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Physical growth in size levels off but continues in the constant cell growth and reproduction necessary to maintain human bodies.

Food and nutrition continue to provide essential support during the adult aging process

Life expectancy is lengthening, so health promotion and disease prevention are even more important as quality of life is ensured throughout the extended years.

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Key Concepts Gradual aging throughout the adult years

is an individual process based on genetic heritage and life experience

Aging is a total life process, with biological, nutritional, social, economical, psychological, and spiritual aspects

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Describe nutrition in adulthood

Describe nutritional needs in the aging process

Identify clinical needs of the older adult

Identify community resources for olderAmericans

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Population and age distribution – by 2050 according to the US Census Bureau the US population will have grown to 439 million people

The older segment of the population will grow significantlyBy 2050 people over 65 will more than

double

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The report from the USDHHS Healthy People 2020 presents national goals for helping all people make informed decisions about their health.

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Life expectancy and quality of life – increased from 47 yrs old in 1900 to 79.5 yrs in 2020. By 2020, life expectancy will be 79.5 years77 years old for men82 years old for women

Impact on health care: Career opportunities in disease prevention

and health promotion are at an all time high

Community and private classes on health lifestyle and nutrition target the prime concerns for this growing adult population

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Graph of elderly population

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4 basic areas of adult life shape its general growth and development:PhysicalPsychosocialSocioeconomicNutritional

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1. Physical growth Overall physical growth of the human body

levels off in the early adult yearsPhysical growth is no longer a process of

increasing numbers of cells and body size but is the vital growth of new cells to replace old ones

Once physical maturity is established, energy requirements decline

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2. Psychosocial development Three stages of development:

Young adults (20 to 44 years) – Increasingly independent. Form new relationships, adopt new roles, make choices concerning education, career, jobs, marriage and family.

- Stress related problems sometimes developFirm establishment of lifestyle behaviors occur during

this periodE.g. regular exercise, choosing balanced mealsImportant for maintaining quality of life long-term

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Middle adults (45 to 64 years) – Expand personal growth – “Its my turn now”; coming to terms with what life has offered, a “refocusing of ideas”, life directions, and activities.Early evidence of chronic disease appears

in some middle adultsFocus: wellness, health promotion, and

reduction of disease risks are becoming the focus of health care

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Older adults (65 years and older) – sense of wholeness and completeness vs increasing withdrawal from life.

New classification: Young old = 65-74Elderly = 75-84Old old = 85+

If the outcome of their life experiences has been positive, Rich with wisdom, enjoy life and health. Some arrive at these years poorly equipped to

deal with the adjustments of aging and the health problems that may arise

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Socioeconomic status – In today’s economic and social shifts and pressures, these pressures directly influence food security and health. Some elderly need help with food assistance.

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Social and financial pressures along with decreasing sense of acceptance and productivity may lead elderly persons to feel unwanted and unworthy – depression is clinical syndrome and not part of normal aging

Basic needs common to older persons are: economic security, personal effectiveness, suitable housing, constructive and enjoyable activities, satisfying social relationships, and spiritual freedom.

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Nutritional needs – vary according to living and working situation

Older Adult populations still under study for their nutrient requirements. Most recent DRIs distinguish the nutrient needs of the 50 – 70 years olds from those 71+ years

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General Physiologic Changes:Biologic Changes: Human growth and then

decline extends over entire life spanMiddle and older adults: Gradual loss of

functioning cells with reduced cell metabolism; starts at about 30 -> body organ systems gradually lose some capacity to do their jobs and maintain their reservesThe rate of this decline accelerates in

later life

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About 25% Americans sedentary

60 minutes moderate exercise recommended/day - NIM

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Biologic Changes cont.Hormonal changes in aging process:

Decline in insulin productionDecrease melatonin (hormone to regulate

body rhythms)Decrease growth hormoneDecrease sex hormones- estrogen and

testosterone

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Menopause = the end of a woman’s menstrual activity and capacity to bear children

Involves a decrease -> cessation of estrogen or progesterone production Increase fat, increase risk of chronic disease such as heart disease and osteoporosis.

