Older Nutrition Flashcards
Nutritional impacts over the lifespan
Cumulative effects of lifelong dietary habits determines nutritional status in old age
Longevity depends on access to health care, genetics, environment, lifestyle
Concern for sarcopenia, cachexia, bereavement and social isolation and starvation
Ageing theories
Programmed ageing
Hayflicks theory of limited cell replication. Our cells can only replicate so many times, so this eventually leads to cell and thus organ death.
Modular clock theory- biological clock linked to our hormones.
Wear and tear theories
Free radical oxidative stress theory, whereby oxidation causes death of tissues. Telomere length shortens over time, resulting in chromosome death.
Calorie restriction that still meets micronutrient needs may prolong healthy life.
Body comp changes
Lean body mass decreased, sum of fat free tissues, mineral as bone and water.
Loss of LBM (sarcopenia)
Fat free mass decreases
Lower mineral, muscle and water reserves
Regular physical activity can help maintain functional status
Weight gain accompanies ageing but is not inevitable
Mean body weight gradually increases with ageing; peaking between 50 and 59
Changing sensual awareness: taste and smell
Declines with age- 55 in men, >60 in women
Disease and medications affect taste and smell more than aging
GI secretions (saliva) decrease
Skeletal systems become weaker, teeth and jaw movements more difficult
Mucous membranes decrease
Muscles (tongue and jaw) decreased motility
Taste buds - reduced taste, may cause addition of more salt
Olfactory nerves (smell and taste) may inhibit ability to smell off foods
Reduced hunger and satiety cues
Reduced thirst regulating mechanisms
GI changes
Poor dentition- food mastication issues
Inadequate salivary amylase- delayed digestion
Dysphagia may lead to aspiration pneumonia
Reduced oesophageal function- GORD
Slowed motility of colon
Reduced pancreatic secretions - maldigestion
Nutrition risk factors
Consider total fat, sat fat, fruits, veg, wholegrains and caloric intake
Compare adequacy of nutrient intake to the NRV
Examine a population and determine how environmental factors predict nutritional health- such as the nutrition screening initiatives determine checklist -
-BMI <22
- loss of appetite
- able to shop or prepare food?
Include the MNA, MST, MUST
Macronutrient intake
Fibre 25-30g
Protein need 1.3g/kg.
Nitrogen balance easier to achieve when protein is high quality, adequate calories are consumed, elders participate in resistance training.
Additional needs for wound healing, tissue repair, surgery, fracture and infection
Minimise sat day and keep total fat bw 20-35% calories
Even though eggs high in cholesterol they are nutrient dense and safe for adults who do not have lipid disorders
Total amount of water decreases with age resulting in smaller margin of safety for staying hydrated
Nutrients of concern
Proteins
Energy
Water
Calcium
Iron- decreased after menopause, but excess iron contributes to oxidative stress. Iron deficiency caused by iron loss from disease, decreased acid secretion and decreased calorie intake
Vit D - limited exposure to sunlight, institutionalisation or homebound, certain medications
Vit B12- some synthetic B12 is better absorbed due to poor HCL status of aged
Heart disease
Potentially reversible by adopting a healthy lifestyle
Hypertension (>140/90)
Increased LDL cholesterol (>130mg/dL or 3.4mmol/L)
Can lead to diabetes
Depends on sex and race
Stroke
Ischaemic- blockage of vessels to brain
Aneurysm- ballooning of vessel wall
Thrombosis- blood clot
Cerebral embolism- wandering blood clot (embolus) lodges in artery and block blood flow to brain
Atrial fibrillation- degeneration of the heart muscle causing irregular contractions
Aetiology
Weakened heart contractions
Easy clotting cells
Blocked arteries
Effects
Deprivation of oxygen to brain causing cell death
Osteoporosis
Increased bone loss linked to decreased blood calcium that increases PTH
Decreased intake of Ca, ang, Ph, Fl, Bo, and vit D and K
Blood pH increases Ca released from bonds
Process of normal ageing results in slow increase of PTH and decrease
In skins ability to make Vit D= bone loss
10-20% die within a year, 50% have a permanent disability
67% vertebral fractures are asymptomatic- results from compression and or bone fracture in spine
Long term phosphorous deficiency Heavy alcohol consumption Smoking Inadequate calcium and vit D Consume foods rich in vitamins, don't consume calcium with antacids
Nutrition and oral health
Xertosomia- dry mouth
Glossodynia- pain of the tongue
Dysgeusia- loss of taste
Candidiasis- yeast infection
Polyphenols in black tea can promote prevention of bacteria
Brushing applies ad hormal
GI diseases
Parts of GI attract most likely to malfunction:
Oesophageal- stomach junction: weekend muscle results in GORD
The stomach- decreased acidity leading to changes in nutrient absorption or increased acidity ulcers
Intestines: resulting in constipation, diarrhoea and some food intolerances
B12 deficiency
Salivary glands in mouth secrete enzymes and mucus to begin breakdown of food and provide substrate for binding
Enzyme mixture enters stomach where acids and enzymes, esp pepsin, detach the B12 from protein in foods and reattach it to binder proteins. The acid and enzymes trigger release of IF from stomach cell wall.
B12 complex moves to small intestine, where enzymes secreted by the pancreas release B12 and transfer it to the IF that was secreted by the stomach. Next the vit B12 IF complex move to the ileum where it enters the cell through specific receptors. IFs degraded and B1: js transported by transcobalamins or through tissues.
Pernicious anaemia- IF
B12 deficiency due to lack of IF Large, undeveloped RBC Glossitis Tongue fissures Irreversible neurological symptoms Uncommon Takes 5-6 years to develop
Risk factors are decreased stomach acid, history of h pylori or fam history
B12 injections given or synthetic orally
