Transcript Nutritional requirements for older adults & eating habits affecting

NUTRITIONAL REQUIREMENTS
FOR OLDER ADULTS AND EATING
HABITS AFFECTING ORAL
HEALTH
CHAPTER 15
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Older Adults: General Health Status
 Obesity is most
common nutritional
disorder
 Malnutrition risk in
those with:
 Less education and
 Contributes to common
chronic diseases:
diabetes, cardiovascular
disease
 Exacerbates age-related
decline in physical
function; leads to frailty




income
Housebound, especially
those living alone
Physical disabilities
Depression and other
mental health issues
Drastic changes, such
as death of spouse
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Physiological Factors
Affect Nutritional Status
 Oral cavity
 Oral health issues including chewing,
swallowing, and mouth pain are indicators
of risk for malnutrition
 Changes in taste and smell may increase
cariogenic food choices
 Xerostomia may lead to avoidance of
crunchy, dry, and sticky foods

May choose hard candies to stimulate saliva,
increasing caries risk
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
From Thibodeau GA, Patton KT:
Anatomy & Physiology, ed 6. St.
Louis: Mosby, 2007.
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Older Adults: Physiological Factors
Affect Nutritional Status
 Oral cavity
 Periodontal disease increases likelihood of weight loss
 Quality nutrient intake decreases as number of teeth
decreases


Studies have found that people with fewer than 28 teeth had
significantly lower intakes of fruits and vegetable and lower
serum levels for beta-carotene, folate, and vitamin C
Japanese study found total protein,
animal protein, sodium, vitamins D, B1, B6,
niacin, and pantothenic acid were
associated with number of teeth
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
From Perry DA, Beemsterboer PL:
Periodontology for the Dental Hygienist,
ed 4. St. Louis: Saunders, 2014.
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Older Adults: Physiological Factors
Affect Nutritional Status
 Gastrointestinal tract
 Changes in esophageal motility and
deterioration of nerve function may
cause dysphagia

Those with dysphagia eat slowly and may
not be able to consume adequate amounts
From Thibodeau GA, Patton KT:
Anatomy & Physiology, ed 8. St.
Louis: Mosby, 2013.
 Diminished hydrochloric acid secretion may affect
absorption of calcium, iron, and vitamin B12
 Constipation may result from altered GI motility and
benefits from fiber-containing foods, adequate fluid
intake, and physical activity
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Physiological Factors
Affect Nutritional Status
 Hydration status
 Decreased thirst associated with aging may
predispose to dehydration
 Certain chronic illnesses (heart and kidney disease)
lead to impairment of homeostatic mechanisms
controlling fluid balance
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Physiological Factors
Affect Nutritional Status
 Musculoskeletal system
 Bone resorption progresses rapidly in the older patient
 After age 45, lean body mass declines up to 0.4%
every year and adipose tissue increases



Inactivity responsible for loss of muscle strength and balance
and may predispose to falls
Sarcopenia is the reduction of skeletal muscle mass and
replacement by fat that occurs in older adults
Maintaining muscle is essential in reducing the risk of falls
 Decline in lean body mass results in decreased basal
metabolic rate
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Socioeconomic and
Psychological Factors
 Socioeconomic factors
 Inflation, failing health, medical bills, and cost of
medications can have a devastating effect on fixed
incomes
 Title III Nutrition Programs for Elderly (congregate
dining and Meals on Wheels) are available
 Psychological factors predispose to decreased
appetite and interest in food
 Apathy
 Depression
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Nutrient
Requirements—Fluids
 Requirements for most micronutrients increased
due to effects of aging on absorption, utilization,
and excretion
 Fluids = minimum 8 glasses of water/day
 Some older adults may restrict fluids because of:
 Nocturia (excessive urination at night)
 Incontinence (inability to control urinary excretion)
 Pain associated with movement due to arthritis
 Having to request assistance to be toileted
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Nutrient
Requirements—Vitamins
 Vitamin D intake is higher for older
adults
 Ages 51 to 70: 10 µg daily
 Ages 71+: 15 µg daily
 30% of persons ages 60 years and older in lower
latitudes have vitamin D insufficiency in the winter
 10% to 30% have  absorption of vitamin B12
 Requirements for folic acid, vitamins B6, and B12
increased to prevent decline in cognitive function
and reduce risk for coronary artery disease
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Nutrient
Requirements—Minerals
 Calcium
 AI = 1200 mg higher than for younger
adults to maintain bone mass and
reduce risk of osteoporosis
 Decreased physical activity contributes
to loss of bone density
 Sodium
 Intake may need to be adjusted based
on physiological condition (e.g.,
hypertension, congestive heart failure)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Eating Patterns
 Many older adults have a poor diet
 Deficiencies
 1 in 4 older adults consumes less than
recommended servings of meat
 Dairy products, fruits, and vegetables
frequently lacking in the diet,
especially for those living alone

Routine consumption of milk is difficult because of its expense
and frequent trips to purchase it
 Choice of soft foods usually results in a decrease
in protein and intake of more simple
carbohydrates
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Eating Patterns
 Snacking and nutritional supplements
 Snacking may ensure older adults consume adequate
amounts of kilocalories and protein
 Healthy snacks such as cheese, hardboiled eggs, lowfat milk products, bananas, and canned fruit can be
recommended
 Milk-based food supplements, such as an instant
breakfast mix, are economical and can help prevent
nutrient deficiencies
 Commercial liquid nutrition supplements, such as
Ensure or Sustacal, may be more convenient
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Older Adults: Eating Patterns
 Food safety
 More susceptible to food-borne illness because of:
 Compromised immune system
 Decreased hydrochloric acid in the stomach
 Lessened senses of smell and taste
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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MyPyramid for Older Adults
 Emphasizes nutrient-dense
foods
 Includes packaged, frozen, or
canned fruits, in addition to
fresh vegetables that may be
more readily available and
have a longer shelf life
 Stresses the importance of
consuming fluids
 Foundation: activities
characteristic of older adults
Copyright 2007 Tufts University. Reprinted with permission
from Lichtenstein AH et al: Modified MyPyramid for Older
Adults. J Nutr 2008; 138:78-82.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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MyPyramid for Older Adults
 Vitamins/mineral supplements
 Flag at the top of MyPyramid for Older Adults reminder
about increased need for calcium, vitamins D and B12
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Calcium—1200 mg
Vitamin D—600 IU for adults ages 51 to 70 and 600 IU for
those older than 70 years
Vitamin B12—2.4 µg
 Dietary Guidelines for Americans recommends
eating fish twice a week for omega-3 fatty acids
 NIH panel advises seniors with early-stage
macular degeneration to take antioxidants
(vitamins C, E, and beta-carotene and zinc)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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HEALTH APPLICATION
Genomics
 Consider nutrigenomics in relation to determining
genetic susceptibility to diet-related chronic
diseases
 Discuss how this research may change the
future of healthcare
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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