NUTRITION FOR OLDER ADULTS CHAPTER 13 NUTRITION FOR

NUTRITION FOR OLDER ADULTS CHAPTER 13

NUTRITION FOR ADULTS AND OLDER ADULTS • Adulthood represents a wide age range from young adults at 18 to the “oldest old. ” • Adults over 50, and especially those over 70, have different nutritional needs than do younger adults.

AGING AND OLDER ADULTS • Aging is a gradual, inevitable, and complex process. • Eventually leads to impairment of organs, tissues, and body functioning • Some changes have nutritional implications. • How and why aging occurs is unknown. • Most theories are based on genetic or environmental causes.

AGING AND OLDER ADULTS— (CONT. ) • Aging demographics – Older adults, especially those older than 85 years of age, represent the fastest growing segment of the American population. – Life expectancies at both 65 and 85 years have increased. o Women and men who live to age 65 can expect to live an average of 19. 2 more years. o For those who live to age 85 q Women will survive an average 7 years more. q Men will survive an average 5. 9 years more.

AGING AND OLDER ADULTS—(CONT. ) • Aging demographics—(cont. ) – Heterogeneous group o Varies in age, marital status, social background, financial status, living arrangements, and health status – Approximately 80% of adults older than 65 years of age have one chronic health problem. – People define wellness and illness differently as they age.

AGING AND OLDER ADULTS—(CONT. ) • Healthy aging – Genetic and environmental “life advantages” have positive effects on both length and quality of life. – Preventing disease is the key to healthy aging. – Good nutrition – Exercise – Evidence shows that initiating healthy changes even in one’s 60 s and 70 s provides definite benefits.

AGING AND OLDER ADULTS— (CONT. ) • Nutritional needs of older adults – Knowledge growing – Health status, physiologic functioning, physical activity, and nutritional status vary more among older adults (especially people older than 70 years of age) than among individuals in any other age group. – Calorie needs decrease yet vitamin and mineral requirements stay the same or increase. – Two DRI groupings exist for mature adults. o People age 51 to 70 o Adults over the age of 70

AGING AND OLDER ADULTS— (CONT. ) • Nutritional needs of older adults—(cont. ) – Calories o Needs decrease with age. o Changes in body composition o Physical activity progressively declines. o Estimated 5% decrease in total calorie needs each decade o Undesirable consequences of aging can be improved or reversed.

AGING AND OLDER ADULTS—(CONT. ) • Nutritional needs of older adults—(cont. ) – Protein o The RDA for protein remains constant at 0. 8 g/kg for both men and women from the age of 19 and older. o Estimated that 7. 2% to 8. 6% of older adult women consume protein below their estimated average requirement.

AGING AND OLDER ADULTS—(CONT. ) • Nutritional needs of older adults—(cont. ) – Protein—(cont. ) o Factors that may contribute to a low protein intake q Cost of high-protein foods q Decreased ability to chew meats q Lower overall intake of food q Changes in digestion and gastric emptying o Groups at risk for inadequate protein intake q Oldest elderly q Those with health problems q Those in nursing homes

QUESTION • Is the following statement true or false? Approximately 60% of adults older than 65 years of age have one chronic health problem.

ANSWER False. Rationale: Approximately 80% of adults older than 65 years of age have one chronic health problem.

AGING AND OLDER ADULTS—(CONT. ) • Nutritional needs of older adults—(cont. ) – Water o The AI for water is constant from 19 years of age through age 70 and above. o Represents total water intake o Elderly are able to maintain fluid balance. o Altered sensation of thirst and an age-related decrease in the ability to concentrate urine increases risk for q Dehydration q Hyponatremia

AGING AND OLDER ADULTS—(CONT. ) • Nutritional needs of older adults—(cont. ) – Fiber o The AI for fiber is based on median intake levels observed to protect against coronary heart disease. q AI for fiber is 38 g/day for men through age 50 years and 30 g/day thereafter. q AI for fiber is 25 g/day for women from 19 to 50 years of age and 21 g/day thereafter.

AGING AND OLDER ADULTS—(CONT. ) • Nutritional needs of older adults—(cont. ) – Vitamins and minerals o Most recommended levels of intake for vitamins and minerals do not change with aging. o Significant exceptions q Calcium q Vitamin D q Iron for women o DRI for sodium decreases. o People over 50 are advised to consume most of their B 12 requirement from fortified food or supplements.

AGING AND OLDER ADULTS— (CONT. ) • My. Plate for older adults – Designed to help healthy, older adults who are living independently choose a diet that is consistent with the Dietary Guidelines for Americans, 2010 (Fig. 13. 2).

