Understanding Trends in Diet Quality Among Older Adults from 2001 to 2018

December 10, 2025 •

4 min read

According to a study published in JAMA Network Open, the overall diet quality among US adults aged 65 and older deteriorated between 2001 and 2018. This concerning trend affects the fastest-growing demographic in the country and has significant implications for public health and wellness.

Quick Summary

A review of major studies reveals a clear decline in the nutritional quality of diets for US seniors from 2001-2018, with significant increases in poor diet classifications. Factors range from socioeconomic constraints to physiological changes, posing heightened health risks.

Key Points

Significant Decline: A major study found that the overall diet quality of US older adults deteriorated between 2001 and 2018.
Poor Diet Increase: The proportion of seniors with a poor diet increased from 50.9% to 60.9% over the period studied.
Nutrient Deficiencies: Declining intake of vitamins B12 and D, calcium, and fiber was a key finding, alongside increased consumption of unhealthy fats and sugars.
Multiple Factors: Contributing factors to poor diet are complex, including natural aging processes, psychosocial challenges like loneliness, and economic barriers.
Health Risks: Worsening diet quality contributes to increased health risks such as malnutrition, frailty, chronic diseases, and higher mortality rates.
Intervention Required: The findings emphasize the need for dedicated public health efforts and strategies to address the nutritional needs of older adults.

Overall Decline in Diet Quality

Research utilizing data from the National Health and Nutrition Examination Survey (NHANES) showed a clear deterioration in diet quality for older adults from 2001 to 2018. Key metrics used to evaluate dietary habits, such as the Healthy Eating Index (HEI)-2015 and the American Heart Association (AHA) diet scores, all reflected this negative trend. The mean HEI-2015 score decreased by 5.4%, and the mean primary AHA score decreased by 7.9% over the study period. Most notably, the proportion of older adults with a poor diet quality significantly increased from 50.9% to 60.9%. This shift, observed despite improvements in overall socioeconomic status, underscores the complexity of factors influencing senior nutrition.

Specific Dietary Component Trends

Analysis of the trends revealed specific shifts in the consumption of various food groups and nutrients. While some older adults improved their intake of certain components, the overall pattern was a move away from ideal dietary recommendations.

Decreased Intake of Nutrients: Many older adults experienced a decline in the consumption of essential nutrients. This includes vitamins such as B12 and D, minerals like calcium and magnesium, and dietary fiber. In some cases, deficiencies in these crucial elements can impact cognitive function, bone health, and immune response.
Increased Intake of Harmful Components: Simultaneously, there was a trend towards higher intake of components associated with poor health outcomes. This includes an increase in added sugars, saturated fats, and sodium. Many older adults also faced challenges from the widespread availability and appeal of energy-dense, but nutrient-poor, processed foods.
Protein Consumption: While many older adults met recommendations for protein from meat and eggs, many fell short of recommended amounts for protein from other sources like beans, lentils, and dairy. This is significant because adequate protein is vital for maintaining muscle mass and strength, which decline with age.

Factors Contributing to Worsening Diet Quality

Numerous intertwined factors contributed to the observed decline. It is not a single issue but a convergence of physiological, psychosocial, and economic challenges.

Physiological Changes with Aging: The natural aging process involves several changes that affect eating habits. These include a decline in the senses of taste and smell, slower metabolism leading to lower energy needs, dental and oral health issues affecting chewing, and difficulties swallowing. Some older adults also experience 'anorexia of aging,' a loss of appetite that can lead to reduced food intake and malnutrition.
Psychosocial and Lifestyle Factors: Social isolation, depression, and bereavement can have a profound impact on appetite and the motivation to prepare healthy meals. The loss of a spouse, for instance, can lead to disruptions in established eating habits. Furthermore, mobility constraints can make grocery shopping and food preparation more difficult.
Economic and Environmental Constraints: Despite overall socioeconomic improvements in some subgroups, financial constraints remain a significant barrier for many seniors. Food insecurity—having limited or uncertain access to nutritionally adequate food—affects a portion of the older adult population. This often forces reliance on less expensive, lower-quality processed foods.

