Nutrition and Older Adults Notes

Chapter 18: Nutrition and Older Adults

Life Expectancy and Nutrition

• Life expectancy is increasing, necessitating adequate nutrition for older adults.
• The United Nations data indicates trends in life expectancy over the years.

Physiological Changes and Nutritional Needs

• Normal aging is associated with shifts in body composition and loss of physical resilience.
• Table 18.3 outlines physiological system changes.
• There is a need for a heart-healthy diet.
• Older adults are at risk of malnutrition due to lower food intake, digestion, and absorption.

Age-Associated Physiological System Changes (Table 18.3)

• Musculoskeletal System:
  • Reduced lean body mass (bone mass, muscle, water).
  • Increased fat mass leading to a decreased resting metabolic rate.
  • Reduced work capacity (strength).
• Nervous System:
  • Blunted appetite regulation.
  • Blunted thirst regulation.
  • Decline in olfactory receptors, blood flow to nasal smell organ, and increased thickness of nasal mucus.
  • Reduced nerve conduction velocity, affecting sense of smell, taste, touch, cognition.
  • Changed sleep patterns, with the wake cycle becoming shorter.
• Renal System:
  • Reduced number of nephrons.
  • Slowed glomerular filtration rate.
• Respiratory System:
  • Reduced breathing capacity.
  • Reduced work capacity (endurance).
• Note: Some age-associated changes, like increased blood pressure, are usual but not normal.

Nutrition Risk Factors

• Factors that potentially place older adults at nutritional risk:
  • Hunger, poverty, low food & nutrient intake.
  • Functional disability.
  • Social isolation.
  • Urban & rural demographic areas.
  • Depression, dementia, dependency.
  • Poor dentition & oral health.
  • Acute or chronic diseases.
  • Polypharmacy.
  • Minority status.
  • Advanced age.
• Identifying risk factors before chronic illness develops is basic to health promotion.

Nutrition Assessment Checklists

• Integrates a list of warning signs of poor nutritional health in older adults.
• The purpose of the checklist is primary intervention (preventing malnutrition before it begins).
• Examples: DETERMINE, MNA, MUST.

Validity of NSI DETERMINE

• Results are mixed.
• Weakly predicts mortality.
• Does not consistently identify all individuals in poor health/low nutrient consumption.
• Alerts older individuals of potential risk factors.

Dietary Recommendations

• Food-Based Guidance: MyPlate.
• Groups like Tufts & UF have developed plate adaptations for older adults.
• Plate adaptations include:
  • Greater nutrient density.
  • Addition of fluids/water.
  • Functional ability-appropriate physical activity.
  • Addition of vitamin-mineral supplements.

MyPlate for Older Adults

• Includes dairy, fruits, grains, vegetables, and protein.
• Recommendations:
  • Choose fiber-rich foods often.
  • Drink water and other beverages that are low in added sugars.
  • Use fortified foods or supplements to meet vitamin D and vitamin B12 needs.
• Vegetables:
  • Vary your veggies.
  • Eat more dark-green veggies, like broccoli, salad greens, and cooked greens.
  • Eat more orange vegetables, such as carrots and sweet potatoes.
  • Eat more dried beans and peas, like pinto, black, or kidney beans, and lentils.
• Fruits:
  • Focus on fruits.
  • Eat a variety of fruits, like bananas, berries, grapes, and oranges.
  • Choose fresh, frozen, canned, or dried fruit.
  • Eat fruit rather than drinking juice for most of your fruit choices.
• Grains:
  • Make half your grains whole.
  • Eat at least 3 oz. of whole-grain cereals, breads, rice, crackers, or pasta every day.
  • 1 oz. is about 1 slice of bread, 1 cup of cold breakfast cereal, or ½ cup of cooked cereal, rice, or pasta.
  • Eat cereals fortified with vitamin B12.
• Protein Foods:
  • Go lean with protein.
  • Choose low-fat or lean meats and poultry.
  • Bake, broil, or grill.
  • Vary your protein sources.
  • Include eggs, dried beans, tofu, fish, nuts, and seeds.
• Dairy:
  • Get your calcium-rich foods.
  • Choose low-fat or fat-free milk, yogurt, and other milk products.
  • If you don't or can't consume milk, choose lactose-free products or other calcium sources, such as fortified foods and beverages.
• For an 1,800-calorie diet:
  • Eat 2\frac{1}{2} cups of vegetables every day.
  • Eat 1\frac{1}{2} cups of fruit every day.
  • Eat 6 oz. of grains every day.
  • Eat 5 oz. of protein every day.
  • Eat 3 cups of dairy every day.
• Eat Right:
  • Choose foods rich in fiber to help keep you regular.
  • Drink plenty of fluids to stay hydrated.
  • Limit sweets to decrease empty calories.
  • Get your oils from fish, nuts, and liquid oils such as canola, olive, corn or soybean oils.
  • Choose and prepare foods with less salt or sodium.
  • Talk to your doctor or pharmacist about supplements you are taking.
• Be Active:
  • Go for a walk.
  • Play with your grandchildren and/or a pet.
  • Work in your yard or garden.
  • Take an exercise or dance class at a community center or gym.
  • Share a fun activity with a friend or family member.
  • Remember: all activity adds up! You don't have to do it all at once.
• Enjoy Life: Spend time with caring people doing things you enjoy.

