Eating constitutes the first pleasure of the newborn. This act can remain a pleasure until the end of life provided that particular attention is paid to the quality of the meal and the environment in which it is eaten. » More cases studies on : http://www.fondation-louisbonduelle.org/france/en/health-professionals/cases-studies.html

1. « Eating constitutes the first pleasure of the newborn. This act
can remain a pleasure until the end of life provided that particular
attention is paid to the quality of the meal and the environment in
which it is eaten. »
All individuals are not equal towards aging.
Many genetic and environmental factors
as well as lifestyle may influence aging.
Diet in particular plays an important role
in orienting towards successful aging. If
not yet done, the fifty year old must adopt
adequate behaviours in order to best
manage the multiple evolutions associated
with aging. This will help entering into
the thrid and fourth age with all the
necessary assets to avoid undernutrition,
a plague for aging people living at home
or in institution. The Louis Bonduelle
Foundation summarizes for you in a few
pages the key nutrition recommendations
to successful aging while dispelling
the spectrum of undernutrition.
A
ll specialists are today
convinced: good eating
habits contribute to successful
aging. This concept, first described in 1987 by Rowe and
Kahn, refers to aging without
pathologies nor handicap,
while maintaining a high level
of physical activity, cognitive
function and autonomy1.
The aging population includes
heterogeneous subjects for
which age does not necessarily constitute the most pertinent criterion when evaluating
the general state of health,
most often influenced by the
quality of aging. Hence, geriatrics specialists and gerontologists classify people over 60
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into three categories1, 2: those
aging in good shape (successful aging), those that are described as frail, not presenting
any pathology but having a risk
of developing diseases (normal
aging) and those presenting
several risk factors, pathologies, and/or early disabilities
(pathological aging). However, two age groups reflecting
very different realities from a
nutritional standpoint must be
distinguished when describing
aging: young seniors around
sixty with good eating habits
delaying the onset of pathologies and the fourth age whom
major preoccupation is to prevent undernutrition.z
© Monkey Business - Fotolia.com
How to eat
for better aging?

2. Sustainable evolution
of eating habits
In theory
Managing evolutions associated to aging
The links between aging and nutrition are com-
plex: the diet may influence the quality of the process
of getting older which in conjunction to aging evolutions
modify the way individuals are eating. Physiological
changes (loss of appetite, reduced taste sensitivity, early
satiety, etc.) as well as lifestyles modifications (retirement, widowhood, etc.) may alter the nutritional status.
Declining sensory perceptions
From a sensory standpoint, aging is linked to the greater or lesser capacity of the elderly to perceive organoleptic properties of food, especially aroma, flavour and texture. The elderly may experiment a reduction of their ability
to detect, discriminate and identify aromas and flavours3, 4.
However, there exists a wide interindividual variability: some aging individuals present a severe alteration
of olfaction, others may maintain intact their chemicosensory capacities. In between these two situations,
there are people with altered olfaction or taste perception
responding positively to increased intensity of sensory
stimuli5. In any case, taste reduction acts specifically: it’s
more significant for bitter and salty tastes than for sour
and sweet6.
Sensory losses associated to normal aging must be
considered carefully. They are due to a progressive decline and a sort of permanent reset of internal food representations and food memories without explicit perception of smell and taste loss. Studies show that increasing
Fruits & vegetables
in the elderly’s diet
The consumption of fruits & vegetables tend to decrease among the elderly because of their reduced
ability to chew15. Eating cooked vegetables (preferably
steamed, cooked in a pressure cooker or microwave to
preserve nutrients) and consuming ripened fruits may
allow to remedy this situation and increase intakes
of foods usually appreciated by the elderly. A French
consumer survey (Inca) shows that fresh fruits & vegetables consumption is higher among the elderly compared to young adults12, 19. These findings are attributable to a generational effect (present elderly are more
familiar with preparation techniques and the consumption of a variety of fruits & vegetables) and to the evolution of preferences linked to age20. Although this trend
is observed in other European countries such as the
UK and Sweden, it cannot be generalized. In Belgium,
the 2004 Belgian consumption survey shows that fruits
& vegetables intakes tend to decline among the elderly
over 75 compared to adults (120 g/d vs 141 g/d)21.
