older adult ppt winter 2013
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Nutrition and
TheOlder Adult
Barbara Robinson, MPH,RD,CNSC
Assistant Professor
Johnson & Wales University
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Late Adulthood LearningObjectives
To identify sensory changes of lateadults w/ respect to food intake
To list physiological changes of aging
To relate social and environmental,
factors to nutrition
To identify nutrition supportassessment & assistance programs forlate adults
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Late Adulthood: Special Issues
1. How old is a late adult! "ver #$
%. hronological age vs. functional age
'. (n)uence of diet!
*.+hats the late adults secret weapon!
$. +hat is a growing population segment!
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US Census Bureau AgeCategories
#$-* 0oung "ld
$-* "ld
$ and over "ldest "ld
$2,222 centenarians in 34 5
some live independently
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Large increase inpopulation in
those >85
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RDs and Jobs6ro7ected growth 1$8 overall
28 in nursing home and home care
enters for 9edicare and 9edicaid4ervices :94;
contracts with chronic care improvementprograms
Nutrition-related conditions
e.g., heart failure, dia
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BIOLOIC AS!"C#S O$AI%
o Our vie& o' aging should be the sa(e as ourvie& o' develop(ent)
oIn both develop(ent and aging* nu(erouschanges occur
o %utrition pro'essionals &ho &or+ &ith olderadults need to
,) Anticipate these changes-) Atte(pt to slo& progression o'
changes
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Reco((ended
.acronutrient Distribution'or Older Adults
>uidelines ar
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Nutrition 4creening for @isk-
N4(%utrition Screening Initiative
looking for warning signs ofmalnutrition in older adults
om
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%utrition Screening 'orRis+1 %SI
Devel ( screen (dentiEes personsneeding preventive nutritionintervention - looks at F9(, diet ha
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/%SI0 Chec+list1 D"#"R.I%"* p) 234
Illness changes 'ood inta+e
"ats 'e&er than - (eals
$e& 'ruits* vegetables* dair5
Dental proble(s
%ot enough (one5 'or 'ood
/6370 "at alone
Unintentional &t change
Issues &8shopping* coo+ing
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uidelines 'or Seniors
Ade9uate Inta+e /AI0
'or #otal $iber
.en:4 gra(s;o(en: -, gra(s
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.ost Recent uidelines'or Seniors
$luids: , to - 9uarts per da5
Di(inished thirst sensation
All
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BIOLOIC AS!"C#S O$BIOLOIC AS!"C#S O$
AI%AI%Oral health1 (outh and teeth
Che(oreception: s(ell* taste* touch
Aging gut
S+eletal aging and changes in leantissue
Cognition 8 de(entia
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BIOLOIC C?A%"S ;I#?BIOLOIC C?A%"S ;I#?
AI%AI%@1,7 decline in brain &eight
Abilit5 to control light declines
"ardru(8bones lose
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BIOLOIC C?A%"S ;I#?AI%Arteries thic+en1 atherosclerosis
Bones thin
osteoporosis
Cells less sensitive
to insulin:
Insulin Resistance
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BIOLOIC C?A%"S ;I#?BIOLOIC C?A%"S ;I#?
AI%AI%
Fody omposition?at mass increases
Gisceral fat increases
4arcopenia age-related loss ofmuscle mass, strength andfunction
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hanges @elated to the
>astrointestinal Tract
That (mpact A
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Oral ?ealth
37 o' all older peoplehave one or (ore dental
treat(ent needs
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Oral ?ealth: So't tissues
Salivar5 glands: saliva is antibacterial* lubricating*
cleansing* re(ineraliing
Ulcerative Sto(atitis/(outh ulcers01i((une co(pro(ise
erosto(ia /dr5 (outh0 increasesdeca5due to erogenic drugs*deh5dration* vita(in deEcienc5 /A0
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Oral ?ealth: #eeth
#eeth have reduced regenerativecapacit5 &ith ageF sur'aces
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Changes in:
Oral ?ealth
.astication* s&allo&ing andspeech
Deca5ed teeth* periodontaldisease
Ill1Etting dentures or edentulous*pain* in
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Oral ?ealth: So't tissues
Atroph5 o' oral (ucosa/li+e thinning dr5ing o' aging s+in0
!eriodontu( /gingivitis periodontitis0
Chronic periodontitis in)ammationwithin the supporting tissues of the teeth,progressive detachment and
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Oral ?ealth: Bone
Alveolar bone lossF less
resistance to oral trau(a*in
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Alveolar BoneAlveolar Bone
The thickened ridge of
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Bone Densit5Bone Densit5"steopenia
"steoporosis
Hip fracture
Gitamin = low sunlight eposure, low intake, lo&cutaneous production*
impaired a
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Bone Growth & Development
Women
Peak bone mineral content: 25-28 yr!
