chapter 1,2,3 & 6

The Physiology of Aging

Aging is multifactorial and nutrition is one of the major determinants of successful aging. 1. Successful aging depends on health behaviors such as diet, maintaining a healthy body weight, and physical activity; and environment, lifestyle, and medical conditions. 2. Lifelong dietary habits influence risk for acute and chronic conditions, disease, and response to age-related physiologic changes. 3. Diet and food contributes to one's social, cultural, and psychological quality of life. 4. Nutritional health and aging is also impacted by access to food, functional ability to prepare meals, and economic resources to purchase foods. B. Aging is characterized by a gradual decline in organ function. 1. In the absence of pathology, aging does not lead to disease; but physiologic changes that occur with aging can make the incidence of disease more likely. 2. Aging cannot be reversed, but one key way to improve quality of life with aging is thorough good nutrition habits. C. Theories of aging: aging involves interactions between genes and environment. Increases vulnerability to mutations and therefore contributes t o illness and death. 1. Charles Darwin's natural selection theory: a gradual process that involves the preservation of a trait/functional advantage enabling a species to compete better in nature and survive longer. 2. Research continues to investigate aging theories and genetics, signaling pathways, nuclear factors, mediators, and biomarkers related to longevity. D. The genetics of longevity: genetic predisposition to longevity for some genes or gene combinations. 1. Researchers are investigating the genomes of centenarians. 2. Genes may offer disease protection or function in combination with environment and lifestyle choices. II. Aging Systems A. Conditions that are age-dependent are closely related to the usual aging process. 1. Age-related changes can influence disease severity, how it manifests and progresses. 2. Distinguishing normal age-related changes from the consequences of diseases, medication use, and physical disuse can be complicated (e.g., atrophic gastritis and vitamin B12 deficiency). III. Gastrointestinal Changes with Age A. Oral health 1. Problems with the oral cavity, taste, and smell contribute to inadequate intake and can lead to malnutrition, worsening disease and health outcomes. 2. Diseases and medications used to treat them can lead to oral pain, tooth loss, xerostomia, and problems with chewing and swallowing. 3. Optimizing oral health in the older adult is key to enhancing dietary quality. B. Olfactory changes 1. Taste and smell affect our food choices and overall health and well-being. 2. The sematosensory system changes with age. It is responsible for: mouth-feel, texture, temperature perception, and irritant perceptions of foods. 3. Taste changes are caused by decrease in number and atrophy of taste buds, olfactory loss, upper respiratory infections, head injury, medication use, problems with chewing such as tooth loss and dentures, and reduction in salvia production. 4. Taste threshold increases with age (older adults need more flavor to taste foods). 5. Smell decreases with age; it is responsible for the detection, recognition, and identification of odors and contributes to the anticipation of eating and appetite. 6. Decreased smell is caused by a decrease in the number and replacement of sensor cells that detect aromas, decreased nerve signaling, reduced mucus production, thinning nose lining, hormonal changes, environmental exposures (e.g., tobacco smoke), age-related diseases, and side effects of medications. 7. Older adults with poor smell are more likely to have reduced appetite and intake, over salt food, or consume spoiled food. C. Esophageal changes 1. Esophageal function is generally unaffected by aging. 2. Disease is the most common cause of esophageal issues. 3. Dysphasia is common in older adults with neurodegenerative diseases (dementia, stroke, the cranial neuropathies triggered by diabetes) and is related to age, frailty, muscular, endocrine, and psychiatric diseases, and use of medications that affect alertness. 4. Age-related physiological changes in swallowing include delayed upper esophageal sensory discrimination, decreased lingual strength, and delayed upper esophageal sphincter relaxation during swallowing. 5. Complications of impaired swallowing include aspiration, hypovolemia, nutritional deficits, pneumonia, failure to thrive, upper-airway obstruction, and depressive symptoms, anxiety or panic during mealtimes, and decreased social interaction. 6. Dysphagia can lead to nutrient deficiency and dehydration. 7. Gastroesophageal reflux disease (GERD) is thought to be related to an underlying disease processes in the esophagus. 8. Causes of GERD: delayed gastric emptying, reduced lower esophageal sphincter functioning, reduced peristalsis, hiatal hernia, medications. D. Gastric function 1. Delays in stomach emptying and declines in gastric output occur with age. 2. Reduced digestive secretions in the stomach and small intestine of older adults results in decreased capacity for nutrient absorption (e.g., hypochlorhydria). E. Pancreatic, gall bladder, liver 1. Reduced production of enzymes needed for digestion occurs with age. 2. Declines in accessory organ function can affect digestion and absorption of fat, protein, carbohydrates, and some vitamins and minerals. 3. With aging, there is an increased number of gallstones, reduced blood flow and size of the liver, and alterations in drug metabolism that occur with decreased liver function. F. Small intestine 1. Completes the digestion of protein, fat and nearly all of carbohydrate and absorbs most nutrients. 2. Serves as a barrier to toxic and infectious agents (damage to the small intestine increases infection risk). 3. The absorptive function is relatively unaffected by age, but diseases and disorders can impact the absorptive capacity (e.g., enzyme deficiencies, celiac disease, enteritis, ischemia and bacterial overgrowth syndrome). G. Large intestine 1. Role: reservoir for fecal matter, reabsorption of water, electrolytes, bile salts, and short-chain fatty acids. 2. Disorders of motility common in the older adult. 3. Constipation is caused by slowing of gastrointestinal (GI) motility, low-fiber diet, low fluid intake, prescription and over-the-counter medication use, dehydration, dementia, functional limitations, chronic disease, and neurologic diseases (e.g., multiple sclerosis and Parkinson's). 4. Other conditions include diverticulosis, inflammatory bowel diseases, diarrhea, and fecal incontinence. IV. Changes in Body Composition with Age A. Increases in the proportion of body fat and loss of lean muscle 1. Part of normal aging process and regarded as inevitable and irreversible. 2. Sarcopenia, a loss of skeletal muscle mass and strength, contributes to worsening of disease burden and illness, nutritional inadequacy, increased disability, and functional dependence. 3. Optimizing intake of high-quality protein and antioxidants, along with progressive resistance strength training may prevent/reverse sarcopenia. B. Changes in body weight with age 1. More than 30% of adults age 65 and older are classified as obese. 2. Obesity in older adults contributes to increased morbidity (increased risk of chronic diseases such as heart disease, diabetes, metabolic syndrome, and cancer) and reduced quality of life. 3. Voluntary weight loss provides benefits to health, quality of life, and physical function, but results in loss of muscle even when excess fat mass is targeted. 4. Unintentional weight loss and low body mass index (BMI) in the elderly is suggestive of underlying disease, associated with poor health outcomes, and deterioration in well-being. 5. Sarcopenic obesity: a deterioration of muscle composition and quality in combination with increased fat mass, caused by excess energy intake, physical inactivity, low-grade inflammation, insulin resistance, hormonal changes, and peptides produced by adipose tissue. V. Changes in Cardiovascular and Respiratory System with Age A. Diseases of the heart and blood vessels are primary causes of morbidity and mortality in the older adult and their incidence increases with age. 1. Greater than 70% of adults over the age of 60 and more than 83% of adults ages 80+ have coronary heart disease (CHD). 2. The heart of an older adult has a decreased ability to utilize oxygen and does not tolerate physical stress well (e.g., increased blood pressure, fever, and strenuous exercise). 3. Changes to the older adult heart include: increased interior walls thickness (accumulation of cholesterol), increase in the rigidity of the vessels, formation of aneurysms in areas of expanding arteriosclerotic plaque, damage in larger arteries, decrease in heart size, decrease in the size of the cavity in the left ventricle, increase in the size of the left atrium, increased collagen deposits, and calcification in the aortic valves. 