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taste concentration in a food or in a meal does not affect
its consumption7, 8. In consequence, increasing taste
concentration does not constitute a high interest to the
elderly9.
However, smell and taste do contribute for a large part
to the pleasure associated to food ingestion. Even if no
correlations between food intake, smell and taste malfunctioning have been found, the reduction of chemicosensory capacities is often found to reduce appetite in
the elderly. A French multidisciplinary survey showed
that individuals presenting a high smell alteration had
frail nutritional status compared to others5. Factors such
as poor dental status and psychological or sociological
changes also play a role in food pleasure and appetite in
the elderly.
Changing lifestyles habits
Throughout aging, the quality of dietary habits tends to
deteriorate. Food variety decreases as well as intakes in
foods such as: bread, meat, cheese and fresh vegetables10,
11
. When individuals are getting older, they have less ability to shop for food which leads to reduced food supply:
intakes of perishable foods decrease12. The elderly’s life
may also be punctuated by breakdowns susceptible to
affect their dietary habits13. Food behaviours do not refer
solely to the ingestion of food to fulfill a need. They are governed by complex inter-relations of motivations, feelings
and pleasures. Hence, it is necessary to considerate the
individual in its social aging context evolving through life
events. Retirement highly modifies food habits14. Different
food typologies may be identified for retired people based
on their link to health, commensality and sociologic profile. Philippe Cardon, lecturer at University of Lille, France,
has identified 5 profiles: the disinterested, the lonely, the
greedy, the cooks and the nutritionists.
Nonetheless, food patterns of retired people are not
immovable since other life events such as widowhood,
diseases, hospitalization can affect the elderly. Cooking
dependency appears during this period and the delegation of all or part of food activities such as shopping or
meal preparation to a third party (family, friend, househelp) may be necessary. The consequences of this dependency vary according to the family structure, the gender, whether the elderly is living alone or not, the type of
deficiency (psychological or physical) and the status of
the house-help. The most important changes are usually
observed when the person in charge of food shopping or
meal cooking is touched by a psychological deficiency
within the couple. The surviving spouse, who is not familiar with these tasks, often needs to simplify these activities. In any case, cooking delegation always leads to a
reduction in food variety and such food degradation is
often perceived as an aging fatality15.
>>
p. 2 - How to eat for better aging ?

3. © Alexander Raths - Fotolia
>> Life breakdowns, including those not necessarily linked to cooking dependency like widowhood or progressive social isolation, favor undernutrition16, 17. Widowhood
implies changes in usual dietary habits previously established among the couple. Foods with high symbolic
value such as homemade pastries, typical family meals
(roast, pot-au-feu, etc.) are neglected. This situation is
generating a succession of learning phases and trials,
mostly for men than women, to help rediscover old preferences forgotten over a long time12. In the case of isolation or monotony, elderly’s appetite often decreases.
For all these reasons, food sociologists specialised in
aging recommend to look beyond nutritional aspects.
Social practices associated to food intake (shopping,
cooking practices, frequency and meal composition) are
equally important to ensure nutritional balance. z
In theory Undernutrition, a reality among the elderly
The loss of sensory perceptions, dental health
degradation, psychological and sociological changes...
All these factors are contributing to decrease appetite and
nutritional status. This is why the fight against under-nutrition must be at the heart of the elderly’s preoccupations.
