Successful Aging

1. Successful Aging Sorosh Roshan, MD, MPH International Health Awareness Network www.ihan.org

2. Who is Old? • Second childhood - Shakespeare late 16th century “sans teeth, sans eyes, sans taste, sans everything” • The United Nations defines older people as those 60 years of age and over, and • The oldest old as those over 80 years of age

3. The Human Rights of Older Women • Equal access to health and social services • Eliminate gender, age, race and income related inequalities • Life long training opportunity • Involving older workers right across the company’s activities e.g., training, worker involvement in redesigning the work place, etc. • Access to the labor market • Elimination of elder abuse

4. Aging • “A process of gradual and spontaneous change, resulting in maturation through childhood, puberty and young adulthood and then decline through middle and late age”

5. Senescence • “The process by which the capacity for cell division, growth, and function is lost over times, ultimately leading to an incompatibility with life; i.e., the process of senescence terminates in death”

6. Successful Aging • A process by which deleterious effects are minimized • Healthy lifestyle from preconception though out life cycle • Nutrition and an active physical, mental and spiritual life

7. Accelerated Aging • Progeroid syndrome • Warner syndrome • Wiedmann-Rautenstrauch syndrome and Hutchinson-Gilford syndrome • Down syndrome

8. Physiology of Aging • Aging is a normal process in which the rate of catabolic changes become greater than the rate of anabolic cell regeneration. • Loss of cells and body mass can lead to varying degree of decreased efficiency and impaired organ function.

9. Physiological Changes • Sensory losses • Oral health problems • Gastrointestinal and metabolic abnormalities • Cardiovascular diseases

10. Physiological Changes (con’t) • Reduction of pleasure of eating due to hyposmia (the ability to taste and smell reduced) and dysgeusia (the capability to digest foods is reduced) • Reduced ability to detect odor can cause food poisoning • Dry mouth (xerostomia), hyposalivation; difficulties in chewing and swallowing; constipation

11. Gastrointestinal Changes • Constipation due to inadequate intake of fiber, fluid, sedentary life style • Glucose intolerance • Increase in plasma levels of 1.5mg/dl per decade • Deficient insulin production or function • Diet modification and exercise are the treatment of choice

12. Gastrointestinal Changes (con’t) • Hypochlorhydria (Lower levels of digestive enzymes) • Diminished absorption of nutrients such as B12, iron and calcium • Metabolism of calcium and vitamin D is altered during aging • These factors and poor dietary intake will accelerate bone loss and osteoporosis

13. Nutritional Requirements • Age, gender, level of activity, food allergies, environment and medical conditions • Caloric requirements begin to decline from 55-60, (500kcal per for men and 300 kcal for women) • Protein requirements increase slightly • 20-30 kcal per kg of body weight-depending on the person’s weight.

14. Nutritional Requirements (con’t) • 1.25g of protein per kilogram of body weight is appropriate for the elderly (12 - 16% of total daily calories). • The US RDA for adults is .8g of protein per kilogram of body weight. • Need varies depending on illness, stress, open wounds, burns, vigorous exercise, infection and altered GI function.

15. Carbohydrate Intake • Limited to 55% of total daily calories. • 40% of it from complex carbohydrate, whole grains, vegetables and fibers. • Fibers help reduce cholesterol and plasma glucose level.

16. Dietary Fat • 30% of daily calories. • Reduce saturated fats. • Increase intake of monounsaturated and polyunsaturated sources including Omega 3 fatty acids (salmon, tuna fish, walnuts and flaxseed powder)

17. Nutrients and Vitamins • Calcium intake 800-1200mg/day • Phosphorus intake to be reduced to 700mg/day. • Vitamin D for the homebound with limited sun exposure. • Iron store tends to increase with age. The recommended dose is 10mg/ day for men and women. (50% of the required dose for under the age of 50)

18. Anemia in the Elderly • Is due gastrointestinal bleeding and malignant disease.

19. Zinc • Zinc deficiency causes: • Impaired immune function • anorexia • dysgeusia • delayed wound healing • development of pressure ulcers • Treat with Zinc supplements

20. Antioxidants • Vitamin E enhances immune function. • 400 IU daily. • Vitamin C may help to protect against cataract, 150-250 mg/day. • B12, B6 and folate may help to improve nutritional status and energy, protects against elevated serum homocysteine, a risk factor for depression, cardiovascular and neurological deficits.

21. Hydration and Fluid Intake • Dehydration is the most important cause of fluid and electrolyte disturbances in the elderly. • A daily fluid intake of 30-35 ml per kilogram of body weight, or a minimum of 1.0-1.5 ml per kilogram's necessary.

22. Daily Fluid Requirements • Fluid requirements increase with: • Exercise • Use of laxative or diuretics • Hot environment • Increase protein or fiber intake • Fever • The elderly often experience reduced thirst sensation

23. The Menu • The food should be prepared for the individual needs. • Good presentation, fresh, nutritious, tasty and nutrient dense. Be considerate of those who wear dentures or suffer from dysphasia. Add supplements if you must. • Serve the food with bouquet of tender loving care.

24. Special Thanks • Azi Ahmadi, MS Nutrition • Laura DiClementi, MS Health Education • Courtney Essary, MBA • Hewitt Simon, Age in Action-S. Africa Council for the Aged