Health Impacts and Consequences

The consequences of declining diet quality in older adults are serious and far-reaching. They can exacerbate existing health issues, increase the risk of new conditions, and reduce overall quality of life.

Malnutrition and Frailty: Poor dietary intake is a leading cause of malnutrition, a condition often linked to frailty. Frailty increases vulnerability to adverse health outcomes like falls, hospitalizations, and disability.
Chronic Disease Risk: The increase in saturated fat and added sugar consumption and inadequate nutrient intake can heighten the risk of chronic diseases. This includes cardiovascular disease, type 2 diabetes, and certain types of cancer.
Increased Mortality: Poor nutrition is associated with higher mortality rates in older adults, regardless of the cause of death. Addressing these nutritional deficits is therefore critical for extending not just lifespan, but healthspan.

Comparison of Dietary Trends and Ideal Guidelines


Dietary Component	Trend (2001-2018)	Ideal Guidelines for Older Adults	Impact of Trend	Sources of Information
Saturated Fat	Intake increased significantly	Limit intake to <10% of daily calories	Increased risk of cardiovascular disease	NHANES data analysis; MyPlate
Added Sugars	Intake increased significantly	Choose foods and drinks with little to no added sugars	Increased risk of chronic diseases and inflammation	NHANES data analysis; MyPlate
Fruits & Vegetables	Inadequate consumption for many	Aim for a variety of colorful fruits and vegetables daily	Decreased intake of fiber, vitamins, and antioxidants	NHANES data analysis; MyPlate
Calcium & Vitamin D	Often deficient due to lower intake or absorption	Regular intake through fortified dairy or supplements	Increased risk of osteoporosis and bone fractures	NCBI; MedlinePlus
Protein	Lower-than-optimal intake for many, especially from diverse sources	Prioritize lean sources and sufficient daily intake	Accelerates loss of muscle mass (sarcopenia) and strength	ODPHP; MedlinePlus

Recommendations and Conclusion

The decline in diet quality among older adults from 2001 to 2018 highlights the need for targeted public health interventions. Strategies should focus on providing older adults with the tools and support needed to overcome the physiological, psychological, and economic barriers to healthy eating. Encouraging nutrient-dense food choices, promoting social engagement around meals, and screening for underlying health conditions are crucial steps. Education and support from health professionals, families, and community programs are vital for improving nutrition and mitigating the health risks associated with a poor diet. The findings from this period serve as a critical reminder that while improvements in other areas of life may occur, dietary quality can easily be overlooked, to the detriment of senior health.

The original research can be found here: Trends in Diet Quality Among Older US Adults From 2001 to 2018.

Frequently Asked Questions

The study, published in JAMA Network Open, found that overall diet quality among US older adults (65+) deteriorated significantly from 2001 to 2018. Metrics like the Healthy Eating Index and American Heart Association scores showed a decline, and the percentage of older adults with a poor diet increased from 50.9% to 60.9%.

The decline was linked to lower intake of nutrient-dense foods like fruits, vegetables, and certain proteins, combined with an increase in unhealthy components such as saturated fats and added sugars.

The study noted that the decline occurred across various sociodemographic subgroups, and despite general improvements in educational and income levels over time, diet quality still worsened.

Physiological changes include a decreased sense of taste and smell, lower energy requirements due to a slower metabolism, dental problems that impact chewing, swallowing difficulties, and natural loss of appetite (anorexia of aging).

Psychosocial factors such as social isolation, loneliness, depression, and loss of a spouse can negatively affect appetite and the motivation to prepare and consume healthy meals.

Poor diet increases the risk of malnutrition, frailty, sarcopenia (muscle loss), cardiovascular disease, type 2 diabetes, and can contribute to higher mortality rates.

Improving nutritional status involves multiple strategies, including prioritizing nutrient-dense foods, ensuring adequate hydration, making mealtimes social events, adapting to dietary restrictions, and addressing underlying physical or mental health issues.

Adequate protein intake is crucial for older adults to combat sarcopenia, the age-related loss of muscle mass. Maintaining muscle mass is vital for strength, mobility, and preventing falls.