Nutrition in Older Adults

1. Nutrition in Older Adults The Aging Impact

2. Objectives Understand the importance of proper nutrition in the older adult Discuss the effect of aging on the nutritional needs of the older adult Identify factors that affect nutrition in the elderly Understand nutrition assessment Discuss nutrition intervention for the elderly

3. Proper Nutrition Enough intake of essential nutrients to maintain good health.. Carbohydrates Fat Protein Vitamins Minerals Water Nutrients are needed for energy, preventing disease, and maintaining a healthy body.

4. Importance of Proper Nutrition Strong relationship between nutritional status and health Malnutrition increases incidence of illness, length of recovery and even mortality Early recognition of malnourishment leads to improved short and long-term health

5. The Aging Population By 2050, 1 in 5 Americans will be >65 yrs of age A large portion of this population will have annual incomes of $10,000 or less Adversely affects access to food and food choices Many will be at least 10% underweight Presents long term challenges to health care

6. Demographics of Nutrition in Older Adults Community 16% consume <1000 kcal daily Protein, calorie , vitamin deficiencies common 30% men, 40% women underweight after age 75 Widows lost 7.8 pounds on average in two years after loss of spouse

7. ...Demographics Hospital 50% of those over 65 are malnourished at admission 66% are malnourished at discharge Nursing Facility 40-85% are malnourished 50% of those with dementia are underweight 45 minutes average to feed one individual

8. Changes in Aging Anabolic vs. catabolic Decreased efficiency and impaired organ function Loss of lean body mass Decrease in energy needs compared to younger adults Decrease in senses Generally seen in >60-70 yrs

9. What happens when the senses go? Induce changes in secretions Salivary Gastric acid Pancreatic Impair metabolic processes Hearing loss/ Impaired vision Decreased food intake, appetite, and food recognition Inability to feed oneself

10. Macro Nutritional Deficiencies Weight loss associated with decline in bone mineral density Protein energy undernutrition Increased hospitalization Susceptibility to infection Postural hypotension Pressure ulcer risk

11. Micro Nutritional Deficiencies Calcium osteoporosis Vitamin D osteoporosis Folate anemia, cognition Iron anemia Magnesium immuno-deficiencies Vitamin B12 cognition, neuropathies

12. Free Radicals and Aging Contribute to cellular aging Fat and high caloric diets increase free radicals Antioxidants inhibit free radicals Vitamin E Vitamin C Vitamin A Selenium

13. Poor Dentition Xerostomia Lack of salivation Affects 70% of elderly Decreases fluid intake because lack of thirst mechanism Dentures Chew 75-85% less efficiently Decreased intake of meat, fresh fruit, and veggies Fe, Vit C, Folate, & beta-carotene

14. Gastrointestinal Changes Decrease in peristalsis Decrease absorption in small intestine Alteration in certain hormone levels Decrease in Ca absorption Hypochlorhydria Correlated with age, Increases pH and alters absorption of B12

15. Constipation� Altered GI motility Poor muscle tone Inadequate fluid intake Inactivity Decreased energy intake (poor fiber) Laxative use 8.8% of elderly in community 74.6% of Nursing home residents Increases with age

16. Other Changes Metabolic Glucose tolerance Increase 1.5 mg/dL per decade Musculoskeletal Sarcopenia: Change in body fat Decreased body fat Osteoporosis � short stature

17. Nutritional Risk: Social Issues Isolation Depression Immobility Fear of crime Dental problems Inadequate income Alcoholism Nutrient intake Metabolized by liver into acetate that is used to form triglycerides Intake amount effects fat mass Common deficiency: Thiamine Folate Pyridoxine

18. Other Risk Identifiers Inappropriate food intake Known weight loss Gradual weight loss is common <10% weight loss in 6 months is significant for malnutrition Limited literacy Dependence, disability Acute and chronic disease Perioperative status Medication use

19. Nutritional Assessment Scales DETERMINE Your Health http://www.nestleclinicalnutrition.com/frameset_solutions_mna.html Meals on Wheels http://www.fpnotebook.com/END31.htm Mini Nutritional Assessment http://www.nestleclinicalnutrition.com/frameset_solutions_mna.html Dysphagia Evaluation http://www.mmhc.com/nhm/articles/NHM9912/cefalu.html

20. DETERMINE Checklist for Malnutrition Disease Eating poorly Tooth loss or oral pain Economic hardship Reduced social contact Multiple medications Involuntary weight loss/gain Need of assistance with self-care Elderly person older than 80 yrs of age

21. Questions From DETERMINE List I eat fewer than 2 meals per day I eat few fruits and veggies I have 3 or more alcoholic drinks/day I have difficulty chewing/swallowing I eat alone I take more than 3 prescribed meds/d I have lost or gained 10 pounds in 6 mo I am not physically able to shop

