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Chapter 18 Nutrition and Older Adults

Introduction

• In “normal” aging, inevitable, & irreversible physical changes occur over time

• The chapter defines aging & provides information about:– Nutrient requirements– Dietary recommendations– Food & nutrition programs designed to

support healthy aging

What Counts as Old?

• There is no one age that defines “old” • 70 – DRI category• 60—the Elderly Nutrition Program• 65—Eligibility for Medicare• 60 - World Health Organization• U.S. Census Bureau uses:

– “young old”– “aged”– “oldest old”

Food Matters: Nutrition Contributes to Long & Healthy Life

• Cumulative effects of lifelong dietary habits determine nutritional status in old age

• CDC suggest that longevity depends on:– 10% access to health care– 19% genetics– 20% environment (pollution, etc.)– 51% lifestyle factors (besides not smoking, a healthy

diet & ample exercise contribute most to longevity)

A Picture of the Aging Population: Vital Statistics

• More Americans are living longer– Currently, ~17.4% are >65 yrs– By 2050, ~19% will be >65 yrs

• Persons ≥85 are the fastest growing population group

Global Population Trends: Life Expectancy and Life Span

• Life expectancy– Average number of yrs of life remaining for

persons in a population cohort or group; most commonly reported as life expectancy from birth

• Life span– Maximum number of yrs someone might live;

human life span is projected to range from 110 to 120 yrs

Global Population Trends: Life Expectancy and Life Span

• Life expectancy at birth in the United States is 78.5 years

• Risk reduction measures include– Immunizations– Treatment of disease– Decreased infant & childhood mortality rates– Clean water and safe food

Healthy People 2020, Objectives for Older Adults

Life Expectancy at Birth and at Age 65

Theories of Aging

• Aging theory tries to explain physical & mental changes that accompany aging

• Theories fall into 2 groups– Programmed aging– Wear & tear theories

• Calorie restriction is an intervention that incorporates aspects to manipulate life span and morbidity longevity

Two Groups of Aging Theories

1) Programmed aging– Hayflick’s theory of limited cell replication– Modular clock theory

2) Wear and tear theories of aging– Free-Radical or Oxidative stress theory– Rate of living theory

Calorie Restriction to Increase Longevity

• Animal studies show that an energy-restricted diet that meets micronutrient needs can prolong healthy life

• Calorie Restriction research ensures nutrient in diets of study subjects

• Nutrient density used to decrease chronic disease risk

Physiological Changes

• Normal aging is associated with shifts in body composition & subsequent loss of physical resilience

Body Composition Changes

• Lean body mass (LBM) – Sum of fat-free tissues, mineral as bone, &

water

• Sarcopenia– Term used for loss of LBM associated with

aging

• LBM decreases 2-3% from age 20 to 70• Older people have lower mineral, muscle,

& water reserves

Muscles: Use It or Lose It

• In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density

• Regular physical activity helps maintain functional status

Weight Gain

• Weight gain accompanies aging, but is not inevitable

• Mean body weight gradually increases with aging, peaking between 50 & 59 yrs– Physical activity moderates weight gain &

increases in body fat– Lack of estrogen promotes fat accumulation

Changing Sensual Awareness:Taste and Smell

• Taste & smell senses decline with age

• Decline in ability to identify smells varies by gender– Women retain their sense of smell better than

men do

• Disease & medications affect taste & smell more than aging

Changing Sensual Awareness:Oral Health—Chew and Swallow

• Oral health depends on:– GI secretions (saliva)– Skeletal systems (teeth & jaw)– Mucus membrane – Muscles (tongue & jaw)– Taste buds– Olfactory nerves (smell & taste)

Changing Sensual Awareness:Appetite and Thirst

• Appetite– Hunger & satiety cues

weaken with age– Older adults may need

to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted

• Thirst– Thirst-regulating

mechanisms decrease with age

– Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective in older men

Three Methods of Identifying Nutrition Risk Factors

• Consider total fat, saturated fat, fruits, vegetables, whole grains & caloric intake

• Compare adequacy of nutrient intake to the RDA or DRI

• Examine a population & determine how environmental factors predict nutritional health—such as the Nutrition Screening Initiative’s DETERMINE checklist

