Transcript Aging and Older Adults (cont`d)

Nutrition for Older Adults
Chapter 13
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true of false?
Approximately 60% of adults older than 65
years of age have one chronic health problem.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False.
Rationale: Approximately 80% of adults older
than 65 years of age have one chronic health
problem.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Screening Criteria for Malnutrition in
Older Adults
• Disease
– Do you have an illness that makes you change the
kind and/or amount of food you eat?
• Eating poorly
– 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?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Screening Criteria for Malnutrition in
Older Adults (cont’d)
• Economic hardship
– Do you sometimes not have enough money to spend
on the food you need?
• Reduced social contact
– Do you eat alone most of the time?
• Multiple medications
– Do you take 3 or more prescribed or over-the-counter
dugs a day?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Screening Criteria for Malnutrition in
Older Adults (cont’d)
• Involuntary weight loss/gain
– Have you gained or lost 10 pounds in the last 6
months without trying?
• Needs assistance in self-care
– Are you sometimes not physically able to shop, cook,
and/or feed yourself?
• Elder years above age 80
– Are you older than age 80?
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
Nutrition-related concerns of older adults include
cataracts and macular degeneration.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True.
Rationale: Nutrition-related concerns of older
adults are cataracts and macular degeneration
and functional limitations such as arthritis,
osteoporosis, and sarcopenia.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition-Related Concerns in
Older Adults (cont’d)
• Functional limitations (cont’d)
– Osteoporosis
o Bone remodeling
o After menopause, women experience rapid
bone loss related to estrogen deficiency
o Estimated direct-care costs of osteoporotic
fractures are $12 to $18 billion annually
o Process actually begins early in life
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
o DHA, an omega-3 fatty acid, may offer some
protection against AD
– AD can have a devastating impact on an
individual’s nutritional status
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition-Related Concerns in
Older Adults (cont’d)
• Obesity
– Major public health problem
– Appropriateness of treating obesity in older
adults is controversial
o 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition-Related Concerns in
Older Adults (cont’d)
• Social isolation
– Eating alone is a risk factor for poor
nutritional status among older adults
o Congregate meals
o Meals on Wheels
o Modified diets, such as diabetic diets and
low-sodium diets, are provided as needed
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Long-Term Care (cont’d)
• The downhill spiral (cont’d)
– Intake assessment system is flawed:
o Food intake records may be neglected
o Lack of skill in accurately judging the
percentage of food consumed
o A practical approach to convert individual
item estimates into meaningful estimates
not assessed
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• What is a risk among long-term–care residents?
a. Dependence
b. Dysphagia
c. Overhydration
d. Increased appetite
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Long-Term Care (cont’d)
• The use of diets
– Use of restrictive diets as part of medical care in longterm–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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins