Upload
nfacma
View
216
Download
0
Embed Size (px)
DESCRIPTION
S
Citation preview
Nutrition in AgingPart 2
Nurpudji A. TaslimNutrition Department
School of MedicineHasanuddin University
@ 2005
NUTRITIONAL NEEDS Energy
Decreased requirement (changes in body composition, ↓ BMR, ↓ physical activity) Calculation Energy need BW, BEE, REE/TEE, actual BW Average calories intake:
♂ 2000 kcal/day♀ 1600 kcal/day
•Protein•Campbell,1996
- protein intake 1g /kg BB - stress-full physical & psychological stimuli negative nitrogen balance-infection altered GI function & metabolic changes reduce efficiency of dietary nitrogen and increased nitrogen excretion
Biomarker Albumin indicator of protein status Pre-albumin and RBP evaluate response to therapy
Carbohydrate Needed to protect protein from being used as energy
source Approximately 45 -65% of total energy Complex carbohydrate legumes, vegetables, whole
grains & fruits to provide phylochemical & essential vitamins & mineral
Lipid 25-35% of total energy Reduced SFA Reduced fat weight control & cancer prevention Consumption of fat < 10% affect quality of diet and
negatively affect taste, satiety & intake.
Mineral Poor mineral status inadequate dietary intake, physiologic
changes affect the need for a nutrient & medications Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need dietary modification
Decrease Ca transport osteoporosis & hypochlorhydria Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)
Vitamins Oxidative mechanism play an important role in the aging process Antioxidant vitamins : tocopherols, carotenoids, vit C Cell damaged accumulate certain disease, e.g catarac, heart
disease, cancer (Ausman & Mayer, 1999)
Vitamin A Fescanich et al,2002: high losses of vitamin A hip
fracture Sources of vitamin A dark green, leafy & yellow-orange
fruits and vegetables provide adequate food excessive β-carotene precursor vitamin A
Vitamin C Older adult have lower serum level of vitamin C Vitamin C requirement increase : stress, smoking,
medication Encouraging the consumption of vitamin C-rich food
most effective
Vitamin D
Depend on concentration of calcium and phosphorus in the diet
Age, sex, degree of exposure to sunlight ( decreased 60%)
Function– heal skin lesions—psoriasis, hyperproliferative disorder of cancer, actinic keratoses
Need moderate supplementation of vitamin D and calcium—improve bone density and prevent bone fracture (Dawson-Hughes 1977)
VITAMIN E
Epidemiologic studies Vit E reduce the risk of CVD by
reducing the susceptibility of LDL to oxidationvascular endothelial cell expression of proinflammary cytokine (Meydani, 2001)
Vit Ecancer prevention
Vitamin B6
Many studiesolder adults do not consume enough B6
Atrophic gastritis, alcoholism&liver dysfunctionrequirement
Severe deficiencyhomocysteine levelanemia&risk for cardiac disease
Encouragedfolate rich foodliver, dried beans, broccoli, avocado, asparagus&spinach
Vitamin B12
Elderly need screening for B12 Prevalence 10-15% in age 60 (Baik&
Russel, 1999), cause: athropic gastritis, bacteria overgrowth, anemia pernicious, crohn’s disease, ileal resection, malabsorbtion syndrome(Hoffbrand & Provan, 1997)
Supplement vit.B12 or injectable for all older adults
Water
Daily fluid replacement is essential Exercise regularly Consume large amount of protein Use laxative or diuretics Live in areas wit high temperatures
Need 30-35 ml/kg BB (actual body weight) or minimum 1500 cc/d
Increased agetotal body water decreases (≠50%) associated with a corresponding decrease LBM
Older risk for dehydration Reduced thirst sensation Reduced fluid intake Limited access to fluid Disminished renal function Urinary inconvenience
Symptoms of dehydration
Electrolyte disturbance Altered drug affected Headache Constipation Thirst, Loss of skin elasticity Weight loss Cognitive status deterioration Dizziness Dry mouth & nose mucous membranous A swollen or dry tongue Change blood pressure Rosessed or sunken eyes Change in urine color or output Speech difficulties
An insufficient fluid intake with frequent diarrhea or vomiting, fever, illness, organ failure or chronic disease requiring hospitalization
Careful monitoring of fluid intake & output is important
Dietary Planning Food with nutrient density
Sufficient fluid, Ca, Fiber, Iron, Protein, Folic acid & vitamins (A, D, B12 & C)
Food is the best source of vitamins
Kauffman et al, 2002-- Supplements is often unnecessary; Vitamins, minerals, herbal supplements used for non specific reason to stay healthy aware potentially toxic doses
Basic diet planning principles for older based on RDA
4 or 5 smaller meals
Nutrition Issues
Older risk of malnutrition Lack of education financial constraints Decreasing physical & psychological
abilities Social isolation Treatments for multiple Concomitant disorder/diseases
Secondary causes of malnutrition
Feeding impairment Anorexia Malabsorption(GIT dysfunction) Increased nutrient needs injury or
disease Drug nutrient interactions
Disease Issues Older Population
Dysphagia Pressure ulcers Alzheimers Parkinsons Geriatric failure DM type II Hypertension & constipation
Dysphagia
Food can chopped, ground or pureed --- eating regular consistencies
The consistency of liquids can be modified to thin, nectar, honey or pudding consistency– thickening agent
Appropriate body positioning– reduced the risk of chocking
Pressure ulcers Most common Location below the waist , but can
develop any where Especially: DM, CV (peripheral), chronic
illness, cognitive impairment, mobility problems, incontinence, neurologic impairments.
Inadequate food; kilocalories, protein, zinc and vitamin C.
Frequent monitoring of BW, skin integrity, lab. value for nutritional status
Management of Pressure Ulcers Based on stage and depth of damage
Therapy; frequent repositioning, use of support surfaces, moisture reduction, debridement and nutritional support
Risk factors: BW 15%, serum albumin level <3,5mg/dl, total lymphocyte count <1800/L
Nutrition therapy; high protein, high energy, vitamin C & zinc supplementation, adequate fluid intake 9 spare protein and tissue epithelialization. Commercial oral supplements or tube feeding – meet higher nutrient need.
Alzheimer’s
Alzheimer’s – degenerative brain disorder– irreversible memory loss and intellectual and personality deterioration--- malnutrition
2,5 millions– USA Fluctuate food intake –emotional state,
confusion level Strategic to improve care can involve
providing a simple, predictable environment and frequent cues relating to daily activities
Parkinson diseases
Neurodegenerative disease that affects voluntary movement
Characterized by loss of brain cells that produce dopamine (a chemical that help direct muscle activity)
Intervention includes; medication, exercise, nutrition management, particularly in the coordination of dietary protein adequacy and timing ofintake with medication
FAILURE TO THRIVE
Malnutrition—compromises the immune system--contribute to development: Infection/sepsis Delayed wound healing MODF disability
Key Factors For Assessing Those At Risk For Malnutrition Weight loss BMI < 21 Serum albumin <3,5g/dl Cholesterol <160mg/dl
Cognitive and emotional status Medications Alcohol intake
Decreased food, fluid & nutrient intake Loss of interest in food or desire to eat
institutionalizations Poverty Presence of infectious disease
Anorexia Early satiety Oral health Dysphagia functional status
Early Alzheimer’s disease loss of ingested nutrients through stools or urine metabolic rate from CHF