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Successful Aging Sorosh Roshan, MD, MPH International Health Awareness Network www.ihan.org Who is Old? Second childhood - Shakespeare late 16th century “sans teeth, sans eyes, sans taste, sans everything” The United Nations defines older people as those 60 years of age and over, and The oldest old as those over 80 years of age The Human Rights of Older Women Equal access to health and social services Eliminate gender, age, race and income related inequalities Life long training opportunity Involving older workers right across the company’s activities e.g., training, worker involvement in redesigning the work place, etc. Access to the labor market Elimination of elder abuse Aging “A process of gradual and spontaneous change, resulting in maturation through childhood, puberty and young adulthood and then decline through middle and late age” Senescence “The process by which the capacity for cell division, growth, and function is lost over times, ultimately leading to an incompatibility with life; i.e., the process of senescence terminates in death” Successful Aging A process by which deleterious effects are minimized Healthy lifestyle from preconception though out life cycle Nutrition and an active physical, mental and spiritual life Accelerated Aging Progeroid syndrome Warner syndrome Wiedmann-Rautenstrauch syndrome and Hutchinson-Gilford syndrome Down syndrome Physiology of Aging Aging is a normal process in which the rate of catabolic changes become greater than the rate of anabolic cell regeneration. Loss of cells and body mass can lead to varying degree of decreased efficiency and impaired organ function. Physiological Changes Sensory losses Oral health problems Gastrointestinal and metabolic abnormalities Cardiovascular diseases Physiological Changes (con’t) Reduction of pleasure of eating due to hyposmia (the ability to taste and smell reduced) and dysgeusia (the capability to digest foods is reduced) Reduced ability to detect odor can cause food poisoning Dry mouth (xerostomia), hyposalivation; difficulties in chewing and swallowing; constipation Gastrointestinal Changes Constipation due to inadequate intake of fiber, fluid, sedentary life style Glucose intolerance Increase in plasma levels of 1.5mg/dl per decade Deficient insulin production or function Diet modification and exercise are the treatment of choice Gastrointestinal Changes (con’t) Hypochlorhydria (Lower levels of digestive enzymes) Diminished absorption of nutrients such as B12, iron and calcium Metabolism of calcium and vitamin D is altered during aging These factors and poor dietary intake will accelerate bone loss and osteoporosis Nutritional Requirements Age, gender, level of activity, food allergies, environment and medical conditions Caloric requirements begin to decline from 55-60, (500kcal per for men and 300 kcal for women) Protein requirements increase slightly 20-30 kcal per kg of body weight-depending on the person’s weight. Nutritional Requirements (con’t) 1.25g of protein per kilogram of body weight is appropriate for the elderly (12 16% of total daily calories). The US RDA for adults is .8g of protein per kilogram of body weight. Need varies depending on illness, stress, open wounds, burns, vigorous exercise, infection and altered GI function. Carbohydrate Intake Limited to 55% of total daily calories. 40% of it from complex carbohydrate, whole grains, vegetables and fibers. Fibers help reduce cholesterol and plasma glucose level. Dietary Fat 30% of daily calories. Reduce saturated fats. Increase intake of monounsaturated and polyunsaturated sources including Omega 3 fatty acids (salmon, tuna fish, walnuts and flaxseed powder) Nutrients and Vitamins – Calcium intake 800-1200mg/day – Phosphorus intake to be reduced to 700mg/day. – Vitamin D for the homebound with limited sun exposure. – Iron store tends to increase with age. The recommended dose is 10mg/ day for men and women. (50% of the required dose for under the age of 50) Anemia in the Elderly Is due gastrointestinal bleeding and malignant disease. Zinc Zinc deficiency causes: – Impaired immune function – anorexia – dysgeusia – delayed wound healing – development of pressure ulcers Treat with Zinc supplements Antioxidants Vitamin E enhances immune function. 400 IU daily. Vitamin C may help to protect against cataract, 150-250 mg/day. B12, B6 and folate may help to improve nutritional status and energy, protects against elevated serum homocysteine, a risk factor for depression, cardiovascular and neurological deficits. Hydration and Fluid Intake Dehydration is the most important cause of fluid and electrolyte disturbances in the elderly. A daily fluid intake of 30-35 ml per kilogram of body weight, or a minimum of 1.0-1.5 ml per kilogram's necessary. Daily Fluid Requirements Fluid requirements increase with: – Exercise – Use of laxative or diuretics – Hot environment – Increase protein or fiber intake – Fever The elderly often experience reduced thirst sensation The Menu The food should be prepared for the individual needs. Good presentation, fresh, nutritious, tasty and nutrient dense. Be considerate of those who wear dentures or suffer from dysphasia. Add supplements if you must. Serve the food with bouquet of tender loving care. Special Thanks Azi Ahmadi, MS Nutrition Laura DiClementi, MS Health Education Courtney Essary, MBA Hewitt Simon, Age in Action-S. Africa Council for the Aged