22. Geriatric Assessment of Nutritional Status Weight, weight status Skin turgor and appearance Mental health status Physical disabilities Hemoglobin, Hematocrit Serum albumin, lipids, glucose UA for glucose, ketones, protein, occult blood Bowel and bladder function Past & present medical history Dietary History Use of medications, laxatives, supplements Living arrangements, social life, income Activity pattern & frequency

23. Clinical Observations General appearance Normal, alert and responsive General vitality Endurance, energy, good sleep habits Weight Look at height, age and body build Muscles Well developed, firm; good tone, some fat under skin Posture Erect Skeleton No malformations Bowlegs, knock-knees, chest deformity Legs, feet No edema, tenderness or tingling Good color Nails Firm, pink, no spoon shape or ridges

24. Clinical Observations Skin Smooth, moist, good color Hair Shiny, healthy scalp Face and neck Uniform color, healthy, no swelling Eyes Bright, clear, shiny Mouth Lips smooth, moist, good color Gums pink, healthy, Tongue pink to red, smooth Nervous system control Good attention span, not irritable or restless, normal reflexes Gastrointestinal function Good appetite and digestion Regular elimination pattern No palpable organs or masses Cardiovascular function Normal rate and rhythm, blood pressure

25. Diagnostic Tests for Nutrition Albumin Pre albumin Transferrin Total Lymphocyte count Serum cholesterol < 3.5 mg/dl variable < 200 mg/dl < 1500 cm3 < 150 mg/dl

26. Body Mass Index (BMI) Weight in kg/Height in m2 <18 Underweight 18.1-25 Normal 25.1-30 Overweight 30.1-35 Obesity class 1 35.1-45 Obesity class 2 >45.1 Morbidly Obese Mortality increased with BMI < 20 & > 25

27. Nutrition Related Conditions Unintended weight loss Dehydration Pressure ulcers Anorexia of aging Failure to thrive

28. Unintended Weight Loss Warning Signs Needs help to eat/drink Eats < � of meals Mouth pain Poor denture fit Difficulty chewing or swallowing Trouble using utensils Wanders or paces Crying, sad, withdrawn Action Steps Alert HC provider Examine oral cavity Evaluated swallow Request dietary consult Request OT consult Assess impact of meds Develop strategies to increase food intake

29. Dehydration Warning Signs Drinks < 6 cups of liquid daily Needs help to drink Trouble swallowing liquids Is dizzy, easily confused or tired Dry mouth, cracked lips, sunken eyes Urine is dark in color or has a strong odor Fever, vomiting, diarrhea Action Steps Review VS Assess hydration status Alert HC provider Treat underlying conditions Identify and implement strategies to assist with drinking Implement scheduled hydration plan Assess medications

30. Pressure Ulcers Warning Signs Incontinence Heavy perspiration Needs help with mobility and positioning Weight loss Dehydration Action Steps Alert HC provider Follow WC protocol Assess underlying conditions Implement mobility, positioning program Follow UWL and D interventions

31. Anorexia of Aging Loss of appetite Lack of desire to eat 10% weight loss in 6 months Differentiate from food intolerance Rule out early satiety May be normal at end of life

32. Factors Relating to Anorexia of Aging Decreased vision Decreased sense of smell Decreased feeding drive Decreased taste Poor dentition Decreased ability to self feed Dementia Decreased ambulation Constipation Increased effort of breathing Cardiac cachexia Early satiety Slowing of gastric emptying

33. Interventions for Anorexia Food preferences Compatible table companions Adequate rest and sleep Maximize calories at best meal Consume liquids at end of meal Avoid gassy foods Manage constipation, diarrhea Promote oral health Emotional support for family at end of life

34. Non Nutritional Interventions Psychiatric treatment for depression Social activity Exercise, fun activity Social relatedness Caring touch, massages, dancing, eye contact Family video/audiotapes Family therapy Phone volunteers Email �pen pals�

35. Failure to Thrive (FTT) 1890: Described malnourished infants 1970: Yale University described older adults Rapid weight loss, listlessness, death Physiological Psychological Social

36. Organic Etiology (FTT) Malignancy Tuberculosis Heart Failure Uremia Cirrhosis Emphysema Chronic obstructive pulmonary disease Inflammatory bowel disease Thyroid disease Diabetes mellitus Cushing's disease Addison's disease Connective tissue disease Gastrointestinal dysfunction Malabsorption End of life

37. Non Organic Etiologies FTT Neglect Abuse Immobility Dementia Depression Psychosis Medications Poor dentition

38. Maximize Independence Tremors: use heavy handled spoon Arthritis: larger handles on utensils Stroke: Rocker bottom knife Deep dish plate Avoid special diets

39. Nutrition in Dependency Maximize dining experience Minimize noise, odors, distractions Appropriate chair to table height Nutritional assistants Appropriate diet consistency Medicate as needed for pain or discomfort Encourage frequent meals/snacks Encourage fluid intake Obtain frequent weights Use of supplements if poor intake Utilize the expertise of your Dietitian Appetite stimulants as appropriate

40. Food Pyramid for Older Adults