Flashcards in 28 - Nutrition and Aging Deck (53):
Why is nutrition important during aging?
- There is a growing aging population
- In Iowa, 3% of the population is older than 85
Describe the hunger profile
Meaning they don't have access or the ability to purchase good food
- 7% (43,662) Iowans aged 60+ were food insecure in 2012
- 2% (14,536) of Iowans aged 60+ faced hunger in 2012
- 50% of all disease impacting older adults are directly connected to a lack of appropriate nutrient intake
- Even food secure older adults generally lack B-vitamins, calcium, Vitamin D and fiber
Describe body composition changes seen with age
- Chronological age does not correlate with health status
- Both under-nutrition and over-nutrition can be a problem
- Increase in body fat in early adulthood with stable muscle and bone composition
- Middle age brings gradual loss of muscle and bone
- Advanced age is associated with potential for marked loss of fat, muscle mass and bone density
Describe under and over nutrition as problems
- BMI 30
Describe under nutrition
Describe over nutrition
BMI > 30
- Obesity is a growing concern after age 50
- Around 35% of American 65 or older are obese
- Excess body fat may have excess energy store but still have inadequate nutrient intake
- Associated risks: cancer, cardiovascular disease, diabetes mellitus, hypertension, osteoarthritis
What is the role of activity in obesity?
- Muscle loss in the elderly is largely due to inactivity
- Poor nutrition also contributes
- Severe loss of muscle mass is called sarcopenia and interferes with activities of daily living (ADLs)
- Maintenance or improvement of muscle mass comes with resistance exercise, adequate protein intake, micronutrient intake)
What is sarcopenia?
**** TEST QUESTION ****
Severe loss of muscle mass is called sarcopenia and interferes with activities of daily living (ADLs)
- Occurs in up to 30% of people over age 60
- Increased frequency with advancing age
- More common in men than women
Describe the muscle mass loss in men and women with aging
Rate of skeletal muscle mass loss:
- 1-2% annual rate
- 0.4grams/decade in women, 0.8 grams/decade in men
Twice as high in men than in women
Why does sarcopenia develop?
- Decreased hormone production
- Mitochondrial DNA damage
- Poor nutrient intake
- Sedentary lifestyle and immobility due to pain
- Blunted cytokine response to exercise
- Decreased muscle innervation
Describe the body changes with aging
*** Important ***
- Decreased ability to produce Vitamin D
- Decreased filtering and concentrating capacities
- Hardening, reduced compliance
- Lower production of testosterone and estrogen
- Blunted cellular and humoral response
- Low gastric acid***, low intrinsic factor*** and low lactase enzyme; constipation
- Decreased sensitivity of smell and taste perception
- Poor dentition, less saliva, difficulty swallowing
- Decreased thirst sensation; concerns re incontinence limits intake
- Reduced physical activity decreases muscle mass and lowers energy use
- Loss of minerals and proteins
- Accumulation causes hyperlipidemia and hyperglycemia
Describe the decline of the sense of smell with aging
- Sense of smell is most complex of our senses
Important to modulate pleasure of eating
- Relationship to the limbic system
- May be damaged by infection or head injury
Describe the decline of taste perception with aging
- Affected by taste buds on tongue, soft palate and epiglottis
- Taste buds sense 5 basic qualities: salty, sweet, bitter, sour and savory (umami--elicited by nucleosides and glutamate in meats and seafood)
- Also influenced by mechanoreceptors (sense particle size and texture), thermoreceptors (sense temperature of the food) and nociceptors (specific pain receptors in the mouth that respond to capsaicin in hot peppers or similar compounds in other spicy-hot foods)
- “Burning mouth syndrome” may be caused by a zinc deficiency (don't want to eat because it hurts)
Describe dental and oral health in the elderly
Affects ability to eat due to changes in mastication (chewing) and pain
Dentition changes seen with aging:
- Recurrent decay at restorations
- Recessed or inflamed gingival margins, with exposed roots
- Wearing of chewing surface due to mechanical abrasion and chemical erosion
- Loosened teeth due to mineral loss in jaw bone ridges
What do these oral changes result from?
