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TRANSCRIPT
• 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
o Women and men who live to 65 can expect to live an average of 18.7 more years
o For 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
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’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
o People aged 51 to 70
o Adults over the age of 70
• Aging and Older Adults (cont’d)
• Nutritional needs of older adults (cont’d)
– 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’d)
• Nutritional needs of older adults (cont’d)
– 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’d)
• Nutritional needs of older adults (cont’d)
– Protein (cont’d)
o Factors 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
o Groups 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
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:
Dehydration
Hyponatremia
• Aging and Older Adults (cont’d)
• Nutritional needs of older adults (cont’d)
– Fiber
o The 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
o Most recommended levels of intake for vitamins and minerals do not change with aging
o Significant exceptions:
Calcium
Vitamin D
Iron for women
o DRI for sodium decreases
o People 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:
o Physical activity forms the base of the pyramid
o 8 glasses of water appear just above physical activity
o Nutrient-dense food choices are used to illustrate each food group
o A flag appears at the top to alert older adults to their unique nutrient needs
o Is available in print form
• Aging and Older Adults (cont’d)
• Modified MyPyramid for older adults (cont’d)
– Additional tips for healthy eating
o Limit foods with added sugar
o Choose healthy fats to limit the intake of saturated and trans fats
o Limit sodium by eating less salt and buying reduced-sodium soups and frozen entrees
o Choose high-fiber grains
o Aging 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
o Vitamin 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:
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’d)
• Vitamin and mineral supplements
– In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods
o 50% 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:
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 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:
o Arthritis
o Osteoporosis
o Sarcopenia
– Nutrition-Related Concerns in Older Adults (cont’d)
• Functional limitations (cont’d)
– 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
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
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’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
o Women and men who live to 65 can expect to live an average of 18.7 more years
o For 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
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’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
o People aged 51 to 70
o Adults over the age of 70
• Aging and Older Adults (cont’d)
• Nutritional needs of older adults (cont’d)
– 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’d)
• Nutritional needs of older adults (cont’d)
– 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’d)
• Nutritional needs of older adults (cont’d)
– Protein (cont’d)
o Factors 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
o Groups 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
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:
Dehydration
Hyponatremia
• Aging and Older Adults (cont’d)
• Nutritional needs of older adults (cont’d)
– Fiber
o The 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
o Most recommended levels of intake for vitamins and minerals do not change with aging
o Significant exceptions:
Calcium
Vitamin D
Iron for women
o DRI for sodium decreases
o People 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:
o Physical activity forms the base of the pyramid
o 8 glasses of water appear just above physical activity
o Nutrient-dense food choices are used to illustrate each food group
o A flag appears at the top to alert older adults to their unique nutrient needs
o Is available in print form
• Aging and Older Adults (cont’d)
• Modified MyPyramid for older adults (cont’d)
– Additional tips for healthy eating
o Limit foods with added sugar
o Choose healthy fats to limit the intake of saturated and trans fats
o Limit sodium by eating less salt and buying reduced-sodium soups and frozen entrees
o Choose high-fiber grains
o Aging 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
o Vitamin 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:
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’d)
• Vitamin and mineral supplements
– In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods
o 50% 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:
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 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:
o Arthritis
o Osteoporosis
o Sarcopenia
– Nutrition-Related Concerns in Older Adults (cont’d)
• Functional limitations (cont’d)
– 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
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
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’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
v