4. Changes to the heart are strongly influenced by environmental factors especially diet. 5. Atherosclerosis is the cause of most cardiovascular disease (CVD) in the older adult, and is the result of years of interaction between genetics, normal aging processes, and environmental factors such as diet, physical activity, and stress. B. Cardiovascular risk factors in older adults 1. CVD risk factors: hypertension, diabetes, oxidative damage, platelet activation, and inflammatory processes as well as modifiable lifestyle factors such as diet, overweight and obesity, and physical inactivity. 2. Eighty-six percent of adults over the age of 65 in the U.S. have at least one nutrition-related risk factor for CVD. 3. Prevalence of modifiable risk factors for CVD increase with age. 4. Dietary goals for American Heart Association (AHA) 2020 include five primary aspects of diet (see Table 2-7). 5. Dietary modifications in the older adult can compromise food intake (e.g., sodium restrictions can leave food tasting bland, compromise diet adequacy, and contribute to nutritional deficits). 6. Elevated low-density lipoprotein (LDL) cholesterol, triglycerides, and decreased high-density lipoprotein (HDL) cholesterol concentrations are independent risk factors for CHD. 7. There is a high prevalence of high blood pressure among older adults. 8. Recommendations for hypertension: achieve and maintain a healthy body weight, adopt a DASH diet (Dietary Approaches to Stop Hypertension) eating pattern including reducing dietary sodium and increasing fruits and vegetables, limiting intake of alcohol beverages, smoking cessation, and regular physical activity. C. Respiratory changes 1. The upper respiratory tract includes the nose, nasal cavity, sinuses, larynx and trachea and the lower respiratory tract includes the lungs, bronchi and alveoli. 2. Frail or malnourished older adults are more susceptible to pulmonary infections such as pneumonia, bronchitis, and tuberculosis as well as aspiration pneumonia. 3. Decreased alveolar surface and progressive loss of elastic recoil lessen the proficiency of gas exchange, optimum breathing power and voluntary ventilation of the lungs. Breathing capacity also declines with age (see Table 2-9). VI. Changes in Renal System with Age A. Aging affects the kidneys and genitourinary systems. 1. By the age of 60, the average person has lost approximately 25% of their kidney function. 2. Common kidney changes that occur with aging include: hardened vessels, reduced blood flow, reduced ability to adapt to glomerular stress and hemodynamic imbalances, decreased diluting and concentrating capacity, disruption in ability to maintain potassium homeostasis and acid-base balance, and reduced ability to concentrate urine (contributing to dehydration in older adults). 3. Kidneys are also affected by medical conditions (diabetes, cardiovascular disease, hypertension, obesity) and medications. 4. Chronic kidney disease (CKD)* increases the risk of heart disease, heart attacks, strokes, high blood pressure, edema, anemia, weakened immunity, depression, osteoporosis and malnutrition. * The definition and stages of kidney disease are shown in Table 2-10. 5. Genitourinary conditions include bladder control issues/infections, urinary system cancers, decreased bladder capacity, enlarged prostate gland, alterations in pelvic support, diminished vaginal and cervical secretions, urinary incontinence, urethral obstruction, and pruritus. 6. Genitourinary conditions may cause older adults to restrict fluid intake increasing risk for dehydration VII. Skeletal Health A. Bone mass is accumulated throughout life until peak bone mass is achieved often in the late 20s. 1. 50-90% of bone strength is influenced by genetic factors. 2. Loss of bone mass is highly dependent on modifiable factors including nutrition and lifestyle. 3. Gender, race, age, ethnicity, body size, and family history are unmodifiable risk factors that influence bone mass. B. Osteoporosis, the most common bone disease in humans, occurs when the skeleton becomes increasingly frail due to poor bone quality and low bone mass. 1. Either primary or secondary in etiology. i. Primary osteoporosis is more common and often accompanies aging. ii. Secondary osteoporosis results from a specific, identifiable cause such as medication use. 2. Can be prevented or delayed with modification of risk factors (diet, weight-bearing exercise, maintaining a healthy body weight, avoiding tobacco products, and consuming alcoholic beverages in moderation). 3. Dietary factors affecting osteoporosis: calcium, vitamin D, phosphorus, vitamin K, magnesium, fluoride, iron, zinc, copper, several B vitamins, carotenoids, protein, and the essential fatty acids. 4. Individuals at risk of osteoporosis should avoid consuming excess phosphorus, sodium, alcohol, vitamin A, and caffeine. VIII. Changes in Other Body Systems A. Immune system changes 1. Aging is accompanied by diverse changes in immunity (immunosenescence). 2. Changes in immunity contribute to increased morbidity and mortality (from infectious disease and cancer). 3. After the age of 50 the immune system begin to deteriorate. 4. Poor nutrition in older adults contributes to declines in the immune system. 5. Physical activity can have positive effects on adaptive immunity. 6. Current research is focused on the role of nutritional status, antioxidants, probiotics, omega fatty acids, caloric restriction, and physical activity. B. Nervous system changes 1. With aging, number of nerve cells and the total weight of the brain and the spinal cord are reduced and message processing time increases. 2. Neurologic changes can affect food sensation, lead to physical/functional decline negatively impacting ability to consume a nutritious diet, and impact GI function (digestion and absorption of food and nutrients). 3. Nutrients present in food influence brain structure. i. Folic acid has been found to preserve memory in aging. ii. Vitamin B6 may be beneficial in treatment of premenstrual depression. iii. Vitamins B6 and B12 are directly involved in the synthesis of some neurotransmitters. iv. Vitamin B12 delays the onset of signs of dementia. v. Vitamin D has recently gained the interest for its potential role in the prevention depression in older adults. C. Endocrine system changes 1. Normal aging results in alterations in circulating hormone levels and their function. 2. Changes in hormone levels affect metabolic functions and can cause alterations in energy and nutrient metabolism (e.g., insulin resistance, development of glucose intolerance, decrease in thyroid hormones and estrogen impacting bone metabolism). 3. Age-related changes in hormones also play a major role in the development of frailty and sarcopenia. D. Hematologic changes: anemia 1. Almost 10% of today's older adult population currently suffers from some type of anemia. 2. Anemia is associated with morbidity including functional impairment and physical decline, increased rates of hospitalization, reduced mobility, and decreased quality of life. 3. Iron-deficiency anemia rates are relatively low in the elderly U.S. population; however, the elderly population in the United States is growing rapidly. 4. Anemia is often considered a normal consequence of aging; however age-related decline of erythrocyte production remains unclear. 5. In the older adult, iron deficiency anemia is most often caused by chronic bleeding from the GI tract (from peptic ulcers, hiatal hernia, gastritis, hemorrhoids, and cancers affecting the GI tract). 6. Anemia of inflammation ("anemia of chronic disease") is associated with medical conditions prevalent in the older adult population (infection, rheumatologic disorders, diabetes, liver disease, heart failure, and malignancy). 7. "Unexplained anemia": pathophysiology remains poorly understood. Mineral and vitamin deficiencies excluding iron, folate, and B12 may play a role. 8. Nutrition evaluation is important. Identifying inadequate dietary folate, alcohol use and/or abuse, and reduction of cobalamin absorption secondary to atrophic gastritis, Helicobacter pylori infection, and use of gastric acid-suppressing agents can help to determine if a nutritional approach can impact the underlying anemia. IX. Conclusion A. Age-related physiologic changes affect our nutritional needs and nutrient status and nutritional intake in turn affect the aging process. 1. Nutrition is a key factor in health and ability to function at advanced ages, and plays a key role in disease management. 2. Diet and health recommendations must acknowledge the normal physiologic changes with aging, individual health, and disease pathophysiology.

