Older Adult PPt Winter 2013

7/25/2019 Older Adult PPt Winter 2013

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Nutrition and

TheOlder Adult

Barbara Robinson, MPH,RD,CNSC

Assistant Professor

Johnson & Wales University


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Late Adulthood LearningObjectives

To identify sensory changes of lateadults w/ respect to food intake

To list physiological changes of aging

To relate social and environmental,

factors to nutrition

To identify nutrition supportassessment & assistance programs forlate adults


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Late Adulthood: Special Issues

1. How old is a late adult! "ver #$

%. hronological age vs. functional age

'. (n)uence of diet!

*.+hats the late adults secret weapon!

$. +hat is a growing population segment!


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US Census Bureau AgeCategories

#$-* 0oung "ld

$-* "ld

$ and over "ldest "ld

$2,222 centenarians in 34 5

some live independently


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Large increase inpopulation in

those >85


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RDs and Jobs6ro7ected growth 1$8 overall

28 in nursing home and home care

enters for 9edicare and 9edicaid4ervices :94;

contracts with chronic care improvementprograms

Nutrition-related conditions

e.g., heart failure, dia


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BIOLOIC AS!"C#S O$AI%

o Our vie& o' aging should be the sa(e as ourvie& o' develop(ent)

oIn both develop(ent and aging* nu(erouschanges occur

o %utrition pro'essionals &ho &or+ &ith olderadults need to

,) Anticipate these changes-) Atte(pt to slo& progression o'

changes


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Reco((ended

.acronutrient Distribution'or Older Adults

>uidelines ar


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Nutrition 4creening for @isk-

N4(%utrition Screening Initiative

looking for warning signs ofmalnutrition in older adults

om


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%utrition Screening 'orRis+1 %SI

Devel ( screen (dentiEes personsneeding preventive nutritionintervention - looks at F9(, diet ha


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/%SI0 Chec+list1 D"#"R.I%"* p) 234

Illness changes 'ood inta+e

"ats 'e&er than - (eals

$e& 'ruits* vegetables* dair5

Dental proble(s

%ot enough (one5 'or 'ood

/6370 "at alone

Unintentional &t change

Issues &8shopping* coo+ing


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uidelines 'or Seniors

Ade9uate Inta+e /AI0

'or #otal $iber

.en:4 gra(s;o(en: -, gra(s


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.ost Recent uidelines'or Seniors

$luids: , to - 9uarts per da5

Di(inished thirst sensation

All


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BIOLOIC AS!"C#S O$BIOLOIC AS!"C#S O$

AI%AI%Oral health1 (outh and teeth

Che(oreception: s(ell* taste* touch

Aging gut

S+eletal aging and changes in leantissue

Cognition 8 de(entia


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BIOLOIC C?A%"S ;I#?BIOLOIC C?A%"S ;I#?

AI%AI%@1,7 decline in brain &eight

Abilit5 to control light declines

"ardru(8bones lose


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BIOLOIC C?A%"S ;I#?AI%Arteries thic+en1 atherosclerosis

Bones thin

osteoporosis

Cells less sensitive

to insulin:

Insulin Resistance


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BIOLOIC C?A%"S ;I#?BIOLOIC C?A%"S ;I#?

AI%AI%

Fody omposition?at mass increases

Gisceral fat increases

4arcopenia age-related loss ofmuscle mass, strength andfunction


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hanges @elated to the

>astrointestinal Tract

That (mpact A


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Oral ?ealth

37 o' all older peoplehave one or (ore dental

treat(ent needs


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Oral ?ealth: So't tissues

Salivar5 glands: saliva is antibacterial* lubricating*

cleansing* re(ineraliing

Ulcerative Sto(atitis/(outh ulcers01i((une co(pro(ise

erosto(ia /dr5 (outh0 increasesdeca5due to erogenic drugs*deh5dration* vita(in deEcienc5 /A0


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Oral ?ealth: #eeth

#eeth have reduced regenerativecapacit5 &ith ageF sur'aces


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Changes in:

Oral ?ealth

.astication* s&allo&ing andspeech

Deca5ed teeth* periodontaldisease

Ill1Etting dentures or edentulous*pain* in


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Oral ?ealth: So't tissues

Atroph5 o' oral (ucosa/li+e thinning dr5ing o' aging s+in0

!eriodontu( /gingivitis periodontitis0

Chronic periodontitis in)ammationwithin the supporting tissues of the teeth,progressive detachment and


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Oral ?ealth: Bone

Alveolar bone lossF less

resistance to oral trau(a*in


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Alveolar BoneAlveolar Bone

The thickened ridge of


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Bone Densit5Bone Densit5"steopenia

"steoporosis

Hip fracture

Gitamin = low sunlight eposure, low intake, lo&cutaneous production*

impaired a


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Bone Growth & Development

Women

Peak bone mineral content: 25-28 yr!

