Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Food politics wikipedia , lookup
Gastric bypass surgery wikipedia , lookup
Overeaters Anonymous wikipedia , lookup
Obesity and the environment wikipedia , lookup
Malnutrition in South Africa wikipedia , lookup
Malnutrition wikipedia , lookup
Epidemiology of metabolic syndrome wikipedia , lookup
Calorie restriction wikipedia , lookup
Human nutrition wikipedia , lookup
• 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. • 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) • 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