Transcript Slide 1
Chapter 17
“Old” / ”senior” > 65 yrs old
Two motivating goals
◦ Promote health
◦ Slow aging
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
Factors influencing life expectancy
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
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
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
Physical activity
◦ Benefits of physical activity in older adults
◦ Additional benefits
◦ Best types of exercise
Aerobic activities
Moderate endurance activities
Strength training
Resistance training
◦ Most powerful predictor of mobility in later years
◦ Physical limitations from inactivity not increasing
age
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.)
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
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
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)
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
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
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
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
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
Psychological changes
◦ Depression
Lose appetite and motivation to cook
Economic changes
◦ Living arrangements and income
◦ Low education level
Social changes
◦ Hospital and nursing home malnutrition
◦ Community malnutrition- living alone and/or
living in HUD
Dietary Reference Intakes (DRI)
◦ Two age categories
51 to 70 years
71 and older
Challenges with setting standards
◦ Individual differences are more pronounced with
age
◦ Refusal to change
◦ Different chronic diseases
◦ Different medications
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
Energy needs decrease by ~5% per decade
Protein to protect muscle mass, boost the
immune system, and optimize bone mass
Carbohydrate for energy
Fiber and water to reduce constipation
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
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
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
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
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
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.
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
The
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
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.
Maintaining body weight is important;
Alzheimer’s patients forget to consume foods.
Older people are an incredibly diverse group
◦ Quality of life has improved
◦ Chronic disabilities have declined
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
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
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.
Challenges for older adults living alone
◦ Purchasing, storing, and preparing food
◦ Small kitchens and cupboards
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
Spend wisely
◦ Wise shoppers
◦ Be creative
Nutrient-Drug Interactions
Use of over-the-counter and prescription
drugs
◦ Average 13 prescriptions per year
◦ Vitamin and mineral supplements
Numerous doctors
Physiological changes that may impact drug
usefulness
Drug
◦ Any substance that modifies one or more of the
body’s functions
Consequences
◦ Desirable
◦ Undesirable- Are the side-effects worth it?
Example of aspirin: 1) thins the blood, doubles
bleeding time, 2) dulls pain- not always ideal
Interactions can:
◦ Lead to nutrient imbalances
◦ Interfere with drug effectiveness
Factors that increase risk for adverse
nutrient-drug interactions
◦ Look them up one by one
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
Sugar, sorbitol, and lactose
◦ Diabetics and sugar
◦ Sorbitol and diarrhea
◦ Lactose intolerance
Sodium
◦ Hypertension