- Poor dental hygiene earlier in life
- Suboptimal nutrient status (calcium, phosphorus, Vitamins D,C, K)
- Few or no functional teeth
Describe food assimilation
Poor chewing, decreased saliva
- less predigestion
- decreased intake
Decreased gastric acid, natural or iatrogenic
- Limited protease activity
- Impaired B12 absorption
- Less anti-bacterial protection
- Avoidance of milk (less calcium and Vitamin D absorption
- Fermentation of residual sugars
Transit time increase
Describe the metabolic changes in the elderly
Impaired metabolism of the main fuel nutrients, carbohydrates and fat
What factors can contribute to hyperglycemia in the elderly?
- Lack of exercise
- Low muscle mas
- Increased visceral adiposity
- Less effective insulin receptors
- Overactive amylin and leptin
What factors can contribute to hyperlipidemia in the elderly?
- Lack of exercise
- Low muscle mass
- Increased visceral adiposity
- Slowed chylomicron clearance
Describe the renal function changes in the elderly
Many nutrients are regulated through the kidney excretion or reabsorption processes, including Na, Cl, K, calcium, phosphate, magnesium, Vitamin D, creatine and taurine
What does normal aging decrease in the kidney?
Normal aging decreases:
- Glomerular filtration rate
- Tubular function
- Ability to concentrate urine
- The ability to excrete salt and urea and to conserve water decreases with age
Describe changes in vitamin D in aging
Vitamin D activation requires glomerular filtration, so with a lower filtration rates, older people produce less active Vitamin D
What are the energy requirements for elderly?
Over time, energy requirements decrease, and may be a function of lean body/muscle mass
- The greater the lean body mass, the greater the energy expenditure
- Physical activity raises the basal metabolic rate
What influences energy requirements?
Energy requirements are also influenced by physical activity
What causes causes decreased lean body mass?
- Hormonal changes
- Inadequate protein
- Decreased cytokines
- Lack of other nutrients
What are some of the causes of decreased physical activity?
- Less independence
What does the food and nutrition board advise in calorie reduction?
Food and Nutrition Board advises a reduction in energy intake for each year above 30
- Men: subtract 10 kcal/day
- Women: subtract 7 kcal/day
What are the protein requirements?
- Recommended Dietary Allowance (RDA) for all healthy adults is 0.8 g high quality protein/kg body weight/day
- Illness such as infections, fractures and other wounds increase protein needs above baseline
- 70 kg man would need 73 grams protein/day
- Sources can be whole grains, legumes, nuts, fish, low fat dairy, soy, eggs, meats
- Caution in renal disease: only 10% of diet should be from protein
What is really important for your elderly patients?
What is the daily fluid requirement?
Adult males: 3.7 liters/day total water
Adult females: 2.7 liters/day total water
What beverages contribute to total water intake?
- All beverages (and moisture in food) contribute to total water intake
What are the signs of dehydration?
- Dehydration signs: sunken eyeballs, dry mucosa, tenting of skin when pinched
- Lab finding: elevated serum sodium, hemoconcentration
What are the contributing factors to dehydration in elderly?
- Decreased thirst sensitivity
- Reduced intake Immobility, confusion)
- Recurrent infections, fever
- Diuretic and laxative medications
- Limiting fluids due to urinary incontinence
- Decreased water recovery by kidneys
What is an often overlooked component of nutrition?
What are the functions of fiber?
- Prevents constipation
- Some types of fiber reduce serum cholesterol (oats, beans)
- Decreases development of diverticular disease
- Some types of fiber reduce cancer risk
What are the recommendations for fiber intake?
- Women: 21gm/day
- Men: 30 gm/day
- Average fiber intake of free-living elderly: 14-18 gm/day
What are the strategies for taking fiber?
