Nutrition in Older People

Question 1

Facts about the ageing population

Answer 1

The increase in lifespan and the percentage of the ageing population is a worldwide success story and health conundrum.
With an ageing population, frailty and dementia have become public health problems.
The improvement of health and well-being will improve the quality of life in later years.

Question 2

Older people’s contributions

Answer 2

Community projects
Childcare and education
Care of the sick and other older people
Income generation
Cultural and religious heritage
Housework
Community Knowledge
Experience
Setting an example
Conflict resolution
Counselling

Question 3

Explain the Programmed longevity theory

Answer 3

It is the idea that aging is caused by certain genes switching on and off over time.

Question 4

Explain the Endocrine theory

Answer 4

it is the idea that regular changes in circulating hormones control aging.

Question 5

Explain Immunological theory

Answer 5

States that the immune system is programmed to decline over time, leaving people more susceptible to diseases.

Question 6

Explain the Error Theories of Ageing

Answer 6

Wear and tear theory.- asserts that cells and tissues simply wear out.
Rate of living theory.- is the idea that the faster an organism uses oxygen, the shorter it lives.
Cross-linking theory.- states that cross-linked proteins.- accumulate and slow down the body’s processes.
Free radicals theory.- asserts that free radicals in the environment cause damage to cells, which eventually impairs their function.
Somatic DNA damage theory.- is the idea that genetic mutations cause cells to malfunction.

Question 7

What are Longevity Genes?

Answer 7

Are specific genes that help a person to live longer

Question 8

What is Cell senescence?

Answer 8

It is the process by which cells deteriorate over time

Question 9

What are Telomeres?

Answer 9

Are structures on the end of DNA that eventually are depleted, resulting in cells ceasing to replicate.

Question 10

What are Stem cells?

Answer 10

Are cells that can become any type of cell in the body and hold promise to repair damage caused by ageing.

Question 11

Explain body composition in elderly

Answer 11

Fat mass increases to about 75 years, then decreases.
Fat may be re-distributed centrally with age.

Question 12

What are the consequences of poor B12 absorption in older people?

Answer 12

Atrophic gastritis
Hypochlorhydria
Bacterial overgrowth

Question 13

Why are older people deficient in Vitamin B12?

Answer 13

Active absorption from food is severely affected.
Passive absorption from supplements constant (1%)

Question 14

What is sarcopenia?

Answer 14

The decrease in fat-free mass, mainly skeletal muscle, but also bone and water. Between 2-5% per decade.

Question 15

Factors influencing sarcopenia

Answer 15

• GH secretion
• CNS Input (loss of motor neurons)
  + Pro-inflammatory cytokines
  + Fat mass
• Muscle mass
• Muscle quality
• Oestrogen/Androgen
  + Inactivity
• Metabolic reserve (disability, morbidity, mortality)

Question 16

What are the protein requirements for older people?

Answer 16

The WHO sets 0.8g/kg body weight. 50g for woman and 63g for men (average)
Combined with resistance training
It needs to be adjusted 1.0 to 1.30g/kg body weight (as much as 35% of calories)

Question 17

At what age does bone mineral density reduction start?

Answer 17

At 30 years, rates of 0.7-1%/year up to 50 years.
Women post menopause 2-5%/year.
By 65 years, there is an average loss of 20%

Question 18

Nutritional requirements for older people

Answer 18

Energy needs decrease with age (2-3%) reduction of the basal metabolic rate due to the reductions of lean tissue, and activity

Question 19

Which vitamin intake needs to decrease?

Answer 19

Thiamine, riboflavin and niacin (decreased kcal intake)
Iron in women (after 50 years/menopause)

Question 20

Which supplement is beneficial for older people?

Answer 20

Vitamin D

Question 21

Anorexia in elderly people

Answer 21

Abnormal hunger and satiety control mechanisms
- Taste and smell
- Energy expenditure
- Exercise
Social problems
Diseases, drugs, depression

Question 22

What are some factors that affect food choice?

