Why Gut Health Matters for Older Adults
Did you know an unhealthy gut can induce brain inflammation and lead to conditions such as anxiety and depression ?
In recent years, research has highlighted digestive health and the effects it can have on physical and mental health. The connection between a poor diet and other lifestyle factors leading to poor gut health is now too hard to ignore. Systematic inflammation and chronic conditions are widespread in older adults, and are now widely associated with unhealthy digestive tracts .
Understanding Gut Health
From the mouth to the bowel, gut health covers the health of the entire digestive system. Each part of the gut has a distinctive role, with different colonies of microorganisms – known as microbiota – breaking down food and drink.
Our diets have a direct relationship with these colonies and what we eat promotes the growth of certain bacteria, which makes our gut microbiome as unique as we are . Ideally, microbiomes should be highly diverse – low diversity has been found to correlate with various health conditions .
Why Does Gut Health Matter?
Poor gut health has been linked to a host of chronic conditions such as colorectal cancer, cardiovascular disease, type 2 diabetes, and inflammatory bowel disease . This is particularly concerning because older adults are already at a significantly higher risk of these conditions .
In the last decade, discoveries have been made around the gut-brain axis (GBA). The GBA is the communication line between our enteric nervous system (which controls the gut) and our central nervous system. As a result, it can influence neurotransmitter and hormone activity; recent studies show that neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease correlate with changes to the gut microbiome and gastrointestinal disorders [6,7].
Are Older Adults Most at Risk?
Poor gut health can affect anyone at any age and with any pre-existing medical conditions. The common belief is that ageing is one of the sole contributors to poor gut health, when, in fact, poor gut health may actually increase the ageing process .
Poor gut health is often caused by poor nutrition – which can itself be caused by conditions such as poor dental health or dysphagia. Over time, not getting the right nutrition will affect microbiota diversity, which is correlated with a lower risk of acute and chronic conditions .
Older adults are also more likely to be prescribed multiple medications (polypharmacy), which has been found to negatively impact microbiota diversity . Finally, age-related muscle weakness (sarcopenia) may also impact gut health .
So, while poor gut health can affect people of all ages, older adults are more likely to be at risk.
Areas Affected by Poor Gut Health
In the past, an unhealthy gut was often believed to only cause digestive issues. Current research, though, indicates that it can impact our overall health, which means older adults with poor gut health could have a higher risk of various conditions .
Cognition and Neurodegenerative Diseases
Poor gut health has been linked to a range of cognitive conditions, such as Alzheimer’s disease, autism, anxiety, and depression . The gut-brain axis means that changes in the gut microbiome can affect various neurotransmitters like dopamine, serotonin and GABA .
Although the exact mechanisms are still unclear, gut microbiota likely play an important role in the development and progression of certain neurological conditions . As such, maintaining a healthy gut should be considered a critical part of good mental health practices for older adults.
It’s widely accepted that, as we age, our skin becomes thinner due to a decrease in the turnover and replacement of epidermal skin cells . From an aesthetic viewpoint, this is concerning, but thinning skin can also have serious health implications. Ageing skin can be more prone to injury like tears or bruising, the formation of chronic wounds, and more complications throughout the healing process .
Dermatitis, psoriasis, and infections are prevalent among older adults and can sometimes lead to severe scenarios of ill health. Imagine an elderly man cutting his finger: he is considerably more at risk of infection and will experience an extended healing time compared to somebody younger. The risk is a simple cut can progress quickly to sepsis, a condition known to be particularly dangerous in old adults.
Like the gut-brain axis, the gut-skin axis is a new model of thought. It outlines the bidirectional relationship between overall skin and microbiome health. If your gut microbiome isn’t healthy, then your skin could be impacted as well .
Autoimmune conditions are caused and amplified by a variety of different factors, including genetics, lifestyle, geographic location, and viral infections. Gut microbiome imbalance has also been identified as a possible contributor – microbiota affect how our immune systems work by interfering with how cells differentiate between self and non-self .
Specifically, rheumatoid arthritis, lupus, spondyloarthritis, and irritable bowel diseases have all been linked to impaired microbiota diversity . Given the prevalence of all four conditions among older Australians – and their potentially severe impacts on quality of life – it’s important to minimise possible risk factors like poor gut health.
Sleep is one of the great modulators of human health. From processing and storing memories, healthy recirculating hormones, and lowering cortisol levels, the quality and quantity of how much we slumber are hugely important.
