Lifespan Nutrition Week 8 Notes
What is disability?
2009 ABS Survey of Disability, Ageing and Carers defined 'disability' as: any limitation, restriction or impairment which has lasted, or is likely to last, for at least six months and restricts everyday activities The same survey reports nearly 3 million Australians over 65 years - half of these had a reported disability, including: Those with lifelong/longer term disability Those acquiring disability as part of the ageing process
Can you discuss the calcium needs of the elderly?
Aging is associated with a decrease in calcium absorption, which is possibly due to alterations in the metabolism of vitamin D. Calcium is a very important nutrient in old age as osteoporosis and increased fracture risk becomes a health problem. Postmenopausal women not on hormone replacement therapy have higher calcium needs (1500mg). The RDI for Calcium for adults is 1000-1300mg/d.
What is the effect of combining aging and diabetes?
Aging is associated with an increased prevalence of NIDDM and glucose intolerance. Two risk factors associated with the development of these conditions include obesity and physical inactivity. In older adults, modest weight reductions can contribute to improvements in diabetic control. This is important as studies show that good blood glucose control reduces the likelihood and severity of stroke, CVD, visual impairment, nephropathy, infections, and cognitive dysfunction.
What is osteoporosis?
Aging is associated with decreased bone mass, and osteoporosis is one of the most prevalent diseases of old age 70% of the fractures that occur annually in Australia can be attributed to osteoporosis. Amongst the aging population, there is an increase in the incidence of osteoporosis, with females most affected. Based on a recent study measuring bone density in a population sample, the prevalence of osteoporosis among those aged 50 and over was estimated to be 23% of women and 6% of men. This estimate includes both diagnosed and undiagnosed cases of osteoporosis.
What changes in neurologic function occur with aging?
Alterations in cerebral functioning Decreased synthesis of neurotransmitters Less efficient nerve conduction CNS changes result in: Diminished coordination and balance Changes in mental acuity and sensory interpretation Less dexterity Mood alterations Difficulty with information retrieval
What changes occur in the pulmonary system with aging?
Alveolar numbers fall Structural changes in lung tissue > reduced elasticity and loss of alveolar surface area Gas exchange surface area can decrease by 30% Chest wall stiffens > difficulty breathing
What cardiovascular system changes occur with aging?
Blood vessels become less elastic Total peripheral resistance increases Increased vascular resistance Modest increase in the left ventricular wall Cardiac function mostly sufficient to meet physiological needs at low or moderate activity levels Markedly impaired cardiac function leads to reduced cardiac output which causes compromise to function of other organ systems
What is the relationship between nutrition and cancer?
Certain food groups are associated with a reduced risk of cancer. Fruit and vegetables are excellent sources of antioxidants, phytochemicals and dietary fibre, and a high intake appears to be associated with a reduced risk of cancer. Particular foods that may help protect against prostate cancer include soy products, tomatoes and pumpkin seeds. Foods high in resistant starch, dietary fibre and salicylates may protect against colorectal cancer.
What is the relationship between anaemia and aging?
Different forms of anaemia: Iron deficiency Anaemia of chronic disease Acute hemorrhage Vitamin B12 and folate deficiency Myelodysplastic syndrome Leukaemia or lymphoma Anaemia in general is related to a number of poor health outcomes - reduce mobility, greater risk of falls, osteoporotic fracture, frailty and reduced cognitive function Prevalence higher in those institutionalised (some estimates as high as 50%) than in the free-living population
Can you discuss the vitamin B6 needs of the elderly?
During the course of life, plasma vitamin B6 falls. Research suggests that age-related changes occur in both the absorption and metabolism of B6 and as a consequence, aged adults have a higher requirement. Studies also show that vitamin B6 deficiency results in decreased immune response. Supplementation of vitamin B6 in healthy elderly people has been found to improve immune function and long-term memory. The RDI for Vitamin B6 for adults 50-70+ years of age is 1.5mg/d.
What changes occur in the gastrointestinal system with aging?
