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Chapter 17
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“Old” / ”senior” > 65 yrs old
Two motivating goals
◦ Promote health
◦ Slow aging
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The ratio of old people to young is increasing
◦ Growing “old” happens day by day
◦ projected to go from 1/8 to 1/5 between 2000 and
2030
◦ Fastest-growing age group is >85 yrs old
◦ 77-81 for women, 70-76 for men
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Factors influencing life expectancy
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Good nutrition and regular physical activity
can
◦ Increase life expectancy. There are many
healthy habits that can increase life span.
◦ Support good health, prevent or prolong
the onset of disease
◦ Improve the quality of life.
A person’s physiological age and
chronological age may be different
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Diversity of older adults’ lives and nutritional
histories
Nutritional influence on aging process
◦ How much aging is inevitable?
◦ Process can be slowed by adopting healthy
lifestyles- nutritious diet and exercise
◦ 70-80% of life expectancy depends on healthrelated behaviors
◦ 20-30% of life expectancy depends on genetics
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Healthy habits for longer life, less disability
◦ Physiological age vs. chronological age
◦ Lifestyle behaviors
 Eating well-balanced meals
 Engaging in physical activity
 Not smoking
 Abstinence or moderate use of alcohol
 Maintaining a healthy body weight
 Sleeping regularly and adequately
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Physical activity
◦ Benefits of physical activity in older adults
◦ Additional benefits
◦ Best types of exercise
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Aerobic activities
Moderate endurance activities
Strength training
Resistance training
◦ Most powerful predictor of mobility in later years
◦ Physical limitations from inactivity not increasing
age
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More lean body mass
Greater flexibility, better balance
Increased endurance and a longer life span
Prevent or delay the decrease in muscle mass
and strength that occur with age
Quicker recovery from injury or surgery
Active people benefit from higher energy and
nutrient intakes (They can eat more without
gaining unnecessary weight.)
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Energy restriction in animals-70% of normal
◦ Animals live longer & have fewer age-related
diseases
 Slows aging process
◦ Food intake
 Prevent malnutrition
 70% of normal energy intake
 Increases antioxidant activity & DNA repair
◦ Age of starting energy restriction
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Energy restriction in human beings
◦ How to define energy restriction
◦ 30 yrs of energy restriction needed to increase life
expectancy by 3 yrs
◦ Moderate restriction
 10 to 20 percent reduction in energy intake
 Less food, less oxidative damage from food choices
 Benefits in body weight and fat, blood pressure, lipids,
insulin response
◦ Versus nutritional adequacy that is essential to a
long and healthy life
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Stress
◦ Stress response burns up nutrients and
oxidizes/ages
◦ Psychological and physical stressors
◦ Bodily response
 Nervous and hormonal systems
 Prolonged or severe stress effects
◦ Men Fight-or-flight response (more stressful)
 Women Tend-and-befriend response (less
stressful)
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Physiological changes
◦ Body weight
 2/3 of older adults in U.S. are overweight or
obese
 Being moderately overweight may not be
harmful
 For adults >65 yrs BMI up to 27 is OK
 Remember normal is 18.5-26
 Insist on measuring height before figuring BMI
 Annually updated height is required in LTC
 Obesity complications
 Risks associated with low body weight
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Physiological changes
◦ Body composition changes: lose bone and
muscle, gain fat
 Sarcopenia – loss of muscle strength/quality
 Predisposes to falls
 Risk factors- smoking, inactivity, weight
loss, obesity
 Optimal nutrition, sufficient protein, and
regular physical activity
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Physiological changes
◦ Immunity and inflammation
 Immune system loses function
 “Inflammaging”
 Associated with Alzheimers, arthritis,
atherosclerosis
 Inflammation – critical in destroying
bacteria/viruses and repairing tissue
 Compromised by nutrient deficiencies, antbx
 Regular physical activity improves immune
system responses
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Physiological changes
◦ GI tract
 Intestinal walls lose strength and elasticity
 Slowing of motility
 Diminished appetite
 Atrophic gastritis- (inflamed stomach) affects
1/3 older adults, bacterial overgrowth in
stomach, low HCl + intrinsic factor, impairs
absorption of B12, biotin, folate, Ca, Zn.