Nutrient Recommendations

• Decrease in physical activity & BMR from early to late adulthood results in lower caloric requirements.
• Often without a decrease (or even an increase) in nutrient needs.

Fiber, Protein & Fat

• Ensure adequate fiber for GI health.
• ~95% of older adults have sufficient protein intake.
• Inactive, older adults living alone may have low protein intakes.
• Several researchers report protein needs for older adults are 1 to 1.5 g/kg body weight (higher than the DRI of 0.8 g/kg).
• Minimize saturated fat & keep total fat between 20 to 35% of calories.

Recommendations for Fluid

• % body water decreases with age, resulting in a smaller margin of safety for staying hydrated.
• ≥6-8 cups of fluid/day will prevent dehydration in most older adults.

Age-Associated Changes in Metabolism: Nutrients of Concern

Vitamin D

• Needed for Ca absorption and bone maintenance.
• Factors that put older adults at risk for deficiency:
  • Insufficient dietary intake.
  • Limited exposure to sunlight.
  • Decreased ability to use UV rays to activate vit D precursor.
  • Medications may interfere with vitamin D metabolism.
• RDA (71+) - 800 IU/d (20 µg/d) compared to 600 IU for adults under 70.

Vitamin B12

• Needed for DNA and RNA synthesis, healthy nervous system.
• Deficiency can lead to cognitive and motor decline.
• Can be mistaken for “normal” ageing process.
• Despite adequate intake, ~30% of older adults have low serum B12 levels.
• B12 in food is bound to protein and needs to be separated from the protein in the stomach and then attach to intrinsic factor (IF) produced in the stomach.
• Gastric HCl & pepsin needed to split B12 from protein carriers.
• IF produced in stomach.
• In cases of atrophic gastritis, HCl, pepsin, and IF not produced in sufficient quantities.
• Synthetic or purified B12 is not protein bound and is much better absorbed.

Iron

• Needed for transport of oxygen.
• Iron needs decrease after menopause.
• RDA = 8 mg/kg (same as in men).
• Most older adults consume more iron than needed.
• Excess iron contributes to oxidative stress.
• Some older adults may have iron deficiency.
  • Iron loss from disease or medications.
  • Decreased acid secretion.

Calcium

• Needed for muscle and nerve activity and bone maintenance.
• High intake associated with lower blood pressure.
• Calcium RDA
  • Adult: 1000 mg/d
  • >51 years (women): 1200 mg/d
  • >70 years (men): 1200 mg/d
• Broad consensus; 1000-1500 mg/d to ensure skeletal optimization across the population at all age groups after childhood.

Nutrient Supplements

• Many older adults do not need supplements.
• When to consider supplements:
  • May be useful with those who:
    • Lack appetite resulting from illness, loss of taste or smell, or depression.
    • Have diseases of GI tract.
    • Have a poor diet due to food insecurity, loss of function, or disinterest.
    • Avoid specific food groups.
    • Take medication or other substances that affect absorption or metabolism.

Food Safety Recommendations

• Older adults with compromised immune status are more vulnerable to foodborne illness.
• Leading hazardous practices:
  • Improper holding temperatures.
  • Poor personal hygiene.
  • Contaminated food preparation equipment.
  • Inadequate cooking time.

Physical Activity Recommendations

• Exercise guidelines:
  • At least 150 min/week for general health.
  • Strength training 2 or more times/week.
  • Drink water while exercising.
• Evaluation is needed to identify contraindications to specific exercise.
• Resistance or weight-bearing activities.
• Aerobic exercise.