Nutritional Risk Factors

• Risk factors for older adults are:– Hunger, poverty, low food & nutrient intake– Functional disability– Social isolation or living alone– Urban & rural demographic areas– Depression, dementia, dependency– Poor dentition & oral health– Diet-related acute or chronic diseases– Polypharmacy– Minority, advanced age

DETERMINE Checklist

• Developed by the:– American Academy of Family Physicians – Academy of Nutrition and Dietetics– National Council on Aging

• Integrates a list of warning signs of poor nutritional health in older adults

DETERMINE Checklist

Determine Your Nutritional Health Checklist

MNA Nutritional Screening and Assessment

Mini-Nutritional Assessment

• The MNA short form uses six screening items

• More extensive than the NSI & includes:– Dietary intake– Anthropometrics – Blood chemistries

Malnutrition Universal Screening Tool

• The MUST was developed for institutional and community use

• Assessment is a five-step process– Height and weight measurement to calculate BMI– Scoring unplanned weight loss– Assigning an acute disease effect score– Summing scores to determine overall risk of

malnutrition– Using the score to plan management

Dietary Recommendations

• Food-Based Guidance: MyPlate

• Groups like University of Florida & Tufts have developed adaptations for older adults

• Adaptations include:– Addition of fluids/water– Addition of vitamin-mineral supplements– Advice on physical activity

Tufts University’s Modified MyPlate for 70+ Adults

UF and ENAFS Pyramid for Nutrition and Fitness in Aging

Using MyPlate Recommendations to Show Dietary Amount of Food Needed

The “discretionary calories”

• A review of NHANES data

• Snacks provide nearly ¼ of daily energy intake

• Snacks make up– 14% of protein– 12% of alcohol

Nutrient Recommendations

• Nutrient recommendations change as scientists learn more about effects of foods on human functions– Specific DRI for those >51 yrs were 1st

established in 1997

• Estimating Energy Needs• Decrease in physical activity & BMR from

early to late adulthood results in 70-100 fewer calories needed

Nutrient Intakes

Micronutrient Intakes

Carbohydrate and Fiber

• Carbohydrate– AMDR between 45 to 65% of calories– A listing of food that provides at least 50% of

carbohydrates with fiber levels is in Table 18.13

• Fiber– Minimum of 22 to 28 grams of dietary fiber

daily for older females and males– See Table 18.14

Protein

• Inactive, older adults living alone may have low protein intakes

• Several researchers report protein needs for older adults are 1 to 1.3 g/kg body wt (higher than the DRI of 0.8 g)

• Nitrogen balance is easier to achieve when: – Protein is a high quality– Adequate calories are consumed – Individuals participate in resistance training

Considerations for Protein Adequacy of Older Adults

• Based on total energy requirements, how much protein will meet individual’s needs?

• Are enough calories eaten so that protein does not have to be used for energy?

• If marginal amounts of protein are eaten, is the protein of high quality?

• Are there additional needs – wound healing?

• Is the individual exercising?

Fats and Cholesterol

• Minimize saturated fat & keep total fat between 20 to 35% of calories

• Even though eggs are high in cholesterol, they are a nutrient-dense, convenient, & safe food for older adults that do not have lipid disorders

Recommendations for Fluid

• The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated

• ≥6 glasses of fluid/day will prevent dehydration in most older adults

• To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL

Age-associated Changes: Nutrients of Concern

• Vitamin A– Plasma levels & liver stores with age– May be linked to clearance from the blood– Older adults more vulnerable to toxicity &

possible liver damage than deficiency– Beta-carotene will not damage the liver

Age-associated Changes: Nutrients of Concern

• Vitamin D, Calciferol– Factors that put older adults at risk for

deficiency:1. Limited exposure to sunlight

2. Institutionalization or homebound

3. Certain medications (barbiturates, cholestyramine, Dylantin, laxatives)

Low Dietary Intake: Nutrients of Concern

• Vitamin E, Vitamin K– Interaction with each other– Antioxidant properties of vit E– Blood coagulation, bone health – vit K

Age-associated Changes in Metabolism: Nutrients of Concern

• Vitamin B12– Despite adequate intake, ~30% of older adults

have serum B12 levels B12 linked to levels of HCL & pepsin

(from atrophic gastritis) in aged persons resulting in inability to split B12 from protein carriers