Antacids worsen it.
 Dysphagia
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Physiological changes
◦ Tooth loss
 Difficult and painful chewing
 Limited food selections
 Less dietary variety
 Lower intakes of fiber and vitamins
◦ Sensory losses: vision, hearing, taste, and
smell
◦ Mobility- ability to shop, stand and cook
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Psychological changes
◦ Depression
 Lose appetite and motivation to cook
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Economic changes
◦ Living arrangements and income
◦ Low education level
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Social changes
◦ Hospital and nursing home malnutrition
◦ Community malnutrition- living alone and/or
living in HUD
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Dietary Reference Intakes (DRI)
◦ Two age categories
 51 to 70 years
 71 and older
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Challenges with setting standards
◦ Individual differences are more pronounced with
age
◦ Refusal to change
◦ Different chronic diseases
◦ Different medications
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Water
◦ Decreased sensitivity to thirst and dry
mouth
◦ Dehydration
 Total body water decreases with age
 Risks associated with dehydration
 Urinary tract infections, pneumonia,
pressure ulcers, confusion and
disorientation.
 Prevention- 6 glasses water per day
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Energy needs decrease by ~5% per decade
Protein to protect muscle mass, boost the
immune system, and optimize bone mass
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Carbohydrate for energy
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Fiber and water to reduce constipation
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Energy and energy nutrients
◦ Caloric needs/activity level/metabolic rate
declines with age
 LBM and thyroid hormones decline
◦ Micronutrient needs remain high
 Modified food guide pyramid
◦ Protein
 Especially important
 Low-calorie sources
 Liquid nutritional formulas
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Energy and energy nutrients
◦ Decline 5% per decade
◦ Monthly weights/weight goals- are they
gaining or losing? Set the kcal rate to wt
goals/changes, not an arbitrary kcal/d
◦ Carbohydrate and fiber
 Recommendations
 Constipation
◦ Fat
 Moderate intake
 Disease risk
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Nutrient-dense vs. “quality of life”
Weight gain and malnutrition common
Vitamins and minerals
◦ Vitamin B12 - bacterial overgrowth uses it
up. Supplement more bioavailable than
food
◦ Calcium + Vitamin D- milk avoidance
◦ Folate- eating less fruits/vegetables
◦ Iron- GI bleed, antacid use
◦ Zinc- depletion by meds
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Nutrient supplements
◦ More than half of older adults use
supplements
◦ Supplements do not contain enough of
certain nutrients
 Calcium
 Vitamin C
 Magnesium
◦ Food is still best source of nutrients
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Vision
◦ Cataracts
 Age-related clouding of the eyes’ lenses
 Lead to blindness if not surgically removed
 Risk factors- oxidative stress/UV, obesity
 Antioxidants C, E, carotenoids protective
◦ Macular degeneration- leading cause of
vision loss
◦ Omega-3 DHA, lutein and zeaxanthin
Food sources of lutein and zeaxanthin
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Arthritis
◦ Osteoarthritis
 Deterioration of cartilage in the joints
 Tends to afflict weight-bearing joints
 Known connection with being overweight
 Benefits of aerobic activity and strength training
◦ Gout
 Deposits of uric acid crystals in joints
 Purines in meat, seafood start it. Alcohol makes
it worse
 Milk products lower uric acid level in blood and
risk of gout.
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Arthritis
◦ Rheumatoid arthritis- bone coverings under
attack
 Autoimmune disorder
 Omega-3 fatty acids
 Heart-healthy diet
 Antioxidant vitamins C, E, carotenoids
◦ Treatment
 Dietary and traditional medical intervention
 Popular supplements glucosamine, chondroitin
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Aging Brain
◦ Responds to genetic and environmental
factors
◦ Characteristic changes with age
 Loss of neurons
 Decreased blood supply
◦ Nutrient deficiencies
◦ Ex: serotonin made from tryptophan
 Loss of memory and cognition
 Senile dementia
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The aging brain
◦ Alzheimer’s disease- abnormal deterioration of the
brain
 Prevalence in U.S. 10% adults > 70 yrs
 Symptoms- memory and reasoning loss
 Possible causes- free radicals and beta-amyloid.
