By Anna Horner | News & Views

Although cardiac rehabilitation (CR) professionals serve patients of all ages, they primarily encounter older patients with age-related needs, including nutrition. To promote their overall well-being, it is crucial that CR professionals understand how the dietary needs of 65-and-older patients differ from those of the general population.

Mary Finckenor, MA, RD, CDCES, BC-ADM, CSSD, CCRP, a dietitian and diabetes educator in the CR program at Morristown Medical Center in New Jersey, says, “Weight is a big issue – being both underweight and overweight is a challenge.” She often sees older, underweight CR participants struggling to gain because they believe they must adhere to a strictly heart-healthy diet. However, their health is compromised because they are underweight.

“We are learning that for those over 65, what is considered a ‘healthy’ BMI runs higher than the standard <25,” Finckenor explains. Conversely, those patients with a lot of weight to lose need support and reassurance. “Many of them expect to lose weight as easy as they did when they were much younger, but with the decrease in caloric needs that comes with aging, that just isn’t going to happen. With either weight gain or loss, slow and steady is the way to go,” she says.

CR professionals should also know that older individuals need more protein in their diet as they age. Studies show that if an older person eats the recommended dietary allowance (RDA) of protein and they are relatively sedentary, they are going to lose lean muscle mass. Finckenor encourages aging participants to have protein with every meal, more than the RDA. “The biggest challenge is usually getting people to add protein to breakfast. We need to give them breakfast ideas beyond eggs – think Greek yogurt, high-protein milk, cottage cheese, tofu scrambles, etc.,” she says. “Most people get protein for lunch and dinner, but breakfast is often low. People don’t know what to do for protein besides eggs and need suggestions.”

Constipation is another significant issue among older patients with low-fiber diets. “They don’t need huge amounts,” Finckenor says. “Having a relatively high-fiber cereal like bran flakes, even every other day, generally will do the trick.” A good general guideline is a cereal with five or more grams of fiber and less than 10 grams of added sugar. “Numbers like five and 10 are easy to remember and easy to tell patients,” she adds.

Additionally, CR professionals should understand that many older patients struggle to hydrate adequately and need strategies to encourage them to drink more water. “Filling a pitcher or large bottle with water to drink over the course of the day or choosing flavored water (sparkling or flat) or unsweetened iced tea are two approaches that work well,” says Finckenor.

The vitamin needs of adults change as they age. While there are thousands of supplements available, Finckenor suggests focusing on two: vitamin D and zinc.  “We know when vitamin D and zinc are low [in older people], the immune system suffers, so encouraging supplements that will correct low levels can help,” says Finckenor. “CR professionals don’t have to be dietitians. There are simple things they can tell older patients to really improve their nutrition status and get them healthier.”

If you missed Finckenor's AACVPR Live Webinar, Optimizing Nutrition for Aging Cardiopulmonary Rehab Patients, the recording is available — at no cost to members — from the AACVPR Learning Center.