"!5#-$!"# lo per year %ollowin ae 5"or menopa'e
(!5# lo per year pot-menopa'e %or
%irt 5-8 year!
http://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animatio
n
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Normal bone
Osteoporotic bone
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Changes in: Che(osensation
ustation /@1,70 /d5sgeusia0Ol'action /@70 /h5pos(ia0
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>astrointestinal :>(;>astrointestinal :>(;4ystem4ystem D5sphagia: Sensation that 'ood
is stuc+ in the throat or upper
esophagus
Due to &ea+ened chee+
and tongue (uscles and less saliva production
@7 o' nursing ho(e clients
http://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animation -
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=iet Teture 9odiEcation 5=iet Teture 9odiEcation 5
tet
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Artistic 6urees
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$ood #eture .odiEcation$ood #eture .odiEcation
LevelsLevels"evel $"evel $: .echanicall5 altered: (oist*
se(i1solidF ground or Enel5 (inced(eats* 'or+1(ashable 'ruits andvegetables)
#hin+ (eatloa' or ver5 so't Esh suchas sole and 'or+1(ashed* coo+edcarrots)
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$ood #eture .odiEcation$ood #eture .odiEcation
LevelsLevels
"evel %"evel % 4oft-solid, reIuires more chewing,easy to cut meats, fruits and vegeta
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+hat are some other >(changes aBecting diet
and nutrition that areseen in older adults!
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>astrointestinal 4ystem>astrointestinal 4ystem
Sto(ach,)Slo&er gastric e(pt5ing
-)Decreased absorption o' ita(in B,-:AtrophicKgastritis /47 in peopleM@0: Di(inished or absent gastric acid
/achlorh5dria0K Atrophy is the partial or complete wasting awayof a part of the
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it) Bit) B,-,- DeEcienc5 andDeEcienc5 and
Achlorh5driaAchlorh5dria6arietal ells in stomach lining
make intrinsic factor or I$
I$is present in the gastric 7uice as well
(?
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6ernicious anemia and F1%
6ernicious anemia is a common olderadult form of anemia due to gastric
atrophy and a loss of (? production.
A type of megalo
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ita(in Bita(in B,-,-DeEcienc5DeEcienc5
9any older AmericansreIuire F1% shots 5
New research high doseliIuid form can
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B,- $unctions DeEcienc5B,- $unctions DeEcienc5
Anemia F1% reIuired for
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S5(pto(s o' B,-S5(pto(s o' B,-
DeEcienc5DeEcienc5
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51
=(GJ@T(3DA@ =K
Diverticulosis9NT
Diverticulitis9NT
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52
=(GJ@T(3D"4(4HTT6//+++.0"3T3FJ."9/+ATH!GL9+A1M3+%99
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Basic DeEnitionsBasic DeEnitions
>erentology The study of normal aging
>eriatrics The study of the chronic
disease freIuently associated withaging
>eriatric Nutrition 9edical
Nutrition Therapy :9NT;
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Chronological age vsChronological age vs
'unctional age'unctional age$unctional age related to a
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Oidation and AntioidantsOidation and Antioidants
?ree radicals molecules containing unpaired,highly reactive electrons
ausal agents in the process ofaging
?ree radical theory damage to cells
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i i l d% t iti l t d
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%utrition1related%utrition1related
Concerns : "5esConcerns : "5esataracts :thickening of eye lenses;Antioidants vitamins and J, seleniumand resveratrol :red wine; may help
prevent progression of cataracts.
arotenoids lutein and Ceaanthin :Cee-uh-Can-thin;, which are also antioidants, mayhelp protect against cataracts.