Nutritional situation and state
of the elderly in Europe
In Europe, the Euronut Seneca Survey (Survey in Europe on Nutrition and the Elderly, a Concerted Action)
conducted between 1988 and 1991 with 2856 individuals, aged between 70 and 75 at the beginning of the
recruitment, indicates a marked energy intake reduction
correlated with age: 2 to 4% of men at 70 and 10 to 20%
of women at 75 years old do not eat enough22, 23. For
instance, individuals over 80 have energy intakes below
1500 kcal/day.
In France, according to the 2007 HAS report (French
national authority for health), the prevalence of proteinenergy undernutrition is 4 to 10% among the elderly
How to eat for better aging ? - p. 3
living at home, 15 to 38% among those living in institution and 30 to 70% in hospitalized patients24. In Belgium,
according to a prevalence study conducted in 2007
among more than 80% of geriatrics departments, 35%
of individuals over 75 are undernourished25. The Solnut
study, conducted in 2001 in France in the south-east department of Drôme, shows that 43% of individuals over
70 have inadequate energy intakes which are gone unnoticed26. These results are alarming knowing that figures are usually based on average data.
In the UK, BAPEN (British Association for Parenteral and
Enteral Nutrition) reported in 2007 and 2010 that there
were over 3 million people undernourished in the UK,
93% of whom are living in community health services.
This represents 5% of the population and this incidence
increases to 14% for those over 65 years of age. Around
30% of patients admitted to hospital as well as 10-14%
of the 700,000 people living in institution27, 28.
The more the individuals are getting older, the more
undernutrition becomes prevalent. This is why it is >>
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4. Sustainable evolution
of eating habits
>> particularly important to monitor people over 75.
One significant figure shows that two thirds of undernourished seniors with no sign of disease die within the
next 5 years29. Moreover, undernutrition at the hospital
increases the risk of complications, morbidity and mortality as well as the average length of hospitalization
and global treatment cost. Micronutrient deficiencies
(vitamins, calcium, iron…) associated with inadequate
dietary intake must also be taken into account. Studies
confirm that these results are common facts among older people at risk of undernutrition22 26.
Key points in prevention
Undernutrition appears when energy and protein intakes
are lower than needs. Hence, the more people are aging
the more the appetite becomes difficult to regulate. The
basis for prevention consists in limiting appetite loss in
order to avoid anorexia to install. Eating must remain a
pleasure. Increasing the organoleptic quality of meals,
encouraging food diversity to avoid monotony, ensuring
exchange moments and conviviality around the meal are
ways to be explored as well.
It is also important to fight the idea that energy and protein needs are reduced among the elderly due to lower
physical activity level. This is false! An aging metabolism is less efficient in transforming ingested food into
nutrients and energy. Hence, the body needs more nutrients to obtain the same results. Even though the body
is less active, more calories are required to meet basal
metabolism needs when aging. This is all the more important when pathologies appear6.
If the quantity of food eaten constitutes a priority for the
elderly, its quality is also important: only a varied diet rich
in fruits & vegetables will provide the required amount of
nutrients to the aging organism. It is necessary to avoid
deficiencies installing because metabolic dysfunctions
may appear and become difficult to restore.
Sarcopenia, characterized by progressive loss of mass
and muscular functions, must also be prevented29. Reduced protein anabolism is often combined to increased
catabolism leading to a high risk of fractures and falls.
In Europe, EFSA (European Food Safety Authority) Panel
Whatever age,
physical activity is essential
Practicing physical activity on a regular basis (30 minutes per day of endurance and/or resistance exercise) provides many benefits to the elderly34, 35 such as:
slowing down bone loss associated to osteoporosis
and helping preventing falls, stimulating protein anabolism, slowing down sarcopenia, decreasing the prevalence of cardiovascular disease and type 2 diabetes,
reducing abdominal fat mass as well as blood pressure
and increasing cardiopulmonary capacity. The cherry
on the cake: when done in the morning or in the afternoon, physical activity stimulates hunger between
meals.
on Dietetic Products, Nutrition and Allergies considers
that the value of 0,66 g/kg body weight per day can be
accepted as the Average Requirement (AR) and the value of 0,83 g/kg body weight per day as the Population
Reference Intake (PRI) derived for Dietary Reference Values for protein. For older adults, the protein requirement
is considered to be equal to that for adults. However,
countries such as France have set greater requirements
for elderly: protein intakes for the elderly should be
1g/ g body weight per day compared to 0,7 to 0,8 / g
k
g k
body weight per day in the younger adult30-33.
