Download Nutrition for older adults chapter 13

•
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
–
•
Eating poorly
–
•
Do you have an illness that makes you change the kind and/or amount of food you eat?
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
–
•
Reduced social contact
–
•
Do you eat alone most of the time?
Multiple medications
–
•
Do you sometimes not have enough money to spend on the food you need?
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
–
•
Needs assistance in self-care
–
•
Have you gained or lost 10 pounds in the last 6 months without trying?
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
–
•
Eating poorly
–
•
Do you have an illness that makes you change the kind and/or amount of food you eat?
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
–
•
Reduced social contact
–
•
Do you sometimes not have enough money to spend on the food you need?
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
–
•
Needs assistance in self-care
–
•
Have you gained or lost 10 pounds in the last 6 months without trying?
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.
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Nutrition-Related Concerns in
Older Adults (cont’d)
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Arthritis (cont’d)
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Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise,
trauma, and bone density
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Symptoms of OA usually appear after the age of 40 and by 65 years of age or above
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Objective of treatment is to control pain, improve function, and reduce physical
limitations
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Nutrition-Related Concerns in
Older Adults (cont’d)
Functional limitations (cont’d)
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Osteoporosis
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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)
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Osteoporosis (cont’d)
–
•
•
Interventions implemented late in life can effectively slow or halt bone loss
Sarcopenia
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Defined as loss of muscle mass and strength
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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
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Related to a sedentary lifestyle and less-than-optimal diet
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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
•
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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
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Risk of AD increases with increasing age
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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
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Nutrition-Related Concerns in
Older Adults (cont’d)
•
Alzheimer’s disease (AD) (cont’d)
–
Development of AD may also be related to oxidative stress
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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
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Nutrition-Related Concerns in
Older Adults (cont’d)
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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
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Nutrition-Related Concerns in
Older Adults (cont’d)
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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
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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
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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
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Dysphagia
–
Loss of independence, depression, altered food choices, and cognitive impairments can
negatively impact food intake
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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
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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.
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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
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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
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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)
•
v
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