NUTRITION FOR OLDER ADULTS

Presented by:Mandi Madoche

Caitlin TowleJesse Sharp

An ounce of prevention is worth a pound of cure

Let’s determine how much you know about the effects of aging.

Activity!

A short true/false Quiz to follow!

Most older adults are sick, frail, and dependent on

others.

False

Most older people live independently.

Health status in older age is not so much dependent on chronological age as it is on lifestyle choices.

Older adults become more difficult and rigid with

advancing years.

False

Personality remains relatively consistent throughout the lifespan.

Older adults cannot cope with the inevitable declines associated with aging.

False

Most older people successfully adjust to the challenges of aging.

The 5 senses (sight, hearing, taste, touch, and smell) all tend to weaken in old age.

True

Physical strength tends to decline in old age.

True

A lot of physical strength decline in older people is due to inactivity. Physical activity contributes to staying strong, no matter the age.

The majority of old people are unable to adapt to

change.

False

Older adults can adapt to change.

It is almost impossible for the average old person to

learn something new.

False

You can teach an old dog new tricks.

It is not safe for an elderly person to exercise.

False Compared to those who are inactive,

older adults who are active weigh less; have greater flexibility, more endurance, better balance, and better health; and live longer.

A 20-week strength-training program on older and younger men and women, found that the training response differed by gender and by race, but not by age.

The majority of old people have defective memory, are

disoriented, or are demented. False Researchers have come to discount

the view that cognitive abilities of older people inevitably decline.

Overall intellectual ability and specific cognitive skills, such as memory and problem solving are more likely to remain strong.

Learning Objectives Be able to distinguish between the

common myths and facts associated with aging.

Learn key physiological changes that occur during the normal aging process.

Discuss key Lifestyle factors that influence health more than chronological age. Physical activity and proper nutrition are the key points that will be discussed.

Discuss common examples of interactions between nutrients and prescription drugs.

Our World is Changing The number of people today aged 60 and over has

doubled since 1980. The number of people aged 80 years will almost

quadruple to 395 million between now and 2050. Within the next five years, the number of adults aged

65 and over will outnumber children under the age of 5. By 2050, these older adults will outnumber all children

under the age of 14.

The fastest-growing age group has been people older than

85 years

Physiological changes

In general, older people tend to lose bone and muscle and gain body fat.

The musculoskeletal system loses up to 15% of fat-free mass.

On average, there is a decline in lean body mass of 2% to 3% per decade from age 30 to 70.

Taste & Smell Taste and smell sensitivities tend to

diminish with age and may make eating less enjoyable.

If a person eats less, then weight loss and nutrient deficiencies may follow.

The prevalence of under nutrition is high among those who are homebound.

Taste perception for sucrose does not decline with age

GI Tract The intestinal wall loses strength and

elasticity with age, and GI hormone secretions change.

These changes slow motility and constipation is common in elderly adults.

Changes in GI hormone secretions diminish appetite leading to decreased energy intake.

Digestion and absorption of nutrients can be impaired by atrophic gastritis-a condition that affects 1/3 of those older than 60.

For anyone who is motivated to obtain the best possible health, it is never too late to learn to eat well, drink water, exercise regularly,

and adopt healthier lifestyle habits.

6 Lifestyle behaviors that have greatest influence on health: Eating well-balanced meals rich in

fruits and vegetables regularly Engaging in physical activity

regularly Not smoking Not using alcohol, or using it only

in moderation Maintaining a healthy body weight Sleeping regularly and adequately

Setting standards for older people is difficult because individual differences become more

pronounced as people grow older.

The Dietary Reference Intakes (DRI) cluster people older than 50 into two age

categories:• 51 to 70 years

• 71 years and older

Exercise No group can benefit more than older

persons from regularly performed exercise. Physical activity seems to be most influential in preventing or slowing the many changes that define a stereotypical “old” person.

Aerobic exercise has long been an important recommendation for preventing and treating many of the chronic and typically age-associated diseases.

Research indicates that strength training is necessary both to stop or reverse sarcopenia—the age-associated loss of body protein—and to increase bone density.

It is never too late in life to start exercising!

Even in frail, elderly people older than 85 years of age, strength training not only improves balance, muscle strength, and mobility, but it also increases energy expenditure and energy intake, thereby enhancing nutrient intakes .

Benefits of Physical Activity Aerobic activities improve cardio

respiratory endurance, blood pressure, and blood lipid concentrations.

Moderate endurance activities improve the quality of sleep; and strength training improves posture and mobility.

Physical activity also increases blood flow to the brain, thereby preserving mental ability, alleviating depression, supporting independence, and improving quality of life.

Recommendations for aerobic and strength-training exercises

for individuals age 60 and older

Aerobic exercise Older persons should build up to at least 30

minutes of aerobic exercise—for example walking, swimming, aqua gym and stationary cycling—on most, if not all, days.

Strength training Strength training 2 to 3 days a week,

with a day of rest between workoutsAny exercise program should always first be discussed with one’s

health care provider.

Water Many older adults do not feel thirsty

or notice mouth dryness. It can be hard to persuade elderly adults to drink enough water.

Dehydration is a risk for older adults. Total body water decreases as people age, so even mild stresses such as fever or hot weather can precipitate rapid dehydration in older adults.

Drinking 6 or more glasses of fluid per day prevents dehydration

Signs of Dehydration

Upper-body muscle weakness Speech difficulty Confusion Dry mucous membranes in nose and

mouth Longitudinal tongue furrows Dry tongue Sunken appearance of eyes in their

sockets

RECOMMENDATIONS FOR SPECIFIC NUTRIENTS CHANGE WITH AGE,

AND FOOD CONSUMPTION PATTERNS NEED TO ADJUST

ACCORDINGLY.

