chapter 18 nutrition and older adults “nutrition is one of the major determinates of successful...
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Chapter 18Nutrition and Older
Adults
“Nutrition is one of the major determinates of successful aging.”
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• Generalizations relative to health status changes with aging are unwise because “older adults” are a heterogeneous population
• Diseases and disabilities are not inevitable consequences of aging
• Functional status is more indicative of health in older adults than chronological age
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Introduction
• In “normal” aging, inevitable & irreversible physical changes occur over time
• We will look at– nutrient requirements– dietary recommendations– food & nutrition programs designed to support healthy aging
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What Counts as Old?There is no one age that defines “old”
• 50—Eligibility for AARP • 60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program
• 65—Eligibility for full Social Security • U.S. Census Bureau uses:
– 65 to 74—“young old”– 75 to 84—“aged”– 85 & older—“oldest old”
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Food Matters: Nutrition Contributes to a Long and
Healthy Life• Cumulative effects of lifelong dietary habits determine nutritional status in old age
• CDC suggest that longevity depends on:– 10% access to health care– 19% genetics– 20% environment (pollution, etc.)– **51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)
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A Picture of the Aging Population: Vital Statistics
• More Americans are living longer–Currently, ~12.4% are >65 yrs
–By 2050, ~20% will be >65 yrs
• Persons ≥85 are the fastest growing population group
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Global Population Trends: Life Expectancy and Life Span
Life expectancyAverage number of yrs of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth
Life spanMaximum number of yrs someone might live; human life span is projected to range from 110 to 120 yrs
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Range of Life Expectancy for 15 of 37 Countries Reported in Health, United States 2005, for 2001, According to
Gender
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Three Groups of Aging Theories
1) Programmed aging– Hayflick’s theory of limited cell replication
– Modular clock theory
2) Wear and tear theories of aging– Oxidative stress theory– Rate of living theory
3) Calorie restriction & longevity
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Physiological Changes
• Body composition changes– Lean body mass (LBM) & fat– Muscles: use it or lose it– Weight gain
• Changing sensual awareness– Taste & smell– Oral health: chewing & swallowing
– Appetite & thirst
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Body Composition Changes
• Lean body mass (LBM) – Sum of fat-free tissues, mineral as bone, & water
• Sarcopenia– Term used for loss of LBM associated with aging
• Fat-free mass decreases ~15% from age 20 to 70
• Older people have lower mineral, muscle, & water reserves
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Muscles: Use It or Lose It
• In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density
• Regular physical activity helps maintain functional status
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Weight Gain
• Weight gain accompanies aging, but is not inevitable
• Mean body weight gradually increases with aging, peaking between 50 & 59 yrs– Physical activity moderates weight gain & increases in body fat
– Lack of estrogen promotes fat accumulation
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Changing Sensual Awareness:Taste and Smell
• Taste & smell senses decline with age
• Decline in ability to identify smells varies by gender– In men, decline begins ~age 55 – In women, decline is >age 60
• Disease & medications affect taste & smell more than aging
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Changing Sensual Awareness:Oral Health—Chew and Swallow• Oral health depends on:
– GI secretions– Skeletal systems – Mucus membrane – Muscles – Taste buds– Olfactory nerves (smell & taste)
• Healthy People 2010 Objective:– Reduce % of people aged 65-74 who have lost all their teeth from 26% to 20%
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Changing Sensual Awareness:Appetite and Thirst
Appetite• Hunger & satiety cues weaken with age
• Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted
Thirst• Thirst-regulating mechanisms decrease with age
• Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective with advancing age
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Nutritional Risk Factors
Risk factors for older adults are:– Hunger, poverty, low food & nutrient intake– Functional disability– Social isolation or living alone– Urban & rural demographic areas– Depression, dementia, dependency– Poor dentition & oral health– Diet-related acute or chronic diseases– Polypharmacy– Minority, advanced age
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Tufts University’s Modified
Food Pyramid for 70+ Adults
Note supplements at the top & water at the
base
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Caloric Intake Comparison of Younger and Older Adults by
Gender
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Eating Occasions
Eating Out• Older adults eat out less than younger persons
Snacking• Older adults snack less than other groups
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Nutrient Recommendations
• Nutrient recommendations change as scientists learn more about effects of foods on human functions– Specific DRI for those >51 yrs were 1st established in 1997
Estimating Energy Needs• Decrease in physical activity & BMR from early to late adulthood results in ~20% fewer calories needed
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Protein
• Inactive, older adults living alone may have low protein intakes
• Several researchers report protein needs for older adults are 1 to 1.25 g/kg body wt (higher than the DRI of 0.8 g)
• Nitrogen balance is easier to achieve when: – Protein is a high quality– Adequate calories are consumed – Elders participate in resistance training
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Considerations for Protein Adequacy of Older Adults
• Based on ht & wt, how much protein will meet individual’s needs?