AoA

Administration on Aging is one of the nations largest providers of home and community based care for older adults and their caregivers. Awards annual grants to state governments to support programs mandated by congress in the Older American Act.

65 and over

1. In 2011, more than half of the adults 65 years or older lived primarily in nine states: California (4.4 million); Florida (3.4 million); New York (2.7 million); Texas (2.7 million); Pennsylvania (2.0 million); and Ohio, Illinois, Michigan, North Carolina with over 1 million. D. Most older adults live in metropolitan areas (81% in 2011). 1. 66% reside outside main cities. 2. 34% dwell inside major cities. 3. 19% live out of urban regions. III. Dietary Guidance A. Promotion of a nutrient-dense diet 1. Essential for prevention of nutrition-related complications that can contribute to increased functional dependency and frailty.

Health promotion

3. Health promotion is key to maintaining a healthy older adult population; increasing quality of life and decreasing disease burden. II. Demographics A. The older adult population is growing. 1. Older adults comprised 13.3% of the U.S. population in 2011 (over one in every eight Americans is over the age of 65). 2. The number of adults 65 and older will grow to 54.8 million in 2020, and to 81.2 million in 2040. 3. By 2040, older adults will make up 21% of the population. B. Older women outnumber older men. 1. By 2020 there will be 30.5 million women over the age of 65, compared to 24.3 million men. C. The number of older adults varies by state.

