NUTRITION FOR THE ELDERLY

NUTRITION FOR THE ELDERLY

Eating is one of our great pleasures. Guided by common sense and moderation, eating well is also a means to good health. Most of us want a long, productive life, free of illness. Yet, many people, from early middle age onwards suffer heart disease, hypertension and strokes, types 2 diabetes, osteoporosis, and other chronic diseases. We can slow the development of, and in some cases even prevent, these diseases by pursuing a diet that works against them. This action is most profitable if we begin early and continue throughout adulthood. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont.... Keep in mind that present day health practices can significantly influence health during later life. Although genetics does play a role, many health problems that occur with age are not inevitable: they result from disease processes that influence physical health. Much can be learnt from older people whose attention to health and physical activity – along with a little luck – keeps them active and vibrant well beyond typical retirement years. Successful aging is the goal. Age fast or slow – it is partly personal choice! Wardlaw….. Perspectives in Nutrition (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

1920’s The decline in deaths from infectious diseases, particularly in the younger age groups, was the driving force behind the decline in mortality in the first half of the 20th century. In 1920, infectious diseases accounted for approximately 15% of all deaths for both males and females; the death rate for males from infectious diseases was 189 per 100,000 males, and 147 per 100,000 females. Three of the leading causes of death at this time for males aged under 5 years were infectious diseases; diarrhoea and enteritis, diphtheria and measles. The decline in deaths from infectious diseases is generally believed to be the result of medical advances and an overall rise in living standards including improved nutrition levels, better sanitary, water and sewerage control, and better control of infection in hospitals.9 (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited. http://www.abs.gov.au/ausstats/abs@.nsf/2f762f95845417aeca25706c00834efa/45feea54e2403635ca2570ec000c46e1!OpenDocument

Life expectancy in Australia increased substantially during the 20th century. In the period 1901-1910, the average life expectancy of a new-born boy was 55 years and that of a new-born girl, 59 years.2 By the end of the 20th century a new-born boy could expect to live 76 years and a new-born girl nearly 82 years (based on deaths during the period 1997-1999).3This increase in life expectancy reflects the generally consistent decline in death rates in Australia throughout the last century. A major exception to this decline was an increase in 1919 which can largely be attributed to a global influenza epidemic. In that year, death rates from diseases of the respiratory system almost doubled for both males and females. Death rates during the 20th century were characterised by a shift in disease patterns, (or what people were dying from) and the age at which people were dying. In the first half of the century, causes of death were dominated by infectious diseases, which tended to impact on the very young and the very old.4 (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Historical Change The Great Depression WW2 Farming revolution – increased farming production and the beginning of automation Human rights of the 1950’s (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Baby Boomers From the 1950s to the 1970s, it was believed that mortality trends had reached their lower limits and that further gains would be minimal.5 From the early 1970s, death rates continued to decline in all age groups. Over the century, in the older age groups, degenerative diseases such as heart disease, cancer and stroke, replaced infectious diseases as the main causes of death.6 (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Identified Risk Factors Risk factors. 17% Australians aged 14 years and over are daily smokers, 10% drank alcohol at risky levels. 30% Australians aged 25 years and over had high blood pressure, 50% Australians adults aged 25 years and over had high blood cholesterol levels, and 60% carried excess weight. This page provides information on prevalence of the risk factors that affect the onset, maintenance and prognosis of a variety of chronic diseases. http://www.aihw.gov.au/cdarf/data_pages/prevalence_risk_factors/index.cfm (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Risk Factors. Those risk factors include: poor diet and nutrition physical inactivity tobacco smoking alcohol misuse high blood pressure high blood cholesterol excess weight. Prevalence estimates are based on either self-reported or measured data from various national surveys (see the AIHW web site Risk factors for detailed data sources and other useful information). (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

To view the visual breakdown http://www.abs.gov.au/ausstats/abs@.nsf/mf/4834.0.55.001/ http://www.aihw.gov.au/chronic-diseases/ (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

COMPONENTS OF ANNUAL POPULATION GROWTH(a): NATURAL INCREASE AND NET OVERSEAS MIGRATION (a) Year ending December(b) NOM estimates contain a break in series. Estimates from September quarter 2006 use an improved methodology. Please refer to Net Overseas Migration in definitions box.Source: ABS Australian Demographic Statistics (cat. no. 3101 (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Australian Trends Australians enjoy one of the highest life expectancies in the world, at 81.4 years—second only to Japan. Death rates continue to fall and life expectancy to rise, but the fertility rate remains below the replacement level—all leading to ageing of the population. Many Australians live with long-term health conditions. Most of these conditions are not major causes of death, but they are common causes of disability and reduced quality of life. One in five Australians (4 million people) lives with some degree of disability. Because of severe disability, more than 1 million people need assistance with the core life activities of mobility, self-care or communication. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

