When chef Dennis Galloway put a portabella mushroom sandwich on the menu at Places Restaurant, he knew he might be "driven out with pitchforks from the village."
To his relief, the vegetarian entree was greeted with enthusiasm. Galloway sold 16 sandwiches on opening day last summer at the newly renovated restaurant/cafe at John Knox Village, a 420-acre retirement community in Lee's Summit.
As Joyce Caldwell, 79, Howard Caldwell, 83, Joie Hendrix, 71, and Rex Hendrix, 70, peruse the lunch offerings they nod their approval.
"The old menu didn't have too many light things and salads," Joyce Caldwell says. "I think most older people are interested in having lighter food."
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The diners are quick to note the new menu includes low-fat, heart-healthy entrees such as grilled chicken salad with a raspberry vinaigrette served on the side, a salad bar chock-full of broccoli and red peppers containing health-promoting phytochemicals, and more beverage choices including wine and green tea, which contain cancer-fighting antioxidants.
As more Americans are living into their 90s and 100s, eating for longevity takes on new meaning. A lifelong nutrition game plan can help extend overall health and promote a continued zest for living.
Senior adults 85 and older are the fastest growing segment of the population, yet the issues of nutrition an obese senior faces can be markedly different from the ones frail elderly people encounter. Malnutrition and over nutrition are both problems of the 65-plus generation.
A study released earlier this month on the Web site for the journal Health Affairs found adults older than 65 account for one-fourth of the obese population in the United States. The study also found obese seniors have much larger Medicare expenditures than their peers who maintain a normal weight.
By 2030 the number of older Americans will double from 35 million to 70 million, and their growing numbers are sure to put increasing demands on the health-care system. Costs of obesity are currently estimated to be between $93 billion and $117 billion a year.
Nutrition experts have found a diet of moderation may be the key to delaying or escaping the diseases of aging such as obesity, Alzheimer's, cancer, stroke and heart disease.
The human metabolism peaks between the ages of 18 and 30, so most senior adults use less energy or calories than they once did.
Although the body needs the same nutrients - protein, carbohydrates, fat, vitamins and minerals - lower calorie requirements mean seniors need to eat nutritious foods with little room left for the empty calories of youth.
As physical mobility declines, maintaining weight becomes more difficult. Maintaining fat stores and muscle mass also becomes more difficult with age as the body grows less efficient at digesting food, causing indigestion and constipation.
At the same time, a series of social and cultural factors also affect the senior appetite. A growing social isolation, lack of finances and even tooth decay can play a role in poor nutrition.
A report by the U.S. Senate Committee on Education and Labor found that 85 percent of older Americans have one or more chronic conditions that could benefit significantly from better nutrition.
Like the many treatment programs and education campaigns used to curb smoking rates, similar nutrition interventions for obesity would be cost effective, health experts say. An American Dietetic Association study found that for every dollar spent on screening or intervention, at least $3.25 is saved.
"(Diet) makes a difference. It's not just something that is academic. It makes a difference in your zest for living," says Mary Meck Higgins, an extension specialist at K-State Research and Extension who works with senior adults. Top and bottom overhaul Nutrition needs change just as radically between ages 60 to 100 as they do from infancy to age 40.
At first glance, Tufts University's Modified Food Pyramid aimed at 70-plus adults appears similar to the standard Food Guide Pyramid. But on closer inspection, several important additions figure into the mature diet.
First, the bottom layer of the pyramid displays eight glasses of water. With age comes a decreased sensation of thirst. That lack of thirst can often lead to dehydration. More than one in three Americans older than 60 do not consume enough water.
Many seniors find drinking eight 8-ounce glasses of water a day excessive, but the water goal doesn't have to include just plain water. Soups, puddings and other foods prepared with water can help meet hydration needs.
Second, the top of the pyramid includes a flag signaling the importance of vitamin supplements. As the body ages, it becomes less able to process calcium, vitamin D and vitamin B-12.
Calcium - To protect against osteoporosis and debilitating bone fractures, calcium requirements rise 20 percent, often requiring a supplement. Seniors should aim for 1,200 to 1,400 milligrams of calcium a day. Calcium supplements are usually taken in three to four increments throughout the day for better absorption.
Milk, cheese and yogurt are considered the best food sources of calcium. Other options include dark leafy green vegetables, fish with edible bones, tofu made with calcium sulfate and calcium-fortified juices and cereals.
Vitamin D - Vitamin D and calcium work in tandem - vitamin D is necessary to process calcium. Sometimes referred to as the "sunshine vitamin," vitamin D is made when sunlight, or ultraviolet light, hits the skin. But older skin is also less able to convert sunshine into vitamin D, and often seniors are not getting outside on a regular basis. Most milk is fortified with vitamin D, as are many cereals.
Vitamin B-12 - With age, a decrease in stomach acid makes vitamin B-12 and calcium more difficult to absorb, and medications also might interfere with the absorption of B-12. A deficiency usually can be addressed with a multivitamin. A lack of B-12 can cause poor memory and impaired balance. Best sources are animal foods.
Other factors that can affect senior nutrition:
Diminishing sense of taste - As appetite decreases, many seniors become less interested in food. A sense of smell is a huge factor in the human ability to taste. But around age 50 many older people gradually begin to lose their sense of smell, to the point that many can't distinguish a banana from a strawberry. Herbs, spices and monosodium glutamate can help pump up the flavor of food to make it more palatable.