– Synthetic or purified B12 is not protein bound and is much better absorbed

Age-associated Changes in Metabolism: Nutrients of Concern

• Folate, Folic acid– Absorption may be impaired– Some medications used can affect folate

metabolism– Folate deficiency can mask B12 deficiency,

which is a more common problem in elderly

Age-associated Changes in Metabolism: Nutrients of Concern

• Iron– Iron needs after menopause– Most older adults consume more iron than

needed– Excess iron contributes to oxidative stress – Reasons that some older adults may have

iron deficiency include • Iron loss from disease or medications acid secretion calorie intake

Age-associated Changes in Metabolism: Nutrients of Concern

• Calcium – Need adequate intake for bone health and to

reduce hypertension– UL has been lowered because of toxic effects

• Magnesium– Need adequate intake for bone health, nerve

activity, glucose utilization– Excessive intake from supplements can

cause overdose

Nutrient Supplements: Why, When, Who, What and How Much?

• When to Consider Supplements, may be useful with those who:– Lack appetite resulting from illness, loss of taste

or smell, or depression– Have diseases in GI tract– Have a poor diet due to food insecurity, loss of

function, or disinterest– Avoid specific food groups– Take medication or other substances that affect

absorption or metabolism

Nutrient Supplements:Who, What and How Much?

• Who Takes Supplements?– Non-Hispanic white females

• What to Take– Vitamin/mineral balance– Safe dose when combined with foods– U.S. Pharmacopeia or NF code– Safety of product

• How Much to Take– Physiological doses

Dietary Supplements

Nutrient Recommendations: Using the Food Label

• In nutrition labeling & dietary guidance, “one size does not fit all”

• Nutrient amounts for older adults are slightly different than those for younger

• Main differences:– Need more calcium & vitamins D & C– Need less iron & zinc

Cross-cultural Considerations in Making Dietary Recommendations

• Cultural differences are reflected in approaches to dietary guidance

• Nutritionists must communicate effectively & avoid misinterpretation in intercultural settings

Food Safety Recommendations

• Older adults are vulnerable to foodborne illness because they have compromised immune systems

• Leading hazardous practices:– Improper holding temperatures– Poor personal hygiene– Contaminated food preparation equipment– Inadequate cooking time

Keep Moving Fitness Chart

Physical Activity Recommendations

• Exercise: the “true fountain of youth”

• Exercise guidelines– Keep Moving—Fitness after 50 screening tool– Strength training activities– Aerobic exercise

Considerations for Educational Materials for Older Adults

• Larger type size

• Serif lettering (such as Times Roman)

• Bold Type

• High contrasts (black on white)

• Non-glossy paper

• Avoid blue, green & violet color

• Reading level of 5th to 8th grade

Community Food and Nutrition Programs

• Nutrition Programs Serving Older Adults—– USDA’s Supplemental Nutrition Assistance

Program (SNAP)– Seniors’ Farmers Market Nutrition Programs– Commodity Supplemental Foods– Child and Adult Care Food Program

Community Food and Nutrition Programs

• Nutrition Programs Serving Older Adults—– Ryan White Comprehensive AIDS Resources

Emergency Act– The U.S. Department of Health and Human

Services (HHS) administers the Older Americans Act programs

• Meals on Wheels-Home delivered meal programs• Nutrition services for tribal & Native Older

Americans’ programs

Model Programs Exemplify Intervention Goals

• Store-to-door—volunteer-led home-delivered grocery program

• Senior Nutrition Program: Promoting Socialization and Improved Nutrition—Title VII of the Older Americans Act of 1965 provided funds for the Senior Nutrition Program

Senior Nutrition Program

• Funds appropriated under Title VII of the Older Americans Act of 1965

• Created to alleviate poor nutritional intake & reduce social isolation among older adults

• Based on evidence that older adults do not eat adequately because of:– Lack of income– Lack of skills– Limited mobility– Feelings of isolation & loneliness

The Promise of Prevention: Health Promotion

• Good nutrition habits make a greater impact when started early in life

• Many people are not motivated to make changes until later in life or when health problems occur

• The belief that a 70 y/o is too old to learn and practice health promotion strategies is an outdated myth