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• NUTRITION DURING THE ADULT YEARS
• -ALVIC S. RODA, RN, MN, MBA, MPA, LPT

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Learning Outcomes

• Discuss the factors that affect the rate of aging
• Describe how physical and physiological
  changesthat occur during adulthood affect
  nutritionneeds
• Know the current nutrition recommendations
  forelderly adults
• Describe community nutrition services for
  olderpersons

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Learning Outcomes

• Identify nutrition-related health issues of
  theadult years and describe the prevention
  andtreatment of these health problems
• Lists the potential benefits and risks
  associatedwith the use of complementary and
  alternativemedicine practices

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What age is considered elderly?

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What age is considered elderly?

• No single, chronological timetable of human
  agingexists.
• Genetics, lifestyle, and disease processes
  affectthe rate of aging
• Assessment of nutritional risk depends on
  avariety of factors
• Separate nutrition recommendations for 51-70
  and70
• Assess overall health, quality of life

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Leading causes of death

• Heart disease 616,067
• Cancer 562,875
• Stroke (cerebrovascular diseases) 135,952
• Chronic lower respiratory diseases 127,924
• Accidents (unintentional injuries) 123,706
• Alzheimer's disease 74,632
• Diabetes 71,382
• Influenza and Pneumonia 52,717
• Nephritis, nephrotic syndrome, and
  nephrosis46,448
• Septicemia 34,828

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As we age

• Around age 2530 the average maximum
  attainableheart rate declines by about one beat
  per minute,per year
• Hearts peak capacity to pump blood drifts downby
  510 per decade.
• This diminished aerobic capacity can
  producefatigue and breathlessness with modest
  activity.

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As we age

• Starting in middle age blood vessels begin
  tostiffen and blood pressure often creeps up.
• Blood becomes more viscous and harder to
  pumpthrough the body, even though the number
  ofoxygen-carrying red blood cells declines.
• Nutrition recommendations low sodium
  diet(1500-2000 mg/day) with potassium rich
  foods(DASH), omega 3s found in fish help thin
  blood

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As we age

• Blood sugar levels rise by about 6 points
  perdecade, making type 2 diabetes
  distressinglycommon in elderly.
• Nutrition recommendations avoid excess
  weightgain, encourage activity

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As we age

• In men, testosterone declines by about 1 peryear
  after the age of 40 leading to a drop inmuscle
  mass and bone density.
• In women bone loss mainly occurs after
  menopause(estrogen loss)
• Nutrition recommendations
• Calcium requirements increase (from 1000mg
  to1200 mg after age 50 in women, 1200 mg after
  age70 in men)
• Vitamin D requirements increase (from 15 ug/d
  to20 ug/d after age 70)

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As we age

• Slowing of the digestive tract,
  decreaseddigestive secretions
• Dietary changes, activity changes,
  andmedications can also play causal role
• Nutrition recommendations
• Increased fiber needs, 21 g for women and 30
  gfor men
• Diet that includes nuts, fruits, veg, and
  wholegrains should provide fiber needs
• Fluid, exercise can also help constipation

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Why are the elderly at risk for malnutrition?

• Sensory Changes
• Change in taste, smell
• Nutrition recommendations
• Ensure adequate intake of zinc
• Try and variety of new flavors, experiment
  withdifferent types of low sodium seasonings
• Dont over cook food

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Why are the elderly at risk for malnutrition

• Structural changes
• Loss of lean mass
• Decreased RMR
• Too many calories for decreased RMR results
  inincreased fat
• This extra fat contributes to a rise in
  LDLcholesterol and a fall in HDL cholesterol
• Nutrition recommendations
• Protein needs 0.8g/kg depending on disease state
• Activity
• Heart healthy diet low in saturated fat and
  transfat and with nutrient dense foods to
  preventweight gain

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Why are the elderly at risk for malnutrition

• Loss of body water
• 72 of total body water is in lean muscle
• Can lose sense of thirst, forgetting to
  drink,frequent urination due to meds
• Recommend 5-8 cups fluid daily

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Why are the elderly at risk for malnutrition

• About 30 of older people in N. America have
  lostall their teeth
• Nutrition recommendations
• Focus on nutrient dense foods
• May need soft, moist forms of protein
  (groundmeat, tofu, beans, eggs, tuna, etc)

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Why are the elderly at risk for malnutrition