AGING AND OLDER ADULTS—(CONT. ) • Nutrient and food intake of older adults – As calorie needs decrease with aging, so does the quantity of food eaten and the amount of calories consumed. – Mean calorie intake falls by 1000 to 1200 cal/day in men and 600 to 800 cal/day in women. – Nutrients with mean intakes less than the DRI o Vitamin E, magnesium, fiber, calcium, and potassium

AGING AND OLDER ADULTS—(CONT. ) • Nutrient and food intake of older adults—(cont. ) – Consume less fruit and vegetables – Older adults need to improve their intakes of o Whole grains o Dark green and orange vegetables o Dried peas and beans o Fat-free and low-fat milk and milk products – Snacking in older adults may help ensure an adequate intake.

AGING AND OLDER ADULTS—(CONT. ) • Vitamin and mineral supplements – In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods. o Fifty percent of older adults have inadequate intakes of vitamin E and magnesium. – Supplements tend to have a positive impact on nutritional adequacy for adults age 51 years and older.

AGING AND OLDER ADULTS—(CONT. ) • Nutrition screening for older adults – Older adults at greatest risk of consuming an inadequate diet are those who are o Less educated o Live alone o Have low incomes – Identifying nutritional problems in older adults can be a challenge.

QUESTION • Which older adult is at greatest risk of consuming an inadequate diet? a. Lives with family b. Is married c. Has and adequate income d. Is less educated

ANSWER d. Is less educated Rationale: Older adults at greatest risk of consuming an inadequate diet are those who are less educated, live alone, and have low incomes.

SCREENING CRITERIA FOR MALNUTRITION IN OLDER ADULTS • Disease – Do you have an illness that makes you change the kind and/or amount of food you eat? • Eating poorly – Do you eat fewer than two meals a day? Do you eat few fruits, vegetables, or milk products? Do you have three or more drinks of beer, liquor, or wine almost every day? • Tooth loss/mouth pain – Do you have tooth or mouth problems that make it hard for you to eat?

SCREENING CRITERIA FOR MALNUTRITION IN OLDER ADULTS—(CONT. ) • Economic hardship – Do you sometimes not have enough money to spend on the food you need? • Reduced social contact – Do you eat alone most of the time? • Multiple medications – Do you take three or more prescribed or over-the-counter drugs a day?

SCREENING CRITERIA FOR MALNUTRITION IN OLDER ADULTS—(CONT. ) • Involuntary weight loss/gain – Have you gained or lost 10 pounds in the last 6 months without trying? • Needs assistance in self-care – Are you sometimes not physically able to shop, cook, and/or feed yourself? • Elder years above age 80 – Are you older than age 80?

NUTRITION-RELATED CONCERNS IN OLDER ADULTS • Should be client-centered and based on the individual’s physiologic, pathologic, and psychosocial conditions • Overall goals of nutrition therapy for older adults – Maintain or restore maximal independent functioning and health – Maintain the client’s sense of dignity and quality of life by imposing as few dietary restrictions as possible

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Cataracts and macular degeneration – Prevalence of cataracts and age-related macular degeneration (AMD) are increasing as the population of older Americans increases. – AMD is the major cause of legal blindness in North America. – Appears that a multivitamin/multimineral supplement containing vitamin C, vitamin E, betacarotene, and zinc is effective in slowing AMD but not cataracts.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Cataracts and macular degeneration—(cont. ) – Observational studies show that a diet rich in antioxidants, especially lutein and zeaxanthin, and omega-3 fatty acids benefits AMD and possibly cataracts. – People who eat diets high in refined carbohydrates (high glycemic index) are at greater risk of AMD progression than people who eat a less refined carbohydrates.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations – Aging causes a progressive decline in physical function. – Major causes of functional limitations among older adults include o Arthritis o Osteoporosis o Sarcopenia

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations—(cont. ) – Arthritis o A leading cause of functional limitation among older adults o Osteoarthritis (OA) is associated with aging and normal “wear and tear” on joints. q Knee is the most commonly affected joint. q Excess body weight is the greatest known modifiable risk factor.

QUESTION • Is the following statement true or false? Nutrition-related concerns of older adults include cataracts and macular degeneration.