HEALTHY PEOPLE

42 topic areas with goals and objectives for each 15 strategies that deal with prevention Tobacco control, managing multiple chronic conditions, "Let's Move campaign," food safety, health literacy, and others

Six Core Services

6 core services funded are supportive services, nutrition services, preventive health services, the National Family Caregivers support program, services that protect the rights of vulnerable older adults and services for Native Americans.

Nervous system changes

Nervous system changes with aging Reduced number of nerve cells Decreased weight of brain and spinal cord Nutrition and the nervous system Change in food sensation leads to reduced food intake and reduced digestion and absorption of nutrients. Nutrients influence brain structure, cerebral functioning, and cognitive and intellectual abilities. B vitamins, vitamin D

DIETARY GUIDELINE

Nutritionally adequate and nutritionally dense diets Promote health Prevent nutrition-related complications Modified MyPlate for Older Adults Emphasizes nutrient-dense foods Importance of fluid balance Forms of foods. Physical activity. Supplements.

Older Americans Act

OAA prvide servies to needy older adults in an effective manner. s

Older Adults

Older Adults topic area is new for 2020 Developed in response to the rapidly aging population Goal: "improve the health, function, and quality of life of older adults" Oncludes 12 objectives Objectives subcategories include Prevention and Long Term Services and Supports

My Plate

B. Modified My Plate for Older Adults 1. Created for older adults over 70. 2. Encourages healthy diet practices, hydration, and an active lifestyle. i. Nutrient dense food choices: fiber-rich foods, focusing on whole-grain products and whole fruits and vegetables. ii. Offers ideas for older adults on a limited income, who live alone, or who have health problems including food choices that are easier to prepare, have a longer shelf life, and that minimize waste. iii. Shows numerous sources of liquids, emphasizing the importance of fluid consumption. iv. Reinforces the need for regular physical activity; icons reflect common activities such as daily errands and household routines. C. Ideally, nutrients should come from food rather than supplements

Gastrointestinal Changes

Oral health changes Changes in oral tissues (nutrient deficiency) Poor dentition Swallowing difficulty Impaired taste and smell

cvd

Oxidative damage, platelet activation and inflammatory processes have also been identified as factors in the development of cvd

Pancreas, gallbladder, & liver function

Pancreas, gallbladder, & liver function changes Reduced pancreatic/gallbladder secretions Affects nutrient absorption Decreased liver size/blood flow/function Impacts effectiveness of medication and nutrient metabolism

programmed cell death

aging theory, mutation accumulation, antagonistic pleiotropy hypothesis

daily values

are the nutrient standards used on food labels. DVs are intended to serve as a guide to allow consumers to compare the nutrition composition of foods.

Glomerular filtration rate GFR

best indicator of kidney function young healthy adult filters at a rate of 120-130 ml plasma/min/1.73 with a normal projected decrease of approx. 0.75 ml plasma. chronicd disease is defined by the National Kidney foundation as GFR less that 60 ml plama/min/1.73m2 and or kidney damage for more that 3 months.

sixth decade

body weight increases until the sixth decade of life after which older adults experience a loss of muscle mass and increase in body fat, increased frailty, declining physical function and worsening health. These changes are falsely attributed to a normal againg processs

Body weight changes

Body weight changes Obesity Affects more than 30% of adults 65 yrs+ Result of low quality diet, inactivity Magnifies health problems Unintentional weight loss Associated with disease, poor health outcomes, reduced quality of life Caused by medical interventions, polypharmacy, social, economic, and environmental circumstances Sarcopenic obesity Coexisting sarcopenia and obesity Detrimental to physical function Results from excess energy intake, physical inactivity, low-grade inflammation, insulin resistance, changes in hormonal environment, and peptides produced by adipose tissue

heterogeneous group

older population

Low body mass index

underlying disease medical interventions, polypharmacy and drug side effects as well as multiple social, economic and environmental causes can contribute to unintentional weight loss in older adults.

lean muscle mass

undesirable correlates negatively with functional capacity for independent living

Fluid Output

Dehydration Body water out > water input Risks Inadequate intake Reduced total body water Lifestyle factors associated with age Complications Associated with increased morbidity and mortality

Fluid Output

Factors that contribute to fluid output Normal physiologic losses Age-related impairments Cardiac output Blood pressure Decline in kidney function Medication use Environmental conditions

Age-associated biological changes

Factors that impact nutrient requirements: Age-associated biological changes; impact nutrient metabolism and requirements Changes in body mass that occur with aging Reduction in body water and bone mass Socioeconomic changes Older adults require services aimed at maintaining independence and health

Gastric function changes

Gastric function changes Changes in gastric motility Age vs. pathology? Reduced digestive secretions Affects nutrient absorption

AGING AND LONGEVITY

Genetics may help protect against age-related disease Affects metabolic systems Impacts immune function Impacts cell cycles Environmental factors Physical activity, health habits, nutrition

Genitourinary changes

Genitourinary changes with aging Increased incidence of infection Cancer (e.g., prostate cancer) Decreased bladder capacity/incontinence Enlarged prostate Alterations in pelvic support Urethral obstruction Pruritus Can lead to changes in dietary intake (e.g., restriction of fluid due to concern of incontinence)

Large intestinal changes

Large intestinal changes Disorders of motility occur with aging Constipation causes: Colon dysmotility and disordered defecation Low fiber and low fluid intake, dehydration Medication use Dementia, functional limitations, chronic disease, neurologic diseases

OLDER ADULTS

Older adults use more healthcare services Three chronic health problems (on average) Use five prescription drugs (on average) Proportionally less professionals with skills in geriatrics Medicare payment issues/reimbursement Healthy People 2020 aims to increase the proportion of healthcare workers with geriatric certification by 10% Older adults are vulnerable to compromised nutrient intake Multiple factors influence eating habits and nutritional status Goal of nutrition intervention: Maintain health and quality of life

