Aging, Nutrition and Taste: Nutrition, Food Science and Culinary Perspectives for Aging Tastefully

Aging, Nutrition and Taste

Nutrition, Food Science and Culinary Perspectives for Aging Tastefully

Jacqueline B. Marcus, MS, RDN, LDN, CNS, FADA, FAND

Jacqueline B. Marcus and Associates, Highland Park, IL, United States

Table of Contents

Cover image

Title page

Copyright

Acknowledgments

Overview—The Aging and Taste Revolution

Introduction

What Is Aging

What Is Taste?

Why Focus on Aging?

Why Focus on Taste?

Why Does Taste Change in Aging People?

What Are the Concerns of Taste Changes in the Aging?

What Can Resolve Taste Changes in the Aging?

Nutrition, Food Science and Culinary Perspectives for Aging Tastefully

Chapter Summaries That Address Nutrition, Food Science and Culinary Perspectives and Aging

Food Science and Aging

Culinary Perspectives and Aging

Chapter Summaries

Other Elements

Chapter 1. Global and US Aging

Abstract

Summary

Introduction

Global Aging

Impact—Global Gerontology and Geriatrics

US Aging

Impact: Gerontology and Geriatrics in the United States

Digest

Manner of Speaking

References

Chapter 2. Nutritional and Physical Concerns in Aging

Abstract

Summary

Introduction

My Plate for Older Adults

Minerals for Aging Diets

Vitamins for Aging Diets

Summary: Vitamins And Minerals in Aging Diets

Other Nutrient Requirements For Aging Diets

Aging and Physical Activity

Physical Activity Needs

Exercise Programs for the Aging

Digest

Manner of Speaking

References

Chapter 3. The Senses, Chemosensory Changes and Aging

Abstract

Summary

Introduction

Aging, Disease, Health Care and Prevention

Decline in Diet Quality During Aging

Decline in Behavioral, Environmental, Physical and Social Factors During Aging

The Senses

Other Sensory Considerations (Balance, Kinesthetic, Pain and Temperature)

Taste Versus Flavor

Gustation

Taste Pathways

Five Basic Tastes

Other Debated Tastes: Fatty and Starchy

Taste Perceptions Across the Lifecycle

Oral Cavity

Taste Buds and Stem Cells

Supertasters

Sensitive Tasters

Taste Loss

Taste Thresholds

Medical Conditions Implicated With Smell and Taste Decline

Medications Implicated With Decline in Taste and/or Smell

Taste and Smell Interactions and Affects

Consequences of Chemosensory Decline

How Olfactory Dysfunction Affects Nutrition Status

How Adulthood Affects Nutritional Status

Digest

Manner of Speaking

References

Chapter 4. A Taste Primer

Abstract

Summary

Introduction

The Sense of Taste

How Taste Is Produced and Perceived

Synopsis of the Five Basic Tastes

Highlights of the Five Basic Tastes

Bitter (Bitterness)

Supertasters and the Bitter Taste

The Bitter Taste in Depth

Salt (Saltiness)

Sour (Sourness)

Sweet (Sweetness)

Umami

Fat and Other Proposed Tastes

Temperature and Touch

Taste Enhancement

Taste Opposition/Antagonism

Taste Juxtaposition

Taste Augmentation

How the Sense of Smell Affects the Sense of Taste

How the Senses of Sight, Sound and Touch Affect the Sense of Taste

Taste and Health

Taste Decline and Loss

Taste Thresholds

Aging Tastes

Oral Disease

Use of Medications

Behavioral Changes

Improving the Sense of Taste

Treatment of Taste and Smell Disorders

Strategies for Addressing Chemosensory Changes

Digest

Manner of Speaking

References

Chapter 5. A Smell Primer

Abstract

Summary

Introduction

The Sense of Smell (Olfaction)

How Smells Are Perceived

Types of Aromas

Aromas and Aging

Smell and Behavior

Pheromones

Smell and Health

Smell and Obesity

Smell and Weight Loss

Smell Disorders: Mechanical and Metabolic

Improving the Sense of Smell

Interactions of the Sense of Smell with Other Senses

Challenging Assumptions About Chemosensory Changes with Aging

Digest

Manner of Speaking

References

Chapter 6. Flavor Enhancement Ingredients

Abstract

Summary

Introduction

Overview of Flavor Enhancement Ingredients

Food Ingredients That Enhance Flavor

Flavor Enhancer Regulations

Allergies

Dietary Restrictions

Flavor Enhancement of the Basic Tastes

Other Flavor-Enhancing Ingredients

Digest

Manner of Speaking

References

Chapter 7. Flavor Enhancement Techniques

Abstract

Summary

Introduction

Sensory Issues and Flavor-Enhancing Techniques

Aging Issues and Culinary Techniques

Overview

Sensory Matters

Culinary Techniques for Flavor Enhancement

Digest

Manner of Speaking

References

Chapter 8. Meeting Nutritional and Disease-Specific Needs of Aging

Abstract

Summary

Introduction

Healthy Eating for Aging

Major Nutrients

Minerals

Vitamins

Water

General Considerations for Meeting Nutritional Needs in the Aging

Conditions and Diseases of Aging: Overviews, Dietary Considerations, Supplements and Support Systems

Digest

Manner of Speaking

References

Chapter 9. Culinary Considerations for the Aging

Abstract

Summary

Introduction

Twenty Strategies and Uses for Addressing Changes in Tastes and/or Smells

Digest

Manner of Speaking

References

Chapter 10. Recipes and Menus That Appeal to Aging Palates

Abstract

Summary

Introduction

List of Recipes (Highlighted Recipes are Accompanied by Photos)