http://www.aihw.gov.au/publications/aus/ah08/ah08-c02.pdf Cardiovascular diseases, cancers and respiratory diseases remain the leading causes of death overall. However, injury is by far the most common cause of death in the first half of life. Almost three-quarters of deaths among people under 75 years are considered to be largely avoidable. Coronary heart disease is the largest single contributor to the burden of disease in Australia, followed by anxiety and depression (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/CC0E264D73F3A637CA2577510019F5DD/$File/41020_ASTJune2010b.pdf (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Sub Groups There are some population groups within Australia that are indentified as at risk, or as having special considerations. These include: Children and adolescence Indigenous people – Aboriginal and Torrens Strait Islanders. Rural Australians Socially disadvantaged people People with a disability Prisoners Immigrants, in particular non-English speaking. Defence force – higher risk of injury Veterans http://www.aihw.gov.au/publications/aus/ah10/ah10.pdf (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Readings that give insight The Underlying factors affecting child health and development and family functioning” : www.rch.org.au/emplibrary/ccch/EY_UF_Summary.pdf Health of children in Australia; A snapshot 2004-5: www.abs.gov.au/ausstats/abs@.nsf/mf/4829.0.55.001 Genetic disorders of children: www.healthinsite.gov.au/topics/Genetic_Diseases_and_Disorders Understanding adolescents: ww.caah.chw.edu.au/resources/gp-section1.pdf (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Life Expectancy Australians enjoy some of the highest life expectancies in the world. In 1995, the highest male expectancies at birth were recorded in Iceland (76.5 years) and Japan (76.4 years) and the highest female expectancies were recorded in Japan (82.9years) and France (82.6 years). The WHO has estimated that the Australian male life expectancy in 2005 (79.0 years) was among the world’s highest, marginally behind Iceland and ahead of Japan for the first time. Similarly, female life expectancy in Australia (83.7 years) was close to that in the countries with the highest life expectancy. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont... A direct consequence of declining death rates, as described earlier, is that Australians in general enjoy one of the highest life expectancies in the world. Australian females born in 2003–2005 could expect to live an average of 83.3 years, and a male could expect to live 78.5 years (ABS 2006b). But not all groups within the Australian community are so fortunate—among Aboriginal and Torres Strait Islander peoples, life expectancy at birth is around 17 years less than this. Leading Cause of Death gov.au (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Life expectancy is not uniform among population groups, such as those who are socioeconomically disadvantaged and Aboriginal and Torres Strait Islander peoples have lower life expectancy than the national average. Life expectancy also shows regional variations. Based on the 1996-98 data, life expectancy at birth in the Northern territory was the lowest for both sexes, considerably lower than the overall Australian levels – 5.3 years for males and 6.5 years lower for females. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont.... These differences largely reflect the high death rates in the indigenous populations, which constitute a large proportion (29%) of the population in the Northern territory (ABS 1999). In other states, male life expectancy ranges from 75.1 years in Tasmania to 77.5 years in the Australian Capita Territory and female life expectancy ranges from 80.4 years in Tasmania to 81.9 years in Western Australia. The Australian institute of Health and Welfare book “Australia’s Health 2000” (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Changes with time • The ability to meet nutritional needs can become increasingly difficult as we age. Some common factors that affect food intake in older Australian's include: • Altered taste and smell • Dentures or dry mouth • Chronic illness • Living and eating alone • Poor mobility and inability to shop for food • Side effects of medications (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont... • Some nutritional concerns that may benefit from professional advice include: • Dehydration - drink plenty of water and other fluids • Constipation • Weight loss and/or poor food intake • Anaemia • Osteoporosis • Vitamin D deficiency - Try to spend some time outside each day as sunshine helps the body to make vitamin D, which has a role in keeping bones strong. A doctor may be able to prescribe a vitamin D supplement if necessary. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

