Transcript chap18_elderly - 35-206-202

Nutrition During the Adult
Years
Chapter 18
Learning Outcomes
• Discuss the factors that affect the rate of
aging
• Describe how physical and physiological
changes that occur during adulthood
affect nutrition needs
• Know the current nutrition
recommendations for elderly adults
• Describe community nutrition services for
older persons
2
Learning Outcomes
• Identify nutrition-related health issues of
the adult years and describe the
prevention and treatment of these
health problems
• Lists the potential benefits and risks
associated with the use of
complementary and alternative
medicine practices
3
THE AGING OF AMERICA
Older Population by Age: 1900-2050 - Percent 60+, Percent 65+, and 85+
30%
25%
20%
15%
10%
% 60+
% 65+
% 85+
5%
0%
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
• So the good news is,
Americans live longer
than ever beforewhich is reflected in
this graph. Those
shows the % of the
population made up
by 60 yo, 65 yo, and
85 yo from 1900 and
projected to 2050.
• This graph suggests
that over 60 is “older”
http://www.cdc.gov/aging/
WHAT AGE IS CONSIDERED ELDERLY?
42
62
50
71
89
WHAT AGE IS CONSIDERED ELDERLY?
• No single, chronological timetable of human aging
exists.
• Genetics, lifestyle, and disease processes affect the
rate of aging
• Assessment of nutritional risk depends on a variety
of factors
• Separate nutrition recommendations for 51-70 and 70+
• Assess overall health, quality of life
LEADING CAUSES OF DEATH IN US
(CDC)
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•
•
•
•
•
•
•
•
Heart disease: 616,067
Cancer: 562,875
Stroke (cerebrovascular diseases): 135,952
Chronic lower respiratory diseases: 127,924
Accidents (unintentional injuries): 123,706
Alzheimer's disease: 74,632
Diabetes: 71,382
Influenza and Pneumonia: 52,717
Nephritis, nephrotic syndrome, and nephrosis: 46,448
Septicemia: 34,828
AS WE AGE…
• Around age 25–30 the average maximum
attainable heart rate declines by about one beat
per minute, per year
• Heart’s peak capacity to pump blood drifts down
by 5%–10% per decade.
• This diminished aerobic capacity can produce
fatigue and breathlessness with modest activity.
AS WE AGE…
• Starting in middle age blood vessels begin to stiffen
and blood pressure often creeps up.
• Blood becomes more viscous and harder to pump
through the body, even though the number of
oxygen-carrying red blood cells declines.
• Nutrition recommendations: low sodium diet (15002000 mg/day) with potassium rich foods (DASH),
omega 3’s found in fish help thin blood
AS WE AGE…
• Blood sugar levels rise by about 6 points per
decade, making type 2 diabetes distressingly
common in elderly.
• Nutrition recommendations: avoid excess weight
gain, encourage activity
AS WE AGE…
• In men, testosterone declines by about 1% per year
after the age of 40 leading to a drop in muscle
mass and bone density.
