•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’d)
•Aging demographics
–Older adults, especially those older than 75 years of age, represent the fastest-growing segment of the American population
–Life expectancies at both 65 and 85 have increased
oWomen and men who live to 65 can expect to live an average of 18.7 more years
oFor those who live to 85:
Women will survive an average 7.2 years more
Men will survive an average 6.1 years more
•Aging and Older Adults (cont’d)
•Aging demographics (cont’d)
–Heterogeneous group
oVaries 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’d)
•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 60s and 70s provides definite benefits
•Aging and Older Adults (cont’d)
•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
–2 DRI groupings exist for mature adults
oPeople aged 51 to 70
oAdults over the age of 70
•Aging and Older Adults (cont’d)
•Nutritional needs of older adults (cont’d)
–Calories
oNeeds decrease with age
oChanges in body composition
oPhysical activity progressively declines
o Estimated 5% decrease in total calorie needs each decade
oUndesirable consequences of aging can be improved or reversed
–Aging and Older Adults (cont’d)
•Nutritional needs of older adults (cont’d)
–Protein
oThe RDA for protein remains constant at 0.8 g/kg for both men and women from the age of 19 and older
oEstimated that 7.2% to 8.6% of older adult women consume protein below their estimated average requirement
•Aging and Older Adults (cont’d)
•Nutritional needs of older adults (cont’d)
–Protein (cont’d)
oFactors that may contribute to a low protein intake
Cost of high-protein foods
Decreased ability to chew meats
Lower overall intake of food
Changes in digestion and gastric emptying
oGroups at risk for inadequate protein intake
Oldest elderly
Those with health problems
Those in nursing homes
•Question
•Is the following statement true of 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’d)
•Nutritional needs of older adults (cont’d)
–Water
oThe AI for water is constant from 19 years of age through age 70 and above
oRepresents total water intake
oElderly are able to maintain fluid balance
oAltered sensation of thirst and an age-related decrease in the ability to concentrate urine increases risk for:
Dehydration
Hyponatremia
•Aging and Older Adults (cont’d)
•Nutritional needs of older adults (cont’d)
–Fiber
oThe AI for fiber is based on median intake levels observed to protect against coronary heart disease
AI for fiber is 38 g/day for men through age 50 and 30 g/day thereafter
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’d)
•Nutritional needs of older adults (cont’d)
–Vitamins and minerals
oMost recommended levels of intake for vitamins and minerals do not change with aging
oSignificant exceptions:
Calcium
Vitamin D
Iron for women
oDRI for sodium decreases
oPeople over 50 are advised to consume most of their B12 requirement from fortified food or supplements
•Aging and Older Adults (cont’d)
•Modified MyPyramid for older adults
–Differs from MyPyramid in that:
oPhysical activity forms the base of the pyramid
o8 glasses of water appear just above physical activity
oNutrient-dense food choices are used to illustrate each food group
oA flag appears at the top to alert older adults to their unique nutrient needs
oIs available in print form
•Aging and Older Adults (cont’d)
•Modified MyPyramid for older adults (cont’d)
–Additional tips for healthy eating
oLimit foods with added sugar
oChoose healthy fats to limit the intake of saturated and trans fats
oLimit sodium by eating less salt and buying reduced-sodium soups and frozen entrees
oChoose high-fiber grains
oAging and Older Adults (cont’d)
•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 1,000 to 1,200 calories/day in men and 600 to 800 calories/day in women
–Nutrients with mean intakes less than the DRI
oVitamin E, magnesium, fiber, calcium, and potassium
•Aging and Older Adults (cont’d)
•Nutrient and food intake of older adults (cont’d)
–Consume less fruit and vegetables
–Older adults need to improve their intakes of:
oWhole grains
oDark green and orange vegetables
oDried peas and beans
oFat-free and low-fat milk and milk products
–Snacking in older adults may help ensure an adequate intake
•Aging and Older Adults (cont’d)
•Vitamin and mineral supplements
–In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods
o50% of older adults have inadequate intakes of vitamin E and magnesium
–Supplements tend to have a positive impact on nutritional adequacy for adults 51 and older
•Aging and Older Adults (cont’d)
•Nutrition screening for older adults
–Older adults at greatest risk of consuming an inadequate diet are those who are:
oLess educated
oLive alone
oHave 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 2 meals/day? Do you eat few fruits, vegetables, or milk products? Do you have 3 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’d)
•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 3 or more prescribed or over-the-counter dugs a day?
