Dietary intake, diet quality and food choices in UK older adults

Background: The proportion of older adults is rising globally; in the UK, older adults aged ≥65 years are projected to comprise 32% of the population by 2030. Ageing is often accompanied by conditions that can affect health, where diet plays a central role. Thus, this thesis’ overall aim was to gain a better understanding of the dietary intake, diet quality and food choices among independently living UK older adults.

Methods: Two quantitative analyses were conducted using two national datasets : National Diet and Nutrition Survey 2016–2019 data, and Food and You 2 Waves 3,5 and 6. Dietary intake data from older adults (≥65 years) and adults (19–64 years) was compared against UK dietary recommendations, and the same dietary intake data was assessed between two age subgroups: (1) older adults (≥65 years) vs
adults (19–64 years), and (2) younger older adults (65–74 years) vs older older adults (≥75 years). Diet quality was evaluated using the Nutrient and Food-based Diet Quality Index-65 (NFDQI-65) across seven sociodemographic subgroups across eleven components. These analyses were carried out using non-parametric t-tests. Dietary behaviour data (including eating practices, food shopping, etc) was
compared between two age subgroups: (1) older adults vs adults, and (2) younger older adults vs older older adults, using chi-square tests. Further, findings from these analyses informed focus group discussions and interviews with older adults living
independently in a medium-size West Yorkshire city to explore perceptions and perspectives of dietary behaviours.

Results: Quantitative analyses showed that older adults aged 65 years and over had low intakes of several nutrients—including fibre, vitamin D, selenium, magnesium and potassium—and consumed fewer than five portions of fruit and vegetables per day as well as fewer oily fish intakes per week (<140 g). Further results highlighted greater intakes of free sugars and protein in older adults aged 65 years and over. From the NFDQI-65, findings revealed that protein intake was particularly low among older older adults (aged 75 years and over), women, those unmarried, living alone, older adults without professional qualifications, and those with the lowest incomes. Regarding food practices, over two thirds (80.1%) preferred in-person food shopping weekly or daily, prioritising food quality and freshness. Higher income was associated with more frequent sweet snack consumption (OR=7.04, 95%CI: 1.68-29.41, p<0.05). Women (OR=1.48, 95%CI: 1.02-2.16, p<0.05) and married older adults—regardless of gender (OR=2.57, 95%CI: 1.11-5.93, p<0.05) were more likely to eat healthy meals frequently, and women (OR=2.26, 95%CI: 1.26-4.05, p<0.05) and older adults with the highest income (£32,000-£63,999) were more likely to eat fruit and vegetables frequently (OR=3.75, 95%CI: 1.72-8.17, p<0.001). Focus groups identified three themes shaping diet quality and food choices: food choice parameters, food shopping experiences, and preference for smaller plates/portions.

Conclusion: Key nutrient intakes—particularly protein, fibre, and several micronutrients—fell below recommendations. Food-related practices (e.g. food shopping, living arrangements, price) may influence dietary intake, but direct associations could not be established within this thesis. further research is needed to confirm these findings and inform targeted interventions. Cross-sector improvements in policy and practice are essential to support healthy ageing and prevent complications among independently living older adults.