ANSWER True. Rationale: Nutrition-related concerns of older adults are cataracts and macular degeneration and functional limitations such as arthritis, osteoporosis, and sarcopenia.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations—(cont. ) – Arthritis—(cont. ) o Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise, trauma, and bone density. o Symptoms of OA usually appear after the age of 40 and by 65 years of age or above. o Objective of treatment is to control pain, improve function, and reduce physical limitations.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations—(cont. ) – Osteoporosis o Bone remodeling o After menopause, women experience rapid bone loss related to estrogen deficiency. o Process actually begins early in life.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations—(cont. ) – Osteoporosis—(cont. ) o Interventions implemented late in life can effectively slow or halt bone loss. – Sarcopenia o Defined as loss of muscle mass and strength o Chronic muscle loss is estimated to affect 30% of people over the age of 60 and may affect more than 50% of those over 80 years of age. o Related to a sedentary lifestyle and less than optimal diet

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Functional limitations—(cont. ) – Sarcopenia o Strength training using progressive resistance is the best intervention shown to slow down or reverse sarcopenia. o Adequate protein intake is also essential.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Alzheimer’s disease (AD) – Most common form of dementia in the United States, it affects an estimated 5. 1 million Americans. – Risk of AD increases with increasing age. – Cause of AD is unknown and there is no cure. – Genetic and nongenetic factors (e. g. , inflammation of the brain, stroke) have been identified in the etiology of AD.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Alzheimer’s disease (AD)—(cont. ) – Development of AD may also be related to oxidative stress. – People who eat fish have less cognitive decline than people who do not eat fish. o DHA, an omega-3 fatty acid, may offer some protection against AD. – AD can have a devastating impact on an individual’s nutritional status.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Obesity – Major public health problem – Appropriateness of treating obesity in older adults is controversial. o Weight loss can be harmful to older adults. – Goal of weight loss therapy for older adults should be to improve physical function and quality of life.

NUTRITION-RELATED CONCERNS IN OLDER ADULTS—(CONT. ) • Social isolation – Eating alone is a risk factor for poor nutritional status among older adults. o Congregate meals o Meals on Wheels o Modified diets, such as diabetic diets and lowsodium diets, are provided as needed.

LONG-TERM CARE • Residents tend to be frail elderly with multiple diseases and conditions. • Malnutrition has a negative impact on both the quality and length of life and is an indicator of risk for increased mortality. • Have same risk factors as those who live independently

LONG-TERM CARE—(CONT. ) • Additional risks among long-term care residents include – Loss of appetite – Pressure ulcers may be a symptom of inadequate food and fluid intake. – Dysphagia – Loss of independence, depression, altered food choices, and cognitive impairments can negatively impact food intake.

LONG-TERM CARE—(CONT. ) • The downhill spiral – Loss of appetite is a major cause of undernutrition in long-term care. – Undernutrition increases the risk of illness and infection. – Undernutrition is exacerbated and a downward spiral ensues. – Minimum Data Set (MDS) requires food intake be assessed so that residents at risk from inadequate intake are identified.

LONG-TERM CARE—(CONT. ) • The downhill spiral—(cont. ) – Intake assessment system is flawed. o Food intake records may be neglected. o Lack of skill in accurately judging the percentage of food consumed o A practical approach to convert individual item estimates into meaningful estimates not assessed.

QUESTION • What is a risk among long-term care residents? a. Dependence b. Dysphagia c. Overhydration d. Increased appetite

ANSWER b. Dysphagia Rationale: Additional risks among long-term care residents include loss of appetite, pressure ulcers, dysphagia, loss of independence, depression, altered food choices, and cognitive impairments.

LONG-TERM CARE—(CONT. ) • Preventing malnutrition – A quality of life issue – Commercial supplements are often given between meals. – Potential benefits must be weighed against the potential negative consequences. – Increase of nutrient-dense foods included in diet

LONG-TERM CARE—(CONT. ) • The use of diets – Use of restrictive diets as part of medical care in long-term care facilities is controversial. – Goals of preventing malnutrition and maintaining quality of life are of greater priority. – Restrictive diets o Potential to negatively affect quality of life o Should be used only when a significant improvement in health can be expected

LONG-TERM CARE—(CONT. ) • A liberal diet approach – Holistic approach is advocated. – Low-sodium diets used in the treatment of hypertension are often poorly tolerated by older adults. – Imposing dietary restrictions on long-term care residents with diabetes is unwarranted. – Epidemiologic studies indicate that the importance of hypercholesterolemia as a risk factor for CHD decreases after age 44 and virtually disappears after the age of 65.

LONG-TERM CARE—(CONT. ) • A liberal diet approach—(cont. ) – Can be modified to meet the needs of residents with increased needs – Foods may be made more nutrient dense. – Supplemental vitamin C and zinc may be ordered to promote healing. – Frequent and accurate monitoring of the resident’s intake, weight, and hydration status is vital.