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Nutrition in Older Adults

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Weight loss associated with decline in bone mineral density. Protein energy undernutrition ... Involuntary weight loss/gain. Need of assistance with self-care ... – PowerPoint PPT presentation

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Title: 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 gt65 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 lt1000 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 gt60-70 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
  • lt10 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_so
    lutions_mna.html
  • Meals on Wheels
  • http//www.fpnotebook.com/END31.htm
  • Mini Nutritional Assessment
  • http//www.nestleclinicalnutrition.com/frameset_so
    lutions_mna.html
  • Dysphagia Evaluation
  • http//www.mmhc.com/nhm/articles/NHM9912/cefalu.ht
    ml

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
  • lt 3.5 mg/dl
  • variable
  • lt 200 mg/dl
  • lt 1500 cm3
  • lt 150 mg/dl

26
Body Mass Index (BMI)
  • Weight in kg/Height in m2
  • lt18 Underweight
  • 18.1-25 Normal
  • 25.1-30 Overweight
  • 30.1-35 Obesity class 1
  • 35.1-45 Obesity class 2
  • gt45.1 Morbidly Obese
  • Mortality increased with BMI lt 20 gt 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 lt ½ 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 lt 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
Gerald J. and Dorothy R. Friedman School of
Nutrition Science and Policy.
http//nutrition.tufts.edu/publications/pyramid.sh
tml
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