These recommendations are difficult to achieve when
appetite is decreasing. One solution consists in encouraging the elderly to maintain appropriate physical activity level to favor protein synthesis and in turn stimulate
appetite. Anabolism increase helps fighting against bone
loss and osteoporosis as well. Calcium and vitamin D
intakes must be monitored. In parallel to undernutrition,
dehydration must be taken into account due to lower
body reserve and decreased taste perception. The elderly must drink regularly (hot drinks, cold drinks, aromatic
water, jellified water,..), in order to maintain daily intakes
of 1 to 1,5 liters and consume a diet rich in water (fruits,
vegetables, dairy products…)6. z
In practice
Seniors, home-helps, health professionals...
Take action against undernutrition
Undernutrition is the main nutritional challenge
facing the elderly, especially over 75. Metabolic changes
(recurring infections, dehydration, healing problems) become
only visible at advanced stage36. Health professionals, househelps, the elderly himself should pay attention to weight and
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its evolution. It is essential to quickly identify weight loss since
every kilogram or pound lost by the elderly is very difficult to
regain. Abnormal fatigue, decline in muscle strength, clothes
getting too big, etc. are all signs of possible undernutrition
and should be taken care of early.
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5. © contrastwerkstatt - Fotolia.com
Detect signs early
Detection by general practitioners of undernutrition for
all seniors is recommended at least once a year. Monitoring weight, calculation of Body Mass Index (BMI) based
on reported height in adulthood using the identity card
(not the current one) and evaluating the dental health
status are actions to be implemented systematically on
a regular basis. The Mini Nutritional Assessment (MNA)
constitutes a simple and reliable tool to detect undernourished individuals or being at risk of undernutrition37.
This test is used to assess nutritional status by asking
six simple questions in less than five minutes.
To asses nutritional status more precisely, blood tests
(albumin, prealbumin, C-reactive protein) may also be
advised6, 38. Albumin is a good indicator to detect undernourished overweight people for which weight loss may
be a sensitive criterion. Lastly, it is useful to question
elderly people about their food intake, meal composition and portion size, for the last 24 hours.
The loss of muscle function, an indicator of sarcopenia,
is detected by clinical tests measuring strength (grip
strength test, extension test) or performance (4-meter
walking speed, sit down and stand up test, etc.).
Stimulate appetite
Whatever the elderly is undernourished or not, the priority remains to stimulate their appetite. Encouraging family or friendly conviviality around the meal as much as
possible (eating should remain a social act) and presenting appetizing dishes adapted to suit individual tastes,
are the main actions to be put in place. Eating must
remain a pleasure!
When the elderly is living at home, it is crucial that family
members or house-helps regularly ensure the refrigerator, freezer and cupboards are filled, taking into account
two points: firstly, checking that products are not expiHow to eat for better aging ? - p. 5
red, indicator of poor dietary intake and secondly, integrating tastes of the moment, knowing that perceptions
can change. Another point: nothing beats homemade
meals. The house-help can prepare a variety of meals
in small portions (single or double), clearly labeled with
date and be placed in the freezer. The meals could then
be heated in the microwave and eaten alone or with
company. Conviviality is important and it is necessary
to encourage the elderly in that sense: participation in
clubs (some cities offer several activities for seniors
and meals at moderate price), listening networks, maintaining relationship with neighbours, etc.
When a specific diet is medically required - recommended by health professional (diabetes, hypertension,
swallowing or chewing disorders, etc.), it is necessary
to consider individual food preferences and eating habits. Otherwise, there will be a risk of non-coverage of
nutritional needs.
