SP Lecture 2: Nutrition in the Older Adult

What age range defines the 'young old'?

65-74

What age range defines the 'middle old'?

75-84

What age defines the 'oldest old'?

85+

By 2040, what percentage of the US population will older adults make up?

21%

More than half of adults ≥65 live in which nine states? (select all that apply)

1. CA 2. FL 3. NY 4. TX 5. PA 6. OH 7. IL 8. MI 9. NC

What are the leading chronic diseases causing death among US adults ≥65? (select all that apply)

1. Heart disease 2. Cancer 3. Chronic bronchitis 4. Chronic lower respiratory diseases 5. Stroke 6. DM 7. Alzheimer's

On average, how many chronic health problems does an older adult have?

3

On average, how many prescription drugs does an older adult use?

5

Because aging changes nutrition needs, what dietary quality becomes especially important in older adults?

Nutrient density

What can preventative care do for older adults?

Promote a high-quality life while preventing health-related issues

How does decreased water intake affect oral health in the elderly?

Poor dentition/enamel

What is xerostomia?

Decreased saliva

What dental consequence does xerostomia cause?

Poor dentition

Xerostomia has greater occurrence with how many daily prescription medications?

>4

What nutritional chain results from poor dentition?

Decreased food/water intake → malnutrition/dehydration

What causes impaired taste in older adults? (select all that apply)

1. Decreased number of taste buds 2. Medications 3. Infection 4. Reduced saliva

How often do taste buds change?

Every 2 weeks

At what age does taste bud atrophy begin in women?

Age 40

At what age does taste bud atrophy begin in men?

Age 50

What is the taste threshold?

The minimum amount required to detect a specific taste

How does the taste threshold change with age?

It increases

Which tastes have an increased threshold with age? (select all that apply)

1. Bitter 2. Sour 3. Umami 4. Salty 5. Sweet

What causes impaired smell in older adults? (select all that apply)

1. Medications 2. Reduction in nasal mucous 3. Reduced nerve signaling

Is dysphagia caused by normal aging?

No — it is caused by pathology, not normal aging

In which conditions is dysphagia most common? (select all that apply)

1. Stroke 2. Parkinson's 3. Alzheimer's 4. Dementia

What underlying diseases cause GERD in older adults? (select all that apply)

1. Reduced lower esophageal sphincter 2. Reduced peristalsis 3. Hiatal hernia 4. Gastroparesis

How does aging change gastric HCl and digestive secretions?

Reduced digestive secretions (decreased HCl), which affects absorption

How does aging affect gastric motility?

Slows it

Which medication class is named as affecting digestion in older adults?

Narcotics

How do medications that treat GERD change stomach pH?

Raise pH (make the stomach less acidic)

Why do GERD medications impair vitamin B12 absorption?

B12 needs acid to bind with intrinsic factor for absorption

What bone-related effect can PPIs have?

Increase bone resorption and accelerate calcium loss

Which form of calcium supplementation is needed in patients on PPIs?

Calcium citrate

How can aging affect the small intestine?

Changes in the microbiome and in the ability to respond to infections

What is the most common age-related motility disorder of the large intestine?

Constipation

What does the large intestine reabsorb? (select all that apply)

1. Water 2. Electrolytes 3. Bile salts 4. Short-chain fatty acids

What are age-related cardiovascular changes? (select all that apply)

1. Reduced tolerance to physical stress 2. Decreased ability to utilize oxygen

What is the leading cause of death in the US?

Cardiovascular disease

How does aging contribute to primary hypertension?

Blood vessel stiffening and endothelial dysfunction

What dietary factor has a direct relationship with the vascular changes seen in HTN?

Increased sodium

What are the age-related respiratory changes? (select all that apply)

1. Decreased alveolar surface 2. Decline in optimum breathing power and voluntary ventilation 3. Increased risk of infection in the frail and malnourished

Which older adults have the highest respiratory infection risk?

The frail and malnourished

What are the age-related renal changes? (select all that apply)

1. Reduced ability to concentrate urine 2. Reduced renal blood flow 3. Reduced number of glomeruli

What are the age-related genitourinary changes? (select all that apply)

1. Enlarged prostate 2. Incontinence

Which nutrients should be adequate to prevent or delay osteoporosis? (select all that apply)

1. Calcium 2. Vitamin D 3. Phosphorus

What type of regular exercise helps prevent osteoporosis?

Weight-bearing exercise

Which lifestyle modifications help prevent osteoporosis? (select all that apply)

1. Avoiding tobacco 2. Alcohol in moderation 3. Maintaining a healthy body weight

What is sarcopenia associated with? (select all that apply)

1. Nutritional inadequacy 2. Increased disability 3. Functional dependence

How does fat mass change with aging?

Increases (obesity)

What causes unintentional weight loss in older adults? (select all that apply)

1. Polypharmacy 2. Social circumstances 3. Economic circumstances 4. Environmental circumstances

What causes sarcopenic obesity?