Answer 22

Isolation
Dentition
Depression
Disability
Chronic illness
Reduced taste perception
Institutionalisation
Transport, access, mobility and income

Question 23

Chronic diseases in older people

Answer 23

Osteoporosis (calcium in bones is reduced, diet containing excessive amounts of phosphorus)
Cancer (a third of cancers are diet-related)
Diabetes (the body does not produce sufficient amounts of insulin for CHO metabolism)
Hypertension (high blood pressure)
Cardiovascular disease (arteries become blocked)
Atherosclerosis (cholesterol accumulates in the walls of the artery)

Question 24

Factors of cognitive decline

Answer 24

Loss Memory
Mood changes
Communication problems

Question 25

Why is dementia caused?

Answer 25

By progressive cognitive decline in older adults over 65 years

Question 26

What is the prevalence of Alzheimer’s disease?

Answer 26

2019 55 M
2030 78 M
2050 139 M

Question 27

Mention the 2 types of Dementia

Answer 27

Alzheimer’s disease: The most common type of dementia, changes in the chemistry and structure of the brain, causing the death of brain cells
Vascular dementia: caused by problems with the supply of oxygen to the brain following a stroke or small vessel disease

Question 28

What diet is recommended to reduce the risk of dementia?

Answer 28

Mediterranean diet (anti-inflammatory & anti-oxidative mechanisms have a neuroprotective effect)
DASH diet (Vegetables, fruits and whole grains)

Question 29

Which foods have anti-inflammatory and neuroprotective properties?

Answer 29

Food rich in antioxidants, polyphenols and omega-3 fatty acids

Question 30

What is the MIND diet?

Answer 30

Mediterranean + DASH diet
Break down 15 food components into “brain-healthy food groups” and “unhealthy foods”

Question 31

What are the brain-healthy food groups?

Answer 31

Green leafy vegetables
Other vegetables
Nuts
Berries
Beans
Whole grains
Fish
Poultry
Olive oil
Wine (in moderation)

Question 32

What are the unhealthy food groups?

Answer 32

Red meat
Butter & margarine
Cheese
Pastries & sweets
Fried food

Question 33

Facts about AD as a metabolic Disease

Answer 33

The Role of mitochondrial dysfunction on AD pathogenesis
Significant metabolic disruption at the early stages of AD (pre-symptomatic phase)
Brain functions require a significant supply of energy in the form of glucose

Question 34

Energy Requirements for the Brain

Answer 34

20-25% of total body energy, making up 2-3% of adult body weight

Question 35

Facts about cerebral glucose metabolism

Answer 35

People with AD exhibit a decrease in brain glucose metabolism.
Cerebral glucose metabolism deteriorates with age (cognitive decline).
Glucose hypo-metabolism affects the parietal and temporal cortices, with a 20-25% glucose deficit in AD patients.
Reduced cerebral glucose metabolism is a pathogenic feature in MCL and AD and occurs before the onset of clinical signs of cognitive impairment.

Question 36

Facts about Cerebral Glucose Hypo-metabolism

Answer 36

Could be attributed to mitochondrial impairment, defects in brain glucose transport and insulin functions or disruption in glycolysis.
Could lead to chronic brain energy deprivation, which causes deterioration in neuronal functions and further decline in glucose metabolism.

Question 37

What is the primary fuel for the brain?

Answer 37

Glucose, but ketones are the most important back-up when glucose supply is low.

Question 38

What are the 2 forms of ketone bodies?

Answer 38

beta-hydroxybutyrate and acetoacetate

Question 39

What are ketones?

Answer 39

Ketones are the by-products of the breakdown of fatty acids in the body that can be used as a backup fuel for the brain when the glucose supply is insufficient.
Ketone bodies can support basal neuronal energy needs, and around half of the neurons activity-dependent oxidative needs

Question 40

Why are ketones beneficial?

Answer 40

Protecting against neuronal insults.
Increasing metabolic efficiency relative to glucose metabolism
Mitigating neurodegenerative mechanism.

Question 41

What is MUST?

Answer 41

‘MUST’ is a five-step screening tool to identify adults who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, communities and other care settings and can be used by all care workers.