Chapter 13Special Topics of Age-related Risks:Unique Nutrition Issues in the Older AdultKaren M. Funderburg MS,RD,LDMigy K. Mathews MD
Reader Objectives Upon reading this chapter and reflecting on the contents, the reader will be able to: • List the unique physiological changes that occur with aging that affect nutrient intake and nutritional status. • List key psychosocial changes associated with aging that can affect the desire or ability to consume an adequate diet.
Reader Objectives, cont. • Discuss the impact that age-related changes have on nutritional status and quality of life. • Understand the consequences of age-related malnutrition and nutrient deficiencies on overall health status and quality of life.
Age-related risks for Malnutrition • Impaired appetite • Appetite assessment • Diet modification • Physiological changes • Psychosocial changes • Medication use
Impaired appetite • Appetite is associated with well-being • Conditions that may take away appetite: changes in GI tract, decreased taste and smell acuity, medication side effects,diet modifications, depression or altered mental status. • Diminished appetite may lead to significant risks to overall health
Appetite Assessment • Declining food intake and anorexia are predictors for undernutrition in older adults. • Early detection--nutrition screening tools are very important • Determine your nutritional health checklist and MNA • SENECA study
Physiological changes • “Anorexia of aging” • Changes in GI tract • Sensory loss • Food-borne illness • Cognitive changes: impaired cognition, Alzheimer’s, Parkinsons, cancer
Psychosocial changes and medication use • Nutritional risk is associated with economic hardship and loneliness • Elderly nutrition program and Meals on Wheels • Medication use: Increased disease leads to increased medication use. Side effects of medications affect appetite and nutritional status.
Interventions for Impaired Appetite • Liberalized diet, freedom in food selection, eating with others, congregate meals, providing assistance, specialized utensils, finger foods, flavor enhancers, adding nutrients to food, nutrient-dense snacks, commercial supplements, pleasant eating environment, praise, stimulants
Oral Health Problems • NHANES--oral health is an increasing problem with age; compounded by poor income status and lower education level • Endentulous, dentures, mouth pain,, xerostomia, dysphagia, visual impairment, impaired motor skills, arthritis, altered mental status
Malnutrition • Estimated that 40% of nursing home residents and 50% of hospitalized elderly patients are malnourished • Malnutrition--any insufficient dietary intake of essential nutrients • Malnutrition--protein-energy undernutrition (PEU)
Weight loss,Calories, PEM • Older adult must be evaluated for unintended weight loss; height and weight; BMI • Calories: energy intake declines with age, reduction in BMR, reduction in lean body mass and decreased physical activity • Protein-energy malnutrition (PEM)
Nutrient Deficits • Vitamin D--especially important for elderly, particularly those institutionalized or homebound • Thiamin--deficiency usually associated with poor intakes, not increased need • Vitamin B6--age-related changes related to the metabolism and absorption • Vitamin B12--deficiency common among older adults due to pernicious anemia and atrophic gastritis • Fluid--risk of dehydration
Health Problems • Cardiovascular disease • Peripheral vascular and cerebrovascular disease • Incontinence (urinary, fecal) • Visual Function • Osteoporosis
Risk factors for Osteoporosis • Risk factors include: age, Asian, Caucasian, female, early menopause, family history, low body weight, medications, smoking, sedentary, heavy alcohol consumption, poor calcium intake for years, poor Vitamin D intake
Special considerations for older women • Long life expectancy--80.1 years • Disease and disability increase with age • Menopause and side effects: risk for bone loss and heart disease • Osteoporosis and hormone replacement therapy (HRT)