Low-quality diet and inactivity

What is the normal body water percentage in adults?

55-65% (men and women)

What is the normal body fat percentage in adult men?

15-20%

What is the normal body fat percentage in adult women?

20-30%

What percentage of calories should come from complex carbs in older adults?

45-65%

What are dietary fiber needs in older adults?

25-35 g/day

What percentage of calories should come from fat in older adults?

20-35%

Which fats should be included for variety?

Omega-3 and omega-6

What are protein needs in older adults?

0.8-1.0 g/kg

What is the minimum daily fluid intake for older adults?

1500 mL/day

What is the fluid requirement for ages 55-65?

30 mL/kg/day

What is the fluid requirement for ages >65?

25 mL/kg/day

Is alcohol classified as a nutrient?

No

How many kcal/g does alcohol yield?

7 kcal/g

Why do older adults reach higher blood alcohol levels?

Body water content decreases with aging

What are the functions of vitamin A? (select all that apply)

1. Vision 2. Bone development 3. Antioxidant 4. Immunity

What special consideration applies to vitamin A in older adults?

Increased absorption of retinol with age

Deficiency of which vitamins is linked to aging/chronic disease-related oxidative stress? (select all that apply)

1. Vitamin A 2. Vitamin E 3. Vitamin C

What are the functions of vitamin D? (select all that apply)

1. Bone health 2. Cardiovascular disease

What does vitamin D deficiency cause? (select all that apply)

1. Osteoporosis 2. Bone fractures 3. Muscle weakness

What special consideration applies to vitamin D in older adults?

Increased dietary dependence with age

What are the functions of vitamin E? (select all that apply)

1. Antioxidant in eye-related diseases 2. Inflammation 3. Heart disease

What caution applies to vitamin E supplementation?

Caution when using anticoagulants

What are the functions of vitamin K? (select all that apply)

1. Blood clotting 2. Bone formation

What does vitamin K deficiency cause?

Osteoporosis

What is the special consideration for vitamin K in older adults?

Encourage adequate vegetable intake

Which vitamins function as coenzymes in RBC formation? (select all that apply)

1. B12 2. B6 3. Folate

What does B12 deficiency cause? (select all that apply)

1. Pernicious anemia 2. Cognitive decline

Why is B12 absorption poor in older adults?

B12 needs HCl for absorption, which declines with age (and PPIs decrease HCl)

What does B6 or folate deficiency cause? (select all that apply)

1. Anemia 2. Dementia

What special consideration applies to B6 in older adults?

High metabolic turnover with age

What has improved folate status in the population?

Fortification

What are the functions of vitamin C? (select all that apply)

1. Antioxidant 2. Connective tissue 3. Hormones 4. Neurotransmitter synthesis

What special consideration applies to vitamin C in older adults?

Possible decreased absorption with age

What is the function of thiamine?

Energy metabolism

What does thiamine deficiency cause? (select all that apply)

1. Beriberi (wet/dry) 2. Wernicke-Korsakoff

In which adults is thiamine deficiency most common?

Adults with alcohol addiction

Which features describe older Hispanic Americans compared with older adult Americans? (select all that apply)

1. Less educated, higher poverty rate 2. Lower rate of cardiovascular disease, cancer, lung disease, and stroke 3. Higher rate of DM 4. More required assistance with personal care

Which features describe older African Americans compared with older adult Americans? (select all that apply)

1. Higher poverty rate 2. Higher rate of HTN (similar rates of other chronic diseases) 3. Similar life expectancy 4. Higher rate of no health insurance

Which features describe older Native Americans compared with older adult Americans? (select all that apply)

1. Higher prevalence of multiple chronic conditions, high rate of DM and stroke 2. Lower life expectancy 3. Rural areas, less access to health care

Which features describe older Asian and Pacific Islanders compared with older adult Americans? (select all that apply)

1. Highest rate of smoking, alcohol intake, obesity 2. Longest life expectancy 3. May use traditional medicine 4. Diet becoming more Americanized 5. Overweight and obesity in Hawaiians

Which features describe older Caucasian Americans compared with older adult Americans? (select all that apply)

1. Highest median age 2. Lower incidence of HTN and DM 3. Arthritis (women) 4. Heart disease (men)

Which older minority group has the longest life expectancy?

Asian and Pacific Islanders

Which older minority group has the lowest life expectancy?

Native Americans

Which older group has the highest median age?

Caucasian Americans

In the hospital, how many calories is a 'carb 3' diabetic diet?

1500 calories

In the hospital, how many calories is a 'carb 4' diabetic diet?

1800 calories

In the hospital, how many calories is a 'carb 5' diabetic diet?

2000 calories

What method is used to teach a diabetic diet at home?

MyPlate method

What carbohydrate-pairing advice is given to diabetics at home?

Don't eat carbohydrate alone — pair it with protein/fat