Older adults need fewer kcalories as they age, but their nutrient needs remain high.

It is important that they select mostly nutrient-dense foods.

Energy Needs Energy needs decline an estimated 5

percent per decade. Over a decade, daily energy needs

could decline by 70-100 calories. While it is important for older adults to

limit their caloric intake, their nutrient recommendations remain high. It is important to eat nutrient-dense food.

The DRI formulas allow energy calculations to be adapted for physical activity levels of older individuals .

Protein Protein is especially important for the

elderly to support a healthy immune system, prevent muscle wasting, and optimize bone mass.

Protein should be obtained from low-kcalorie sources of high-quality protein.

The RDA for protein is 0.8 grams per kg body weight/day .

Fiber & Fat Depending on caloric intake, a

minimum of 21 - 30 grams of dietary fiber daily is recommended for adults aged 51 and older.

The role of dietary fat does not change with age. Minimizing the amount of saturated fat in the diet and keeping total fat between 20 and 35% of calories is recommended.

Vitamin B12 Vitamin B12 levels decrease with age

even in health adults. Many older adults are unable to use B12 efficiently.

It takes years to develop a B12 deficiency; but once developed, the neurological symptoms are irreversible. Symptoms include deterioration of mental function, change in personality, and loss of physical coordination.

B12 is better absorbed in synthetic form

Vitamin D Age-associated metabolic changes affect

vitamin D status, independent of dietary intake, primarily due to a decrease in the ability of aged skin to synthesize vitamin D.

Dietary recommendations for vitamin D are higher for older adults than for any other population group.

800-1000 IU for vitamin D is needed to maintain adequate vitamin D serum levels.

Cod liver and other fish oils contain medicinal levels of vitamin D.

Iron & Vitamin A Women’s iron needs decrease after

menopause. Iron is stored more readily in the old than the

young. Excess iron contributes to oxidative stress.

Plasma levels and liver stores of vitamin A increase with age. Older adults are more vulnerable to vitamin A toxicity and possible liver damage than younger individuals are.

The UL for vitamin A is 3000 mcg (3mg) for adults aged 19 and older,

Calcium The AI for adults aged 51 and older is at

1200 mg daily, independent of gender or hormone status.

Recommended levels are met by a small portion of the population.

Low calcium intake has been linked to colon cancer, overweight, and hypertension.

UL for calcium is 2500 mg per day. There are adverse side effects reported at 4400 mg a day.

Magnesium Age does not seem to affect magnesium

metabolism The RDA is constant at 429 mg for males and

320 mg for females after age 31. Older adult intake is below the RDA. Signs of

deficiency include: personality changes (irritability, aggressiveness), vertigo, muscle spasms, weakness, and seizures.

Drugs used by older adults may lead to magnesium overdose. Signs of magnesium toxicity are diarrhea, dehydration and impaired nerve activity.

Vitamin E

It is a problematic nutrient because dietary intake is well below the recommended 15 mg.

Vitamin E plays a special role it the health of older adults due to its antioxidant functions.

Vitamin E is associated with enhanced immune function and cognitive status .

At high doses vitamin E is linked to longer blood clotting times and increases bleeding.

Nutrients and Drug Interactions

Physiological changes associated with aging may alter drug metabolism and excretion, which may, in turn, diminish drug effectiveness or create potential toxicities.

People older than age 65 take 1/3 of all the over-the-counter & prescription drugs sold in the U.S.

They receive an average of 13 prescriptions a year and may take as many as 6 drugs at a time.

Drugs may alter food intake by:

Altering the appetite (Amphetamines suppress appetite; corticosteroids increase appetite.)

Interfering with taste or smell (Amphetamines change taste perceptions)

Inducing nausea or vomiting (Digitalis).

Causing sores or inflammation in the mouth (methotrexate may cause painful mouth ulcers.)

Drugs may alter nutrient absorption by:

Changing the acidity of the digestive tract (Antacids may interfere with iron & folate absorption.)

Damaging mucosal cells (Cancer chemotherapy)

Binding to nutrients (Bile acid binders bind to fat-soluble vitamins).

Foods and nutrients may alter drug absorption by:

Stimulating secretion of gastric acid Altering rate of gastric emptying

(absorption of drugs may be delayed when taken with food).

Binding to drugs (calcium binds to tetracycline, reducing drug & Ca absorption).

Competing for absorption sites in the intestines (Dietary amino acids interfere with levodopa absorption.

Drugs may alter nutrient excretion by:

Altering reabsorption in the kidneys (some diuretics increase the excretion of sodium and potassium.)

Causing diarrhea or vomiting (may cause electrolyte losses).

Foods may alter medication excretion by:

Inducing activities of liver enzymes that metabolize drugs to allow their excretion (Components of charcoal-broiled meets increase metabolism of warfarin, theophylline, and acetominophen.)

Toxicity may occur from diet and drug interactions by: Increasing side effects of the drug

(Caffeine in beverages can increase adverse effects of stimulants.)

Increasing drug action to excessive levels (Grapefruit components my block metabolism of drugs and enhance drugs’ actions and side effects.)

References Brown, J. (2011). Nutrition through the life cycle. (4

ed.). Wadsworth, Cengage Learning. Feldman, R. S. (2009). Discovering the life span. (1

ed.). Upper Saddle River: Pearson College. My plate for older adults. (2011). Tuffs University,

Boston, MA. Retrieved from http://nutrition.tufts.edu/research/modified-mypyramid-older-adults

Whitney, E., & Rolfes, S. (2010). Understanding nutrition . (12 ed.). Belmont, CA: Wadsworth.

World Health Organization. (2002). Keep fit for life: Meeting nutritional needs of older persons. Retrieved from http://www.who.int/nutrition/publications/en/nut_older_p ersons_1.pdf