Olfactory changes

Olfactory changes Taste Changes caused by reduction in number of taste buds, medications, infection, head injury, tooth loss, dentures, reduced saliva Smell Changes caused by reduction in nasal mucus, number of sensory cells, reduced nerve signaling, hormones, environmental factors (e.g. smoking), and medications Impact: appetite, intake, seasoning of food, and food safety

Other conditions

Other conditions Diverticulosis, inflammatory bowel diseases, diarrhea and fecal incontinence Individualized assessment helps to determine organic vs. secondary causes and underlying etiology of issues

Proteins

Physiologic aging and protein requirements Consequences of reduced body protein Dietary recommendations: topic of debate Benefits of exercise Dietary protein Trend towards decreased protein intake with age High biological value protein sources pg 62

Alcohol

Not classified as a nutrient Yields 7 kcal/gram of energy Soluble in both fat and water Alcohol concentration in tissues is influenced by the water content of the tissue Water content decreases with aging; leads to higher blood alcohol levels in older adults Absorption NOT digested, but absorbed via diffusion First pass metabolism (FPM) More active in men Less active with age Affected by nutritional status Metabolized by the liver Health benefits Moderate intake associated with lower cardiovascular risk and reduced breast cancer rates, improved appetite and quality of life Recommendations 2010 Dietary Guidelines: Moderation is key Special concerns History of alcoholism or other disease impacted by alcohol consumption Polypharmacy

Nutrition

Nutrition influences how a person will age Process of aging affects nutrition Older adults are a diverse group and have dramatically different nutritional, health, and social requirements Older adults are living longer and are the largest growing segment of the population

Physiology of Aging

Nutrition status is a determinant of healthy aging Key factor in disease risk and functional status Aging impacts our nutrition needs Nutrient density is important Nutrition recommendations for older adults must address: Normal physiologic changes with aging Social, cultural, and psychological factors Individual health and disease pathophysiology

Dietary Carbohydrates

Sources Complex carbohydrates Simple carbohydrates Carbohydrate recommendations Complex, unrefined carbohydrates Acceptable Macronutrient Distribution Range (AMDR) DRI: 45%-65% of daily calories 2010 Dietary Guidelines for Americans Discretionary calories Dietary fiber Not digestible Functional fibers Total fiber Nonviscous fiber Reduces postprandial blood glucose Viscous fibers Fat and cholesterol absorption Dietary fiber: recommendations 25-35 g/day Adequate intake for fiber (over age 51): 14 g of fiber per 1000 kcal, or 30 g/day for men, 21 g/day for women Mean intake by older adults is lower than recommended levels: 14.0 (women over age 71) 14.4 (women between 50 and 70 years) 17.5 (men over age 71) 18.5 (men between 51 and 70 years) Dietary fiber Food sources Few processed, more natural foods and whole-grains Fruits and vegetables Ensure adequate water intake High-fiber diets increase satiety and may cause decreased food intake

osteoporosis

age related bone loss calcium and vitamin d weight bearing exercises, lifestyle modifications healthy body weight, avoid tobacco, alcoholic beverages in moderation phosphorus, vitamin k, magnesium and fluoride another nutrients such as iron copper vitamin B, carotenoids, protein, and the essential fatty acids are important for bone health. Older adults need to strengthen bones and improve balance. weight bearing exercises can simultaneously improve muscle mass, muscle strength, balance and bone strength and as a result decrease the risk of fractures in par by reducing the risk of falls.

dysphagia

any disruption in normal swallowing

AoA Programs

focuses on improving efficiency, measures efficiency of all progam activities, improves client outcomes, loos at indicators like nursing home predictors, the success of caregiver programs and protection of vulnerable older adults., effectively targeting services to vulnerable elder populations, ensures that states and communities focus on providing services to the most vulnerable elders. A tool used by Aoa is Nursing home predictor scores which measure success based on scientific literature and the AoA performance measure project. easure the the older adult needs for transportation and congregate meals. the higher the score the greater the need

essential fatty acids

foods high in dietary fat provide a necessary source of the essential fatty acids linoleic acid and linolenic acid. linoleic acid n-6 am p,ega 6 fatty acid is an essential structural component of cell membrans. also involvedin cell signaling lprocesses and is a precursor for eicosanoids.

biochemistry of longevity

genetics, signaling pathways, nuclear factors, mediators

Aging

gradual decline in organs the bodies ability to maintain homeostasis especially under conditions of stress. referred to as normal or physiologic. beginning as early as 30 to 40 years.

response

heat production system, salivary glands, cardiovascular, gastrointestinal tract, pancreas, renal system. medication alter taste, flavor, perception and appetite. poor oral health, dentition and problems chewing and swallowing

Health disparities

iii. Health disparities exist because of: language and communication barriers, limited access to care, decreased socioeconomic status, and different cultural norms. C. Older adults are living longer. 1. Advances in technology and medical care have contributed to increased life expectancy. 2. In 2011, 65-year-old adults had a mean life expectancy of an added 19.2 years (20.4 years for females and 17.8 years for males). D. Caring for an aging population puts a strain on the medical community; healthcare costs rise to meet new healthcare demands. 1. Healthcare for an older adult is three to five times more costly 2. Caring for an aging population will increase healthcare spending by approximately 25% by 2030.

Geriactrics

largest training gap

Dietary Cholesterol Intake

limited to less than 300 mg per day for all adults while consuming a nutritionally adequate. pg 60

Fats

lipids found in foods or in the body composed of triglycerides and small amounts of phospholipids and sterols.

