recently released by the U.S. departments of Agriculture and Health and Human Services urge Americans to “make every bite count.” The DGAs are updated every five years and this latest edition highlights the importance of a healthy diet at every life stage. As a result, these DGAs for the first time include a chapter on nutrition for older adults. Below, let’s unpack some of the latest DGA recommendations for those ages 60 and older, and discuss an opportunity for policy advocacy.

Healthy Dietary Patterns

Health & Well-Being is a strategic priority for the American Society on Aging and healthy dietary patterns are the centerpiece of the DGAs. Older adults are encouraged to follow a balanced dietary pattern that includes vegetables, fruits, grains, dairy, protein foods and oils. The pattern provides a variety of food and beverage options for older adults to customize their choices within each food group, based on lifestyle, traditions, culture and/or other individual needs.

The DGAs note that an increasing number of Americans enter older age with excess body weight. Healthy aging is best supported by preventing additional weight gain and achieving a healthy weight by “following a healthy dietary pattern and adopting an active lifestyle.” It is never too late to make improvements!

Current Intakes

The DGAs find most Americans do not follow a healthy dietary pattern, although compared to other age groups older adults have the highest diet quality. Older adults can improve their diets by eating more vegetables, fruits, whole grains and dairy, while ensuring adequate protein and eating foods with fewer added sugars, saturated fats and sodium. The DGAs also recommend older adults choose nutrient-dense foods and watch portion sizes because calorie needs decline with age.

Special Considerations

The DGAs note a number of health and social changes that can affect older adults’ nutrition. “Compared to younger adults, older adults are at greater risk of chronic diseases, such as cardiovascular disease and cancer, as well as health conditions related to changes in bone and muscle mass, such as osteoporosis and sarcopenia.” Older adults often do not eat enough protein, which is important to prevent the loss of lean muscle mass that occurs naturally with age. Adequate vitamin B-12 and fluids were also identified as potential concerns. In addition, the DGAs recommend “to help older adults move toward a healthy dietary pattern and minimize risks associated with drinking, older adults can choose not to drink or drink in moderation.”

Defeat Malnutrition Today has identified that up to one in two older adults is at risk of becoming or is malnourished.

Supporting Healthy Eating

Costs, preferences, traditions and access are all factors that can affect healthy eating. For older adults, enjoyment of food, the ability to chew and swallow and food safety are important considerations as well. The DGAs highlight the government resources available to help support healthy eating for older adults:

A number of these programs have had increased attention and funding during the COVID-19 pandemic and continue to prove essential for older adults, particularly those who are challenged by social isolation and food insecurity.

Policy Opportunity to Support Older Adult Nutrition

The DGAs also note that “Older adults should follow a healthy dietary pattern because of the changing dietary needs and the heightened risk of malnutrition that occurs with age.”

The Defeat Malnutrition Today coalition has identified that up to one in two older adults is either at risk of becoming or is malnourished, and has outlined specific goals and strategies to help overcome malnutrition in its “National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update.”

One of these strategies addresses the important gap in connecting nutrition and healthcare for older adults, noting that malnutrition care is not included in the Centers for Medicare & Medicaid Services (CMS) quality measures that help to assess healthcare value and effectiveness. This gap was similarly underscored in a recent Senate resolution that encouraged the “adoption of malnutrition electronic clinical quality measures.”  

A Global Malnutrition Composite Score has been developed, consisting of four quality measures centered on the critical steps of malnutrition risk identification, diagnosis and treatment for hospital patients. The Measures Application Partnership Hospital Workgroup is set to review this composite measure in early 2021, for its appropriate inclusion in the CMS Hospital Inpatient Quality Reporting Program. The National Quality Forum also is reviewing the measure to endorse its use.

Now is the time to advocate for endorsement of the Global Malnutrition Composite Score to help ensure nutrition is part of high-quality, safe and coordinated healthcare for older adults and to better identify those who need help, support and encouragement to achieve a healthy diet.

Meredith Ponder Whitmire, JD, is the policy director for Defeat Malnutrition Today in Washington, DC.