Leftovers: Practical, Economical and Tasteful

Risks of Foodborne Illnesses

Foods and Beverages to Avoid to Prevent Foodborne Illnesses

Food Safety Tips for Preventing Foodborne Illness

Creative Leftover Concepts

Moving On: Dining Out/Carrying In

Digest

Manner of Speaking

References

Chapter 11. Cooking Aids, Tableware Tips and Dining Advice

Abstract

Summary

Introduction

Rational for Kitchen Modifications for the Aging

Adapted Kitchen Layout, Functionality and Safety

Modified Kitchen Layout

Adjustments of Kitchen Appliances

Pots, Pans and Cooking Equipment

Additional Kitchen Considerations

Fire and Smoke Safety

Prevention of Foodborne Illnesses in the Kitchen

Rationale for Accommodated Cooking Aids

Preparation, Cooking and Dining Aids Designed for the Aging or Disabled

Tableware for Accommodated or Disabled Consumers

Other Useful Medical and Personal Care Devices

Techniques to Avoid Visual Overload in the Aging

Dining and Living Considerations

Dining Rooms in Assisted Living Facilities

Improving Appetite Within Dining Environments to Enhance Aging Appetites

Digest

Manner of Speaking

References

Chapter 12. Prime Time Resources for Aging, Taste and Health

Abstract

Summary

Introduction

Educational Institutions, Organizations and Support Groups A Through Z

Digest

Manner of Speaking

References

Index

Copyright

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Cover Photographer: © 2019 Grace Natoli Sheldon. Reprinted with Permission.

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Acknowledgments

Jacqueline B. Marcus

This book represents 20 plus years of my involvement in the field of taste and aging and of translating chemosensory research into nutritional and practical ways of feeding the aging both healthfully and satisfactorily.

There are many people and organizations that have been instrumental in this pursuit. These include Catherine Broihier, RD, MS, who helped support my countless national and international speaking engagements and writing projects; the Institute of Food Technology and the World of Food Ingredients that showcased my writing; and the Academy of Nutrition and Dietetics and the International Association of Culinary Professionals that both featured my speaking and writing.

As with Culinary Nutrition: The Science and Practice of Healthy Cooking (Elsevier, 2014), I want to once again thank my intrepid editor Nancy Maragioglio who spearheaded this undertaking as well as this text, Aging, Nutrition and Taste: Nutrition, Food Science and Culinary Perspectives for Aging Tastefully.

Chef Golda Ewalt, MS, RDN, LDN, CEC, was instrumental in expert recipe testing and preparing the finished dishes for photography. Photography/Stylist Grace Natoli Sheldon was indispensible once again for her exceptional photography, as in Culinary Nutrition: The Science and Practice of Healthy Cooking (Elsevier, 2014).

Also, throughout the writing of this textbook, my family has been insurmountable in their backing of my drive and determination in nutrition, food science and the culinary arts. My husband, Harvey, and my children, Meredith, Morgan and Mason, have endlessly supported my ongoing quest to help the science behind food and nutrition come alive through healthful, memorable and tasteful beverages and foods. They have been my truest tests and the keenest results of the impact of taste and flavor enhancement throughout the lifecycle.

Spring, 2019

Overview—The Aging and Taste Revolution

Abstract

This chapter provides an overview of why taste is changing and what can be done about it and provides a foundation for the nutrition, food science and culinary perspectives for aging healthfully and tastefully that follow throughout this text.

Keywords: Aging; chemosensory changes and aging; culinary perspectives and aging; food science and aging; global aging; nutrition and aging; physical concerns in aging; smell; taste; US aging

Photo: Forks and Plates. © 2019 Grace Natoli Sheldon. Reprinted with permission.

Pearl of Wisdom: I don’t like to eat plain foods anymore—such as plain fish. I like very flavorful foods with accompaniments, like sauces.

M.W.

Introduction

The world is aging exponentially. People around the globe are living longer and in some instances, they are living healthier. While this aging phenomenon is considered as a crowning achievement of the last century, it is also sometimes considered as a significant challenge.

This is because living longer may not ensure living better, it may not always be healthful, nor physiologically or psychologically tasteful. In fact, living longer may actually be tasteless for a significant portion of the aging population. The reasons are likely multifactorial, as one will learn throughout this text.

Different countries are aging at different rates due to such factors as access to healthy beverages and foods, chronic disabilities, diseases, education, gender, healthcare costs, injuries, race, socioeconomic influences and many others. Loss or decline in the chemosensations of taste and smell may also be contributing factors, and in some instances, at the root of tastelessness in the aging.

What Is Aging

Simple speaking, aging is the process of becoming older. Rather than the notion that aging is 50 years or older, from the moments that humans enter this world, everyone ages.

Though everyone ages, the aging process is genetically determined and environmentally regulated. While there are some exceptions to this norm, the rate at which the aging process occurs may be modulated by such factors as activity, diet, environmental considerations, health issues and other influencers.

What Is Taste?

Taste is the perception that results from the stimulation of a gustatory nerve from the oral cavity to the gustatory cortex of the brain where it is established. Taste is also inextricably linked with the sense of smell that also declines with aging and might be at the heart of decreased taste perception.

Humans are born with a certain number of taste cells at birth that generally decline over the years. In great part, taste determines food and beverages preferences throughout the lifecycle. This factor may be as important to those who are aging as it is to infants, since it is one of the cornerstones of health and well-being.

Why Focus on Aging?

Declining taste and smell are major reasons why aging people lose their interest in foods and beverages. Declining taste and smell may translate into poor diets and contribute to chronic conditions and/or diseases.

Decline in taste generally occurs in people over 50 years of age; however, taste and smell loss may occur even sooner. The phenomenon of global and US aging is exponentially increasing, as addressed in Chapter 1, Global and US Aging, and taste and smell disorders may be parallel in growth.

Why Focus on Taste?

By improving taste, people who are aging may show increased interest in foods and beverages, thus improving their dietary intakes and reducing their health risks. By ignoring taste, aging people may make poor food and beverages choices that may contribute to poor health and ill feeling. Quality of life may also suffer and healthcare costs may soar.

Why Does Taste Change in Aging People?

Compared to the decreases in other body cells and systems, loss or decline in the cells that determine taste and smell is a normal occurrence in the aging process. People may not be aware of the subtle changes in taste and smell as opposed to other sensory changes, such as vision or hearing loss. The exception may be the start of a new medication with change-of-taste side effects, such as when a person detects a bitter taste that dissipates when medication is completed.

What Are the Concerns of Taste Changes in the Aging?

Since taste and smell changes may go unnoticed or overlooked, they are important to address with healthcare providers that may include nutrition professionals such as Registered Dietitians/Nutritionists. /. Changes in taste and/or smell may provoke higher fat, sodium or sugar intake to make foods and/or beverages taste better, that may contribute to conditions such as cardiovascular disease, hypertension, diabetes and others.