• 20 of nursing home residents and 5-10 of
  olderpeople outside of nursing homes suffer
  fromdepression
• Other barriers to healthy eating
  includefinancial barriers, difficulty cooking
  for one,limited resources for shopping and
  preparing food
• Adequate social support and possiblypsychological
  interventions are important

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Why are the elderly at risk for malnutrition

• 1/3 of alcohol abuse begins later in life
• Due to more free time, loneliness,
  depression,more social events with alcohol
• Older adults have less body water to
  distributealcohol and metabolize alcohol slower
• Alcohol can deplete B vitamins
• Nutrition recommendations
• Men and women over 65 should limit alcohol to
  1drink/day (12 oz beer, 1.5 oz shot, 5 oz wine)

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Why are the elderly at risk for malnutrition

• Increased risk of food borne illness due to
• Weaker immune systems
• Decreased stomach acid needed to
  controlbacteria.

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Prevent food borne illness

• Raw, rare or undercooked meats, poultry, and
  fish(rare hamburgers and beef or steak
  tartare,sushi)
• Undercooked and raw shellfish (clams,
  oysters,mussels and scallops)
• Unpasteurized dairy products, fruit and
  vegetablejuice (raw milk and cheeses)
• Raw or undercooked eggs (soft-cooked, runny
  orpoached)
• Washing hands, washing counters where raw
  meatwas handled, proper thawing, not using
  expiredproducts

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Medication interactions

• ¼ of elderly adults take multiple
  prescriptionmedications
• Different medications can affect
  appetite,absorption of nutrients
• Some medications cannot be taken with
  certainfoods and certain foods can interfere
  with theiraction

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Nutrition needs change

• Iron-too much iron is a pro oxidant,
  onlysupplement if iron deficiency anemia
• DRI for women 51 decreases to 8 mg
• B12 is common deficiency due to decreased
  gastricacid (needed to free B12 from food)
• Deficiency associated with pernicious
  anemia,nerve damage, cognitive decline
• DRI is 2 ug/d (no change), however supplements
  orfortified foods are better absorbed than B12
  infood

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Nutrition needs change

• Vitamin B6 requirement is increased
  withadvancing age, although the reasons for this
  areuncertain
• Deficiency can lead to irritability,
  depression,and confusion additional symptoms
  includeinflammation of the tongue, sores or
  ulcers ofthe mouth
• Anti-Parkinson drugs form complexes with
  vitaminB6 and thus create a functional
  deficiency.
• DRI increases from 1.1 mg to 1.4 mg in men
  and1.3 mg in women after age 50

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Nutrition needs change

• Calcium and vitamin D insufficiency can lead
  toincreased risk of osteoporosis.
• A decrease in the intestinal absorption
  ofcalcium
• The kidneys are less able to retain
  calcium,leading to increased urinary calcium
  loss
• Less frequent exposure to sunlight
• A decrease in the capacity of the skin
  tosynthesize vitamin D
• A decrease in the capacity of the kidneys
  toconvert vitamin D into the most active
  form,1,25-dihydroxyvitamin D
• Calcium requirements increase (1200 mg after
  age50 in women, 1200 mg after age 70 in men)
• Vitamin D requirements increase (20 ug/d
  afterage 70)

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Recommendations

• If exercise were a pill it would be the
  mostprescribed medication in the world

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Recommendations for exercise

• Endurance exercise improves cardiovascularfunctio
  n, lowers blood pressure, protects againstwt
  gain, improves insulin sensitivity,
  improvecholesterol. Recommendation is 30 min
  most daysof the week.
• Resistance exercise and flexibility training
  20minutes two or three times a week
• Exercises for balance will help avoid
  injuriesand prevent the falls

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How to age well

• Exercise
• Eat properly for heart health and
  weightmanagement
• May need supplemental calcium, D, and B12
• Drink plenty of water
• Limit to 1 alcoholic drink a day
• Keep the mind active and stimulated
• Build strong social networks
• Get regular medical care

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Nutrition products targeted to elderly

• Multivitamins for people over 50
• No iron
• Extra D, B12, and B6
• Added lutein and lycopene
• Vitamins for memory
• Omega-3
• Vitamin B-12 and B-6
• Vitamin D-3
• Meal replacement products
• Protein Drinks
• 300-350 kcal, 10-20 grams protein, low
  saturatedfat 

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