Chapter 18 Nutrition and Older Adults

1. Chapter 18Nutrition and Older Adults “Nutrition is one of the major determinates of successful aging.”

2. Generalizations relative to health status changes with aging are unwise because “older adults” are a heterogeneous population • Diseases and disabilities are not inevitable consequences of aging • Functional status is more indicative of health in older adults than chronological age

3. Introduction • In “normal” aging, inevitable & irreversible physical changes occur over time • We will look at • nutrient requirements • dietary recommendations • food & nutrition programs designed to support healthy aging

4. What Counts as Old? There is no one age that defines “old” • 50—Eligibility for AARP • 60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program • 65—Eligibility for full Social Security • U.S. Census Bureau uses: • 65 to 74—“young old” • 75 to 84—“aged” • 85 & older—“oldest old”

5. Food Matters: Nutrition Contributes to a Long and Healthy Life • Cumulative effects of lifelong dietary habits determine nutritional status in old age • CDC suggest that longevity depends on: • 10% access to health care • 19% genetics • 20% environment (pollution, etc.) • **51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)

6. A Picture of the Aging Population: Vital Statistics • More Americans are living longer • Currently, ~12.4% are >65 yrs • By 2050, ~20% will be >65 yrs • Persons ≥85 are the fastest growing population group

7. Global Population Trends: Life Expectancy and Life Span Life expectancy Average number of yrs of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth Life span Maximum number of yrs someone might live; human life span is projected to range from 110 to 120 yrs

8. Range of Life Expectancy for 15 of 37 Countries Reported in Health, United States 2005, for 2001, According to Gender

9. Three Groups of Aging Theories 1) Programmed aging • Hayflick’s theory of limited cell replication • Modular clock theory 2) Wear and tear theories of aging • Oxidative stress theory • Rate of living theory 3) Calorie restriction & longevity

10. Physiological Changes • Body composition changes • Lean body mass (LBM) & fat • Muscles: use it or lose it • Weight gain • Changing sensual awareness • Taste & smell • Oral health: chewing & swallowing • Appetite & thirst

11. Body Composition Changes • Lean body mass (LBM) • Sum of fat-free tissues, mineral as bone, & water • Sarcopenia • Term used for loss of LBM associated with aging • Fat-free mass decreases ~15% from age 20 to 70 • Older people have lower mineral, muscle, & water reserves

12. In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density Regular physical activity helps maintain functional status Muscles: Use It or Lose It

13. Weight Gain • Weight gain accompanies aging, but is not inevitable • Mean body weight gradually increases with aging, peaking between 50 & 59 yrs • Physical activity moderates weight gain & increases in body fat • Lack of estrogen promotes fat accumulation

14. Changing Sensual Awareness:Taste and Smell • Taste & smell senses decline with age • Decline in ability to identify smells varies by gender • In men, decline begins ~age 55 • In women, decline is >age 60 • Disease & medications affect taste & smell more than aging

15. Changing Sensual Awareness:Oral Health—Chew and Swallow • Oral health depends on: • GI secretions • Skeletal systems • Mucus membrane • Muscles • Taste buds • Olfactory nerves (smell & taste) • Healthy People 2010 Objective: • Reduce % of people aged 65-74 who have lost all their teeth from 26% to 20%

16. Appetite Hunger & satiety cues weaken with age Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted Thirst Thirst-regulating mechanisms decrease with age Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective with advancing age Changing Sensual Awareness:Appetite and Thirst

17. Nutritional Risk Factors Risk factors for older adults are: • Hunger, poverty, low food & nutrient intake • Functional disability • Social isolation or living alone • Urban & rural demographic areas • Depression, dementia, dependency • Poor dentition & oral health • Diet-related acute or chronic diseases • Polypharmacy • Minority, advanced age

19. Tufts University’s Modified Food Pyramid for 70+ Adults Note supplements at the top & water at the base

20. Caloric Intake Comparison of Younger and Older Adults by Gender

21. Eating Out Older adults eat out less than younger persons Snacking Older adults snack less than other groups Eating Occasions