What Can Resolve Taste Changes in the Aging?

The purpose of this book is to inform and educate all parties who are involved with aging people and to provide tasteful solutions for chemosensory changes that are associated with aging. Some simple strategies in food selection, preparation and presentation may offer some surprising and welcome options and improve dietary intake and health status. Instead of viewing the aging process as a bleak ending to life, the ideas in this book are celebratory, caring and progressive and focus on the possibilities for eating enhancement, enjoyment and recovered energy.

Nutrition, Food Science and Culinary Perspectives for Aging Tastefully

This book is similar to Culinary Nutrition: The Science and Practice of Healthy Cooking (Elsevier, 2014) in that is uses a three-prong approach to taste and aging: nutrition, food science and the culinary arts. This is because the food science behind nutrition also has culinary roots. The acts of eating and drinking have both science and art implications, so the three disciplines of nutrition, food science and the culinary arts should be viewed in an interdisciplinary manner.

For example, if a person does not perceive a plated arrangement of food as appealing, he or she may not consume it. This is significant since food is not nutritious unless it is consumed, nor can it contribute to good health and well-being. Furthermore, this is why the recommendations provided in Chapter 9, Culinary Considerations for the Aging, are so critical for approachability and satisfaction.

Chapter Summaries That Address Nutrition, Food Science and Culinary Perspectives and Aging

Nutrition and Aging

Nutrition and the aging process are covered in Chapter 1, Global and US Aging, Chapter 2, Nutritional and Physical Concerns in Aging, Chapter 8, Meeting Nutritional and Disease-Specific Needs of Aging and Chapter 12, Prime Time Resources for Aging, Taste and Health, with guidelines that are driven by the nutritional and physical needs of the aging.

Highlights of Chapters 1, 2, 8 and 12:

• Comprise the 2015 US Dietary Guidelines with general and specific recommendations for the aging.

• Feature solutions for eating issues with easy-to-incorporate foods/beverages that meet specific nutrient requirements and targets recommendations for nutrient-related conditions and disease states.

• Focus on phytonutrients and incorporates nutraceuticals (if and where needed) and their roles in healthy diets for the aging.

Food Science and Aging

Food science awareness and roles that address chemosensory decline in the aging and parallel conditions and disease states are discussed in Chapter 3, The Senses, Chemosensory Changes and Aging, Chapter 4, A Taste Primer, Chapter 5, A Smell Primer, Chapter 6, Flavor Enhancement Ingredients and Chapter 7, Flavor Enhancement Techniques.

Highlights of Chapters 3 to 7

• Comprise practical research and applications on taste and smell: informs about the basic tastes of sweet, sour, salty and umami for aging diets, dietary fats as their own taste and texture and products that address acceptance or rejection of foods and beverages by the aging based on taste and smell.

• Feature products that are designed for aging diets with their physiological functions, including those that are or contain substances with antioxidant-rich ingredients (for immunity); glucosamine and chondroitin (for joint/mobility); beta glucans (for heart/circulatory health); higher-fiber, higher protein (for muscle maintenance); lactose-free, nondairy calcium sources (for bone health); reduced-acidity, omega 3-fatty acids and B vitamins (for cognition); rich in vitamin A and lutein (for vision); and vitamin C (for immunity) and others.

• Focus on brain–gut connections and emotional and physical satiety that interact with chemosensations and food and beverage intakes.

Culinary Perspectives and Aging

Culinary perspectives that include instructions and applications with recipes, menus, tips and techniques for healthful and sensory-appealing foods and beverages and are featured in Chapter 7, Flavor Enhancement Techniques, Chapter 9, Culinary Considerations for the Aging, Chapter 10, Menus and Recipes That Appeal to Aging Palates, and Chapter 11, Cooking Aids, Tableware Tips and Dining Advice.

Highlights of Chapters 7, 9, 10 and 11

• Comprise creative dining programs, menus and recipes that are designed for the aging in a variety of settings, including those who age at home.

• Feature unique tips and techniques designed for compromised mobility and functionality, diminished eyesight, taste and smell and reduced functionality of the gastrointestinal and other organ systems.

• Focus on chewing and swallowing issues, familiar foods and beverages, flavor enhancement, moist cooking techniques, smaller portions and other age-appropriate considerations.

Chapter Summaries

Chapter 1: Global and US Aging

Summary: To imperatively stress the importance of the growing demographic of aging people in the United States in relation to other population groups and the need for individual and collective attention to their exponentially expanding needs

Chapter 2: Nutritional and Physical Concerns in Aging

Summary: To specifically identify the uniqueness of nutritional and physical concerns during aging and the emotional, nutritional and physical stresses on individuals, their care providers, family and friends and healthcare

Chapter 3: The Senses, Chemosensory Changes and Aging

Summary: To resourcefully explore the sensations of sight, smell, taste, sound and touch during the aging process, with particular attention to the chemosensory changes of taste and smell and their long-range implications

Chapter 4: A Taste Primer

Summary: To expressly examine the sense of taste in the aging, how this sense interacts with the sense of smell and what may be done to compensate for decreased overall taste or specific taste losses in the aging

Chapter 5: A Smell Primer

Summary: To explicitly investigate the sense of smell, how this sense interacts with the sense of taste and what can be done to compensate for decreased sense of smell or specific smell losses in the aging

Chapter 6: Flavor Enhancement Ingredients

Summary: To uniquely examine flavor enhancement ingredients specifically designed for the aging from common, everyday foods and beverages to novel manufactured products

Chapter 7: Flavor Enhancement Techniques

Summary: To principally examine flavor enhancement techniques that are specifically designed for the aging that may be self-implemented or employed by food healthcare providers or food service personnel and determine their use for improving nutrition and well-being.

