In our last blog we saw how protein and energy are the two key nutrients that help keep our residents active and independent.
But there’s a lot more than just those two nutrients that help keep aged care residents fit and well. There’s a whole range of vitamins, minerals and other nutrients that work together to keep everyone in top form. Because they’re needed in small amounts we call them “micronutrients”.
Vitamin D has a role in bone health, nerves and muscle function. Vitamin D deficiency has been linked to an increase in falls. There’s emerging research that vitamin D also plays a role in the immune system, inflammation and dementia.
We get most of our vitamin D from sunshine, which is why less-mobile aged-care residents are one of the main population groups in New Zealand who’re at risk of vitamin D deficiency.
The New Zealand government subsidises a monthly vitamin D supplement for aged-care residents. In New Zealand, vitamin D deficiency has been found in 65% of aged-care residents who weren’t taking these monthly supplements. Of those who were taking the supplement only 1.5% were deficient.
How much vitamin D does your resident need?
The AI (Average Intake) for adults over 70 years is 15ug (800IU) daily.
Help them get their vitamin D
- 15-30 minutes of sunlight 2-3 times a week will provide this
- Egg, salmon and fortified dairy products are good food sources of vitamin D
Keep an eye on those at risk
- Immobile residents
- Those on texture modified or a restricted diet
- During winter
Calcium has an important role in bone strength, nerve health and heart function.
How much calcium do seniors need?
The Recommended Dietary Intake (RDI) for both men and women over the age of 70 is 1300mg daily.
Where to get your calcium
- 1 glass of whole milk (250ml) provides 320mg calcium
- Other good sources are sardines and anchovies, cheese and yoghurt
Watch out for those at risk
- Lactose or dairy intolerance or allergies
- Those who need thickened drinks
Magnesium is needed in over 600 enzyme reactions in the body. It’s closely linked with glucose metabolism, DNA repair, mood and sleep. For older people, making sure they get enough magnesium can help improve both quality and quantity of sleep.
How much magnesium does your resident need?
The RDI for men over 70 is 420mg/day and for women 320mg/day
Be careful because supplements containing over 350mg magnesium may cause diarrhoea.
Food sources of magnesium
- White fish, chickpeas, silverbeet, nuts, pumpkin seeds, peas and baked potato are all good sources of magnesium
- Using ground nuts and seeds in baking is a great way of boosting magnesium
Residents who might be low
- People with Type 1 or 2 Diabetes
- High blood glucose levels (prediabetes)
Folate has been shown to be important in heart and brain health. National and international studies have shown that older people in aged-care facilities are often not meeting their daily folate requirements. Folate deficiency is called megaloblastic anaemia which may show as shortness of breath, heart palpitations, headache, weakness & fatigue.
How much do your residents need?
The RDI of folate for men and women over 70 years is 400ug/day
The best sources of folate
- Dark green leafy veg
- Dried beans and legumes
- Orange juice, banana or grapefruit
- Peanut butter
- Sunflower seeds
Residents at risk of folate deficiency may have
- Malabsorption conditions
- Alcohol dependency
Zinc is another micronutrient that’s often deficient in our older adults. It’s important for a healthy immune system, and is used to help create building blocks for proteins and healing wounds.
Watch out for zinc deficiency if your resident has
- Gastrointestinal disorders
- Chronic diarrhoea
- Vegetarians or those with low meat intake
- Alcohol dependency
How much zinc do seniors need?
The RDI of zinc for men over 70 years is 14mg/day, and for women is 8mg/day
The best sources of zinc are
- Beef, pork and seafood
- Fortified breakfast cereals
- Yoghurt and milk
Symptoms of zinc deficiency are
- Reduced taste and smell, frequent infections
- Poor appetite
- Slow healing wounds
Achieving a balanced diet for our residents
Because micronutrients are needed in such small amounts, we need to be making sure the meals we provide contain just the right amounts. Some micronutrients are stored in the body, however some are not so they need to be supplied daily to make sure the body gets enough.
Getting out of balance
Changing diet or menus can mean micronutrients are at risk of getting out of balance. If your residents fall into any of these groups it may be worth double checking with your dietitian that their micronutrient needs are taken care of.
- Needing texture modified diets and/or thickened fluids
- On diets where certain food groups are avoided (e.g. gluten free, vegetarian)
- Food preferences meaning certain food groups are avoided (e.g. don’t like veges)
It’s also important to realise that any change in proportion of foods on the plate (e.g. increase in fibre or carbohydrates) can also throw out the balance of micronutrients.
Where to go next?
Micronutrient deficiencies are less obvious than if someone isn’t eating enough energy or protein. But the effects they can have on the health of our residents can be just as devastating.
Have your facility menu reviewed by a dietitian to make sure it meets the micronutrient needs of your residents in the first place.
If you have clients who are frequent fallers, have frequent infections, had alcohol dependency or gastrointestinal disorder then make sure their micronutrient intake is being monitored. Nutrition screening and assessment should show whether supplements are needed.
Want to learn more? Here are the studies and sources of information we looked at.
MacDonell S, O et al (2016) Vitamin D status and it’s predictors in New Zealand aged-care residents eligible for a government-funded universal vitamin D supplementation programme. Public health nutrition.
National Health and Medical Research Council, Australian Government Department of Health and Ageing, New Zealand Ministry of Health. Nutrient Reference Values for Australia and New Zealand. Canberra: National Health and Medical Research Council; 2006. Updated 2016
Wham, C., Teh, R., Moyes, S. A., Rolleston, A., Muru-Lanning, M., Hayman, K., ... & Adamson, A. (2016). Micronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, life and living in advanced age: a cohort study in New Zealand (LiLACS NZ). British Journal of Nutrition, 116(10), 1754-1769.
Xiaopeng J. et al. 2017. The relationship between micronutrient status and sleep patterns: a systematic review. Public Health Nutrition 20:687-701
Meta description tag: Five of the most common micronutrient deficiencies in older people and what you can do to spot and stop them causing harm.