1、 Nutrition for Older AdultsChapter 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 gradua
2、l, 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 (contd) Aging demographics Older
3、 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 increasedo Women and men who live to 65 can expect to live an average of 18.7 more yearso For those who live to 85: Women will survive an av
4、erage 7.2 years more Men will survive an average 6.1 years more Aging and Older Adults (contd) Aging demographics (contd) Heterogeneous groupo Varies in age, marital status, social background, financial status, living arrangements, and health status Approximately 80% of adults older than 65 years of
5、 age have one chronic health problem People define wellness and illness differently as they age Aging and Older Adults (contd) 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 nutrit
6、ion Exercise Evidence shows that initiating healthy changes even in ones 60s and 70s provides definite benefits Aging and Older Adults (contd) Nutritional needs of older adults Knowledge growing Health status, physiologic functioning, physical activity, and nutritional status vary more among older a
7、dults (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 adultso People aged 51 to 70 o Adults over the age of 70 Aging and Older Adults (c
8、ontd) Nutritional needs of older adults (contd) Calorieso Needs decrease with age o Changes in body compositiono Physical activity progressively declineso Estimated 5% decrease in total calorie needs each decadeo Undesirable consequences of aging can be improved or reversed Aging and Older Adults (c
9、ontd) Nutritional needs of older adults (contd) Proteino 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 (contd) Nu
10、tritional needs of older adults (contd) Protein (contd)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
11、 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.
12、 Aging and Older Adults (contd) Nutritional needs of older adults (contd) Watero The AI for water is constant from 19 years of age through age 70 and aboveo Represents total water intake o Elderly are able to maintain fluid balance o Altered sensation of thirst and an age-related decrease in the abi
13、lity to concentrate urine increases risk for: Dehydration Hyponatremia Aging and Older Adults (contd) Nutritional needs of older adults (contd) Fibero 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
14、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 (contd) Nutritional needs of older adults (contd) Vitamins and mineralso Most recommended levels of intake for vitamins and minerals do not change with agingo Signific
15、ant 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 (contd) Modified MyPyramid for older adults Differs from MyPyramid in that:o Physical activity f
16、orms the base of the pyramido 8 glasses of water appear just above physical activityo Nutrient-dense food choices are used to illustrate each food groupo A flag appears at the top to alert older adults to their unique nutrient needso Is available in print form Aging and Older Adults (contd) Modified
17、 MyPyramid for older adults (contd) Additional tips for healthy eatingo Limit foods with added sugaro Choose healthy fats to limit the intake of saturated and trans fatso Limit sodium by eating less salt and buying reduced-sodium soups and frozen entreeso Choose high-fiber grainso Aging and Older Ad
18、ults (contd) 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 tha
19、n the DRIo Vitamin E, magnesium, fiber, calcium, and potassium Aging and Older Adults (contd) Nutrient and food intake of older adults (contd) Consume less fruit and vegetables Older adults need to improve their intakes of: o Whole grainso Dark green and orange vegetableso Dried peas and beanso Fat-
20、free and low-fat milk and milk products Snacking in older adults may help ensure an adequate intake Aging and Older Adults (contd) Vitamin and mineral supplements In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foodso 50% of older adul
21、ts 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 (contd) Nutrition screening for older adults Older adults at greatest risk of consuming an inadequate diet are those who are: o Less
22、 educatedo Live aloneo 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 familyb. Is marriedc. Has and adequate incomed. Is less educated Answer d. Is less educatedRational
23、e: 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 ea
24、t 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
25、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 (contd) Invol
26、untary 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 Shoul
27、d be client-centered and based on the individuals physiologic, pathologic, and psychosocial conditions Overall goals of nutrition therapy for older adults Maintain or restore maximal independent functioning and health Maintain the clients sense of dignity and quality of life by imposing as few dieta
28、ry restrictions as possible Nutrition-Related Concerns in Older Adults (contd) 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 Americ
29、a 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 (contd) Cataracts and macular degeneration (contd) Observational studies show that a diet rich in an
30、tioxidants, 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 Old
31、er Adults (contd) Functional limitations Aging causes a progressive decline in physical function Major causes of functional limitations among older adults include: o Arthritiso Osteoporosiso Sarcopenia Nutrition-Related Concerns in Older Adults (contd) Functional limitations (contd) Arthritiso A lea
32、ding 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?Nutrit
33、ion-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 Ad
34、ults (contd) Arthritis (contd) 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
35、physical limitations Nutrition-Related Concerns in Older Adults (contd) Functional limitations (contd) 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 P
36、rocess actually begins early in life Nutrition-Related Concerns in Older Adults (contd) Functional limitations (contd) Osteoporosis (contd) 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 esti
37、mated 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 (contd) Sarcopenia Strength training using progressive resistance is the best interventio
38、n shown to slow down or reverse sarcopenia Adequate protein intake is also essential Nutrition-Related Concerns in Older Adults (contd) Alzheimers 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
39、 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 (contd) Alzheimers disease (AD) (contd) Development of AD may also be related to oxidative stress People who
40、 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 individuals nutritional status Nutrition-Related Concerns in Older Adults (contd) Obesity Major public health problem Appropri
41、ateness 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 (contd) Social isolation Eating alone is a risk f
42、actor 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-termcare resi
43、dents 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 (contd) Additional risks among long-termcare residents inc
44、lude: 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 (contd) The downhill spiral Loss of appetite is a major cause of un
45、dernutrition 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 (contd) The down
46、hill spiral (contd) 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-termcar
47、e residents?a. Dependenceb. 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-Te
48、rm Care (contd) 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 (contd) The use of diets Use of restrictive diets as part of medical care in long-termcare 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 lifeo Should be
