Q&A: How much energy do older people need and how can they get it?

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 ageing 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 a fuel source found in macronutrients carbohydrates, proteins and fats which the body is able to break down. Alcohol is also a source of energy.

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

Alcohol

29 kJ/ml


Why do we need energy from foods?

Energy is required to support bodily functions and preserve protein stores. If insufficient energy is eaten on a regular basis, 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 eg 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).

How can we add energy to meals at Christmas?

Christmas is a great time for adding high energy foods into older persons' diets. Gifts of easily eaten high energy foods which do not require preparation are always welcome;  such as fruit jellies, chocolates, marshmallows, different varieties of high energy drinks, shortbread biscuits, dried fruit and nuts. Snacking on these foods at regular intervals, making sure Christmas treats and high energy drinks are easily accessible, will support older people to get the increased energy they need. Throughout the festive season, there are opportunities to add generous quantities of sauces and gravies to main meals as well as brandy sauce, cream and ice cream to traditional desserts i.e Christmas pudding, trifle and pavlova.

What does a high energy diet look like for a  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).

Bills 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.

References:

  • Volkert D, et al., ESPEN guideline on clinical nutrition and hydration in geriatrics, Clinical Nutrition (2018), https://doi.org/10.1016/j.clnu.2018.05.024
  • NZ Ministry of Health Food and Nutrition Guidelines for healthy older people, 2013
  • Keller H, Prevalence and determinants of Poor Food Intake of Residents Living in Long Term Care, JAMDA 18 (2017) 941-947
  • Dorner B, Niedert K.C, Welch PK   Liberalised diets for older adults in long term care Position of the American Dietetic Association, Set 2002, Vol 102. Issue 9, pp. 1316-1323

 

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