Chapter 8: Meeting Nutritional and Disease-Specific Needs of Aging

Summary: To distinctively connect specific nutritional needs, conditions and disease states in the aging with foods, beverages, supplements and support systems that may meet nutrient deficiencies, dietary guidelines, drug interactions, ethnic preferences and other specialized requirements

Chapter 9: Culinary Considerations for the Aging

Summary: To tangibly comprehend cooking and baking techniques that will be more desirable and palatable for aging palates, contribute to food and beverage appeal, ingestion and ongoing attraction and be easy to prepare, economical, memorable, recognizable and simplistic

Chapter 10, Menus and Recipes That Appeal to Aging Palates

Summary: To creatively assist in Chapter 8, Meeting Nutritional and Disease-Specific Needs of Aging, and Chapter 9, Culinary Considerations for the Aging, relevant and useful for aging people, their care providers or food service operators. Recipes cover Starters, Soups, Salads, Entrées, Sides, Desserts, Beverages, Breakfasts and Finishing Touches with information about leftovers and eating out. Each recipe contains tips such as basic tastes, featured ingredients, techniques, substitute ingredients, optional ingredients, recipe variations, nutritional analyses and nutrient modifications. Over 30 finished dishes are captured in color photographs.

• Starters: Little Appetizer Bites

• Soups: Light and Wholesome

• Salads: Fiber and Nutrient Rich

• Entrées: Animal and Vegetable Options

• Sides: Simple Vegetables and Wholesome Grains

• Desserts: Healthy and Memorable

• Beverages: Practical and Filling

• Breakfasts: To Start the Day or Anytime

• Finishing Touches: Dressings, Marinades, Sauces and Relishes to Increase Palatability

• Leftovers: Practical, Economical and Tasteful

• Moving On: Eating Out/Carrying In

Chapter 11: Cooking Aids, Tableware Tips and Dining Advice

Summary: To collectively provide special attention to address the ease and pleasure of eating and drinking for the aging, with unique tools, concepts and instructions designed for those who need dietary assistance due to behavioral or physical compromises, especially chewing and swallowing, decreased eyesight, reduced manual dexterity and/or other disabilities

Chapter 12: Prime Time Resources for Aging, Taste and Health

Summary: To comprehensibly provide additional resources, from government agencies and educational institutions and other nonprofits to housewares and food and beverage manufacturers, for nourishing aging people enjoyably, healthfully and safely, attending to their healthcare and determining disability and end-of-life choices

Other Elements

Supportive materials accompany many chapters and include tables and figures, insightful sayings from aging people called "Pearl of Wisdom, a word bank entitled Manner of Speaking," references after each chapter and an index that provides clarity of information and easy access. In addition to the photos that accompany Chapter 10, Menus and Recipes That Appeal to Aging Palates, characteristic photos serve to open each chapter.

Chapter 1

Global and US Aging

Abstract

Aging is the process of growing older. Taste is the perception or experience of flavor. Revolution is a major change. The amalgamation of aging, taste and revolution might seem like an unorthodox mix. On the contrary: the sense of aging may decline as people age and aging populations are growing exponentially worldwide. This is revolutionary, because while people are living longer as their sense of taste declines this may lead to poor nutrition, reduced ability to fight disease and/or decreased wellness. This chapter provides an examination of aging throughout the United States and globally and attempts to identify the implications of taste and other chemosensory changes that are associated with aging on diet, nutrition, health and well-being. This chapter also provides the foundation for the 11 chapters that follow and gives credence for an interdisciplinary approach of nutrition, food science and culinary arts perspectives as they relate to aging and taste.

Keywords

Aging in place; baby boomers; food insecurity; functional ability; gerontology; intrinsic capacity; life expectancy; nutritional frailty; primary, secondary and tertiary aging; sarcopenic obesity

Pearl of Wisdom: I like hot sauce on everything—salsa, srirache, Tobasco. Otherwise nothing has taste anymore. I even use it on salad!

H.M.

Outline

Summary 2

Introduction 2

Global Aging 2

Global Aging by the Numbers 2

World Population 3

Aging Populations Worldwide 3

Global Aging and Life Expectancy 3

Global Aging and Disease 4

Global Aging and Ethnic and Racial Disparities 4

Global Aging and Residence 4

Global Aging and Education 4

Global Aging and Employment 5

Global Aging, Health, and Health Care 6

Global Aging and Nutrition 6

Global Aging and Chemosensory Changes 7

Global Aging Impacts on Nutrition, Food Science, and Culinary Perspectives 7

The Impact of Global Aging 8

Global Aging by the Numbers 8

Impact—Global Gerontology and Geriatrics 9

US Aging 10

US Aging by the Numbers 10

US Life Expectancy 10

US Aging and Disease 11

US Aging and Chronic Diseases 11

US Aging and Ethnic and Racial Disparities 12

US Aging and Residence 12

US Aging and Education 13

US Aging and Employment 13

US Aging and Socioeconomic Costs 13

US Aging, Health, and Health Care 14

US Aging and Nutrition 14

US Aging and Chemosensory Changes 15

US Aging Impacts on Nutrition, Food Science, and Culinary Perspectives 15

Nutrition and Culinary Arts Partnerships for the Aging 16

Impact: Gerontology and Geriatrics in the United States 18

Digest 19

Manner of Speaking 19

References 23

Learning Objectives

1. Examine US and global population trends for the aging.

2. Identify US and global aging impacts on nutrition, food science, and the culinary arts.

3. Speculate on future US and global requisites to meet growing aging needs.

4. Highlight food, nutrition and health collaborations that address growing aging needs in the United States and globally.

5. Present forthcoming opportunities that meet increasing nutrition and health needs of the aging in the United States and globally.

PHOTO: Steamer Basket © 2019 Grace Natoli Sheldon. Reprinted with permission.

Summary

To imperatively stress the importance of the growing demographic of aging people in the United States in relation to other population groups and the need for individual and collective attention to their exponentially expanding needs.

Introduction

This chapter provides an examination of aging throughout the United States and globally and attempts to identify the implications of chemosensory changes that are associated with aging on diet, nutrition, health and well-being.

The importance of this growing demographic in relation to younger population groups is stressed, as well as the need for more attention to aging populations for improved health, longevity and quality of life.

This chapter also provides the foundation for the chapters that follow and gives credence for this interdisciplinary approach of nutrition, food science and culinary arts perspectives. While the population figures and trends for the aging were the most current at the time of this writing, it is important to note that they are anticipated to grow both globally and within the United States, not decline in numbers.