Dysphagia Gastric atrophy Alterations in gastric acidity (B6, B9, B12 and iron) Delayed gastric emptying Changes in bowel motility (constipation) Decreased lactase activity Achlorhydria (atrophic gastritis) Decline in taste and smell functioning Reduced pancreatic secretions Reduced sensitivity of the gallbladder to cholecystokinin Development of diverticula Reduction in size of liver and portal blood flow
Can you discuss the folate needs of the elderly?
Elevated homocysteine levels have been defined as a marker of poor folate status in older people, which has been linked with an increased risk of heart disease and strokes. Folate absorption appears to be affected by atrophic gastritis, common in older adults. Folate metabolism may also be altered by the ingestion of antacids, anti-inflammatory drugs and diuretics, commonly used by older adults. The RDI for dietary folate equivalents for adults 50-70+ years of age is 400ug/d.
What are functional age classifications?
Functional age classifications: Well fit elderly Disabled elderly Frail elderly Elderly living at home Elderly living in residential care
What are the different groups of elderly?
Groups of Elderly: 'Young' elderly - 55-70 years 'Old' elderly - 70+ years
What are the changes that occur in immune function with age?
Immune function decreases with age Reduction in cellular and passive immunity General level of chronic illness Diminished ability to fight infections As people age, their ability to adapt to both external and internal stressors, especially via the immune system, is diminished owing to the physiological changes that occur with age. The immune system can also be compromised by nutritional deficiencies. A combination of age and subclinical nutrient deficiencies makes older adults vulnerable to infectious diseases, including chronic diseases where the immune system is involved, such as arthritis and cancer.
What is the effect of food education on the nutrition of the elderly?
Knowledge of previously acquired health and cooking skills not helpful in providing a balance of nutrients Favoured cooking and food preparation techniques reduce bioavailability of nutrients and leads to excessive use of: Saturated fat Sugar Salt Contemporary foods unfamiliar Challenge for individuals needing to make adjustments to diet as a result of illness
What are factors that enhance longevity?
Limited or no alcohol consumption Regular balanced meals Weight control Adequate sleep Regular physical activity Abstinence from smoking Energy restriction may also be beneficial
What is frailty in the elderly?
Not only are malnourished older adults prone to adverse health outcomes, they are also prone to frailty Frailty, once termed failure to thrive in older adults, is now considered a distinct syndrome, a precursor to or a cause of disability A general definition of frailty is a "biological syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiological systems, and causing vulnerability to adverse outcomes." OR A condition in which at least three of the following five symptoms are present: weakness, a slow walking speed, a low level of physical activity, unintentional weight loss, and exhaustion
What is the relationship between nutrient deficiencies and immunity against infection?
Nutrient deficiencies impair passive and cellular immunity: PEM B vitamins Vitamin A Trace Elements Chronic or recurrent infection can exacerbate the effects of ongoing malnutrition In the elderly, the relationship between nutritional status and immune function is of greater significance Availability of nutrient supplements may lessen the impact of immune senescence
What is the diet of the elderly like?
Older adults are at risk of poor nutrition: little or no appetite problems with eating or swallowing inadequate servings fewer than two meals a day Malnutrition among free-living elderly 5-10% Malnutrition among institutionalised elderly 30-65%
What are the effects of chronic illness on the nutritional status on the elderly?
Older adults are more likely to have chronic conditions that affect intake Disability can hinder the ability to prepare or ingest food, depression can cause a decrease in appetite Poor dental health (including cavities, gum disease, and missing teeth) Xerostomia, or dry mouth, which impairs the "ability to lubricate, masticate, and swallow food." Major disease states associated with malnutrition in the elderly (Cancer, CVD, renal disease)
Can you discuss the vitamin D needs of the elderly?
