Diet and mental health

Definition

The food choices a person makes throughout his or her life influence the risk of physical diseases that may contribute to early death or disability, such as heart disease , stroke , cancer , and diabetes, in senior adults. Diet , nutritional status, and vitamin and mineral intake may also affect mental health and psychological well-being during the senior years.

Description

Older adults have unique nutritional needs. Because physical activity is often reduced in old age and metabolic activity slows down, seniors require fewer calories. At the same time, though, seniors need the same or more nutrients to remain healthy and avoid nutritional deficiencies that may contribute to mental or other health problems.

Mental health problems in seniors

Depression , anxiety , and dementia are the primary mental health conditions that affect elderly. In many cases, older adults and their caregivers do not understand mental illness or fail to recognize the disorders' symptoms.

According to the National Institute of Mental Health, between 1% and 5% of elderly adults living in the community experience depression, but the prevalence of the condition rises to 11.5% in elderly hospital patients and up to 13.5% in older adults needing health care at home. Older adults are also disproportionately likely to die by suicide , with people age 65 and older accounting for 16% of all suicide deaths in 2004.

Symptoms of depression, including changes in eating or sleeping habits and persistent sadness, may be easy to overlook in older adults because they are less obvious or the patient is less likely to admit feeling sadness or grief. Symptoms of depression in the elderly also often present with symptoms of anxiety, such as excessive fears, agitation, and impaired memory. As with depression, diagnosing anxiety may be particularly challenging, as these symptoms mimic those of other chronic conditions or problems that afflict the elderly, such as dementia or use of certain prescription medications.

Dementia, characterized by loss of memory and feelings of confusion and disorientation, affects about 15% of older Americans. Dementia may be associated with specific health conditions such as Alzheimer's disease , stroke, or other chronic health conditions, such as high blood pressure , Parkinson's disease, or blood vessel disease.

Energy intake and seniors

Malnourishment, or lack of adequate nutrients, is one problem that may interfere with senior's mental health and functioning. According to a survey of hospital patients 65 and older, 44% of seniors were at risk for malnourishment and 15% were malnourished. Other studies have shown that 50% of people in longterm care facilities were malnourished.

Often, chronic conditions such as diabetes, cancer, hyperthyroidism, renal disease, and pulmonary disease interfere with the body's ability or desire to take in food and nutrients. Seniors may also fail to eat enough for a variety of reasons, including problems chewing, difficulty shopping or cooking, low appetite or loneliness, problems affording healthful food, or medication use that reduces appetite.

If seniors do not take in enough calories and nutrients, they may become confused and experience decreased mental activity. Not eating enough calories can cause blood sugar levels to drop, and the elderly may become confused or experience personality changes. Poor nourishment can also cause anemia , a blood disorder with symptoms such as irritability, depression, and dementia.

Eventually, persistent malnourishment can cause permanent deterioration of mental health and mobility, as well as quality of life in general.

Vitamins, minerals, and mental health for seniors

Seniors may be at particular risk for deficiencies in certain nutrients, and not getting enough of them may impair mental ability and physical function.

Vitamins and minerals seniors need include:

• Calcium and vitamin D: Higher levels of calcium are necessary to keep bones strong and reduce the risk of osteoporosis, or brittle-bone disease. Vitamin D also plays an important role in maintaining bone density and strength.
• Vitamin B₆: The body needs an adequate amount of this vitamin for healthy blood cell formation and to synthesize the neurotransmitters serotonin and norepinephrine. Deficiency in this vitamin often occurs in people with low-quality diets and can cause mental health symptoms such as depression and confusion.
• Vitamin B₁₂: The aging process adversely influences the body's ability to use vitamin B₁₂. Deficiencies in this vitamin can lead to problems walking as well as numerousmental health problems, such as personality changes, dementia, and symptoms of depression and psychosis.

Caffeine, alcohol, and seniors

Some mental health concerns in adults may be caused or exacerbated by common foods or beverages in the diet, such as caffeine and alcohol. Consuming beverages or foods that contain the stimulant caffeine, including coffee, tea, soda, and chocolate, may cause seniors to feel jittery, overstimulated, nervous, or agitated.

Consuming the depressant alcohol, on the other hand, may worsen existing mental health problems. Alcohol use interferes with sleep patterns (sleeping poorly can increase stress levels and symptoms of depression and mood disorders) and also causes dangerous interactions with prescription or over-the-counter medications. A senior who drinks too much alcohol may feel confused or experience mood changes.