Taking time to laying the table is important for the elderly (tablecloth, dishes, flowers), presenting catering
foods in a nice plate are all little things that count to
increase meal palatability. Encouraging the elderly to
walk a few minutes before meals, for getting bread for
example, can contribute to stimulate appetite.
Optimize dietary intakes
In the case the elderly do not eat enough, despite efforts,
they must be advised to adopt a fortified and varied diet
which meets, as much as possible, daily nutritional recommendations (3-4 dairy products per day, 2 portions
of meat, fish or eggs rich in proteins, one vegetable portion and one starchy food per meal and at least one
daily serving of raw vegetables or fruits, etc.). Products
high in proteins and/or energy can be recommended to
boost meals for example: adding an hard-boiled egg
or bacon, sardines, surimi, cheese cubes to the
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6. Sustainable evolution
of eating habits
vegetable-based starter. Many different ingredients
could be added or topped to soups such as: tapioca,
croutons, cream, milk powder, ham, etc. Vegetables
are more caloric when prepared with bechamel sauce
or enriched with milk powder or served with mashed
potatoes, pasta or rice, added cheese, cream, butter,
egg or minced meat. Dairy products and desserts could
be fortified with milk powder, condensed milk or cream
but also products such as: jam, honey, chestnut cream
puree, caramel, chocolate, fruits in syrup, etc. Finally,
drinks may be enriched with milk or milk powder, served hot or cold, plain or flavoured (chocolate, coffee,
fruit syrup). Eggnog (beaten egg with milk, sugar and
other flavourings) and milkshake (beaten with ice cream
or fresh fruit and milk) could also be tasty alternatives.
In order to meet dietary requirements, the elderly must
take the necessary time to eat. The 2005 National Food
Council recommendations (NAC) encourage the elderly
to spend at least 30 minutes for breakfast, an hour for
lunch, and 45 minutes for dinner. In order to maximize
food intake, meals should be split during the day and
eaten within a maximum interval of three hours including several healthy snacking between meals and by
reducing to 12 hours night fasting. z
In practice home, in institution, at the hospital:
At
Proposing an adapted food offer
The food offer plays an essential role in managing
undernutrition in many ways: by providing a varied and wellbalanced diet among healthy seniors, by being pro-active to
help undernourished people or those at risk of undernutrition. Meals must be adapted to the elderly whether they are
living at home, in institution or as patients at the hospital.
In order to compensate the decline of chemico-sensory abilities, meals can be enhanced with spices or herbs. Garlic
and parsley are usually appreciated among seniors. Other
spices can be used (curry, soy sauce, coriander, ginger,
etc.). Never forget to ask for feedback after meals. Including
palatable foods such as cold cuts or sweet desserts could
Workshops dedicated to residents of Marpa
Professionals working with French’s rural homes
adapted to the elderly (Marpa) know the magnitude
of the challenge and the interest of motivating elderly
residents about their diet. The Louis Bonduelle Foundation knows it as well. This is why the Foundation
is supporting the national federation of Marpa in the
conduction of a national and innovative operation
with the objective of developing food pleasure and
relationship-building among the elderly. Two different
workshops have been developed: the first one, “Art
nature” is encouraging the elaboration of short-lived
creations using vegetables and the second one, “Art
flavours”, involves blind tests stimulating sensory perceptions where foods have to be identified through
smell or taste and encouraging as well the creation
of simple recipes. These workshops get residents
to meet each other and arouse their curiosity about
food. In that, they are contributing to maintain elderly’s autonomy.
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be an interesting alternative. However, specific attention
should be paid to the volume of the food. Although portions
should be increased to cover daily needs, older people can
be discouraged in front of a plate judged too full. Thus, proposing small portions of fortified meals constitutes a more
efficient strategy.
At home
As discussed previously, nothing beats homemade meals.