CHARACTERISTICS OF NORMAL AGING Heart: the heart grows slightly larger with age. Maximal O2 consumption during exercise declines in men by about 10% with each decade of adult life and in women by about 7.5. Decreased elasticity of blood vessels and valves; thickening of vessel walls and arthrosclerosis Kidneys: increased size of pores in bowmen’s capsule; reduced filtration efficiency; accompanies by a decline in bladder capacity. Urinary incontinence occurs with tissue atrophy (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont.... Brain:the brain loses neurons but increases connections between cell synapses and regrows dendrites and axons. Perception can be decreased; response and reflexes reduced. Lungs:maximum vital capacity declines by about 40% from 20 – 70 years of age. Decreased elasticity and pulmonary respiration. Body fat:the body redistributes fat from under the skin to deeper parts of the body. Women tend to store fat in the hips and thighs, whereas men store fat in the abdominal areas. Fat cells can replace damaged muscle cells (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Muscles: gradual loss of muscle tone, elasticity and strength. Can reduce strength and performance. Skeleton: bones become porous and loose its strength and flexibility. Joint damage leading to arthritis Metabolic system: gradual decline in thyroid activity – decreased BMR. Digestive system:gradual slowing of the system, decreased secretion of saliva and enzymes – decreased digestion, elimination and absorption of nutrient. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Sight: vision acuity and difficulty focusing begin in the 40’s. Susceptibility to glare and difficulty seeing at low levels of illumination increase with age Sensory acuity:decreased sense of touch, hearting, smell and taste. Skin, hair and nails: reduced connective tissue, CV integrity. Leads to softer skin, greying of hair and easier bruising. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Hearing: hearing declines more quickly in men than women, with an additional decline in the ability to hear high frequencies Personality:personality is consistent unless it is altered by a disease process Nutritional deficiencies in aged people that can have an effect on: • Taste: cancer; chronic renal failure; liver disease; niacin deficiency; Zinc deficiency • Smell: chronic renal failure; liver disease; B12 deficiency, Zinc deficiency (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

HYPOTHESES ABOUT THE CAUSES OF AGING Errors occur in copying the genetic blueprint (DNA), some being spontaneous and others arising from degenerative processes of chemicals, radiation, and time. Connective tissue stiffens. As this happens, flexibility is decreased in key body components altering organ function and causing such problems as wrinkles, joint stiffening and artery stiffening. It also restricts some nutrients from entering the cells. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont.... Toxic products build up. Breakdown products of lipids called lipofuscin may act as intracellular sludge, hampering normal metabolic processes, by clogging cells. Oxidation - Electron-seeking compounds damage cell membranes and proteins. One way to prevent some of this damage is to consume adequate – not excessive – amounts of vitamins C and E, selenium and carotenoids. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont... Hormone function changes e.g. a) DHEA, produced by the adrenal gland, circulates at high concentrations in young adults, and begins to fall after the age of 30 b) a fall in growth hormone concentration c) testosterone concentration declines with age and is linked to a decline in muscle strength d) melatonin, best known for its ability to induce sleep, declines after puberty (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Cont.... The immune system loses some efficiency – it is less able to recognise and counteract foreign substances, such as viruses, that enter the body. Nutrient deficiencies particularly of protein, vitamin E, vitamin B6, and zinc, hamper immune function, making matters worse for the aging body. Death is programmed into the cell. Acceleration or deceleration of this natural process can lead to problems, such as cancer cell growth. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

