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Flashcards in 28 - Nutrition and Aging Deck (53):
1

Why is nutrition important during aging?

- There is a growing aging population
- In Iowa, 3% of the population is older than 85

2

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

3

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

4

Describe under and over nutrition as problems

Under nutrition
- BMI 30

5

Describe under nutrition

BMI

6

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

7

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)

8

What is sarcopenia?

**** TEST QUESTION ****

Severe loss of muscle mass is called sarcopenia and interferes with activities of daily living (ADLs)

**********

9

Describe sarcopenia

******

- Occurs in up to 30% of people over age 60
- Increased frequency with advancing age
- More common in men than women

10

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

11

Why does sarcopenia develop?

Why?
- Decreased hormone production
- Mitochondrial DNA damage
- Poor nutrient intake
- Sedentary lifestyle and immobility due to pain
- Blunted cytokine response to exercise
- Decreased muscle innervation

12

Describe the body changes with aging

*** Important ***

Skin
- Decreased ability to produce Vitamin D

Renal function
- Decreased filtering and concentrating capacities

Arteries
- Hardening, reduced compliance

Hormones
- Lower production of testosterone and estrogen

Immune function
- Blunted cellular and humoral response

GI function
- Low gastric acid***, low intrinsic factor*** and low lactase enzyme; constipation

Gustatory senses
- Decreased sensitivity of smell and taste perception

Mouth
- Poor dentition, less saliva, difficulty swallowing

Hydration
- Decreased thirst sensation; concerns re incontinence limits intake

Muscles
- Reduced physical activity decreases muscle mass and lowers energy use

Bones
- Loss of minerals and proteins

Adipose tissues
- Accumulation causes hyperlipidemia and hyperglycemia

13

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

14

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)

15

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

16

What do these oral changes result from?

Results from
- Poor dental hygiene earlier in life
- Suboptimal nutrient status (calcium, phosphorus, Vitamins D,C, K)

Consequences
- Few or no functional teeth

17

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

Lactase deficiency
- Avoidance of milk (less calcium and Vitamin D absorption

Bacterial overgrowth
- Fermentation of residual sugars
- Flatulence

Transit time increase
- Constipation

18

Describe the metabolic changes in the elderly

Impaired metabolism of the main fuel nutrients, carbohydrates and fat

19

What factors can contribute to hyperglycemia in the elderly?

- Overeating
- Lack of exercise
- Low muscle mas
- Increased visceral adiposity
- Less effective insulin receptors
- Overactive amylin and leptin

20

What factors can contribute to hyperlipidemia in the elderly?

- Overeating
- Lack of exercise
- Low muscle mass
- Increased visceral adiposity
- Slowed chylomicron clearance

21

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

22

What does normal aging decrease in the kidney?

Normal aging decreases:
- Glomerular filtration rate
- Tubular function
- Ability to concentrate urine

Also,
- The ability to excrete salt and urea and to conserve water decreases with age

23

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

24

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

25

What influences energy requirements?

Energy requirements are also influenced by physical activity

26

What causes causes decreased lean body mass?

- Hormonal changes
- Inadequate protein
- Disease
- Decreased cytokines
- Lack of other nutrients

27

What are some of the causes of decreased physical activity?

- Arthritis
- Immobility
- Retirement
- Less independence
- Depression

28

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

29

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

30

What is really important for your elderly patients?

Hydration

31

What is the daily fluid requirement?

Adult males: 3.7 liters/day total water

Adult females: 2.7 liters/day total water

32

What beverages contribute to total water intake?

- All beverages (and moisture in food) contribute to total water intake


33

What are the signs of dehydration?

- Dehydration signs: sunken eyeballs, dry mucosa, tenting of skin when pinched
- Lab finding: elevated serum sodium, hemoconcentration

34

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

35

What is an often overlooked component of nutrition?

Fiber

36

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

37

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

38

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

39

What are the micronutrient requirements?

B vitamins
- Thiamine B1
- Pyridoxine B6
- Cyanocobalamin B12
- Folate

Vitamin C
Vitamin D
Vitamin E
Calcium
Magnesium

40

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

41

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

42

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)

***

43

What nutrient requirements decrease with age?

***** TEST QUESTION *****

These are the ones you don't need as much of as you age
- Iron
- Chromium

44

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

45

What are diseases of aging?

- Osteoporosis
- Cognitive decline
- Stroke
- Atrial fibrillation
- Osteoarthritis
- COPD
- Renal failure
- Cardiovascular disease
- Diabetes

46

Describe osteoporosis

- 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

47

What is the prevalence of osteoporosis?

- > 50% of elderly women
- 25% of elderly men
- 54 million Americans affected
- 2 million fractures/year

48

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

49

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%

50

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

51

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*****

52

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

53

What to know for exam....

- Sarcopenia numbers
- Iron less needed
- The mouth oral cavity
- COPD energy