"!5#-$!"# lo per year %ollowin ae 5"or menopa'e

(!5# lo per year pot-menopa'e %or

%irt 5-8 year!

http://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animatio

n


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Normal bone

Osteoporotic bone


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Changes in: Che(osensation

ustation /@1,70 /d5sgeusia0Ol'action /@70 /h5pos(ia0


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>astrointestinal :>(;>astrointestinal :>(;4ystem4ystem D5sphagia: Sensation that 'ood

is stuc+ in the throat or upper

esophagus

Due to &ea+ened chee+

and tongue (uscles and less saliva production

@7 o' nursing ho(e clients
http://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animationhttp://www.spineuniverse.com/conditions/osteoporosis/osteoporosis-animation


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=iet Teture 9odiEcation 5=iet Teture 9odiEcation 5

tet


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Artistic 6urees


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$ood #eture .odiEcation$ood #eture .odiEcation

LevelsLevels"evel $"evel $: .echanicall5 altered: (oist*

se(i1solidF ground or Enel5 (inced(eats* 'or+1(ashable 'ruits andvegetables)

#hin+ (eatloa' or ver5 so't Esh suchas sole and 'or+1(ashed* coo+edcarrots)


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$ood #eture .odiEcation$ood #eture .odiEcation

LevelsLevels

"evel %"evel % 4oft-solid, reIuires more chewing,easy to cut meats, fruits and vegeta


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+hat are some other >(changes aBecting diet

and nutrition that areseen in older adults!


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>astrointestinal 4ystem>astrointestinal 4ystem

Sto(ach,)Slo&er gastric e(pt5ing

-)Decreased absorption o' ita(in B,-:AtrophicKgastritis /47 in peopleM@0: Di(inished or absent gastric acid

/achlorh5dria0K Atrophy is the partial or complete wasting awayof a part of the


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it) Bit) B,-,- DeEcienc5 andDeEcienc5 and

Achlorh5driaAchlorh5dria6arietal ells in stomach lining

make intrinsic factor or I$

I$is present in the gastric 7uice as well

(?


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6ernicious anemia and F1%

6ernicious anemia is a common olderadult form of anemia due to gastric

atrophy and a loss of (? production.

A type of megalo


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ita(in Bita(in B,-,-DeEcienc5DeEcienc5

9any older AmericansreIuire F1% shots 5

New research high doseliIuid form can


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B,- $unctions DeEcienc5B,- $unctions DeEcienc5

Anemia F1% reIuired for


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S5(pto(s o' B,-S5(pto(s o' B,-

DeEcienc5DeEcienc5


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=(GJ@T(3DA@ =K

Diverticulosis9NT

Diverticulitis9NT


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=(GJ@T(3D"4(4HTT6//+++.0"3T3FJ."9/+ATH!GL9+A1M3+%99


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Basic DeEnitionsBasic DeEnitions

>erentology The study of normal aging

>eriatrics The study of the chronic

disease freIuently associated withaging

>eriatric Nutrition 9edical

Nutrition Therapy :9NT;


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Chronological age vsChronological age vs

'unctional age'unctional age$unctional age related to a


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Oidation and AntioidantsOidation and Antioidants

?ree radicals molecules containing unpaired,highly reactive electrons

ausal agents in the process ofaging

?ree radical theory damage to cells


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i i l d% t iti l t d


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%utrition1related%utrition1related

Concerns : "5esConcerns : "5esataracts :thickening of eye lenses;Antioidants vitamins and J, seleniumand resveratrol :red wine; may help

prevent progression of cataracts.

arotenoids lutein and Ceaanthin :Cee-uh-Can-thin;, which are also antioidants, mayhelp protect against cataracts.