Older adults at are greater risk of vitamin D deficiency and therefore at greater risk of exacerbated bone health decline. Highest in housebound elderly people and those in residential care Risk factors for vitamin D deficiency include: Lack of exposure to sunlight (due to less physical activity) Decline in renal function (common in the aged) Impaired skin synthesis (due to aging skin) Vitamin D is important not only for bone, but also for immune function and muscle strength. The RDI for Vitamin D for adults is 10-15ug/d
Can you discuss protein and the elderly?
Older adults may consume less protein due to the affordability of red meat, and the difficulty in chewing and digesting protein owing to the age related physiological changes. The NRVs for protein for Australian adults are: Male 51-70 64g/day Male 70+ 81g/day Female 51-70 46g/day Female 57g/day The main goal for energy requirements is to maintain a healthy body weight.
What role does social isolation play in the nutrition of the elderly?
Older adults who live alone may lose the desire to cook because of loneliness. Studies have found that the appetites of widows often decrease, as does their enjoyment of meals Women are at greater risk because they live longer. Older adults may have difficulty cooking for themselves because of disabilities or inexperience in the kitchen Older adults (especially those in rural areas) can be at high risk for undernutrition if they lack access to transportation to supermarkets Institutionalised advantage over living alone
What is the status or nutrition in older adults?
Older people are the single largest demographic group at disproportionately high risk of inadequate diet and malnutrition. They are vulnerable to nutritional deficiencies because of chronic illness, heavy use of medication, and periods of lengthy hospitalisation. Lifestyle factors, immobilisation, isolation, and physiological factors associated with ageing compound these risks and affect the ability of older people to meet nutritional needs, or to digest, absorb, or utilise nutrients that are ingested.
What is the effect of obesity on the elderly?
Overweight and obesity are common problems in the aged, not because they are an inevitable part of growing older, but the associated sedentary lifestyle. Although a less serious problem in older people than malnutrition, obesity can impair functional status, increase the risk of pulmonary embolus and pressure sores, and aggravate chronic diseases such as diabetes and hypertension. Greater body fatness increases the risk of insulin resistance, hypertension and hypercholesterolemia in the aged.
What is the effect of medication on the elderly?
People 65 years old and older are prescribed medications more frequently than any other age group. Older adults often have more than one medical condition at the same time. This can affect how dugs are absorbed, eliminated, or metabolised. Weight gain may affect how medications are distributed to different parts of the body. Liver and kidney function also decrease with age, which can slow drug metabolism and elimination.
What role does limited income play in the nutrition of the elderly?
Poverty is a major risk in this group Limited income can result in a restriction in the number of meals eaten each day or reduce the quality of food consumed Potential change to shopping styles according to the time of the month Transport affects access to food
What is cognitive decline?
Prevention of cognitive loss, or dementia, poses a particular challenge in older people. Some deterioration can be attributed to atherosclerotic disease and thus interventions such as aspirin, or particular dietary patterns that reduce cardiovascular risk, may also be protective. Continued mental stimulation may also be protective. It may be possible to delay the onset of poor cognitive function in old age if food intake is adequate.
What are the different theories of aging?
Programmed Longevity: Aging is caused by certain genes switching on and off over time. Endocrine Theory: Changes in hormones control aging. Immunological Theory: The immune system is programmed to decline over time, leaving people more susceptible to diseases. Cell Senescence: The process by which cells deteriorate over time. Wear and Tear: Cells and tissues simply wear out. Rates of Living: The faster an organism uses oxygen, the shorter it lives. Cross-Linking: Cross-linked proteins accumulate and slow down body processes. Free Radicals: Free radicals cause damage to cells that eventually impairs function. Somatic DNA Damage: Genetic mutations cause cells to malfunction.
What are age associated physiological changes?
Reduced blood vessel elasticity & blood volume. Increased arterial stiffening, blood pressure. Reduces levels of oestrogen & testosterone. Decreased secretion of hGH & thyroid secretions. Increased cortisol. Reduced glucose tolerance. Reduced secretion of saliva, mucous, HCl & enzymes. Missing teeth. Difficulty swallowing. Less ATP production. Slower peristalsis. Reduced lean body mass & increased fat mass. Blunted appetite & thirst regulation. Declining number of olfactory receptors. Reduced nerve conduction velocity.