The imperative is to gather the information that is presented in the context of diverse aging environments and considerations and take action.

Global Aging

Global Aging by the Numbers

For the majority of human history, the aging demographic has represented 5% or less of worldwide populations. This was until the nineteenth century and the Industrial Revolution in the developed world when aging populations comprised about 15% of the world’s population. By the mid-21st century, this number is projected to increase threefold or more than in 2015. This increase in the aging demographic means that most developed countries will have both aging populations and declining or stagnant populations simultaneously [1].

World Population

In July, 2015 the world population was 7.3 billion and was projected to reach 8.5 billion by 2030 (most current figures to date). From 2015 to 2050 half of the population growth around the world is expected to be concentrated in nine countries (listed according to their size of contribution to total world population growth): India, Nigeria, Pakistan, Democratic Republic of the Congo, Ethiopia, United Republic of Tanzania, the United States, Indonesia, and Uganda [2].

As of 2016, the number of people worldwide who were aged 65 years or older was 8.5% (around 617 million). This percentage is projected to double to almost 17% (around 1.6 billion) of the world’s population by 2050 and more than triple by 2100 [2].

Aging Populations Worldwide

Growing aging populations around the world are an upward trend that impacts both developed and underdeveloped countries. As the world populations age, burdens are placed on both economic and social support systems.

Throughout Europe, 34% of the population is projected to be over 60 years of age by 2050. In Italy and Germany the aging populations are expected to increase from about one-fifth to one-third of their respective populations by 2050.

In Italy, 22% of the population that was 65 years or older in 2015 and this number is projected to increase to 35% in 2050. In 2015, 21% of the population in Germany was 65 years or older and this number is projected to increase to 32% by 2050 [3].

Rapid increases in populations have already impacted Japan where the number of aging people is projected to surpass that of the United States by 2050. Twenty-six percent of the population of Japan was aged 65 years or older in 2015. In comparison, this number is expected to increase to 35% in 2050 [3].

Other parts of Asia, including China and India, have also projected escalated aging populations. By 2050, South Korea will be competing with Germany, Italy and Japan for the country with the oldest country in the world.

The biggest increase in aging people over 65 years of age is expected in China that is projected to have about 371 million people by 2050. As of 2015, this number is greater than the entire US population. This is particularly concerning since low fertility levels and rapid economic developments in China and other countries have caused the proportion of older persons to increase over time and reduce available care providers.

In general, the US population is aging at a slower rate than in other developed countries. While 15% of the US population was aged 65 years or older in 2015, this segment is projected to increase to 22% in 2050.

In comparison, in the Caribbean and Latin America the aging populations are projected to increase from 11% to 12% of people over the age of 60 years in 2015 to more than 25% by 2050. Only 8% of the population of Brazil was 65 years or older in 2015. This figure is estimated to increase to 23% in 2050 (more than in the United States). Mexico, with just 7% of the population aged 65 years and older in 2015, is anticipated to increase to 19% in 2050. As of 2015, Africa had the youngest aging population, but it is projected to age rapidly, from 5% in 2015 to 9% by 2050 [3].

Global Aging and Life Expectancy

In recent years, global life expectancy has substantially increased in the least developed and poorest countries. Because people are living longer, this phenomenon increases the relative number of aging people.

Postwar era, life expectancy in developed countries has increased about 10 years. Now, in most countries, people live until their late seventies or early eighties.

For example, life expectancy in China is 76 years, which is higher than in 1950 when it was 41 years. In Mexico, life expectancy is 78 years, which is higher than in 1950 when it was 51 years. In South Korea, life expectancy is 83 years, which is higher than in 1950 when it was 48 years [3].

There was a 6-year gain in life expectancy among the poorest countries worldwide from 56 years during 20–05 to 62 years in 2015. This is about double the gain in life expectancy than in more developed countries around the world. This difference is expected to markedly decrease by 2050 [3].

Global Aging and Disease

Noncommunicable diseases among the aging, including certain cancers, diabetes, heart disease, hypertension and lung disease are anticipated to rise globally. Other common conditions in the aging which include back and neck pain and osteoarthritis, cataracts and refractive errors, chronic obstructive pulmonary disease (COPD), dementia, depression and hearing loss are also expected to increase proportionally with aging.

Global aging is also characterized and complicated by complex health states due to multiple underlying factors. These may include delirium, falls, frailty, pressure ulcers, and urinary incontinence among others. A large part of who is inflicted with what health state depends on environmental, physical and social factors as well as ethnicity, gender, genetic and healthcare inequalities worldwide. Changing gender norms, globalization, migration, technological innovations, and urbanization are also concerning and complicating factors in global aging.

Global Aging and Ethnic and Racial Disparities

Certain cancers, cardiovascular disease, chronic respiratory disease and diabetes are considered the four main noncommunicable diseases. When at least two of these chronic health conditions occur in an individual, the state is referred to as multimorbidity. Multimorbidity may impact health and quality of life, require complex care management and increase health needs and services.

Aging may increase the occurrence of noncommunicable diseases and multimorbidity, and there is a higher incidence of these conditions associated with lower income, low-level education and unemployment, concurrent with higher levels of depression, disability, and poorer quality of life.

Physical activity is positively correlated with better health and longevity as well as education and income. It is negatively correlated with age, gender, nonwhite race and ethnicity, rural residency, and weight.

Prior to the 20th century, sufficient research on minority populations was sparse. Subsequently, it was then postulated that cost-effective, culturally appropriate and responsive programs may be able to eliminate disparities and thus providing opportunities for better fitness, health, and longevity [4].

There may be more access to health care for intervention in urban environments to help to prevent/control noncommunicable diseases and multimorbidity. The past 50 years have seen massive demographic shifts from rural to urban living worldwide. The majority of the world’s population now lives in cities, although as in the United States there is increasing disparity. Older people with financial flexibility, desirable knowledge and skills might have better access to global health care and better equipped to control the ravages of the diseases of multimorbidity and the escalating healthcare costs than those with less means.

