Study Guide: Chapter 14 - Nutrition for Older Adults

1. Physiologic Changes with Aging & Impact on Nutrition

• Digestive System Changes:

  • Reduced stomach acid (achlorhydria) affects nutrient absorption (e.g., vitamin B12, calcium, iron).

  • Slower gastric emptying and reduced enzyme production lead to digestive discomfort.

• Metabolic Changes:

  • Basal metabolic rate (BMR) declines, reducing energy needs.

  • Decreased insulin sensitivity increases the risk of type 2 diabetes.

• Muscle & Bone Changes:

  • Sarcopenia (muscle loss) affects mobility and increases protein needs.

  • Bone density decreases, increasing the risk of osteoporosis and fractures.

• Taste & Smell Decline:

  • Alters appetite and food choices, leading to potential nutrient deficiencies.

• Dental & Oral Health Issues:

  • Tooth loss, gum disease, and dry mouth make eating difficult, impacting nutrient intake.

• Cognitive Changes:

  • Dementia and Alzheimer’s can lead to forgetfulness about eating or difficulty with meal preparation.

2. Increased Protein Needs in Older Adults

• Muscle Preservation: Prevents sarcopenia and maintains functional independence.

• Immune Function: Supports wound healing and resistance to infections.

• Recommended Intake:

  • Older adults should aim for 1.0-1.2 g of protein/kg body weight (higher than the 0.8 g/kg RDA for younger adults).

  • Sources: Lean meats, fish, dairy, eggs, legumes, and soy products.

3. Need for Calcium, Vitamin D, and Vitamin B12 Supplementation

• Calcium:

  • Bone loss accelerates with age, increasing the risk of osteoporosis.

  • Recommended intake: 1,200 mg/day for adults over 50.

  • Sources: Dairy products, leafy greens, fortified plant-based milk.

• Vitamin D:

  • Necessary for calcium absorption and bone health.

  • Reduced skin synthesis and dietary intake in older adults.

  • Recommended intake: 800-1,000 IU/day.

  • Sources: Fortified dairy, fatty fish, sunlight exposure.

• Vitamin B12:

  • Reduced stomach acid affects B12 absorption, leading to potential deficiency and neurological issues.

  • Recommended intake: 2.4 mcg/day from fortified foods or supplements.

4. Mediterranean Diet & Healthy Aging

• Characteristics:

  • Emphasizes plant-based foods (fruits, vegetables, whole grains, legumes, nuts).

  • Healthy fats from olive oil and fatty fish.

  • Moderate red wine intake.

  • Limited processed foods and red meat.

• Health Benefits:

  • Supports cardiovascular health by reducing cholesterol and blood pressure.

  • Anti-inflammatory properties help protect against cognitive decline and neurodegenerative diseases.

  • Reduces the risk of metabolic syndrome and type 2 diabetes.

5. MIND Diet vs. Mediterranean Diet

• MIND (Mediterranean-DASH Diet for Neurodegenerative Delay):

  • Combines the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets.

  • Focuses on brain health and cognitive decline prevention.

• Key Differences:

  • Greater emphasis on leafy greens and berries.

  • Encourages whole grains, beans, nuts, fish, and poultry.

  • Limits butter, cheese, red meat, fried food, and sweets.

• Cognitive Benefits:

  • Research suggests it lowers the risk of Alzheimer's and slows cognitive aging.

6. Malnutrition Screening Criteria in Older Adults

• Unintentional Weight Loss (>5% in 3 months or >10% in 6 months).

• Low BMI (less than 18.5 kg/m² in younger seniors, <22 kg/m² in frail elderly adults).

• Reduced Food Intake (due to appetite loss, difficulty chewing/swallowing, or gastrointestinal issues).

• Muscle Loss & Weakness (sarcopenia-related malnutrition).

• Poor Hydration Status (increased risk of dehydration due to reduced thirst sensation).

• Micronutrient Deficiencies (iron, vitamin D, B12, and folate deficiencies are common).

7. Liberal Diets in Long-Term Care Facilities

• Traditional vs. Liberalized Diets:

  • Traditional: Restrictive, focused on disease management (e.g., low-sodium, diabetic diets).

  • Liberal: Prioritizes quality of life and individual food preferences over strict dietary rules.

• Benefits of Liberal Diets:

  • Encourages better food intake and weight maintenance.

  • Improves meal enjoyment and psychological well-being.

  • Reduces risk of malnutrition and pressure ulcers.

  • Enhances socialization at mealtimes.

8. Strategies for Enhancing Food Intake in Long-Term Care Residents

• Improve Meal Presentation & Taste:

  • Use herbs and spices to enhance flavor without excess salt.

  • Ensure visually appealing food to stimulate appetite.

• Modify Food Textures:

  • Provide soft or pureed options for those with chewing/swallowing difficulties.

• Encourage Social Dining:

  • Create communal eating experiences to promote engagement.

• Offer Nutrient-Dense Snacks:

  • Provide high-protein and high-calorie options like yogurt, nuts, or smoothies between meals.

• Address Special Needs:

  • Accommodate dietary preferences and cultural food choices.

  • Provide adaptive utensils for those with limited mobility.

9. Effects of Alzheimer’s Disease on Nutrition

• Cognitive Impairment:

  • Forgetting to eat or drink, leading to malnutrition and dehydration.

• Changes in Taste & Smell:

  • Reduced ability to recognize flavors, leading to a disinterest in food.

• Difficulty Chewing & Swallowing:

  • Dysphagia increases the risk of choking and aspiration pneumonia.

  • Pureed or thickened foods may be necessary.

• Behavioral Challenges:

  • Agitation, wandering, or refusal to eat.

  • Encourage calm, routine mealtimes in a quiet environment.

• Nutritional Interventions:

  • Provide nutrient-dense small meals.

  • Finger foods can aid independent eating.

  • Hydration reminders to prevent dehydration.

Conclusion

Proper nutrition plays a crucial role in promoting healthy aging. Addressing physiological changes, nutrient needs, malnutrition risks, and dietary patterns can help support the well-being of older adults. Individualized approaches, liberalized diets, and support for those with cognitive impairments can significantly enhance quality of life and longevity.