In 2001 there were already 2.2 million South Africans older than 65 years, representing 4.9% of the total population. While HIV/AIDS, and other emerging infectious pandemics, such as H1N1, may reduce life expectancy and increase mortality, South Africa, in keeping with global trends, is facing a rapid increase in persons older than 65 years. This booming older population has specific nutrition needs and faces age-related health risks, some of which may be addressed by encouraging the elderly to increase their intake of milk and dairy products.

Age-related nutrition problems

Advancing age is associated with nutrition problems, including malnutrition, obesity, hypertension and osteoporosis.

Malnutrition and calcium deficiency

The prevalence of undernutrition in older African men and women is high (9.5-36.1% and 13.1-27% respectively). Globally the incidence of malnutrition among elderly individuals living in nursing homes ranges from 17% to 75%, while free-living elderly persons have a prevalence of undernutrition ranging from 5-10% which is often undetected.

A definitive study, undertaken among the elderly black population of Cape Town, showed that 27% of men and 36% of women had energy intakes of less than 67% of the RDA. These low energy intakes were accompanied by inadequate intakes of vitamin D, calcium, zinc and vitamin B6. In addition to the other poor intakes, these subjects had had less than one serving of calcium-rich foods daily which may account for the low calcium intake.

Similar findings of inadequate energy and micronutrient intakes have been identified in other population groups in South Africa and many elderly populations living in other countries. Other inner-city black Americans have a “particularly high prevalence for limited intakes of fruits, vegetables and milk”.

Obesity

The incidence of obesity in the elderly is high despite their reported lower energy intakes. For example, in South African black studies over half (51.3%) of elderly women and 18% of men were found to be obese with a BMI exceeding 30. Dietary factors and inactivity due to physical inability to walk or exercise, chronic medications and diseases, such as diabetes, probably contribute to the high levels of obesity seen in persons older than 65 years.

Hypertension

At 24.4% - particularly in the black population – high blood pressure or hypertension is common in elderly South Africans. Genetic susceptibility, high salt or sodium intakes, lack of potassium in the diet, obesity and concurrent illnesses are contributing factors.

Osteoporosis

This systemic skeletal disease is characterized by low bone mass and a high incidence of fragility fractures, particularly of the hip and vertebrae. Osteoporosis is not only a debilitating disease that impacts negatively on the quality of life of older persons, but it is also extremely costly in terms of medical resources. For example, in 1995 more than 9 million Euros were spent on the treatment of osteoporosis fractures in the EU. Osteoporosis is linked to inadequate intakes of calcium and vitamin D, which are two nutrients that have repeatedly been identified as lacking in the diets of seniors.

Reasons for inadequate food intake in the elderly

Many causes contribute to the decline of food intake and nutritional health of the elderly. It is known that people eat less and make different food choices as they get older. Factors such as household food insecurity, food poverty, HIV/AIDS, famine, war and natural disasters play a major role in Africa and it has been said that “In Africa, the elderly are not considered a priority for targeting of nutrition interventions”. Physiological factors that contribute to poor food intake and lack of variety in the diet of senior citizens include:

• Lower gastric emptying
• Altered hormonal responses
• Decreased basal metabolic rate
• Altered taste and smell
• Marital status
• Income
• Education
• Diet-related attitudes and beliefs
• Convenience

Dental status, particularly the lack of teeth, can seriously restrict chewing ability and reduce the intake of protein, calcium, iron and vitamins.

Include dairy in the diet of the elderly

• Dairy products such as milk, yoghurt, maas and soft cheeses are easy to swallow. Inclusion of dairy helps to improve the nutritional status.
• Seniors who suffer from lactose intolerance, which is often cited as a reason for avoiding dairy products, can use fermented milk products such as maas or yoghurt and cheese, which are low in lactose due to the fermentation process.

Having milk with breakfast cereals, soft cheese for lunch, a yoghurt for dessert and a glass of warm milk at night, can help older adults live a healthier and more productive life.

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