22. Nutrient Recommendations • Nutrient recommendations change as scientists learn more about effects of foods on human functions • Specific DRI for those >51 yrs were 1st established in 1997 Estimating Energy Needs • Decrease in physical activity & BMR from early to late adulthood results in ~20% fewer calories needed

23. Protein • Inactive, older adults living alone may have low protein intakes • Several researchers report protein needs for older adults are 1 to 1.25 g/kg body wt (higher than the DRI of 0.8 g) • Nitrogen balance is easier to achieve when: • Protein is a high quality • Adequate calories are consumed • Elders participate in resistance training

24. Considerations for Protein Adequacy of Older Adults • Based on ht & wt, how much protein will meet individual’s needs? • Are enough calories eaten so that protein does not have to be used for energy? • If marginal amounts of protein are eaten, is the protein of high quality? • Are there additional needs: wound healing, tissue repair, surgery, fracture, infection? • Is the individual exercising? (Nitrogen balance is harder to achieve while sedentary.)

25. Fats and Cholesterol • Minimize saturated fat & keep total fat between 20 to 35% of calories----same as young & middle-aged adult • Even though eggs are high in cholesterol, they are a nutrient-dense, convenient, & safe food for older adults that do not have lipid disorders

26. Recommendations for Fluid • The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated • ≥6 glasses of fluid/day will prevent dehydration in most older adults • To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL

27. Age-associated Changes in Metabolism: Vitamin D, Calciferol • Factors that put older adults at risk for deficiency: 1. Limited exposure to sunlight 2. Institutionalization or homebound 3. Certain medications (barbiturates, cholestyramine, Dylantin, laxatives)

28. Age-associated Changes in Metabolism: Iron • Iron needs  after menopause • Most older adults consume more iron than needed • Excess iron contributes to oxidative stress • Reasons that some older adults may have iron deficiency include • Iron loss from disease or medications •  acid secretion •  calorie intake

29. Low Dietary Intake: Nutrients of Concern • Vitamin E • Folate, folic acid • Calcium • Magnesium • Zinc

30. Nutrient Supplements: When ? • May be useful with those who: • Lack appetite resulting from illness, loss of taste or smell, or depression • Have diseases in GI tract • Have a poor diet due to food insecurity, loss of function, or disinterest • Avoid specific food groups • Take medication or other substances that affect absorption or metabolism

31. Dietary Supplements Potentially Used by Older Adults for Health Conditions

32. Nutrient Recommendations: Using the Food Label • In nutrition labeling & dietary guidance, “one size does not fit all” • Nutrient amounts for older adults are slightly different than those for younger • Main differences: • Need more calcium & vitamins D & C • Need less iron & zinc

33. Food Safety Recommendations • Older adults are vulnerable to foodborne illness because they have compromised immune systems • Leading hazardous practices: • Improper holding temperatures • Poor personal hygiene • Contaminated food preparation equipment • Inadequate cooking time

34. Physical Activity Recommendations • Exercise: the “true fountain of youth” • Exercise guidelines • Keep Moving—Fitness after 50 screening tool • Resistance or weight-bearing activities • Aerobic exercise

35. Nutrition Policy and Intervention for Risk Reduction Nutrition Education 4 C’s: -Commitment -Cognitive processing -Capability -Confidence

36. Considerations for Educational Materials for Older Adults • Larger type size • Serif lettering (such as Times Roman) • Bold Type • High contrasts (black on white) • Non-glossy paper • Avoid blue, green & violent • Reading level of 5th to 8th grade

37. Community Food and Nutrition Programs Elderly Nutrition Programs • Government programs include: • USDA’s food stamp & extension programs • Adult Day Services Food Programs • Nutrition Assistance Programs for Seniors • Meals-on-Wheels • Senior Nutrition Program of the Older Americans Act

38. The Promise of Prevention: Health Promotion • Good nutrition habits make a greater impact when started early in life • Many not motivated to make changes until later in life or when health problems occur • The belief that an 80 y/o is too old to learn and practice health promotion strategies is an outdated myth