LDL cholestrol

lowered by substituting PUFA's and MUFAs for SFAs, souble fiber, plant stanol/sterol ester containing foods and soy protein, dietary giber, weight loss, physical activity elevated by saturated fat, trans fatty acids and cholestrol

oral cavity

optimizing oral health is fundamental involuntary weigh loss altered oral integrity, pain ill fitting dentures leads to limited social interactions

Anexoria

oral health in the mouth and olfactory changes. these physiologic changes play a role in the anorexia of again, postprandial hypotension, aspiration pneumonia, bacterial infection, fecal incontinence, gallstones and alterations in the metabolism of drugs

blood lipid

patterns of risk for atherogenic blood levels and their relationship to CHD differ men and women. elevated LDL , triglyceride leVels and decreased high density hdl cholesterol concentrations are independent rish factor for CHD

RDAs

pg 53 recommended dietary allowances are nutrient intake goals for individuals for which there is significant scientific agreement to the average daily nutrient intake level to meet the needs to 97% of healthy people of a specific age category and gender

nitrogen balance

pg 60 & 61

Proteins

pg 60 Physiologic aging and protein requirements Consequences of reduced body protein Dietary recommendations: topic of debate Benefits of exercise Dietary protein Trend towards decreased protein intake with age High biological value protein sources

Prolonged use of medication

prolonged use of medication, such as histamine h2 blockers, metformin or proton pump inhibitors is low gastric acid a considerable risk factor in the development of vitamin b deficiency.

triglycerides

provide the body with a valuable source of energy. fats from foods also carry fatsoluble vitamins a,d,e,k fat soluble phytochemicals carotenoids and essential fatty acids. Pg 58

RDA

set at 56g per day for males and 46 for femals

BLOOD PRESSURE

systolic blood pressure 120-139 and 80-90

HDL cholesterol

elevated by physical activity, lowered by elevated triglycerides, overweight and obesity, physical inactivity, cigarette smoking, very high carbohydrate diet 60% total calories or substituting carbohydrates for fats, dietary trans fats

HEALTH INDICATORS

Access to Health Services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant, and Child Health Mental Health Nutrition, Physical Activity and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco

Older adults

1. Older adults can struggle to get in good nutrition from food alone, especially when calorie needs are reduced. 2. May need certain supplemental nutrients, such as calcium, vitamin D, and vitamin B12, the needs for which increase with age. IV. Healthy People 2020 A. The Healthy People initiative (updated every 10 years) began in 1979 in the U.S. Department of Health and Human Services. 1. 42 topic areas i. Each topic area has goals and objectives that serve as a mechanism for monitoring national progress. 2. 15 strategies that deal with prevention i. Examples: tobacco control, managing multiple chronic conditions, a "let's move campaign", food safety, health literacy Older Adults" topic area is new for 2020. 1. Developed in response to the rapidly aging population. 2. Goal: "improve the health, function, and quality of life of older adults." 3. Includes 12 objectives with subcategories including prevention and long-term services and supports. (C. Healthcare access is a concern among the older adult population. 1. Common obstacles to securing healthcare services include: limited availability, high cost, or not having health insurance. 2. Most older adults have health insurance, yet are less likely to receive regular or quality health care, especially minority older adults. V. Administration on Aging (AoA) 3. Compared to other older adult groups: i. Less educated ii. More likely to live in poverty iii. More likely to live longer than non-Hispanic whites iv. Lower incidence of chronic ailments such as cardiovascular disease, cancer, lung disease, and stroke v. Require assistance for personal cares B. African Americans 1. Comprise 8.3% of the minority older adult population; by 2050, 11% of older Americans will be African American. 2. Live predominantly in eight U.S. states: New York (9.1%), California (6.5), Florida (7.1%), Texas (6.4), Georgia (6.1%), Illinois (5.4%), North Carolina (5.5%), and Virginia (4.4%). 3. Compared to other older adult groups: i. Increased poverty rate ii. Similar life expectancy rates iii. Higher rate of hypertension iv. Similar rates of other chronic diseases v. Higher rate without private health insurance C. Native Americans 1. Population is projected to increase to approximately 918,000 by 2050, representing approximately 2% of the U.S. total population. 2. Indian Health Service (IHS) provides funds for health care. 3. Approximately 41% have private insurance coverage. 2. Most Asian Americans live in Hawaii, as 42% of all people in Hawaii are Asian. Other states with high Asian American populations are California (40.5%), New York (9.2%), Texas (4.3%), New Jersey (3.9%), Washington DC (3.3%), and Florida (3%). 3. Compared to other older adult groups: i. High proportions own homes and complete college. ii. Longest life expectancy among different racial groups. iii. May use traditional medicine. iv. Higher rates of smoking, alcohol consumption, and obesity. v. Low percent are uninsured or live under poverty level. E. Caucasian Americans (Non-Hispanic Whites) 1. Compared to other older adult groups: i. Highest median age ii. Lower incidence of hypertension and diabetes VII. Health and Well-Being A. Health and well-being are influenced by numerous interrelated factors accumulated over a lifetime. 1. Nutrition is a determinant of successful aging. i. 85% of non-institutionalized older adults have one or more chronic health conditions that could be improved by nutrition, and up to half may have clinical evidence of various forms of malnutrition. ii. Malnourished older adults are more prone to infections and diseases, their injuries take longer to heal, surgery is riskier, and their hospital stays are longer and more expensive. iii. Food choices are influenced by physiologic, behavioral, social, environmental, and psychological factors. VIII. The Healthcare Workforce A. Older adults use more healthcare services than any other age group. 1. Older adults utilize ~ 50% of total physician visits and hospital stays. 2. Older adults age 75 and above have an average of three chronic health problems and use five prescription drugs. B. The number of healthcare professionals prepared in geriatrics is few. 1. Very few medical graduates in the U.S. are pursuing advanced training in geriatrics. In 2010, only 75 residents in internal medicine or family medicine entered geriatric fellowship programs—down from 112 residents in 2005. i. Physicians in internal medicine, family medicine, and geriatrics earn less and have less predictable schedules making the geriatrics field less appealing. ii. The current medical reimbursement system does not provide physicians with incentive to provide quality and coordinated services that could help decrease healthcare cost. 2. Less than 1% of registered nurses (RNs), physician assistants, and pharmacists, and approximately 2.6% of advanced practice RNs are certified in geriatrics. 3. Only 3% of psychologists and 4% of social workers devote the majority of their practice to older adults. 4. Healthy People 2020: initiative to increase the proportion of healthcare workers with geriatric certification by 10%. IX. Conclusion A. Older adults are vulnerable to compromised nutrient intake. 1. Multiple factors impact nutrient intake: chronic and acute illnesses, medications, low levels of physical activity, poor dentition, impaired mental status, depression, inability to self-feed. 2. Poor nutritional status can affect ability to remain independent and lead to increased medical burden, polypharmacy, and reduced socialization and physical activity. B. Consumption of a high-quality, nutritionally dense diet is critical for the older adult. 1. Address each older adult as an individual and consider diverse needs in regard to nutritional requirements, food preferences, and disease prevalence to promote overall healthy aging. 2. Goal of nutrition intervention is to maintain health and quality of life.