• In women bone loss mainly occurs after menopause
(estrogen loss)
• Nutrition recommendations:
• Calcium requirements increase (from 1000mg to
1200 mg after age 50 in women, 1200 mg after age
70 in men)
• Vitamin D requirements increase (from 15 ug/d to 20
ug/d after age 70)
AS WE AGE…
• Slowing of the digestive tract, decreased
digestive secretions
• Dietary changes, activity changes, and
medications can also play causal role
• Nutrition recommendations:
• Increased fiber needs, 21 g for women and
30 g for men
• Diet that includes nuts, fruits, veg, and whole grains should
provide fiber needs
• Fluid, exercise can also help constipation
WHY ARE THE ELDERLY AT RISK
FOR MALNUTRITION
• Sensory changes
• Sight (fear of cooking, trouble shopping, reading labels,
reading menus)
• Carotenoids (lutein, zeaxanthin, beta caroteine) may prevent
retinal degeneration
• Carotenoids and C and E may prevent macular degeneration
• Vitamin C can prevent cataracts
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• Sensory Changes
• Change in taste, smell
• Nutrition recommendations
• Ensure adequate intake of zinc
• Try and variety of new flavors, experiment with different
types of low sodium seasonings
• Don’t over cook food
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• Structural changes
• Loss of lean mass
• Decreased RMR
• Too many calories for decreased RMR results in increased
fat
• This extra fat contributes to a rise in LDL cholesterol and a
fall in HDL cholesterol
• Nutrition recommendations:
• Protein needs 0.8g/kg depending on disease state
• Activity
• Heart healthy diet low in saturated fat and trans fat and
with nutrient dense foods to prevent weight gain
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• Loss of body water
• 72% of total body water is in lean muscle
• Can lose sense of thirst, forgetting to drink, frequent
urination due to meds
• Recommend 5-8 cups fluid daily
WHY ARE THE ELDERLY AT RISK
FOR MALNUTRITION
• About 30% of older people in N. America have lost
all their teeth
• Nutrition recommendations:
• Focus on nutrient dense foods
• May need soft, moist forms of protein (ground meat,
tofu, beans, eggs, tuna, etc)
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• 20% of nursing home residents and 5-10% of older
people outside of nursing homes suffer from
depression
• Other barriers to healthy eating include financial
barriers, difficulty cooking for one, limited resources
for shopping and preparing food
• Adequate social support and possibly
psychological interventions are important
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• 1/3 of alcohol abuse begins later in life
• Due to more free time, loneliness,
depression, more social events with alcohol
• Older adults have less body water to
distribute alcohol and metabolize alcohol
slower
• Alcohol can deplete B vitamins
• Nutrition recommendations
• Men and women over 65 should limit
alcohol to 1 drink/day (12 oz beer, 1.5 oz
shot, 5 oz wine)
WHY ARE THE ELDERLY AT RISK FOR
MALNUTRITION
• Increased risk of food borne illness due to
• Weaker immune systems
• Decreased stomach acid needed to control bacteria.
PREVENT FOOD BORNE ILLNESS
• Raw, rare or undercooked meats, poultry, and fish
(rare hamburgers and beef or steak tartare, sushi)
• Undercooked and raw shellfish (clams, oysters,
mussels and scallops)
• Unpasteurized dairy products, fruit and vegetable
juice ("raw" milk and cheeses)
• Raw or undercooked eggs (soft-cooked, runny or
poached)
• Washing hands, washing counters where raw meat
was handled, proper thawing, not using expired
products
MEDICATION INTERACTIONS
• ¼ of elderly adults take multiple prescription
medications
• Different medications can affect appetite,
absorption of nutrients
• Some medications cannot be taken with certain
foods and certain foods can interfere with their
action
NUTRITION NEEDS CHANGE
• Iron-too much iron is a pro oxidant, only
supplement if iron deficiency anemia
• DRI for women 51+ decreases to 8 mg
• B12 is common deficiency due to
decreased gastric acid (needed to free B12
from food)
• Deficiency associated with pernicious
anemia, nerve damage, cognitive decline
• DRI is 2 ug/d (no change), however supplements or
fortified foods are better absorbed than B12 in food
NUTRITION NEEDS CHANGE
• Vitamin B6 requirement is increased with
advancing age, although the reasons for
this are uncertain
• Deficiency can lead to irritability,
depression, and confusion; additional
symptoms include inflammation of the
tongue, sores or ulcers of the mouth
• Anti-Parkinson drugs form complexes with
vitamin B6 and thus create a functional
deficiency.
• DRI increases from 1.1 mg to 1.4 mg in men and 1.3
mg in women after age 50
NUTRITION NEEDS CHANGE
• Calcium and vitamin D insufficiency can lead to
increased risk of osteoporosis.