Prescription drugs - Medications have an impact on the taste of food and overall nutrient absorption. The average American over 65 takes two to seven prescription drugs a day and fills 14 types of prescriptions a year.
Tooth decay or ill-fitting dentures - Good teeth are a reflection of good health. Dental care can be expensive but is often key to whether seniors get adequate satisfaction from a meal and, ultimately, the proper nutrition.
Changing with the times
Health experts say seniors who function at a high level up until the day they die pay close attention to their diets.
Best friends Joyce Caldwell and Joie Hendrix try to watch what they eat and get plenty of exercise. Both women say the only nutrition advice they got growing up was to eat their vegetables and clean their plates.
Their dietary education actually began as they entered retirement, after Caldwell's career as an automobile executive and Hendrix's career as a third-grade teacher. The women say retirement has given them the time to pay attention to health and medical news as well as the financial stability to make better food choices at the supermarket.
Both women have made lifestyle changes to support their expanding knowledge of nutrition. For instance, Caldwell never eats fried food, avoids snacking between meals, drinks skim milk and orders only decaffeinated coffee. Hendrix avoids snacking and says she can't remember the last time she had a potato chip.
They attend Weight Watchers. They take water aerobic classes at the John Knox Village fitness center and they play golf several times a week.
Contrary to many seniors who prefer to eat out or take advantage of a daily meal plan, the women like to cook and entertain in their homes. "If you're eating out all the time you get too much sodium and preservatives," Hendrix says. "I think my problem, if I have a problem, is that I'm too good to myself. I've got to cut the food portions."
To get recipes and ideas for entertaining, they subscribe to an eclectic combination of food and health magazines including Prevention, Taste of Home and Gourmet.
And when dining out, the women aren't shy about asking for what they want. They were instrumental in getting the dinner hour extended at Places Restaurant, as well as lobbying for the addition of wine to the menu.
"This new generation is really changing the way we do business," says Kelli Quinn, John Knox's director of communications and public relations. "This is the first generation to have credit cards. These people are out and about. They have had a lot of experience as a consumer, and they know what they want." Getting good mileage Just in his mid-20s, Dennis Galloway has already been promoted to manager of Fireside Dining, a cafeteria-style restaurant at John Knox Village.
After working from behind-the-line as a chef, Galloway could likely have landed a job at any hip restaurant that pulls in a fashionably trendy crowd. Instead, he's content to cater to a devoted audience old enough to be his grandparents and in some cases great-grandparents.
"I could go out on the Plaza and prepare this food for people who are used to it, but I like the chance to expose the customers to new stuff," he says.
Devri Morello, a registered dietitian at John Knox Village, says Galloway takes a personal interest in the residents and listens carefully to the feedback he gets from them.
"We added green tea to the menu because residents requested it," Morello says. "Most seniors know what they need and are not shy about telling you. They know about conjointin for their joints or the antioxidant benefits of green tea."
Although it's not likely Places Restaurant will become the next "in" dining spot, neither is the next generation of seniors stuck on meat and potatoes fare. They are more willing to try new foods because they've been introduced to a wider array of tastes during their youth, including different ethnic cuisines, pasta and seafood.
The staff at the various kitchens in the village also caters to a variety of diets required by its diverse clientele, including low sodium, low cholesterol and diabetic diets.
"This is the one (restaurant) that provides the full flexibility of being creative," Galloway says. "We can have more experimental foods. We're not yet ready to put a sushi bar in, but most of the residents have been very accepting."
Fountain of youth
For seniors born in the early 1900s when most vitamins had yet to be discovered and named, nutrition has come a long way.
At the turn of the last century, life expectancy for men and women was barely 47 years. With improved sanitation and nutrition, today's average life expectancy has climbed to 77 years.
Experts expect nutrition science to continue to evolve. But for now, at least one thing is clear: Diet and exercise are the closest thing to a fountain of youth.
"It matters what you put in your body," says registered dietitian Morello. "It's like a car. As soon as we drive it off the showroom floor, we have to start maintaining it."
The key to keeping the motor purring?
Stay physically active.
Like the American population at large, seniors have become sedentary. More than 30 percent of seniors are obese, a figure that has jumped from one out of eight in 1991 to one out of every five in 1998.
Inactivity is responsible for loss of muscle strength and balance, conditions that can result in a fall. Every year fall-related injuries alone account for $20.2 billion in medical costs.
By 2020 that figure could rise to $32.4 billion. Experts say improving the physical activity level of seniors may significantly lower health-care costs.
A Center for Disease Control Study found that more than 60 percent of seniors are inactive. By age 75, about one in three men and one in two women engage in no leisure physical activity.
Moderate activity several times a week can prevent or lessen some age-related medical conditions - including heart disease, arthritis, diabetes, osteoporosis and muscle degeneration.
Health experts insist if you don't use it, you'll lose it. Results can be achieved at any age, with a payoff of better health and more independence longer.
That's why seniors should aim for a combination of aerobic activity and strength training as a part of their daily routine. Mall walking, gardening, water aerobics, chair yoga and a host of other activities through churches and senior centers can help keep older adults moving and avoid obesity in later years.
Hate to exercise alone?
Find a workout buddy. Like Joyce Caldwell and Joie Hendrix, about 60 percent of adults who exercise do so with a companion or in a group.
In fact, the friends enjoy their water aerobics workouts so much they're busy lobbying for an Olympic-size swimming pool at John Knox Village.