Global Aging and Residence

An increasing number of aging people are residing in urban areas. As of 2007, about half of the world’s population was living in cities. Mega-cities, with 10 million inhabitants (such as Mexico City, Moscow, New Delhi, Rio de Janeiro, Shanghai, and Tokyo) or more increased 10-fold during the 20th century and accounted for 9% of the world’s urban population in 2005. This number is projected to rise, particularly in cities with fewer than 5 million inhabitants and that by 2030 three out of five people globally are projected to reside in cities [5].

Aging people who reside in cities in less developed regions of the world will then outnumber those who reside in developed regions of the world by about four times. This number is projected to increase from 56 million in 1998 to over 908 million in 2050. The aging will then comprise about one-fourth of the total urban population in less developed countries [5].

In general, people want to age in place where it is familiar as long as possible. This phenomenon is caringly referred to as aging in place. Place-based interventions are needed to help to accommodate this unending need. Creating more age-friendly cities worldwide my help to promote the health and well-being of their residents and the continuity of community life.

Global Aging and Education

Differences in rural and urban education among countries worldwide may reflect distinct epidemiological and social histories and present unique disparities. These differences may also determine how people age across time and place and may reveal how education is related to life expectancy.

Low levels of education vary globally. A low level of education may be considered as only a third-grade education in the United States; slightly higher than a third-grade education in Taiwan, through a middle school education in China and England; and a slightly higher education level than third grade in Mexico. This makes early education a difficult variable for comparison among countries and their aging populations.

Additionally, low education in certain countries may be associated with underweight (such as in Indonesia), while in China, England and Mexico obesity is more common with low education. While being too under- or overweight is considered a health risk during aging, obesity is consistently a marker of greater health hazards and reduced life expectancies at other junctures of the lifecycle [6].

Global Aging and Employment

There are clear differences in the labor force and labor force participation in those who are aging around the world. In general, countries with more substantive economic resources, higher income per capita and patterns of public spending that provide financial security for people who are aging tend to have lower rates of active labor force participants by the aging. For example, declining labor force participation by aging men in 2015 occurred in Greece, Japan, and Poland.

In lower-income countries where residents may have to work until they are mentally or physically unable, early retirement may not be an option. For example, some aging African men and women had the highest rates of labor force participation than in the rest of Europe in 2015. More than 50% of African men and more than 30% of African women were employed at during 2015, versus less than 10% of European men and less than 5% of European women in the workforce.

However, the impressive amount of aging people that were working at that time was contradicted by Algeria, South Africa, Egypt, and Tunisia where the aging labor force was below 15% in 2015. In Malawi, Mozambique, the Central African Republic, and Zimbabwe more than 70% of their aging were not working.

Also at this time, countries with increasing labor force participation by both aging men and women were Australia, New Zealand, Sweden, and the United States. This was especially true in countries where the aging were employed in agriculture and mining.

The global gender gap among people 65 years of age and older in the workforce has been held constant since the 1990s. While labor force participation rates for older men have increased more than older women in developing countries, the impact of economic activity by older women is on the rise.

Aging female laborers are more prevalent in more developed societies, among women who accept less traditional roles and among women who have fewer children. Though European countries had the smallest gaps between men and women in the labor force, Guatemala and Pakistan had the largest gaps. Unless the retirement ages increase parallel to increased life expectancy, global societies may have to shoulder the extra costs that are incurred by longer periods of retirement.

Part-time work provides an income stream for the aging and an outlet for social connections. It is more common among older women than in older men worldwide.

In 2013, about 40% of older women were employed part-time worldwide compared to 33% employed full-time. In comparison, under 20% of older men were employed part-time in countries that include Greece, Latvia, Russia and South America, and over 60% of older men were employed full-time in Belgium, Germany, Luxembourg, the Netherlands, and Sweden. Countries that had a higher interest in hiring aging employees were Germany, India, and Sweden and those with a lower interest in hiring aging employees were Greece, Japan, and Spain.

Unemployment patterns tend to vary across different genders and over time. They are difficult to access due to business cycles, differences among countries and lack of data. During the Great Recession (2007–09) that originated in the United States, world markets experienced a general economic decline and nearly all European Union member countries were affected. China and India also experienced slow economic growth during this time period.

The retirement plans and wealth of aging populations that were most affected by the Great Depression were also affected by declines in asset prices—especially in financial investments and housing.

Concurrently, the Great Depression had major impacts on unemployment rates among the aging, but rising labor force participation in developed countries around the world continued (except in Ireland, Greece, and Portugal). Some aging people were motivated to postpone retirement while other aging people returned to the workforce (and still others retired). Financial circumstances and health problems complicated their decision-making.

Aging workers in Canada and China were more optimistic about their lifestyle post- retirement, while those who were aging in France, Hungary, Poland, and Spain were less confident in 2013. In the United States, Baby Boomers were generally pessimistic about their future living standards postretirement that could have been attributed to difference in experiences and hope.

Statutory requirement ages vary worldwide from 55 to 65 years of age. Some European countries and the United States are gradually increasing (or considering to increase) their statutory ages for pensions [7].

It is projected that global government budgets will be pressured by rising pensions and healthcare expenditures. Businesses will have fewer young workers and families will have frailer elders. Budget allocations for social security will need to increase.

To date, the social security system in India only covers about 10% of its working population and the system operates at a deficit. India is expected to experience a 46% increase in its working-age population over the next 25 years, but with slow economic growth. India’s oldest old may be destined for economic ruin.

China, Japan and Mexico are expected to experience a decline in their workforce from 2030 to 2050.

In European countries, some nations have payroll tax rates that equal or exceed 20% of wages to fund social security. In the United States, it was projected that social security contributions may fall short of legislated benefits in 2017 and beyond.

These changes might lead to an increase in the "age dependency ratio," which is the ratio of working-aged individuals to older-aged individuals. In 1970, this age dependence ratio worldwide was 10 workers for each person who was 64 years of age or older. By 2050, the Age Dependency Ratio is anticipated to be four workers for each person who will be aged 64 years or older [8].

Economic growth is also predicted to slow as the rates of savings and investments are prone to fall as the aging workforce declines. However, pension and healthcare reform and support of healthier and longer work lives may help to ameliorate some of these declines in proactive countries worldwide.

Global Aging, Health, and Health Care

The World Health Organization (WHO) estimated that by eliminating the major health risk factors (inadequate diet, lack of exercise and smoking) that are implicated with chronic disease, then cardiovascular disease, stroke, and type 2 diabetes would substantially be reduced as much as 80% [9].