• Are enough calories eaten so that protein does not have to be used for energy?
• If marginal amounts of protein are eaten, is the protein of high quality?
• Are there additional needs: wound healing, tissue repair, surgery, fracture, infection?
• Is the individual exercising? (Nitrogen balance is harder to achieve while sedentary.)
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Fats and Cholesterol
• Minimize saturated fat & keep total fat between 20 to 35% of calories----same as young & middle-aged adult
• Even though eggs are high in cholesterol, they are a nutrient-dense, convenient, & safe food for older adults that do not have lipid disorders
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Recommendations for Fluid
• The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated
• ≥6 glasses of fluid/day will prevent dehydration in most older adults
• To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL
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Age-associated Changes in Metabolism: Vitamin D,
Calciferol• Factors that put older adults at risk for deficiency:1. Limited exposure to sunlight2. Institutionalization or homebound
3. Certain medications (barbiturates, cholestyramine, Dylantin, laxatives)
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Age-associated Changes in Metabolism: Iron
• Iron needs after menopause• Most older adults consume more iron than needed– Excess iron contributes to oxidative stress
• Reasons that some older adults may have iron deficiency include – Iron loss from disease or medications
acid secretion calorie intake
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Low Dietary Intake: Nutrients of Concern
•Vitamin E•Folate, folic acid•Calcium•Magnesium•Zinc
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Nutrient Supplements: When ?
• May be useful with those who:– Lack appetite resulting from illness, loss of taste or smell, or depression
– Have diseases in GI tract– Have a poor diet due to food insecurity, loss of function, or disinterest
– Avoid specific food groups– Take medication or other substances that affect absorption or metabolism
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Dietary Supplements Potentially Used by Older Adults for Health
Conditions
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Nutrient Recommendations: Using the Food Label
• In nutrition labeling & dietary guidance, “one size does not fit all”
• Nutrient amounts for older adults are slightly different than those for younger
• Main differences:– Need more calcium & vitamins D & C– Need less iron & zinc
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Food Safety Recommendations
• Older adults are vulnerable to foodborne illness because they have compromised immune systems
• Leading hazardous practices:– Improper holding temperatures– Poor personal hygiene– Contaminated food preparation equipment
– Inadequate cooking time
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Physical Activity Recommendations
• Exercise: the “true fountain of youth”
• Exercise guidelines– Keep Moving—Fitness after 50 screening tool
– Resistance or weight-bearing activities
– Aerobic exercise
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Nutrition Policy and Intervention for Risk
Reduction Nutrition Education4 C’s:-Commitment-Cognitive processing
-Capability -Confidence
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Considerations for Educational Materials for
Older Adults• Larger type size• Serif lettering (such as Times Roman)
• Bold Type• High contrasts (black on white)• Non-glossy paper• Avoid blue, green & violent• Reading level of 5th to 8th grade
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Community Food and Nutrition Programs
Elderly Nutrition Programs
• Government programs include:– USDA’s food stamp & extension programs
– Adult Day Services Food Programs– Nutrition Assistance Programs for Seniors
– Meals-on-Wheels– Senior Nutrition Program of the Older Americans Act
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The Promise of Prevention: Health Promotion
• Good nutrition habits make a greater impact when started early in life
• Many not motivated to make changes until later in life or when health problems occur
• The belief that an 80 y/o is too old to learn and practice health promotion strategies is an outdated myth