In the ageing population, sleep is crucial for maintaining good cognition . Sufficient sleep has also been linked to reduced medication requirements, better cardiovascular health, and enhanced memory .
The body makes melatonin, a critical sleep hormone, using serotonin (another hormone); serotonin production can be affected by the gut microbiome . As such, a healthy gut may have a direct impact on sleep, which can lead to other positive effects like the reduction of sleep medication and better cognition .
As already mentioned, the ramifications of poor gut health are multifaceted. Perhaps the most alarming impact is the promotion of conditions such as cardiovascular disease, type 2 diabetes, and colorectal cancer . Ageing and the Western diet already correlate with incidences of diabetes and heart disease, which makes supporting good gut health especially important for older people.
Maintaining Optimum Gut Health
Providing the right conditions for good gut health in older adults should be approached with a holistic stance that addresses root causes.
Diet considerations and the limitations around them should be the first consideration for caregivers and medical professionals. Multidisciplinary teams, including GPs, speech pathologists, and dietitians, will need to develop interventions to address problems such as poor dental health, sarcopenia, polypharmacy, and dysphagia. For older people with dysphagia, for example, texture-modified diets can make getting the right nutrition easier – and in a way that doesn’t compromise the dining experience .
Certain types of food and drink can also improve the state of the microbiome. Probiotic supplements contain live microbiota, which may help elevate the levels of ‘good’ microflora in the gut. Some foods and drinks, like Greek yoghurt or kefir, contain natural probiotics.
Prebiotics are foods and drinks (typically high-fibre foods) that good microflora feed on. Some everyday foods are natural prebiotics – think pantry staples such as garlic, onions, asparagus, bananas, and apples.
Ideally, meal planning for older adults should be conducted by an Accredited Practising Dietitian. A dietitian can work with other healthcare professionals to diagnose root causes, and then develop appropriate dietary interventions that balance individual lifestyle and health considerations.
The ramifications of gut health are further reaching than previously thought, and older people are at higher risk of ill health if their dietary needs are not properly monitored and managed. Poor gut health can affect mood, skin, autoimmune conditions and even sleep, and can be affected, in turn, by conditions such as polypharmacy, poor dental health, sarcopenia, xerostomia, and dysphagia.
Proper nutritional intake, which may include interventions such as texture-modified diets, and increased intake of pre- and probiotics can help support good gut health for older people.
Medical information on FlavourCreations.com.au is merely informational and is not the advice of a medical practitioner. This information is general in nature and was accurate at the time of publication. For more information about nutrition and your individual needs, see a GP or an Accredited Practising Dietician.
 Ghosh, T. S., Rampelli, S., Jeffery, I. B., Santoro, A., Neto, M., Capri, M., Giampieri, E., Jennings, A., Candela, M., Turroni, S., Zoetendal, E. G., Hermes, G. D. A., Elodie, C., Meunier, N., Malpuech Brugere, C., Pujos-Guillot, E., Berendsen, A. M., De Groot, L. C. P. G. M., Feskins, E. J. M., Kaluza, J., Pietruszka, B., Jeruszka-Bielak, M., Comte, B., Maijo-Ferre, M., Nicoletti, C., De Vos, W. M., Fairweather-Tait, S., Cassidy, A., Brigidi, P., Franceschi, C., & O’Toole, P. W. (2020). Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut, 69(7), 1218–1228. DOI: 10.1136/gutjnl-2019-319654
 Lozupone, C. A., Stombaugh, J. I., Gordon, J. I., Jansson, J. K., & Knight, R. (2012). Diversity, stability and resilience of the human gut microbiota. Nature, 489(7415), 220–230. DOI: 10.1038/nature11550
 Hills, Jr., R. D., Pontefract, B. A., Mishcon, H. R., Black, C. A., Sutton, S. C., & Theberge, C. R. (2019). Gut microbiome: Profound implications for diet and disease. Nutrients, 11(7), 1613. DOI: 10.3390/nu11071613
 Calder, P. C., Ortega, E. F., Meydani, S. N., Adkins, Y., Stephensen, C. B., Thompson, B., & Zwickey, H. (2022). Nutrition, Immunosenescence, and Infectious Disease: An Overview of the Scientific Evidence on Micronutrients and on Modulation of the Gut Microbiota. Advances in nutrition (Bethesda, Md.), 13(5), S1–S26. DOI: 10.1093/advances/nmac052
 Chen, Y., Xu, J., & Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients, 13(6), 2099. DOI: 10.3390/nu13062099
 Sochocka, M., Donskow-Łysoniewska, K., Diniz, B. S., Kurpas, D., Brzozowska, E., & Leszek, J. (2019). The Gut Microbiome Alterations and Inflammation-Driven Pathogenesis of Alzheimer’s Disease-a Critical Review. Molecular neurobiology, 56(3), 1841–1851. DOI: 10.1007/s12035-018-1188-4
 Hu, X., Wang, T., & Jin, F. (2016). Alzheimer’s disease and gut microbiota. Science China. Life sciences, 59(10), 1006–1023. DOI: 10.1007/s11427-016-5083-9
 Gemikonakli, G., Mach, J., Zhang, F., Bullock, M., Tran, T., El-Omar, E., & Hilmer, S. N. (2023). Polypharmacy With High Drug Burden Index (DBI) Alters the Gut Microbiome Overriding Aging Effects and Is Reversible With Deprescribing. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 78(2), 213-222. DOI: 10.1093/erona/glac195.