• A decrease in the intestinal absorption of calcium
• The kidneys are less able to retain calcium, leading
to increased urinary calcium loss
• Less frequent exposure to sunlight
• A decrease in the capacity of the skin to synthesize
vitamin D
• A decrease in the capacity of the kidneys to
convert vitamin D into the most active form, 1,25dihydroxyvitamin D
• Calcium requirements increase (1200 mg after age
50 in women, 1200 mg after age 70 in men)
• Vitamin D requirements increase (20 ug/d after age
70)
PROGRAMS
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•
•
•
Congregate dining
Home delivered meals
Food stamps
The Senior Farmers' Market Nutrition Program
(SFMNP) provides low-income seniors with coupons
that can be exchanged for foods at farmers'
markets, roadside stands, and community
supported agriculture programs.
http://www.ssa.gov/pubs/10100.html
RECOMMENDATIONS
“If exercise were a
pill it would be the
most prescribed
medication in the
world”
THE DALLAS BED REST AND TRAINING
STUDY
• In 1966, five healthy 20 yo men spent three
weeks on bed rest
• They developed many physiologic
characteristics of men twice their age
(faster resting heart rates, higher blood
pressures, a drop in the heart’s maximum
pumping capacity, a rise in body fat, and a
fall in muscle strength)
• After an 8-week exercise program the
deterioration had reversed and some
measurements were better than after the
training.
Taken from the Harvard Health newsletter
www.health.harvard.edu/newsweek/exercise_and_aging
THE DALLAS BED REST AND TRAINING
STUDY
• The original subjects all agreed to be
evaluated again at the age of 50.
• Over the years, the men gained an average
of 50 pounds.
• Their average body fat doubled from 14% to
28% of body weight.
• There was a rise in resting heart rate and
blood pressure and a fall in maximum
pumping capacity.
Taken from the Harvard Health newsletter
www.health.harvard.edu/newsweek/exercise_and_aging
THE DALLAS BED REST AND TRAINING
STUDY
• After six months of endurance training, the
men averaged a modest 10-pound loss of
their excess weight, but their cardiovascular
function and blood pressure was the same
as age 20.
Taken from the Harvard Health newsletter
www.health.harvard.edu/newsweek/exercise_and_aging
RECOMMENDATIONS FOR EXERCISE
• Endurance exercise improves cardiovascular
function, lowers blood pressure, protects against wt
gain, improves insulin sensitivity, improve cholesterol.
Recommendation is 30 min+ most days of the week.
• Resistance exercise and flexibility training 20 minutes
two or three times a week
• Exercises for balance will help avoid injuries and
prevent the falls
HOW TO AGE WELL
• Exercise
• Eat properly for heart health and weight
management
• May need supplemental calcium, D, and B12
• Drink plenty of water
• Limit to 1 alcoholic drink a day
• Keep the mind active and stimulated
• Build strong social networks
• Get regular medical care
NUTRITION PRODUCTS TARGETED TO
ELDERLY
• Multivitamins for people over 50
• No iron
• Extra D, B12, and B6
• Added lutein and lycopene
• Vitamins for memory
• Omega-3
• Vitamin B-12 and B-6
• Vitamin D-3
• Meal replacement products
• Protein Drinks
• 300-350 kcal, 10-20 grams protein, low saturated fat
CENTENARIANS
• There are more centenarians per capita in
Okinawa, Japan than anywhere else in the
world.
• Typical diet is filled with tofu, whole grains,
vegetables, and fish.
• They eat very little meat and dairy.
• They only eat to the point where they are
about 80% full.
• They practice martial arts exercises, and
generally have a positive spiritual attitude,
and a low-stress way of living
From Okinawa Centenarian Study
http://www.okicent.org
COMPREHENSIVE ASSESSMENT OF LONGTERM EFFECTS OF REDUCING INTAKE OF
ENERGY
• CALERIE is the first study to investigate prolonged calorie
restriction in healthy humans
• A smaller predecessor study ended in 2006. Forty-eight
subjects were randomly assigned to a control group and a
treatment group; those in the treatment group were put on a
25% calorie reduced over a 6 month period.
• It was found that the treatment group had less insulin
resistance, lower levels of LDL cholesterol, lower body
temperature and blood-insulin levels as well as less oxidative
damage to their DNA.
• The second, larger, phase of CALERIE began in 2007. The
participants are subjected to a 25% calorie restriction over a 2year period.
Das SK et al. American Journal of Clinical Nutrition; 2007