Lutein and eaanthin: in beta1 .g per serving1


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carotenein so(e 'ruits and vegetables)

.g per servingLutein

Pale :raw or cooked; %$.2 / 1 cup

4pinach :cooked; %2.* / 1 cup

ollards :cooked; 1*.# / 1 cup

Turnip greens :cooked; 1%.% / 1 cup

>reen peas :cooked; *.1 / 1 cup

4pinach :raw; '. / 1 cup

orn :cooked; 1.$ / 1 cup

Froccoli :raw; 1.' / 1 cup

@omaine lettuce :raw; 1.1 / 1 cup>reen


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Dutein is released when the

cells walls of the food are


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"5es are vulnerable to"5es are vulnerable to

oidationoidation"idative stress is high in eyesdue to

1. (ntense light eposure

%. High rate of oidative

meta


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Age1Related .acularAge1Related .acular

Degeneration /A.D0Degeneration /A.D0

Freakdown of the Ma'!la, the central part of theretina

central vision loss

9acula contains luteinand Ceaanthin

Oinc also helps prevent A9=Average intake 1 - % mg/day vs. *- mg

recommended A %22$

"


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=ia


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Changes in Lean and $atChanges in Lean and $at

#issue /bod5 co(position0#issue /bod5 co(position0Sarcopenia Age-related loss of muscle mass, strength, and function

sarcoL )esh/musclepenia L loss

rate of lossL 18 every yr after *$


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+hat is the older

adults secretweapon!

!h5sical Activit5 as =$ountain!h5sical Activit5 as =$ountain


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!h5sical Activit5 as =$ountain!h5sical Activit5 as =$ountain

o' Nouth>o' Nouth>

9uscle 9ass 9aintenanceFalance

A 4ense of well


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Reducing SarcopeniaStrength trainingAerobic eercise less eective /good 'orother reasons0

I(proves 'unctional status

In illness* protein stored in (uscles is&ithdra&n 'or repair and other reasons

Ade9uate protein inta+e RDA1 orperhaps (ore according to ne& research


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overn(ent !rogra(sovern(ent !rogra(s

'or "lderl5'or "lderl5Administration on Aging under

The 34 =epartment of Healthand Human 4ervices

:34=HH4;


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Administration on AgingAdministration on Aging

.ission State(ent

(he mission of AoA is to evelo)

a 'om)rehensive, 'oorinate an'ost*e+e'tive system of home an'omm!nity*base servi'es that

hel)s elerly inivi!alsmaintain their health anine)enen'e in their homes an'omm!nities

Ad i i t ti A iAd(inistration on Aging


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Ad(inistration on AgingAd(inistration on Aging

!rogra(s!rogra(s

Older A(ericans Act %utrition !rogra(sAvailaroup dining atsenior centers in many communities

%.Nutrition 4creening

'.Home delivered foods 9eals on+heels

Child and Adult Care $oodChild and Adult Care $ood


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Child and Adult Care $oodChild and Adult Care $ood

!rogra(!rogra(

A?6 ?unding for meals andsnacks to adult day care centers

(n order for foods costs to


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%utrition !rogra(s USD??S%utrition !rogra(s USD??S

USDA USDA34=HH44tate-run w/ variation among states

ongregate and home-delivered meals

#2R w/ greatest economic & social need

3nder 34=A 5 Title (((c ?ood Assistance6rogram

?ood 4tamps:4NA6;, ?ood 4tamp NutrJduc, ommodity 4upplemental ?ood,4eniors ?armers 9arket Nutrition6rograms


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.edicare !rogra(s.edicare !rogra(s

All Americans eligi


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%utrition ?ealth Insurance BeneEt%utrition ?ealth Insurance BeneEt

under .edicare /under .edicare /

MM

age 3@0age 3@0

9edical Nutrition Therapy :9NT;

4ervices 6rovided


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.ultidisciplinar5Assess(ent

(nterrelationships w/ nutrition frommany life issues

9edications 5 6olypharmacy

9ultidisciplinary perspective critical

5 9=, @N, @=, "T, 4D6, 6T, 4+

=aily living evaluation reIuired


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Documents

Older Adult PPt Winter 2013