The elderly have a decreased sense of thirst and are at greater risk of becoming dehydrated, which can cause mental health symptoms of confusion and difficulty concentrating. Both caffeine and alcohol increase the body's need for water and increase the risk of dehydration .

Omega-3 fatty acids and mental health

One recent avenue of mental health research is the effectiveness of omega-3 fatty acids in alleviating mental health disorders.

Omega-3 fatty acids are essential nutrients that the body cannot make on its own, but they can be obtained by eating food sources of the nutrient, such as fish, seafood, flaxseeds, and eggs. In the past 150 years, as Western civilization has changed and expanded, so, too has fatty acid intake. Previous generations took in plenty of omega-3 fatty acids by consuming a diet rich in fish, wild game, and plants. Today, the typical adult diet consists of more saturated fats and a shift to higher consumption of omega-6 fatty acids from corn, safflower, and soybean oils. There are numerous health effects as a result. Evidence suggests that as omega-3 fatty acid intake goes down, cardiovascular disease rates go up. In addition, some research has indicated that the increased omega-6 intake of recent years increases inflammation in the body, and in turn, is partially responsible for the higher rates of depression and bipolar disorder in the U.S. population.

The good news for seniors is that increasing omega-3 fatty acid intake in the diet may in turn improve mental health. In one study published in the Journal of Clinical Psychiatry, researchers evaluated the effect that taking omega-3 fatty acid supplements had on major depressive disorder, bipolar disorder, and other mood disorders. The researchers found that the supplement offered a significant benefit in alleviating depression and symptoms of bipolar disorder. However, although omega-3 fatty acids may be used in conjunction with traditional treatments, patients should not use it instead of traditional mental health treatments, such as therapy or medication.

Challenges

The challenge for many seniors is maintaining a healthy, balanced diet in the face of the physical, financial, or emotional challenges of later life.

The National Institute of Aging suggests that an older woman should consume:

• 1,600 calories, if her physical activity is low
• 1,800 calories, if she is moderately active
• 2,000 to 2,200 calories if she is very active

An older man should consume:

• 2,000 calories, if he gets minimal activity
• 2,200 to 2,400 calories if he is moderately active
• 2,400 to 2,800 calories if he is very active

To help older adults maintain adequate nutrition and mental health, Tufts University has developed a Food Guide Pyramid especially for mature adults. These nutritional guidelines suggest the following to ensure adequate nutrient, vitamin, and mineral intake for good mental health:

• Low-fat and nonfat dairy products: Eat or drink three or more servings daily.
• Dry beans and nuts, fish, poultry, lean meat, and eggs: Eat two or more servings daily.
• Bright-colored vegetables: Choose three or more servings of fresh, frozen, or canned vegetables.
• Deep-colored fruit: Eat two or more servings of fresh, frozen, or canned fruit packed in juice.
• Whole, enriched, and fortified grains and cereals: Eat six or more servings of high-fiber varieties.
• Water: Consume at least eight 8-ounce glasses daily.

Seniors and their caregivers should also ensure their diet contains 2.4 micrograms of vitamin B₁₂ daily and 1,200 milligrams of calcium and 400 International Units [IU] of vitamin D for people age 51 to 70 and 600 IU for those over age 70. Older men should consume 1.7 milligrams and older women should consume 1.5 milligrams of vitamin B6 daily.

The U.S. Food and Drug Administration recommends that people take no more than 3 grams of omega-3 fatty acids per day, with no more than 2 grams from a supplement.

Although overcoming malnutrition seems like it should be an easy task, simply urging seniors to eat more is not necessarily the solution. For caregivers, the challenge may be to help the older adult overcome the issues that contributed to the malnutrition in the first place. Overcoming malnutrition in seniors may include:

• Encouraging or helping them to prepare nutritionboosting food. For seniors with arthritis or mobility problems, it is easy to grab toast or crackers, but these foods contain little nutrition. Caregivers might chop, slice, and refrigerate fresh fruits, vegetables, low-fat cheese, and nuts for easy-to-grab snacks.
• Addressing dental issues. If chewing or swallowing is painful, work with the senior's doctor and dentist to find ways to reduce pain and improve nutrition.
• Fostering relationships. Older adults may skip meals because it feels too lonely to eat by themselves. Inviting the senior for a visit, stopping by during mealtimes, or looking for social opportunities at a adult day care or senior center may alleviate some of the mealtime loneliness.

