Download Nutrition in the elderly - Wk 1-2

Nutrition in the elderly
Week 25
1. Identify changes in nutritional requirements throughout the lifecycle
Infancy and early Childhood
 ↑ Requirement for macro and micronutrients relative to weight due to rapid cell
division occurring during growth, which requires protein, energy, and nutrients involved
in DNA synthesis and metabolism of protein, calories, and fat.
 infants require
 ↑ water and fluid requirement than adults due to increased surface area per unit body
weight and ↓ sweating ability
 ↑ fatty acid requirement compared to adults
Adolescents
 a higher protein and energy intake than adults is recommended for growth
 micronutrients are generally the same as for adults (some texts recommend ↑ Ca and Pi
for bone growth, but this is controversial due to lack of evidence of their absolute
requirement for bone growth)
Adulthood
 Micronutrient needs in adults 19 to 50 years of age differ slightly according to gender.
Males require more of vitamins C, K, B1, B2, and B3; choline; magnesium; zinc; chromium;
and manganese. Menstruating females require more iron, compared with males of
similar age.
Later Years
 Due to reductions in lean body mass, metabolic rate, and physical activity, elderly
persons require less energy than younger individuals.
 in order to reduce the risk for age–related bone loss and fracture, the DRI for vitamin D
is increased from 200 IU/day to 400 in individuals 51 to 70 years of age and from 200
IU/day to 600 IU/day for those >70 years of age.
 Suggested iron intakes drop from 18 mg per day in women ages 19 to 50 to 8 mg/day
after age 50, due to iron conservation and decreased losses in postmenopausal women,
compared with younger women
 The role of vitamin B6 in immunity also presents a rationale for higher recommended
intakes for elderly persons
 healthy eating is recommended first and then supplements if needed
 Alcohol intake can be a serious problem in elderly persons. The hazards of excess
alcohol intake include sleep disorders, problematic interactions with medications, loss
of nutrients, and a greater risk for dehydration, particularly in those who take diuretics.
Roughly one–third of elderly persons who overuse or abuse alcohol first develop their
drinking problems after the age of 60 years
Pregnancy and Lactation
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Pregnant and lactating women have increased requirements for both macronutrients
and micronutrients
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Protein requirements in pregnancy rise more than 50% to allow for fetal growth and
milk production
Pregnant women should not meet their increased need for protein by the intake of
certain types of fish, such as shark, swordfish, mackerel, and tilefish, which often
contain high levels of methylmercury, a potent human neurotoxin that readily crosses
the placenta
Vegetable protein sources, aside from meeting protein needs, can help meet the
increased needs for folate, potassium, and magnesium and provide fiber, which can help
reduce the constipation that is a common complaint during pregnancy.
Pregnant and/or lactating women also require increased amounts of vitamins A, C, E,
and certain B vitamins (thiamine, riboflavin, niacin, pyridoxine, choline, cobalamin, and
folate). Folate intake is especially important for the prevention of neural tube defects
and should be consumed in adequate amounts prior to conception
Pregnant women also require increased amounts of calcium, phosphorus, magnesium,
iron, zinc, potassium, selenium, copper, chromium, manganese, and molybdenum.
Dietary Guidelines for Australian adults (NH&MRC)
 Enjoy a wide variety of nutritious foods
- Eat plenty of vegetables, legumes and fruits
- Eat plenty of cereals (including breads, rice, pasta and noodles), preferably
wholegrain
- Include lean meat, fish, poultry and/or alternatives
- Include milks, yoghurts, cheeses and/or alternatives.
- Reduced-fat varieties should be chosen, where possible
- Drink plenty of water
- and take care to:
• Limit saturated fat and moderate total fat intake
• Choose foods low in salt
• Limit your alcohol intake if you choose to drink
• Consume only moderate amounts of sugars and foods containing added sugars
 Prevent weight gain: be physically active and eat according to your energy needs
 Care for your food: prepare and store it safely
 Encourage and support breastfeeding
Dietary Guidelines for Australian children and adolescents (NH&MRC)
 Encourage and support breastfeeding
 Children and adolescents need sufficient nutritious foods to grow and develop normally
• Growth should be checked regularly for young children
• Physical activity is important for all children and adolescents
 Enjoy a wide variety of nutritious foods
Children and adolescents should be encouraged to:
- Eat plenty of vegetables, legumes and fruits
- Eat plenty of cereals (including breads, rice, pasta and noodles), preferably
wholegrain
- Include lean meat, fish, poultry and/or alternatives
- Include milks, yoghurts, cheese and/or alternatives. Reduced-fat milks are not
suitable for young children under 2 years, because of their high energy needs, but
reduced-fat varieties should be encouraged for older children and adolescents
- Choose water as a drink. Alcohol is not recommended for children
- and care should be taken to:
• Limit saturated fat and moderate total fat intake. Low-fat diets are not suitable for
infants
• Choose foods low in salt
• Consume only moderate amounts of sugars and foods containing added sugars
 Care for your child’s food: prepare and store it safely
Dietary Guidelines for Older Australians (NH&MRC)
(These appear to have been rescinded but have not been replaced by anything)
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Enjoy a wide variety of nutritious foods
Keep active and maintain muscle strength and health weight
Eat at least 3 meals/day
Care for your food, prepare and store it correctly
Eat plenty of vegetables (incl. legumes) and fruit
Eat plenty of cereals, breads and pastas
Eat I diet low in saturated fats
Drink adequate amounts of water and other fluids
If you dink alcohol, limit your intake
Choose foods low in salt and use salt sparingly
Include foods high in calcium
use added sugars in moderation
3. Identify the major factors contributing to the prevalence of malnutrition in the elderly
Factors afftecting Nutritional Status in the Elderly
a. Physiological changes
Body Composition
- ↓ lean body mass means ↓ energy and ↑ nutrient needs
↓ Thirst and renal function
- ↑ risk of dehydration
- thirst is poor indicator of hydration status
- most elderly need 1.5-2L/day
↓Taste and smell
- can’t tell if food is off – food poisoning
- all food tastes the same
↓ Gastric acid and Intrinsic Factor
- ↑ atrophic gastritis with age
- affects Ca, Fe, Folate, B6, B12, absorption
↓ Immune function
- need for ↑ in Vit A, E and zinc
↓ Nutrient Production and Utilisation
- ↓ Vit D conversion and ↓ bone health
- ↓ efficiency in use of Vit B6
↓ Homocysteine levels
- B12, folate and B6 deficiency
b. Physiological and Social Changes
Depression
- ↓ appetite and intake
- ↓ interest in food
- self neglect
Isolation and loneliness
- death of a spouse or separation
- long distance to shops
- ability to cook/feed self (especially men)
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Medication and Diseases
↓ appetite and oral intake
↑ anorexia and nausea
compete for vitamins – deficiency
d. Economical changes
- pension
3. Identify the disease states to which poor nutrition in the elderly contributes
Good nutrition decreases mortality and morbidity in the elderly because:
- ↑ capacity for wound healing
- ↓susceptibility to infection
- ↑ ability to fight infection
- ↑ response to various therapeutic treatments
Poor nutrition leads to:
- ↑ incidence of illness
- ↑ impact of illness
- ↑ hospital admissions
- ↓ QOL
- ↓ recover
- ↓ outcomes post surgery
- as well as:
o osteoporosis
o anaemia (FE, folate and B12 deficiencies)
o CVD and cerebrovascular disease (excessive fat intake)
o renal failure – exacerbated by ↓ fluid intake
o Liver problems: especially from long term alcohol consumption