© 2011 Pearson Education, Inc. 18 Nutrition Through the Life Cycle: The Later Years.

© 2011 Pearson Education, Inc.

18Nutrition Through the Life Cycle: The Later Years

© 2011 Pearson Education, Inc.

Older Adults

• Age 65 years and older• Age >85 years: • “Very elderly” or “oldest of the old”• Fastest growing U.S. population subgroup

• Average U.S. life expectancy = 78.1 years • Life span is the age to which the longest-living

member of the species has lived

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Aging Process

• Aging occurs at the molecular, cellular, and tissue levels

• Senescence: processes that increase risk of disability, disease, and death

• Programmed theories of aging• Error theories of aging• Cell damage from environmental insults • Linked to nutrient or energy status

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Physiologic Changes

• Systems begin to slow and degenerate• Declined odor, tactile, and visual perception• Dysgeusia, abnormal taste perception

secondary to disease or medication use• Loss of visual acuity• Food selection and preparation techniques

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Gastrointestinal Function

• Xerostomia, declined salivary production• Dysphagia, difficulty swallowing foods • Atrophic gastritis• Achlorhydria, low gastric HCl production,

limits calcium, iron, folate, vitamin B12 absorption

• Lactose intolerance

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Body Composition

• Increased body fat, sarcopenic obesity• Decreased muscle and lean tissue• Decreased production of hormones:

testosterone and growth hormone • Bone mineral density declines • Adequate dietary intake and regular

physical activity (strength/resistance training) help maintain muscle mass and strength

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Organ Function

• Less adaptable to environmental or physiologic stressors

• Kidneys: less able to concentrate waste• Liver: less efficient in breaking down drugs• Pancreas: reduced blood glucose control • Bladder control may decline• Connective tissues and blood vessels become

increasingly stiff and less pliable• Neurons in the brain decrease: impaired memory,

reflexes, coordination, learning ability

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Factors Accelerate Aging

• Biologic age is influenced by lifestyle:• Smoking habits• Alcohol consumption • Sun exposure• Weight status• Level of physical activity

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© 2011 Pearson Education, Inc.

Macronutrients

• Decreased energy needs from loss of muscle mass and lean tissue:• Lower basal metabolic rate• Reduced activity levels

• Recommendations for fat, carbohydrate, proteins: same as for younger adults

• Older adults can eat slightly less fiber

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Micronutrients

• Calcium and vitamin D requirements increase: poor calcium absorption and reduced vitamin D production in the skin

• Iron needs decrease: reduced muscle mass; cessation of menstruation in women

• Adequate intake of B-vitamins (B12, B6, and folate) is a special concern

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Fluid

• AI for fluid: same as for younger adults• Men: 3.7 liters/day• Women: 2.7 liters/day

• Impaired thirst mechanism • Hypernatremia (elevated blood sodium levels)

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© 2011 Pearson Education, Inc.

Overweight and Obesity

• Increases severity and consequences of osteoarthritis

• Limits mobility• Causes functional declines in daily activities • Weight loss improves functional status

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Underweight

• Fewer protein reserves • Risk for poor wound healing and a depressed

immune response • Geriatric failure-to-thrive: “the dwindles”

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Osteoporosis

• Diagnosed after menopause as estrogen levels sharply decline

• Males: linked to declining testosterone levels, steroid therapy, and alcohol abuse

• Most serious risk: hip fracture • Osteoporosis treatment: vitamin D and

calcium supplementation, resistance training, medications

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Arthritis

• One of the most prevalent chronic diseases • Osteoarthritis: a disease of “wear and tear”• Rheumatoid arthritis (RA): typically strikes

younger adults, not associated with obesity or overuse syndromes

• Nontraditional treatments (glucosamine)

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Additional Concerns

• Constipation—fluid and insoluble fiber• Dental health issues may cause older adults

to avoid healthful foods• Eye disorder studies show beneficial effects of

antioxidants• Dementia: lower risk with antioxidants, certain

unsaturated fatty acids, folate, vitamin B12, healthy weight

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Medication

• Polypharmacy: more than five prescription medications at once

• Affects appetite• Alters nutrient digestion and absorption • Food–drug interactions• Appropriate use of nutrient supplements can

enhance the nutritional status of older adults

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

Social Concerns

• Elder abuse and neglect• Food insecurity and hunger • Social isolation

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Community Programs

• Supplemental Nutrition Assistance Program (SNAP)—former Food Stamp Program

• Child and Adult Care Program• Commodity Supplemental Food• Nutrition Services Incentive Program• Emergency Food Assistance Program• End-of-life care

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Minority Elderly

• Require adaptations in current medical and social service interventions

• Increased risk for nutrition-related chronic diseases and complications

• Cultural awareness • Flexible meal plans• Effective communication