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Effect on food patterns – secretion of digestive juices and motility of gastrointestinal muscles gradually diminish decreased absorption and use of nutrients

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Other conditions commonly affecting the elderly and their food intake:Decreased hand functionDecreased eye-hand

coordinationConcern over body

functionsDecreased taste, smell,

and visionDecreased ability to cook

and prepare food

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Other conditions commonly affecting the elderly and their food intake:More social stress, personal losses and fewer

social opportunities to maintain self esteem

Lack of sufficient nourishment is primary nutritional problem of older adults

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Individuality of the aging process (senescence) - older persons get old at different rates and in different ways depending on genetic inheritance and health and nutritional resources over past years

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Kilocalories: EnergyBecause of the gradual loss of functioning body

cells and reduced physical activity, adults generally require less energy intake as they grow older

Kilocalories: energy – Basal Metabolic Rate decreases 1- 2 % each decade. More rapid decline at 40 for men and 50 for women

Basic fuel necessary to supply these energy needs:Primarily CHOModerate fat

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Carbohydrate = 45 % to 65 % of the total diet kcalsthe majority should be complex CHO

[e.g. whole grains]Note: there is a tendency for

decreased glucose tolerance with aging. Balanced meals can help avoid excessively high blood glucose concentrations and help delay or avoid the onset of Diabetes

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Fat = 30 % of total kcals; provides back-up energy source, fat-soluble vitamins, and essential fatty acidsFat digestion and absorption may be delayed

in the elderlyAvoid large quantitiesEmphasize the quality of the fat usedMay help food taste better -> improved

appetite and may provide needed kcals for those who have wt. loss

Protein = 10 – 35 % of the total kcalsIncreased need for protein during

illness, ,convalescence, or wasting disease

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Vitamins and Minerals Some essential nutrients may need special attention in

relation to possible health problems with aging:Osteoporosis - Vitamin D and Calcium

Bone mineral density is low and bones are brittle and easily broken. Risk increases with age

10 x more common in women than menContributing factors: less use of calcium-rich foods;

loss of appetite and lack of adequate body fat; less outdoor physical exercise; decreased capacity of the skin to produce Vitamin D with exposure to sunlight; decreased estrogen

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Anemia – the poor diet of many older adults lacks sufficient iron to prevent iron-deficiency anemia Give list of high iron foods and high Vit C-rich

foods (Vit C helps with absorption)

Nutrient supplementation – 44 % of women and 35 % of men take vitamin supplements regularlyUse of supplements on a

Often recommended for persons in debilitated states or malabsorption

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Health Promotion and Disease PreventionThe emphasis of adult health care: Reduction of

Risk for chronic diseaseNutritional Status: Many problems of older adults

come from general aging and states of malnutrition – i.e. undernourishment. May be due to:Poor food habits/lack of appetite/ lonelinessOral problemsEconomic hardshipGI problemsMultiple medicinesNeeds assistance in self care

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Dehydration:Decreased thirst sensation + decreased

kidney function overall decrease in body water status

Weight management – Excessive Wt loss or gain can be signs of malnutrition Obesity among adults has been on the rise

in all subgroups of the elderly population.Physical Activity – a major contributor to

weight managementCan prevent many debilitating conditions

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Individual Approach - In all cases, personal and realistic planning with every person is essential – e.g. a malnourished older person needs much personal, sensitive support to build improved eating habits.

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Maintain ability to live independently and decreases risk of falling or fracturing bones

Reduce blood pressureHelp people with chronic, disabling conditions

improve stamina and muscle strengthReduces symptoms of anxiety and depressionMaintain healthy bones, muscles, and jointsHelps control joint swelling an pain associated

with arthritis

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Chronic diseases of aging – E.g. Heart disease, renal disease,

arthritis, HTN, CVA, diabetes, cancer, asthma, emphysema

Health experts believe that chronic disease is not an inevitable consequence of aging and estimate that the majority of these cases could have been prevented by lifestyle modification.

Diet Modifications and nutritional support are an important part of therapy for chronic disease

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Medications: Multiple medication use (polypharmacy) can affect overall nutritional status because: many drug-nutrient interactions can occur Can affect appetite, absorption, and use of

nutrients malnutrition Check use of dietary supplements and

herbs since these may interact with medications

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Medications that may affect nutritional status: Blood Pressure meds Antacids Anticoagulants Laxatives Diuretics Decongestants

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Government Programs for Older Americans Adults living below the national poverty level had

a higher incidence of multiple chronic diseases than any other socioeconomic group

Health care providers must be aware of community resources and refer when appropriate

Older Americans Act Nutrition Services Incentive Programs provide

cash and/or commodities to supplement meals. Services include congregate and home-delivered

meals Nutrition Education

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US Dept. of Agriculture provides both research and services for older adults – including the Food Stamp Program

Public Health Service: Skilled health professionals work in the

community through local and state public health depts.

Public health nutritionists provide nutrition counseling, education, and help food assistance programs

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Professional Organizations and Resources The American Geriatric Society The American Gerontological Society Local medical societies and nursing

organizations Volunteer Organizations

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Alternative Living Arrangements offer options for seniors for living and meal provision: Congregate Care: focuses on keeping the elderly in

their own homes for as long as possible with outside assistance including home-delivered meals

Continuing Care Retirement Communities: provide a continuum of residential long-term care from independent living to nursing facilities with dietary assistance available

Assisted Living Facilities: provide meals and snacks Nursing Home: provide the most medical, nursing

and nutritional support

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