To achieve the ultimate goal of achieving active and healthy aging, in 2006 the WHO developed a policy framework that focuses on the prevention and reduction of chronic diseases, disabilities and premature mortality; the reduction of risk factors that are associated with noncommunicable diseases and functional decline to protect health; the enactment of policies and strategies for a continuum of care for the aging with chronic diseases and/or disabilities; the education and training of care providers; the dignity, protection safety; and aging of the aging and the enablement of the aging to contribute to their communities and their families and economic development. In 2015, the WHO released the first World Report on Ageing and Health that considers aging from a lifecycle perspective and focuses on the second part of life [10].

Global Aging and Nutrition

According to the WHO, those people who are aging are especially positioned for malnutrition. In addition, there are practical problems for the provision of adequate nutrition to the aging. Though caloric needs are less than during younger years due to decrease in both lean body mass and basal metabolic rate, other nutrient needs may actually increase.

In 2002, despite the increasing numbers of older people in developing countries, the nutritional requirements for the aging were not well defined. This created a need to review the current recommended daily nutrient requirements and WHO guidelines. Collaborative efforts with the WHO included the US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts to examine the epidemiological and social aspects of aging [11].

Factors that were taken into consideration were influences that affect dietary intake and nutrient absorption in the aging; nutritional requirements of aging people; nutrition for people who are aging in developing countries; nutrition and immune function in the aging; dietary guidelines for the aging; and community support and interventions among the aging [11].

Recommendations for energy (calories), calcium, copper, chromium, fat, folate, iron, magnesium, protein, riboflavin, selenium, vitamins A, B12, C, D, E, K, and zinc were established, as well as food-based guidelines, phytochemicals, water, exercise, and physical activity need to maintain an optimal immune response and reduce the burden of disease. These nutrients and other considerations will be discussed in Chapter 2, Nutritional and Physical Concerns in Aging.

Global Aging and Chemosensory Changes

With the considerable population changes that are anticipated globally, requisite changes in such areas as packaging, product design, private and public spaces, transportation and workplace features are looked-for to follow. This is especially important to meet the chemosensory changes that may parallel aging and their effects on cognition, sensory function and mobility. Chemosensory changes (or alterations in responses to chemical stimuli) include audition (hearing), gustation (taste), kinesthesis (body movements), olfaction (smell), textural and trigeminal senses (touch or pain), and vision (sight).

From global food science and technology standpoints, while obvious solutions to these changing needs is to develop flavor systems with enhanced flavors to appeal to chemosensory decline, older consumers may not think that they need or want flavor-enhanced foods and beverages. Due to problems chewing and/or swallowing some aging people may also require more texture-modified foods. These realizations and acceptances may require more professional and public education about availability, benefits and costs, and other variables.

It is also important to note that other age-associated factors that impact food intake, such as appetite and satiety, eating alone and healthy food and beverage access should be considered along with chemosensory changes in the aging for optimal nutrition, health, and well-being.

Global Aging Impacts on Nutrition, Food Science, and Culinary Perspectives

The aforementioned population predictions indicate that the number of aging people worldwide are, and will be, significant yet wide-ranging. However, this makes it virtually impossible for blanket recommendations for all aging people. Still, nutrition, food science and the culinary arts may both independently and collectively address the profound changes that are, and will be occurring, throughout the United States and global aging. Many are addressed and outlined in the following chapters of this book.

Nutrition

In 2014, the World Health Assembly initiated a comprehensive global strategy and action plan for aging and health. In 2016 the 69th World Health Assembly produced the report, Multi-sectorial action for a life course approach to healthy ageing: global strategy and plan of action on ageing and health. This strategy was considered a significant step in the establishment of a framework for member states to move forward so that all people can live healthy and long lives [12].

The strategy had two goals: (1) 5 years of evidence-based actions to maximize functional ability that reaches every person and (2) by 2020, establish evidence and partnerships necessary to support a Decade of Healthy Aging from 2020 to 2030.

The strategy also had five strategic objectives: (1) commitment to action on Healthy Ageing in every country; (2) developing age-friendly environments; (3) aligning health systems to the needs of older populations; (4) developing sustainable and equitable systems for providing long-term care (i.e., communities, home, and institutions); and (5) improving measurement, monitoring, and research on healthy aging.

In this document, healthy ageing (aging) is defined as the process of developing and maintaining the functional ability that enables well-being in older age. Functional ability is determined by intrinsic capacity (a combination of physical and mental capacities) and environmental factors—nutrition, health, and long-term care vital components.

Economic and resource issues, food insecurity, nutrient intake (both excessive and inadequate), nutrition screening, sarcopenic obesity, and weight loss were some of the independent and collective concerns considered essential to address during this Strategy’s timeframe [12].

Food Science

The global food industry has been addressing aging consumers’ needs for products to help them cope with chronic conditions and illnesses, combat some of the ravages of aging (such as diminished eyesight, hearing, and taste) and potentially help extend lifetime.

Some of these strategies have included products with increased animal and vegetable proteins to boost metabolism and prevent fat gain and muscle loss; antioxidants such as vitamins A and C to strengthen immunity; B-vitamins and omega-3-fatty acids for cognition and to protect against dementia and Alzheimer’s disease; beta glucans and fibers for heart health and circulation; eye-enhancing nutrients such as lutein and vitamin A for better eyesight; supplements such as chondroitin and glucosamine for joint health and mobility; and vitamins A, D, and K and minerals such as calcium, phosphorus, and magnesium for bone health.

Other food products on the global horizon may offer options for balancing blood sugar, boosting the immune system, decreasing the risk of prostate cancer, lowering blood pressure, and many more prospective benefits.

Culinary Arts

The aging might experience some difficulties cooking that may be caused by dysfunctional kitchen designs and products along with decreased functional capacities. The acts of bending down to retrieve items from lower shelves or storing items on higher shelves; cleaning the kitchen after cooking (particularly the stove and its accompanying equipment); using major and small appliances; and opening packaging continue to be some of the topmost concerns worldwide that prevent those who are aging from cooking.