What physical changes tend to decrease the food intake of the elderly?
Reduced efficiency of the gastrointestinal tract Bowel issues: Degeneration of brush border >lactose intolerance Reduced sense of taste and smell
What changes in renal function occur with aging?
Renal function and GFR can diminish by as much as 60% between 30 and 80 years of age Kidney mass can decrease by as much as 30% at age 90 General decrease in the ability of the kidneys to concentrate urine > less able to respond to changes in fluid status and challenges to the acid-base balance Changes to renal function also limit the capacity to excrete waste products Caution with large doses of water soluble vitamins
What is sarcopenia?
Sarcopenia (meaning "poverty of flesh") is the degenerative loss of skeletal muscle mass (0.5-1% loss per year after age 25), quality, and strength associated with aging. It is characterized first by muscle atrophy, along with a reduction in muscle tissue quality, caused by factors such as replacement of muscle fibres with fat, increased fibrosis, changes in muscle metabolism, oxidative stress, and degeneration of the neuromuscular junction. Combined, these changes lead to progressive loss of muscle function and frailty.
What changes in body mass occur with aging?
The change that occurs during aging that has the biggest effect on nutritional status is due to shifts in the musculoskeletal system, which loses up to 15% of fat-free mass. After age 70, weight, begins to decline. Body fat increases, especially visceral. - This extra fat may provide an energy reserve during times of low food intake, or recovery from illness or surgery - It may also act as an insulator in colder weather, or cushion falls.
What is cell senescence?
The decline in function and degeneration of organ systems that occurs during aging is the physical manifestation of what is happening at a cellular level. Most cells enter a phase of senescence, or quiescence and can remain in that state for a considerable period of time before their destruction via apoptosis. This accumulation of senescence cells has an impact upon the functions of organs and tissues with aging. Although they are in a differentiated state, they tend to under- and overexpress the enzymes, receptors, and proteins necessary for their normal function.
What is protein energy dysnutrition (PED)?
The most common nutritional scenario for the aged is the decrease in lean mass, comprising protein dominant tissue, and an increase in fat. This disorder could not be described as the more common protein-energy malnutrition (PEM), but as protein-energy dysnutrition (PED). Illness or inadequate food intake may result in PED. It is associated with impaired immune response, infections, poor wound healing, anaemia, osteoporosis/hip fracture and decreased muscle strength (frailty), and is a risk factors for falls.
Can you discuss the vitamin B12 needs of the elderly?
The prevalence of pernicious anaemia increases with age, as does atrophic gastritis; The absorption of vitamin B12 is reduced in individuals with either condition The prevalence of H.pylori also increases with age and has been shown to be associated with B12 malabsorption Vitamin B12 deficiency not only increases the risk of irreversible neurological damage, it is likely to contribute to megaloblastic anaemia and elevated homocysteine concentrations The RDI for Vitamin B12 for adults is 2.4ug/d.
Can you discuss the water needs of the elderly?
Total body water declines with age. As a result, an adequate intake of fluids, especially water, becomes increasingly important, as thirst regulation is impaired and renal function declines. Dehydration is a particular risk for those who may not notice or pay attention to thirst, or who may find it hard to get up and make a drink or reach the bathroom. Older people who have decreased bladder control may also be at risk because they may be afraid to drink too much water. Reduced ability of the kidneys to concentrate urine and kidneys less able to conserve and excrete sodium
Can you discuss the zinc needs of the elderly?
Zinc plays an important role in wound healing, taste acuity and normal immune function, and may affect albumin status in older adults. Older adults may absorb zinc less effectively and efficiency is likely to compromise immune function with greater risk of infection, particularly respiratory, such as pneumonia. Some of the symptoms of zinc deficiency are similar to those associated with normal aging such as diminished taste. The RDI for zinc for adults is 8-14mg/d.
