Nutrition Through the Life Cycle: The Later Years

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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

2011 Pearson Education, Inc.

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

2011 Pearson Education, Inc.

 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

2011 Pearson Education, Inc.

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)

2011 Pearson Education, Inc.

 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

2011 Pearson Education, Inc.

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)

2011 Pearson Education, Inc.

Additional Concerns
Constipationfluid 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

2011 Pearson Education, Inc.

Medication
Polypharmacy: more than five prescription medications at once Affects appetite Alters nutrient digestion and absorption Fooddrug 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

2011 Pearson Education, Inc.