Aging eyesight may interfere with aging people from reading packaging and recipes correctly. Aging smell may preclude aging people from knowing when food is ripe or spoiled. Aging taste may contribute to too much fat, salt, or sugar used in cooking. Aging touch may cause hot foods and beverages to be too hot or too cold, interfere with food choices and perhaps the digestion process. These sensory changes may not be universal.

Given anticipated societal changes with fewer younger family or eldercare providers, people who are aging may be alone to handle the challenging and cumbersome chores of cooking. Providing realistic, nutritious foods and beverages that require a minimum of shopping, preparation, cooking, and cleanup may be necessities of food preparation for this rapidly growing demographic. Smaller kitchens and age-friendly cooking and dining equipment are also anticipated to be in demand. See Chapter 11, Cooking Aids, Tableware Tips and Dining Advice, for more details. Also see below.

The Impact of Global Aging

It may be difficult to fathom the enormity of global aging or the ramifications. As a country or society, it may be easier to address and manage current population needs than to anticipate or strategize for the future. The summary in Table 1.1 may help to condense the facts and illuminate the immediacies for calls to action.

Table 1.1

Global Aging by the Numbers

Impact—Global Gerontology and Geriatrics

Many global organizations are dedicated to gerontology and geriatrics, as in the United States. What follows is a sampling. See Chapter 12, Prime Time Resources for Aging, Taste and Health, for more ideas and sources.

The mission of the International Association of Gerontology and Geriatrics (IAGG) is to promote gerontological research and training worldwide and to interact with other intergovernmental and nongovernmental organizations and international associations to help to enhance the quality of life and well-being of aging people at individual and societal levels.

Members include key opinion leaders in health and social services, housing and income support, public policy and administration, research and education, and other disciplines that impact the aging worldwide.

The IAGG for the European Region has four main purposes in addition to those of the IAGG: (1) To promote gerontological research in the behavioral, biological, medical, and social–psychological fields; (2) to promote the training of highly qualified personnel in the aging field; (3) to promote the interests of the gerontological organizations in international matters; and (4) to promote and assist in the European and International Congresses [13].

The Global Coalition on Aging (GCOA) is a compilation of world leaders who represent different industries and geographies, from health and pharmaceutical companies to financial services and technology. The coalition is committed to fostering discussions about global aging and longevity.

The GCOA aims to reshape how global leaders both approach and prepare for the world’s aging population growth. It serves to advance innovation solutions through advocacy, communication, public policy analysis and research for fiscally sustainable economic growth, social value creation and wealth enhancement [14].

The GCOA designates people who are aged 55 through 75 years as the new middle age and supports them for their productivity and potential wealth creation. Advocacy for policy adjustments and workplace programs that promote healthy living, saving, smarter learning and working along with reduced dependence on government programs are also supported, as well as optimism for the achievements that are attained with longevity.

The International Federation on Ageing is an international, nongovernmental organization comprised of academics, governments, industry, NGOs and individuals worldwide. It consults with the United Nations and the WHO and has been involved with such key initiatives as the US Principles for Older Persons and the Sustainable Development Goals. It is particularly concerned with the maintenance of a strong voice in the protection of the rights of the aging around the world [15].

Other international organizations that are dedicated to gerontology and geriatrics include the regional suborganizations of the IAGG, the International Council on Active Aging, and the International Psychogeriatric Association among many other regional and local societies and groups. There is also cross-membership among the US organizations that are also committed to gerontology and geriatrics. It is anticipated that more analogous organizations will form and grow as the world ages. Also see the section Gerontology and Geriatrics in the United States that follows in this chapter.

US Aging

As expressed in the overview of this textbook and introduction to this chapter, global aging is occurring in exponential numbers, and this includes aging throughout the United States.

Shared concerns include life expectancy, disease, ethnic and racial disparities, residence, education, employment, sodium-economic costs, health and health care, nutrition, chemosensory changes, and other concerns. An eye-opening account of the numbers of aging people in the United States follows.

US Aging by the Numbers

As of November, 2016, the number of Americans who were aged 65 years or older was over 50 million. This figure was more than the combined population of 25 US states and a new milestone, since was the first time in US history that so many Americans were recorded to be aging in record numbers.

Additionally, this number has steadily increased since the 1960s. The number of Americans who are aged 65 years or older is projected to more than double to over 98 million by 2060. Their share of the total US population is projected to increase from 15% to about 24% during this time period.

Moreover, the aging US population is transforming by more racial and ethnic diversity. From 2014 to 2060 the aging non-Hispanic white segment of the US population is projected to decrease from about 78% to about 54% [16].

US Life Expectancy

A combination of the post-World War II baby boom and longer life expectancy has contributed to this aging population surge in every US state. This trend is projected to result in more US Medicare beneficiaries and higher US Medicare spending, with fewer contributions into the US Medicare system.

This trend parallels the increase in US life expectancy from an average of 68 years of age in 1950 to 79 years of age in 2013. In 2017, US life expectancy was 76.5 years for US men and 81.2 years for US women. It was speculated that nearly 10,000 baby boomers will become 65 years of age each day for the subsequent 15 years.

The growth in the aging segment of the US population is due, in part, to declines in fertility and immigration after the US Great Recession during 2007–09. This growth is considered as one of the most notable demographic trends in the United States [17].

The United States is on course for the lowest average life expectancy levels of all the richest countries worldwide. The average life expectancy predicted by 2030 is 79.5 years for men and 83.3 years for women, which is similar to the life expectancies forecasted for Mexico and Croatia.

As of 2012, the United States ranked only 27th out of 34 countries in overall life expectancy, as determined by the Organization for Economic Cooperation and Development. This may be due to obesity and tobacco use in the United States [18].

Healthy Americans may expect to live disability-free until about 70 years of age. There is a trend for increased life expectancy while disability-free due to the prevention and treatment of certain chronic diseases, including eye disorders and heart disease. While US baby boomers are less likely to smoke cigarettes than their parent’s generation, they tend to have more diabetes, high blood pressure, and obesity than other generations that may require more disability benefits.

The number of centenarians in the United States has increased since 1980, from about 32,000 Americans to more than 53,000 in 2010. This number is speculated to increase to more than 600,000 Americans that are