When it is not feasible, ready-made dishes could be a good
alternative. The most suitable products for this age-group
are: individual portions at reasonable prices, easy-to-open
packagings, information on how to prevent food poisoning,
etc. Food poisoning is a major concern among the elderly
because they often forget how long products have been
stored in the refrigerator.
Several studies (Euronut-Seneca22, 23 and Solinut26) have
shown how important the support provided to elderly people
living at home when preparing, delivering and/or consuming
meals is.
In Institution
In institution, problems are different40. Food intakes are
part of the medical treatment and the input of health professionals is key to contribute to meal quality. The dietician
can provide valuable help to kitchen staff and train them
about elderly’s requirements (well-balanced menus, texturemodified or enriched foods etc.). However, nutritional and
sensory qualities of the plate are not always enough. People
removed from their familiar environment must be given back
the desire to eat. One suggestion could be to involve seniors
in meal organization and food choices. Studies show that
such participation can increase food intake up to 25%.
If one looks at the substance (of the plate), it is also important
not to neglect form (meal): eating remains a social act and
the conditions under which it takes place are crucial.
p. 6 - How to eat for better aging ?

7. ©Monkey Business - Fotolia.com
The environment and the table - including decoration,
guests and pleasant ambience - must stimulate the desire to
share the meal with others. Specific factors linked to aging
(swallowing disorders, tremor, noise sensitivity, etc.) do not
justify the exclusion of these moments of conviviality. A meal
spent in the dining room could increase food intake from 20
to 30% compared with the same meal served in the patient’s
room. It is everyone's responsibility to find solutions41.
Multiple actions could be put in place in order to increase
the interest of the elderly for food and stimulate their appetite: participation to menu task force, therapeutic culinary
workshops, themed meals, special events, etc. A little imagination and a lot of goodwill can do miracles!
At the hospital
In the case of exceptional dietary conditions further to
long-term hospitalization or serious illness, it is essen-
Senior' Act a food offer
adapted to seniors
In 2011, Vitagora - an independent innovation “TasteNutrition-Health” network based in Dijon – in conjunction with the interregional division of gerontology (PGI)
of Burgundy, France, have initiated the “Senior'Act”
project. This project consists in a collective effort to
provide guidance, to the industry, on business innovation and development about the senior market: nutrition, packaging, food equipment, distribution or marketing. Through this research, the network helps better
understand the food environment and the culinary patterns of the elderly. Objective: to offer products and
services tailored to the needs and expectations of
older people.
How to eat for better aging ? - p. 7
Cold vegetables even
in case of chewing disorders
The introduction or reintroduction of vegetables, especially cold vegetables, among the elderly having been
deprived for a long time - due to chewing problems
for example - requires some hints and tips. Vegetables
with a soft texture should be preferred: avocado, corn
salad, beets, asparagus and artichoke. If tomatoes
are used, serve them peeled, seeded and cut into tiny
cubes rather than sliced.
tial to take the necessary time to encourage the elderly
to eat their meal at their own pace. Lack of personnel
or logistical constraints should never justify removing
patients’ tray before it is finished. The hospital environment with its own rotating shifts and procedures can
have negative impact on patient’s nutritional intakes42.
In order to reduce the risk of undernutrition, special attention must be paid to mealtime. In addition, cooperation between care teams and kitchen staff is essential.
In summary, at all ages and especially over fifty, good
health is favored by a well-balanced diet combined to
regular physical activity (to be maintained as much as
possible even for very old people). Throughout aging,
many factors lead to the reduction of food intake
whereas metabolic changes are increasing nutritional
needs. Undernutrition is the enemy to fight among
the elderly. Using useful weapons such as adding nutrients-rich ingredients or spices to the meal combined to appropriate listening and empathy are the key
components contributing to the independence of the
elderly.z
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8. © Ioana Davies (Drutu) - Fotolia.com
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www.fondation-louisbonduelle.org