NUTRITION OF OLDER PEOPLE To predict the nutritional problems of an older person (aged 65 and over), it is necessary to know the extent of physiological change caused by aging and whether the person shows early warning signs for long-term poor nutrition. Some diseases associated with aging are: (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Rate of occurrence per 1000 people Chronic condition 45-64yrs 65-74yrs 75+yrs Total _______________________________________________________ arthritis 131 280 460 508 Hypertension 124 265 408 395 Hearing impairment 91 149 261 381 Heart condition 83 137 291 339 Visual impairment 35 46 72 136 Deformities or orthopaedic impairment 121 175 191 198 Diabetes 26 55 98 92 Diverticula of intestines 8 15 36 45 Asthma 37 32 47 26 __________________________________________________________________ Wardlaw…. Perspectives in nutrition (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Effects of aging • Immunodeficiency: • underlying proneness to infection in the aged, as in children, is the problem of immunodeficiency, which we know, is partly reversible by nutritional means. • Consuming enough protein, vitamins (especially vitamin E and B6), and zinc help maximise the health of the immune system. • Older people often eliminate meat from their diet because it’s too hard to chew. • Balanced nutritional supplements can help bridge the gaps in vitamin and mineral intake (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Protein energy malnutrition: • the most common nutritional scenario in the aged is for there to be a decrease in lean mass (comprising water and protein-dominant tissues like muscle and organ like liver, and also bone) and an increase in abdominal fat. • Lifestyle greatly determines the rate of muscle mass deterioration. Therefore, an active lifestyle tends to maintain muscle mass, whereas an inactive one encourages its loss. • Older adults also benefit from physical activity because it stimulates food intake by raising energy expenditure. By eating more, they increase their chances of consuming adequate amounts of nutrients. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Neoplastic diseases: These would include tumours and cancers of various kinds • Chronic non-communicable diseases: these would include: • Osteomalacia: which is primarily due to a deficiency in vitamin D as well as calcium • Osteoporosis: where the main problem is a loss of calcium rather than a lack of vitamin D • Pernicious anaemia: which usually results from poor absorption or lack of vitamin B12 • Anaemia: the result of deficiencies of iron, folic acid and / B12 (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Diabetes:can be managed by a proper diet. Chromium deficiency is common in these people • Degenerative diseases: these would include: • Arthritis: most commonly osteoarthritis but also can be rheumatoid or gout. Obesity is generally regarded as a risk factor for osteoarthritis in weigh bearing joints • Incontinence: while nutritional factors are unlikely to play a significant role in the development of incontinence, elderly people may seek to control this problems by restricting fluid intake (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Dementia / Alzheimer’s disease: • can lead to indifference to food, failure to remember to eat, failure to recognise the need to eat, and behavioural abnormalities, such as holding food in the mouth and apraxia of eating. • Weight loss is common with dementia. • Changes in smell and taste could also lead to anorexia symptoms. • A number of causes have been suggested, such as slow virus infections; genetic factors; thyroid disease; B12 deficiency; aluminium toxicity; strokes; as well as loss of oestrogen in women at menopause. • The main nutritional goal for these people is a healthy diet that maintains body weight. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Constipation: this is the major intestinal problem for older people. • Digestive problems: the stomach slows its acid production as people age, usually limiting the synthesis of intrinsic factor. These changes can contribute to poor absorption of vitamin B12. Less stomach acid may also hamper iron absorption. Iron status can also be affected by regular use of aspirin, and the use of antacids, which bind iron • Psychiatric disorder: food intake plays an important role in social facilitation, and therefore, not engaging in the social occasion of eating may contribute to loneliness and depression. In turn, loneliness and depression can contribute to nutritional disorders. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Nutrient deficiencies: • These may occur when • food intake is below a critical level • when a restricted range of food is eaten • when malabsorption occurs • when nutrient loss occurs • as a result of malabsorption problems • poor dietary intake. • Folate and B12 deficiency are important to monitor with the diets of the elderly • Decreased appetite and food intake: • a poor appetite usually occurs as a part of the normal aging process, but can also be caused by illnesses, smoking and certain nutritional deficiencies (e.g. Zinc can produce a loss of appetite). (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Ignorance can be another cause of this problem. • Decreased senses of taste and smell: • sensitivity to taste and smell often decreases with age, starting at about age 60. Food may require stronger seasonings. • An inadequate diet and possibly a zinc deficiency can also contribute to a loss of taste. • Therefore, a poor appetite should never be dismissed as a characteristic of old age. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Dental health: • poor dental health influences an older persons ability to chew and thus to digest food. • Those with bad teeth, dentures, ill-fitting dentures or no dentures, tend to avoid foods such as meat which needs a lot of chewing. Meat is their major source of iron, zinc and B vitamins. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

Alzheimer’s Disease (AD) and Lipoic acid (LA) (Muench,G (2009), Lipoic acid as an anti-inflammtory and neuroprotective drug for Alzheimer’s disease, presented at the International Evidence-Based Complementary Medicine Conference, Armidale) • Alzheimer’s disease is a progressive neurodegenerative disorder that detroys patient memory and cognition. Patients don’t complain of symptoms but a strong inflammatory response is occurring  the condition occurs without obvious signs and symptoms. • Lipoic acid has been shown to have a variety of properties that interfere with the pathogenesis or progression of AD  it down regulates the pro-inflammatory markers, including TNF and inducible nitric oxide synthase in microglia cells and reduced hydrogen peroxide induced cell death in Neuro-2A cells. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

LA also : • mimics our own defence system and is a fatty acid transporter • Is a recycling antioxidant  it can regenerate as opposed to other antioxidants which only get used once. It also helps glutathione, vitamin E and CoQ10 to be regenerated. • Blocks internal cell signalling for pro-inflammatory cytokines and free radicals, that is, it scavenges inside the cell. • Is used extensively in Europe for the high level, stressed out executive. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

In an open-label study in Hannover, Germany, 600mg R- lipoic acid (natural form) was given daily to 43 patients in AD (also receiving standard pharmaceutical treatment with cholinesterase inhibitors) over an observation period of up to 48 months. It was found that: • The improvements in patients with moderate dementia were not significant. • In patients with mild dementia the disease progressed at approximately half the rate than those in the control group treated only with cholinesterase inhibitors. • Therefore it works best in early AD  catch it early and stop the damage. (C) 2011 Prepared by Leah Marmulla for use by the Academy of Complementary Health. Use without written permission prohibited.

NUTRITION FOR THE ELDERLY