•Screening Criteria for Malnutrition in Older Adults (cont’d)
•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’d)
•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, beta carotene, and zinc is effective in slowing AMD but not cataracts
•Nutrition-Related Concerns in
Older Adults (cont’d)
•Cataracts and macular degeneration (cont’d)
–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’d)
•Functional limitations
–Aging causes a progressive decline in physical function
–Major causes of functional limitations among older adults include:
oArthritis
oOsteoporosis
oSarcopenia
–Nutrition-Related Concerns in
Older Adults (cont’d)
•Functional limitations (cont’d)
–Arthritis
oA leading cause of functional limitation among older adults
oOsteoarthritis (OA) is associated with aging and normal “wear and tear” on joints
Knee is the most commonly affected joint
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’d)
•Arthritis (cont’d)
–Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise, trauma, and bone density
–Symptoms of OA usually appear after the age of 40 and by 65 years of age or above
–Objective of treatment is to control pain, improve function, and reduce physical limitations
•Nutrition-Related Concerns in
Older Adults (cont’d)
•Functional limitations (cont’d)
–Osteoporosis
•Bone remodeling
•After menopause, women experience rapid bone loss related to estrogen deficiency
•Estimated direct-care costs of osteoporotic fractures are $12 to $18 billion annually
•Process actually begins early in life
–Nutrition-Related Concerns in Older Adults (cont’d)
•Functional limitations (cont’d)
•Osteoporosis (cont’d)
–Interventions implemented late in life can effectively slow or halt bone loss
•Sarcopenia
–Defined as loss of muscle mass and strength
–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
–Related to a sedentary lifestyle and less-than-optimal diet
–Nutrition-Related Concerns in
Older Adults (cont’d)
•Sarcopenia
–Strength training using progressive resistance is the best intervention shown to slow down or reverse sarcopenia
–Adequate protein intake is also essential
•Nutrition-Related Concerns in
Older Adults (cont’d)
•Alzheimer’s disease (AD)
–Most common form of dementia in the U.S., it affects an estimated 4.5 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’d)
•Alzheimer’s disease (AD) (cont’d)
–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
•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’d)
•Obesity
–Major public health problem
–Appropriateness of treating obesity in older adults is controversial
•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’d)
•Social isolation
–Eating alone is a risk factor for poor nutritional status among older adults
•Congregate meals
•Meals on Wheels
•Modified diets, such as diabetic diets and low-sodium diets, are provided as needed
•Long-Term Care
•Residents tend to be frail elderly with multiple diseases and conditions
•Estimated 23% to 85% of long-term–care residents suffer from malnutrition or dehydration
• 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’d)
•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’d)
•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’d)
•The downhill spiral (cont’d)
–Intake assessment system is flawed:
•Food intake records may be neglected
•Lack of skill in accurately judging the percentage of food consumed
•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’d)
•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’d)
•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
oPotential to negatively affect quality of life
oShould be used only when a significant improvement in health can be expected
•Long-Term Care (cont’d)
•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’d)
•A liberal diet approach (cont’d)
–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
•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’d)
•Aging demographics
–Older adults, especially those older than 75 years of age, represent the fastest-growing segment of the American population
–Life expectancies at both 65 and 85 have increased
oWomen and men who live to 65 can expect to live an average of 18.7 more years
oFor those who live to 85:
Women will survive an average 7.2 years more
Men will survive an average 6.1 years more
•Aging and Older Adults (cont’d)
•Aging demographics (cont’d)
–Heterogeneous group
oVaries 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’d)
•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 60s and 70s provides definite benefits
•Aging and Older Adults (cont’d)
•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
–2 DRI groupings exist for mature adults
oPeople aged 51 to 70
oAdults over the age of 70
•Aging and Older Adults (cont’d)
•Nutritional needs of older adults (cont’d)
–Calories
oNeeds decrease with age
oChanges in body composition