 Senile plaques and neurofibrillary tangles
 Acetycholine breakdown may affect memory.
 Cardiovascular disease risk factors
 Treatment drugs are useful, but are not a cure.
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Maintaining body weight is important;
Alzheimer’s patients forget to consume foods.
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Older people are an incredibly diverse group
◦ Quality of life has improved
◦ Chronic disabilities have declined
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Use strategies for growing old healthfully
Spend more money on foods to eat at home
and less money on foods away from home
Influential factors in food choices
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Nutrition Screening Initiative
◦ Identify and treat nutrition problems in older
persons
 Older Americans Nutrition Program, formerly
called Elderly Nutrition Program
 DETERMINE (next slide)
 www.aafp.org/afp/980301ap/edits.html
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Older Americans Act Nutrition Program
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Congregate meals at group settings
Meals on Wheels
Eligibility
Senior Farmers Market Nutrition Program
Supplemental Nutrition Assistance Program
Buy only what you will use.
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Challenges for older adults living alone
◦ Purchasing, storing, and preparing food
◦ Small kitchens and cupboards
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Foodborne illness
◦ Risk is greater for older adults- less HCl,
weaker immune systems
◦ Letting the meals-on-wheels lunch sit around to be
picked at until bedtime
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Spend wisely
◦ Wise shoppers
◦ Be creative
Nutrient-Drug Interactions
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Use of over-the-counter and prescription
drugs
◦ Average 13 prescriptions per year
◦ Vitamin and mineral supplements
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Numerous doctors
Physiological changes that may impact drug
usefulness
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Drug
◦ Any substance that modifies one or more of the
body’s functions
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Consequences
◦ Desirable
◦ Undesirable- Are the side-effects worth it?
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Example of aspirin: 1) thins the blood, doubles
bleeding time, 2) dulls pain- not always ideal
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Interactions can:
◦ Lead to nutrient imbalances
◦ Interfere with drug effectiveness
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Factors that increase risk for adverse
nutrient-drug interactions
◦ Look them up one by one
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Methods of nutrient and medication
interactions
 Drugs
alter food intake
◦ Eating may be difficult or unpleasant
◦ May stimulate appetite and cause
weight gain
◦ May suppress appetite and promote
weight loss
 Drugs
alter nutrient absorption
◦ Most likely occurs with medications
that damage the intestinal mucosa
◦ May bind with nutrients in GI tract,
preventing nutrient absorption
◦ May reduce stomach acidity
◦ May interfere with intestinal
metabolism or transport of nutrients
into mucosal cells
 Diets
alter drug absorption
◦ Most drugs are absorbed in upper small
intestine
◦ Influences on drug absorption
 Stomach acidity and emptying rate
 Direct interactions with dietary
components
 Drug formulation
 Binding with nutrients and nonnutrients
 Compete for absorption sites
Folate
Methotrexate
 Drugs
alter nutrient metabolism
◦ Some drugs may enhance or inhibit
activities of enzymes needed for nutrient
metabolism (folate and methotrexate)
◦ Compete for transport proteins
 Diet
alters drug metabolism
◦ Some foods affect the activities of
enzymes that metabolize drugs
◦ May counteract the drugs’ effects
◦ Some food and drug interactions can
cause toxicity and exacerbate side effects
 Drugs
alter nutrient excretion
◦ Interfere with nutrient reabsorption in
kidneys
 Mineral depletion
 Diets
alter drug excretion
◦ May lead to toxicity
◦ Urine acidity
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Sugar, sorbitol, and lactose
◦ Diabetics and sugar
◦ Sorbitol and diarrhea
◦ Lactose intolerance
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Sodium
◦ Hypertension