Risks

Seniors concerned about their mental health should ensure they eat a varied, balanced, nutritious diet, but overdoing it with dietary supplements might have the opposite intended effect. Depending on the person's health, the medications taken, and age, taking more than the 100% Daily Value of a vitamin or mineral could actually be harmful to health and may prevent prescription medications from being absorbed or utilized properly.

Consuming more than 3 grams of omega-3 fatty acids daily may lead to excessive bleeding. As with any dietary supplement, seniors should talk with their health care providers before taking these supplements to prevent dangerous interactions with other over-the-counter or prescription medications.

Talking to a geriatric health care provider or registered dietitian who specializes in senior health can help seniors determine if their nutritional needs are being met for optimal mental health and examine the benefits and risks of dietary supplementation.

Results

Although eating a healthy diet and consuming adequate amounts of vitamins and minerals does not ensure that an older adult will never experience mental health problems, it does reduce the risk of mood disorders or changes related to malnourishment or deficiency.

KEY TERMS

Anxiety —Exaggerated worry or tension, which may make it difficult to concentrate or relax.

Depression —A mental health disorder that interferes with a person's ability to eat, sleep, work, and enjoy everyday activities.

Malnourishment —Lack of adequate nutrition.

Neurotransmitter —Brain chemicals that help nerve cells communicate.

Serotonin —A neurotransmitter that affects mood and satiety, or satisfaction from food.

Supplements —Pills, capsules, powders, extracts, or liquids that include vitamins, minerals, herbs, or other additives that purportedly improve diet or nutrition.

Caregivers should regularly observe an older person's behavior and moods and talk to the health care provider about any changes that occur. Even older adults can benefit from psychiatric evaluation, therapy, and treatment with medication if a mental health disorder is present.

Resources

periodicals

American Psychiatric Association. “Let's Talk About the Mental Health of the Elderly.” http://healthyminds.org/multimedia/ltfelderly.pdf.

Anxiety Disorders Association of America. “Anxiety in the Elderly.” http://www.adaa.org/GettingHelp/FocusOn/Elderly.asp.

Food and Drug Administration. “Questions and Answers: Qualified Health Claim for Omega-3 Fatty Acids, Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA).” http://www.cfsan.fda.gov/̃dms/labo3qa.html.

Freeman, MP, JR Hibbeln, D Mischoulon, et al. “Omega-3 Fatty Acids: Evidence for Treatment and Future Research in Psychiatry.” Journal of Clinical Psychiatry December 2006.

“Health and Age. Guarding Against B12 Deficit in Seniors.” http://www.healthandage.com/professional/healthcenter/18/article/1683/Guarding-Against-a-B12-Deficit-in-Seniors.html.

Lichtenstein, AH, H Rasmussen, WW Yu, SR Epstein, RM Russell. “Modified MyPyramid for Older Adults.” J Nutr. 2008; 138:78–82.

National Institute of Mental Health. “Older Adults: Depression and Suicide Facts.” http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts.shtml.

National Institute on Aging. “Good Nutrition: It's a Way of Life.” http://www.niapublications.org/agepages/nutrition.asp.

Palmer, RM. “Management of Common Clinical Disorders in Geriatric Patients: Malnutrition.” http://www.medscape.com/viewarticle/534768.

Parker, GP, NA Gibson, H Brotchie, et al. “Omega-3 Fatty Acids and Mood Disorders.” http://ajp.psychiatryonline.org/cgi/reprint/163/6/969.pdf.

Tufts University. “Modified Food Pyramid for Mature Adults.” http://nutrition.tufts.edu/docs/pdf/releases/ModifiedMyPyramid.pdf.

organizations

American Psychological Association, 750 First Street, NE, Washington, DC, 20002-4242, (202) 336-5500, (800) 374-2721, www.apa.org.

Anxiety Disorders Association of America, 8730 Georgia Avenue, Suite 600, Silver Spring, MD, 20910, (240) 485-1001, (240) 485-1035, www.adaa.org.

National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD, 20892-9663, (301) 443-4513, (866) 615-6464, (301) 443-4279, [email protected], www.nimh.nih.gov.

National Institute on Aging, Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD, 20892, (301) 496-1752, (800) 222-4225, (301) 496-1072, [email protected], www.nia.nih.gov.

Amy Sutton