Aging Populations

Heterogenous process of getting older

Longevity is linked with

diet quality and physical activity

Theories of aging: Hayflick’s limited cell replication

human cells have a pre-programed limited ability to divide and after which they go through cellular senescence

Theories of aging: Molecular Clock

reduction of telomeres, shortening the chromsome each division

Theories of aging: Free radical and Oxidative stress theory

• accumulation of reactive oxygen species (ROS) that damages cells and membranes

• Humans have the antioxidant capacity to combat these free radical species which declines with age

despite the theory we all…

age and experience a physiological decline in the major systems of our body

5 physiological changes when old

1. gastrointestinal

2. endocrine

3. musculoskeletal

4. cardiovascular

5. nervous system

Gastrointestinal changes

decline in…

• mastication → ability to mechanical breakdown

• dental health → ability to chew food

• xerostomia → reduce in saliva

• stomach acid and digestive enzymes in the pancreas

• peristalsis → random constriction and relaxation of muscles in the intestines, decreasing rate at which foods go through the body

Endocrine changes

• reduce in estrogen → bone loss

• reduce in testosterone → muscle loss

• decrease in vitamin D production

• dysregulation of ghrelin, insulin and leptin

  • involved in regulating appetite and satiety cues

  • ghrelin → hunger hormone

  • insulin → cant digest sugar

  • leptin → satiety hormone

cardiovascular / musculoskeletal changes

• Thickening of the chamber walls of the left ventricle

  • decrease cardiac output

• Reduction in blood volume

• reduction in bone and muscle mass → lower basal metabolic rate

Nervous system changes

• decay of nerve cells(atrophy) → signaling capacity

• decline in olfactory signaling receptors → taste and smell

  • reduction in appetite → no enjoyment in eating food

  • food safety → cant tell if it went bad

• decline in cognitive function

  • dementia

  • alzheimer’s disease

  • reduced ability to self-feed

TEE declines by ____ there for ____ declines too

age, EER

Calculating EER using the DRI chart

subtract calories to account for the decline in TEE from DRI charts.

• males → subtract 10kcal/day

• females → subtract 7kcal/day

Water function

maintenance of body temperature, vascular volume, transport medium for nutrient and removal of waste

• makes up 60% of our body weight

adequate intake of water

male → 15 cup eq or 3.7L

female → 11 cup eq or 2.7L

water: aging considerations

deficiency in thirst and fluid regulation → forgets they are thirsty

• could result in dehydration and hyper-natreimia (too much sodium in blood)

aging population lack b12 becuase…

1. stomach acid declines

2. intrinsic factor doesn’t release

3. cant digest protein

4. no b12 absorbed

vitamin b12

• obtained from animal source

vitamin b12 deficiency

pernicious anemia → deficiency in cellular division

solution for Vitamin b12 deficiency

b12 injection directly to the blood stream

→ DO NOT advise an elder to eat more animal product to supplement b12 since without intrinsic factor, no matter how much you eat, you will not absorb b12.

what is important consideration in advising elders ?

Delivering the Nutrient requirements while being sensitive to the physiological changes happening with age

• maintaining of autonomy, independence, and social integrity

Challenges following the neurological changes

1. failure to feel hungry or thirsty

2. dementia → reduced ability to be self-fed via memory lost

3. decline in the olfactory receptors → no taste or smell = no appetite

solution for the neurological changes

1. food timer → alarms as reminder to eat and drink

2. eating in a social environment → meals with family and peers

3. select foods with high nutrient density → make every bite matter

   ex. peanut butter, eggs, salmon

4. nutrition supplements → high energy drinks & caloric enhancement powders added to beverages

Challenges: Gastrointestinal changes → Difficulty swallowing

1. Xerostomia → decline in saliva making it painful to eat certain food like whole fruits or insoluble fibers

2. Dysphagia → difficulty swallowing as it slips out of forming food bolus

   • risk for chocking and aspiration → food/liquid entering lungs

   • social concern → anxiety when eating food as it dribbles out the moth

Solutions: Challenges: Gastrointestinal changes → Difficulty swallowing

Provide a diet specific to Dysphagia to improve oral consumption

• level 3: soft solid foods that are easily cut and mashed

  • steamed sweet potatoes, strawberries, bananas, steamed cauliflower

• level 2: chopped softened foods that are mashed

  • mashed sweet potatoes, cottage cheese, peanut butter w soft bread

• level 1: completely pureed to a pudding like consistency. No chewing required

  • pudding, apple sauce, pureed meats and vegetables

  • beverages are THICKENED → promote bolus formation and enhance swallowing of liquids

    ** liquids are harder to swallow as it just slips out of their mouth

level 1 Dysphagia Diet

1. molded into food shapes → maintain independence and social integrity

2. thickening agents are added to increase the viscosity of the liquid without changing the property of the food → starches or agar

3 different consistencies

nectar → mild

honey → moderate

pudding → substantial

Challenges: Challenges: Gastrointestinal changes → reduction in digestive capacity

• decrease in stomach acid and enzymes

  • can’t digest food therefore no nutrient absorbed

Solution: Challenges: Gastrointestinal changes → reduction in digestive capacity

• elemental diet → provide foods that have pre-hydrolyzed lipid, carbs, and protein in liquid form

  • UNBEARABLE TASTE

2 Ways to overcome elemental diet’s unbearable taste

1. Nasogastric tube (NG) → tube through nose

2. Gastric Tube (G-tube) → tube that is surgically placed through the gastric wall

→ both methods bypass tongue so they don’t have to taste the pre-hydrolyzed

Challenges: Endocrine Changes → loss of lean muscle and bone density

Sarcopenia → muscle wasting as a natural result of aging

Osteoporosis → severe decrease in bone mineral density, creating a porous bone that is fragile and susceptible to breaks

Kyphosis → significant curvature of the spine

Solution: Endocrine Changes → loss of lean muscle and bone density

• promote dietary adequacy of

  • high-quality protein → muscle loss

  • calcium → bone holes

  • vitamin D

• use it or lose it → work the muscles

Food insecurity in aging population

7 million americans aged 60 and above are moderate to high food insecurity

• cause → financial, accessibility, cognitive function, health status

pension

a fund in which u make regular payments during working days then get distributed as routine payments once one retires

personal savings

personal saving for retirement

social security

today’s working force pay social security taxes for the elders to get monthly

Medicare

healthcare service for 65 yrs or older.

• part B → covers medical expenses and prescribed drugs and Medical Nutrition services

Medicare: Medical Nutrition services

→ nutrition / life style assessment and management, nutritional therapy,

• may cover medical nutrition therapy (MNT)

• definitely covers individuals with diabetes or kidney disease

• MNT can only be conducted by registered dietitian and a referral by a physician

Older American Act: nutrition services program

federal initiative to provide comprehensive support nutrition services to senior citizens aged 60 and older

• provide at least one meal per day with the consultation of a registered dietitian

• meal must adhere to the dietary guidelines and each meal must provide a third of the DRIs

• sanitary handling of foods

Goals of Older American Act: nutrition services program

1. reduce hunger and food insecurity

2. promote the socialization of older adults

3. promote the health and well-being of older individuals by assisting to access nutrition services

Congregate Nutrition Programs

promotes socialization and maintenance of independence,

• meal service in a group setting → senior community center / adult daycare

• transportation provided

• nutrition education programs offered quarterly by a registered dietitian

Home delivered nutrition programs

meals on wheels → fresh, frozen, dried, or canned