Eating and nutrition

A. Eating and nutrition are essential to sustain life and promote wellness. 1. Diet is a risk factor that can be changed positively (or negatively) to reduce (or increase) the risk of disease. 2. Nutrition can influence how a person will age; the process of aging affects nutrition. 3. Older adults are a diverse population and meeting nutrition requirements can be challenging. B. The older adult population in the United States (U.S.) is the largest growing segment of the population. 1. The older adult population is increasingly diverse; in 2011, 21% of adults over the age of 65 were members of a racial or ethnic group. i. Minority groups will account for 43% of the older adult population by 2050. ii. Older adults in minority groups historically have experienced the effects of health disparities more than their younger counterparts.

Seven metrics

AHA 2020 goals seven health behaviors and health factors shown to influence morbidity and mortality from CVD and the development and progress on of atherosclerosis. smoking, body, bmi, physical activity, healthy diet score, total cholesterol, blood pressure and fasting plasma glucose.

Physiologic Age-Related Changes

Age-related changes in the body may influence how a disease manifests and progresses, and the severity of the disease.

Nutrition and the Physiology of Aging

Age-related physiologic changes affect our nutritional needs and nutrient status. Nutrient status and nutritional intake affect the aging process and play a role in disease management Important to eat nutrient-dense, wholesome foods that contribute to health, quality of life, and well-being. Nutrition is a key factor in promoting health and ability to function at advanced ages

Inevitable and irreversible

Inevitable and irreversible Muscle mass changes Sarcopenia - loss of skeletal muscle Affects 8%-40% over 60 yrs, >50% over 75 yrs Leads to worsening of disease burden, nutritional inadequacy, increased disability, and functional dependence Fat mass changes Increased fat mass with aging

DEMOGRAPHICS

By 2040, older adults will make up 21% of the population Older women outnumber older men By 2020, there will be ~30.5 million woman and ~24.3 million men over the age of 65 More than half of the adults 65 years or older live primarily in nine states California, Florida, New York, Texas, Pennsylvania, Ohio, Illinois, Michigan, and North Carolina

conclusion

Consume a nutrient-dense diet Strive to maintain a healthy body weight Strive to maintain a physically active lifestyle Reduce fat, saturated fat, trans fat, and simple sugars Meet fluid and fiber needs Alcohol in moderation as appropriate

Genomes Centenarians

Determine which genes determinefavor long life

(DRIs

Dietary Reference Intakes (DRIs) Basis for planning and assessing diets of healthy people Additional interpretation may be necessary Multiple medical conditions Nutrition for Aging Adults Website

Cardiovascular/Respiratory Changes

Diseases of the heart and blood vessels: an important cause of morbidity and mortality Cardiovascular changes with aging Decreased ability to utilize oxygen Reduced tolerance to physical stress Changes in heart structure and function (i.e., changes in heart size, atherosclerotic changes) Dietary: fat, sodium, energy, vitamin intake Other: obesity, hyperinsulinemia, dyslipidemia, hypertension, diabetes, elevated C-reactive protein, smoking, low level of physical activity Progressive decline in lung function with age Decreased alveolar surface, progressive loss of elastic recoil in the lung tissue Decline in optimum breathing power and voluntary ventilation of the lungs as well as maximum breathing capacity Increased risk of infection in the frail and malnourished

65 and older

Eighty-one percent of adults 65 and older lived in metropolitan areas in 2011 A person over 65 has 3x greater health care costs

Endocrine system

Endocrine system changes with aging Changes in hormone production (e.g., thyroid hormone changes, sex hormone changes) Impacts metabolism and nutrient intake Plays role in the development of sarcopenia and frailty Hematologic changes with aging Anemia Most often associated with gastrointestinal blood loss, chronic disease, or nutrient deficiency

Energy

Energy needs Energy balance Energy intake Energy expenditure Estimated Energy Requirement (EER) Prediction equations should be used cautiously Decline in energy requirements Decline in energy expenditure Body weight changes

Esophageal changes

Esophageal changes: caused by pathology, not normal aging Dysphagia: Most common in those with neurodegenerative diseases Impact: aspiration leading to infection, nutritional deficiency, upper airway obstruction, depressive symptoms, dehydration 41% of adults with dysphasia felt anxiety or panic during mealtimes, and 36% avoid eating with others Esophageal changes (cont'd.) Gastroesophageal reflux disease (GERD) Causes: Underlying disease processes: gastroparesis, reduced lower esophageal sphincter functioning, reduced peristalsis, hiatal hernia Medications used to treat common conditions

