Chapter 13Special Topics of Age-related Risks:Unique Nutrition Issues in the Older Adult

Karen M. Funderburg MS,RD,LDMigy K. Mathews MD

Reader Objectives

Upon reading this chapter and reflecting on the contents, the reader will be able to:

• List the unique physiological changes that occur with aging that affect nutrient intake and nutritional status.

• List key psychosocial changes associated with aging that can affect the desire or ability to consume an adequate diet.

Reader Objectives, cont.

• Discuss the impact that age-related changes have on nutritional status and quality of life.

• Understand the consequences of age-related malnutrition and nutrient deficiencies on overall health status and quality of life.

Age-related risks for Malnutrition

• Impaired appetite

• Appetite assessment

• Diet modification

• Physiological changes

• Psychosocial changes

• Medication use

Impaired appetite

• Appetite is associated with well-being• Conditions that may take away appetite:

changes in GI tract, decreased taste and smell acuity, medication side effects,diet modifications, depression or altered mental status.

• Diminished appetite may lead to significant risks to overall health

Appetite Assessment

• Declining food intake and anorexia are predictors for undernutrition in older adults.

• Early detection--nutrition screening tools are very important

• Determine your nutritional health checklist and MNA

• SENECA study

Physiological changes

• “Anorexia of aging”

• Changes in GI tract

• Sensory loss

• Food-borne illness

• Cognitive changes: impaired cognition, Alzheimer’s, Parkinsons, cancer

Psychosocial changes and medication use

• Nutritional risk is associated with economic hardship and loneliness

• Elderly nutrition program and Meals on Wheels

• Medication use: Increased disease leads to increased medication use. Side effects of medications affect appetite and nutritional status.

Interventions for Impaired Appetite

• Liberalized diet, freedom in food selection, eating with others, congregate meals, providing assistance, specialized utensils, finger foods, flavor enhancers, adding nutrients to food, nutrient-dense snacks, commercial supplements, pleasant eating environment, praise, stimulants

Oral Health Problems

• NHANES--oral health is an increasing problem with age; compounded by poor income status and lower education level

• Endentulous, dentures, mouth pain,, xerostomia, dysphagia, visual impairment, impaired motor skills, arthritis, altered mental status

Malnutrition

• Estimated that 40% of nursing home residents and 50% of hospitalized elderly patients are malnourished

• Malnutrition--any insufficient dietary intake of essential nutrients

• Malnutrition--protein-energy undernutrition (PEU)

Weight loss,Calories, PEM

• Older adult must be evaluated for unintended weight loss; height and weight; BMI

• Calories: energy intake declines with age, reduction in BMR, reduction in lean body mass and decreased physical activity

• Protein-energy malnutrition (PEM)

Nutrient Deficits• Vitamin D--especially important for elderly,

particularly those institutionalized or homebound

• Thiamin--deficiency usually associated with poor intakes, not increased need

• Vitamin B6--age-related changes related to the metabolism and absorption

• Vitamin B12--deficiency common among older adults due to pernicious anemia and atrophic gastritis

• Fluid--risk of dehydration

Health Problems

• Cardiovascular disease

• Peripheral vascular and cerebrovascular disease

• Incontinence (urinary, fecal)

• Visual Function

• Osteoporosis

Risk factors for Osteoporosis

• Risk factors include: age, Asian, Caucasian, female, early menopause, family history, low body weight, medications, smoking, sedentary, heavy alcohol consumption, poor calcium intake for years, poor Vitamin D intake

Special considerations for older women

• Long life expectancy--80.1 years

• Disease and disability increase with age

• Menopause and side effects: risk for bone loss and heart disease

• Osteoporosis and hormone replacement therapy (HRT)