 Liu, C., Cheung, W.-H., Li, J., Chow, S. K.-H., Yu, J., Wong, S. H., Ip, M., Sung, J. J. Y., & Wong, R. M. Y. (2021). Understanding the gut microbiota and sarcopenia: A systematic review. Journal of Cachexia, Sarcopenia and Muscle, 12(6), 1393-1407. DOI: 10.1002/jcsm.12784.
 Chen, Y., Xu, J., & Chen, Y. (2021). Regulation of neurotransmitters by the gut microbiota and effects on cognition in neurological disorders. Nutrients, 13(6), 2099. DOI: 10.3390/nu13062099
 Kovacs E. J. (2005). Aging, traumatic injury, and estrogen treatment. Experimental gerontology, 40(7), 549–555. DOI: 10.1016/j.exger.2005.04.009
 Dyer, J. M., & Miller, R. A. (2018). Chronic skin fragility of aging: current concepts in the pathogenesis, recognition, and management of dermatoporosis. Journal of Clinical and Aesthetic Dermatology, 11(1), 13–18. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5788262/
 Simpson, H. L., & Campbell, B. J. (2015). Review article: dietary fibre-microbiota interactions. Alimentary pharmacology & therapeutics, 42(2), 158–179. DOI: 10.1111/apt.13248
 Xu, H., Liu, M., Cao, J., Li, X., Fan, D., Xia, Y., Lu, X., Li, J., Ju, D., & Zhao, H. (2019). The dynamic interplay between the gut microbiota and autoimmune diseases. Journal of Immunology Research, 2019. DOI: 10.1155/2019/7546047
 Li, J., Vitiello, M. V., & Gooneratne, N. (2018). Sleep in Normal Aging. Journal of Clinical Sleep Medicine, 13(1), 1–11. DOI: 10.1016/j.jsmc.2017.09.001
 Gulia, K. K., & Kumar, V. M. (2018). Sleep disorders in the elderly: a growing challenge. Psychogeriatrics: the official journal of the Japanese Psychogeriatric Society, 18(3), 155–165. https://doi.org/10.1111/psyg.12319
 Matenchuk, B. A., Mandhane, P. J., & Kozyrskyj, A. L. (2020). Sleep, Circadian Rhythm, and Gut Microbiota. Sleep Medicine Reviews, 53. DOI: 10.1016/j.smrv.2020.101340
 Li, Y., Hao, Y., Fan, F., & Zhang, B. (2018). The role of microbiome in insomnia, circadian disturbance and depression. Frontiers in Psychiatry, 9, 669. DOI: 10.3389/fpsyt.2018.00669.
 Hills, Jr., R. D., Pontefract, B. A., Mishcon, H. R., Black, C. A., Sutton, S. C., & Theberge, C. R. (2019). Gut microbiome: profound implications for diet and disease. Nutrients, 11(7), 1613. DOI: 10.3390/nu11071613.
 Ott, A., Voigt, M., Sieber, C. C., & Volkert, D. (2021). Validity of Plate Diagrams for Estimation of Energy and Protein Intake of Nursing Home Residents Receiving Texture-Modified Diet: An enable Study. Journal of the American Medical Directors Association, 22(3), 630–635. DOI: 10.1016/j.jamda.2019.12.014