Water Balance andRecommended Intakes

Essential nutrient Required for metabolic reactions Medium for transport Support vital body functions Balancing input and output

OLDER MINORITY GROUP

Hispanic Americans 7% of older adult population expected to increase to more than 20% by 2050 Compared to all older Americans Less educated Higher poverty rate Higher rate of diabetes Lower rate of cardiovascular disease, cancer, lung disease, and stroke More require assistance for personal care African Americans Compared to all older Americans Higher poverty rate Similar life expectancy Higher rate of hypertension Similar rates of other chronic diseases Higher rate without private health insurance Native Americans Indian Health Services Provides funds for health care ~41% have private insurance coverage Compared to all older Americans Higher prevalence of multiple chronic conditions High rate of diabetes and stroke Women more likely to be obese, and less likely to exercise Lower life expectancy Rural areas = less access to health care Asian Americans and Pacific Islanders Compared to all older Americans High proportions own homes and complete college Longest life expectancy among different racial groups May use traditional medicine Caucasian Americans (non-Hispanic Whites) Compared to all older Americans Highest median age Lower incidence of hypertension and diabetes

Immune system changes

Immune system changes with aging: immunosenescence Reduced number and function of immune cells Increased risk of infections, malignancy, and autoimmune disorders Immune system impacted by nutrition status and physical activity

Nutritionists and dietitians

In long term care settings and hospitals manage older adults in common.

healthy people 2020 initiatves

Increase the proportion of healthcare workers with geriatric certification by 10%

Essential Fatty Acids

Linoleic acid Omega-6 fatty acid Component of cell membranes Sources: nuts, seeds, and vegetable oils Linolenic acid Omega-3 fatty acid Neurologic growth and development Precursor for EPA and DHA Sources: canola, soybean, and flax seed oils, nuts, seeds, soybeans, and fatty fish

FATS

Lipids found in the body Triglycerides Valuable energy source Carry fat-soluble vitamins Carry phytochemicals Carry essential fatty acids Source of energy Dietary recommendations Older adults: Choose fats in similar distribution to those recommended for younger adults AMDR for fats is 20% to 35% of total calories for men and women aged 50 and older Saturated fat: Limit to no more than 8% to 10% of total calories Polyunsaturated fats: ~ 10% of total calories Monounsaturated fats: 10% to 15% of total calories

Literature update

Literature update: what are effects of body weight on physical function and mortality in older adults? 43 studies reviewed by the Academy of Nutrition and Dietetics (AND) Findings: further research is needed to differentiate protective vs. detrimental effects of body weight Recommendation: the decision is a personal choice for the older adult and need for weight loss should be based on input from various members of the healthcare team

Gene types

May influence through their effects on metabolic sustems immune functioning and cell cycles

Administration on Aging

Providers of home and community-based care Supportive services Nutrition services Preventive health services National Family Caregiver Support Program Services that protect rights of vulnerable older adults Healthy aging

Renal changes

Renal changes with aging Reduced number of glomeruli Hardened blood vessels (reduced renal blood flow) Reduced ability to concentrate urine Other factors influencing renal function Diabetes, CVD, hypertension, obesity

Heart Disease in Older Adults

Risk factor Elevated total cholesterol levels HDL cholesterol levels below 35 mg/dL Adult Treatment Panel III (NCEP) recommendations

Skeletal changes with aging

Skeletal changes with aging Osteoporosis Primary vs. secondary Prevented or delayed with modification of risk factors Adequate intake of key dietary components Regular weight-bearing exercises Lifestyle modifications: maintaining a healthy body weight, avoiding tobacco, consuming alcoholic beverages in moderation

Small intestinal changes

Small intestinal changes Aging can affect small intestinal immune functioning, immunosenescence, the microbiome, and the ability to respond to infections Disorders impacting the small bowel: enzyme deficiencies, celiac disease, enteritis, ischemia, and bacterial overgrowth Impact on nutrient digestion and absorption

Water Balance andRecommended Intakes (cont'd.)

Water intake Body composition influences total body water Lean tissue Fat Controllers of balance Renal function Imbalances more likely during times of stress Water intake (cont'd.) Controllers of balance Thirst Sensation delayed and reduced Forgetfulness or deliberate fluid restriction

Fluid Output

Water recommendations Factors that influence fluid requirements Physiologic Environmental Social Medications

Factors

classification of factors that affect food choice in older adults, food choice - function, environmental, psychological, physiological, behavioral, health social

stimulus

cognition, sound, appearance, odor, taste/tactile, tasting food,mouthfeel

anatomic changes

decrease in hearat size, decrease in the size of the cavity in the left ventricle and incrase in the size of the left atriu. heart valves become more rigid and thick as collagen deposits increase. calcification in the aortic valves also occurs.

renal tubular changes

decreases in diluting and concentrating capacity and disruptions in ability to maintain potassium homeostasis and acid base balance are consequences of rental tubular changes.

smell

detection, recognition and identification of odors and contribute to the anticipation of eating and appetitite

triglycerides

elevated b overweight and obesity, physical inactivity, cigarette smoking, high carbohydrate diet 60% total calories or substituting carbohydrates for fats, certain drugs, excessive alchol intake dietary saturated fat, cholesterol and trans fatty acids, genetics lowered by increasing dietary fruits and vegetable, physical activity, substituting fish high in omega 3 fatty acids for meats high in saturated fat, subtitling monounsaturated and polyunsaturated fats for saturated fats