In this Q&A, our expert dietitian, Kaye Dennison (NZRD) shares insights around energy and tips for how older people can get more of it.
Older people’s energy needs vary on an individual basis depending on their gender, weight, physical activity level (PAL), metabolic needs. In general, energy needs decrease with age following a reduction in basal metabolic rate due to decreased muscle mass. In particular, chronic disease or inflammatory conditions, require increased energy. However, some older people with energy demanding medical problems will require more energy, such as people with chronic respiratory and wound healing requirements.
What is energy and where can we get it from?
Energy is not a nutrient but is a fuel source found in macronutrients such as carbohydrates, proteins and fats which the body is able to break down.
These macronutrients provide different amounts of energy for each gram that is broken down in the body:
|Macronutrient||Energy per gram ( kJ/g) or Energy per ml (kJ/ml)|
|Protein and Carbohydrates||16.7 kJ/g|
|Fats and Oils||37 kJ/g|
Why do we need energy from foods?
Energy is required to support bodily functions and preserve protein stores. If there is insufficient energy, the body will automatically use muscle (protein stores) to provide the energy it needs for normal functioning. This muscle wasting can affect the older person’s balance and increase the risk of falls.
What determines energy requirements?
Calculation of an individual’s energy requirements involves a calculation of their basal metabolic rate (using their gender, age, weight and height) and multiplying this by their physical activity levels (PAL).
This calculation will take into account the effects and demands of disease, such as a person losing weight due to poor intake, caused by loss of appetite due to drug interactions. They may also have increased energy requirements due to energy-demanding medical problems, such as respiratory disease or healing of chronic wounds.
How much energy do older people need?
In general older people require 125kJ (30 kcals)/per kg body weight/per day and this requirement varies depending on the older person’s energy expenditure (which reduces with age) along with their nutritional status, clinical condition, and tolerance to nutritional interventions.
How can we get this energy into at-risk older people?
Some older people are unable to consume large amounts of food due to decreased appetite, poor dentition, and swallowing problems. In addition, when suffering from some clinical conditions they will require more energy than a healthy younger adult. This is where we can intensify the energy in familiar foods by fortifying them with healthy fats, proteins and healthy sugars such as honey.
Research shows there is a strong consensus for the older person with malnutrition, or risk of malnutrition, to be provided with fortified, familiar foods to meet their daily energy requirements.
There are also other ways to increase the intake of energy in residents of aged care facilities, including increased mealtime assistance, liberalising previous diet restrictions and ensuring the dining environment is pleasant and promotes quality of life. Facilities with committed person-centred care have been shown to increase energy intake in residents living in long-term care facilities (Keller 2017).
What does a high energy diet look like for an older person with a chronic disease?
Take Bill, for example, an 80-year-old man living in an aged care facility with a condition which requires additional energy.
- He has emphysema, a chronic obstructive pulmonary disease (COPD) and needs an intake of 146kJ (35 cals)/per kg body weight/per day just to maintain weight.
- This energy requirement is based on the fact he is already underweight, with a BMI of 17 (1.82m /58kg).
- Bill has a high risk of further weight loss due to significant SOB, loss of appetite and gastrointestinal distress.
- Bill fatigues easily and needs to have his main energy intake before mid-afternoon when he starts to have fatigue and tires quickly when eating.
Supporting Bill to consume easily eaten, energy dense meals at breakfast and at midday (when he has a good appetite), as well as encouraging consumption of tasty, energy dense, familiar fluids between meals, will help him to maintain weight and hopefully enjoy a good quality of life.
To give you some idea of Bills meal pattern if we aim to provide him with an energy intake of 8468 kJ a day (based on 146kJ energy per kg body weight/day):
In this way, he has the bulk (85%) of his energy (7274kJ) before mid-afternoon with a light evening meal of cream of vegetable soup ( 600kJ) and a small supper of hot chocolate made with full cream milk (637kJ). Making up his total energy intake for the day (8511 kJ).
Bill’s condition may continue to deteriorate as the course of his disease progresses. Increased assistance at meal times plus fluids, will support him to maintain an optimum quality of life for as long as possible.
For further information on individual energy needs for older people with complex medical problems consult your facility dietitian or the doctor with the duty of care for the resident.