Lutein and eaanthin: in beta1 .g per serving1
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carotenein so(e 'ruits and vegetables)
.g per servingLutein
Pale :raw or cooked; %$.2 / 1 cup
4pinach :cooked; %2.* / 1 cup
ollards :cooked; 1*.# / 1 cup
Turnip greens :cooked; 1%.% / 1 cup
>reen peas :cooked; *.1 / 1 cup
4pinach :raw; '. / 1 cup
orn :cooked; 1.$ / 1 cup
Froccoli :raw; 1.' / 1 cup
@omaine lettuce :raw; 1.1 / 1 cup>reen
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Dutein is released when the
cells walls of the food are
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"5es are vulnerable to"5es are vulnerable to
oidationoidation"idative stress is high in eyesdue to
1. (ntense light eposure
%. High rate of oidative
meta
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Age1Related .acularAge1Related .acular
Degeneration /A.D0Degeneration /A.D0
Freakdown of the Ma'!la, the central part of theretina
central vision loss
9acula contains luteinand Ceaanthin
Oinc also helps prevent A9=Average intake 1 - % mg/day vs. *- mg
recommended A %22$
"
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=ia
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Changes in Lean and $atChanges in Lean and $at
#issue /bod5 co(position0#issue /bod5 co(position0Sarcopenia Age-related loss of muscle mass, strength, and function
sarcoL )esh/musclepenia L loss
rate of lossL 18 every yr after *$
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+hat is the older
adults secretweapon!
!h5sical Activit5 as =$ountain!h5sical Activit5 as =$ountain
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!h5sical Activit5 as =$ountain!h5sical Activit5 as =$ountain
o' Nouth>o' Nouth>
9uscle 9ass 9aintenanceFalance
A 4ense of well
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Reducing SarcopeniaStrength trainingAerobic eercise less eective /good 'orother reasons0
I(proves 'unctional status
In illness* protein stored in (uscles is&ithdra&n 'or repair and other reasons
Ade9uate protein inta+e RDA1 orperhaps (ore according to ne& research
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overn(ent !rogra(sovern(ent !rogra(s
'or "lderl5'or "lderl5Administration on Aging under
The 34 =epartment of Healthand Human 4ervices
:34=HH4;
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Administration on AgingAdministration on Aging
.ission State(ent
(he mission of AoA is to evelo)
a 'om)rehensive, 'oorinate an'ost*e+e'tive system of home an'omm!nity*base servi'es that
hel)s elerly inivi!alsmaintain their health anine)enen'e in their homes an'omm!nities
Ad i i t ti A iAd(inistration on Aging
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Ad(inistration on AgingAd(inistration on Aging
!rogra(s!rogra(s
Older A(ericans Act %utrition !rogra(sAvailaroup dining atsenior centers in many communities
%.Nutrition 4creening
'.Home delivered foods 9eals on+heels
Child and Adult Care $oodChild and Adult Care $ood
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Child and Adult Care $oodChild and Adult Care $ood
!rogra(!rogra(
A?6 ?unding for meals andsnacks to adult day care centers
(n order for foods costs to
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%utrition !rogra(s USD??S%utrition !rogra(s USD??S
USDA USDA34=HH44tate-run w/ variation among states
ongregate and home-delivered meals
#2R w/ greatest economic & social need
3nder 34=A 5 Title (((c ?ood Assistance6rogram
?ood 4tamps:4NA6;, ?ood 4tamp NutrJduc, ommodity 4upplemental ?ood,4eniors ?armers 9arket Nutrition6rograms
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.edicare !rogra(s.edicare !rogra(s
All Americans eligi
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%utrition ?ealth Insurance BeneEt%utrition ?ealth Insurance BeneEt
under .edicare /under .edicare /
MM
age 3@0age 3@0
9edical Nutrition Therapy :9NT;
4ervices 6rovided
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.ultidisciplinar5Assess(ent
(nterrelationships w/ nutrition frommany life issues
9edications 5 6olypharmacy
9ultidisciplinary perspective critical
5 9=, @N, @=, "T, 4D6, 6T, 4+
=aily living evaluation reIuired
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