- To avoid flatulence or impaction, increase intakes slowly and add fluids
- Increase consumption of whole grains, legumes, fruits, vegetables
- Decrease intake of refined foods
What are the micronutrient requirements?
- Thiamine B1
- Pyridoxine B6
- Cyanocobalamin B12
What is important about cyanocobalamin (B12)?
Even if you are taking B12, if you do not have enough intrinsic factor or if you have something wrong with your ileum (Crohn's or bypass surgery), you can have a B12 deficiency
What foods can you consume that are nutrient-rich?
Focus on nutrient dense food to improve nutrient intakes:
salmon, kale, seaweed, garlic, shellfish, potatoes, liver, sardines, blueberries, egg yolks, dark chocolate, sweet potatoes, grass fed beef
What nutrient requirements increase with age?
***** TEST QUESTION *****
These are the ones you need more of with age
- Vitamin D
- Calcium (women need more earlier, but all need an increase)
- Vitamin B6 (pyroxidine)
What nutrient requirements decrease with age?
***** TEST QUESTION *****
These are the ones you don't need as much of as you age
Describe the mentality of the disease of aging
If I'd known I was going to live so long, I'd have taken better care of myself
What are diseases of aging?
- Cognitive decline
- Atrial fibrillation
- Renal failure
- Cardiovascular disease
- Loss of bone mineral density
- Reflects both prior nutritional adequacy (adolescence and young adulthood)
- At time of menopause or andropause, mineral loss occurs at a rate of 0.5-2%/year
- Lack of calcium, magnesium, copper, phosphate and Vitamins D,K and C accelerates bone loss
What is the prevalence of osteoporosis?
- > 50% of elderly women
- 25% of elderly men
- 54 million Americans affected
- 2 million fractures/year
Describe the cognitive decline seen in aging
- Over time, membranes proteins and mitochondria are damaged by free radicals and reactive sugars. Damage leads to loss of synaptic connections in the brain
- Narrowing or blockage of the arteries may damage brain tissue (micro-infarcts)
- Accumulation of neurofibrillary tangles may occur, reflecting disease specific processes
- Prudent lifestyle delays memory loss and cognitive impairment
What are the dietary and lifestyle approaches to delaying cognitive decline?
- Maintain normal weight
- Regular exercise
- Limit saturated and trans fats to slow atherosclerosis
- Maintain Vitamin E and other anti-oxidants to decrease neuron damage
- B12 deficiency is common due to decrease intrinsic factor production and contributes to dementia
- Thiamine deficiency causes symptoms of dementia (common in alcoholics)
- Mild iron accumulation accelerates the onset of cognitive failure by several years
- Diabetes increases risk of Alzheimer’s disease by 30-90%
Describe COPD in the elderly
- Increased work of breathing leads to increase energy expenditure***
- Recurrent infections come from both the disease and weakened immune systems from protein malnutrition
- Intermittent GI discomfort
What nutrients are important in the care of COPD patients?
**** TEST QUESTION *****
- Energy: may need up to 150% of BMR
- Carbohydrates: avoid high carb diets as this causes more CO2 to be produced, putting stress on the lungs
- Omega 3 fatty acids and antioxidants are important
- Vitamin C important in lung function
- Magnesium-both deficiency and excess affect lung function
**** INCREASES ENERGY EXPENDITURE WITH COPD ******
***** THESE PATIENTS WILL NEED INCREASED PROTEIN AND CALORIE INTAKE*****
Describe stroke in the elderly
- Also called a cerebrovascular accident
- Chewing and swallowing difficulties (dysphagia)
- Dominant side paralysis makes self-feeding difficult
- Visual field changes may interfere with ability to see what is left on the plate
- If stroke was a result of an embolus from atrial fibrillation, the use of warfarin complicates intakes of Vitamin K
- Immobility post-stroke may increase risk of decubitus ulcers