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Chapter 11
Nutrition and Aging

Objectives (1 of 3)

Demonstrate knowledge of current research on the impact of aging on nutrition status for healthy individuals and individuals with chronic diseases.

Describe the importance of early screening and intervention for nutritional risk in older adults.

Identify screening tools for the assessment of nutritional risk in the older adult.

Objectives (2 of 3)

Recognize the multiple factors that affect nutrition status in older adults (physiologic, social, psychological, economic, and environmental).

Describe the physiologic impact of aging on dietary intake and absorption.

Use MyPlate to advise the older adult about the implementation of the 2010 Dietary Guidelines for Americans.

Objectives (3 of 3)

Describe the basics of the Mediterranean diet and the DASH diet for the treatment of common chronic diseases in the older adult.

Recognize the impact of polypharmacy on nutritional status and drug–nutrient interactions in older adults.

Describe the appropriate use of nutritional supplements for the older adult.

Screening (1 of 20)

  • The Nutrition Screening Initiative (NSI)
  • Encourages early and routine screening and intervention for nutrition risk in older adults
  • Views nutrition status as a vital sign
  • Strives to increase older adults’ awareness about nutrition and health and offers health \care practitioners the tools to do so, including the DETERMINE questionnaire

Screening (2 of 20)

The National Resource Center on Nutrition & Aging

Screening (3 of 20)

The National Resource Center on Nutrition & Aging

Screening (4 of 20)

  • Malnutrition Screening Tool (MST)
  • Consists of three questions:
  • Have you lost weight recently without trying?
  • If yes, how much weight have you lost?
  • Have you been eating poorly because of decreased appetite?

Screening (5 of 20)

  • Malnutrition Screening Tool (continued)
  • First two questions are scored as 0 (No), 1 (Yes), or 2 (Unsure)
  • Third question is scored from 1–4, based on the amount of weight lost
  • Total score of 2 or more indicates that the older adult is at risk of malnutrition and further assessment is warranted

Screening (6 of 20)

  • Malnutrition Universal Screening Tool (MUST)
  • Malnutrition risk is determined by assessing:
  • Body mass index (BMI)
  • Unintentional weight loss
  • Severity of acute disease

Screening (7 of 20)

  • Nutrition assessment tools
  • Used for patients identified as “at risk” for malnutrition
  • Useful in:
  • Quantifying risk
  • Determining severity and duration of malnutrition
  • Identifying possible causes for the deficits

Screening (8 of 20)

  • Subjective Global Assessment (SGA)
  • Classifies patients from well-nourished to severely malnourished
  • Clinician records patient weight history, diet history, primary diagnosis, stress level, and changes in functional status
  • Clinical judgment needed in analyzing the information provided

Screening (9 of 20)

  • Mini Nutritional Assessment (MNA)
  • Includes:
  • Anthropometric measurements
  • Diet history
  • Appetite
  • Feeding mode
  • Laboratory measures of nutritional status
  • Developed especially for use with older adults

Screening (10 of 20)

  • Diagnosis of malnutrition needs to include two or more of the following characteristics:
  • Insufficient energy intake
  • Weight loss
  • Loss of muscle mass
  • Loss of subcutaneous fat
  • Localized generalized fluid accumulation that may mask weight loss
  • Diminished functional status as measured by handgrip strength

Screening (11 of 20)

  • Undernutrition: weight and malnutrition
  • Prevalence of malnutrition varies depending on factors such as age distribution and living situation
  • Decreases in body weight are common in adults ages 65 to 90
  • Considered a warning sign for nutritional risk
  • Strong association between undernutrition and increased morbidity and mortality

Screening (12 of 20)

  • Involuntary weight loss may be caused by:
  • Inadequate dietary intake
  • Loss of appetite
  • Muscle atrophy
  • Inflammatory effects of disease
  • Many older adults may experience a combination of these factors

Screening (13 of 20)

  • Inadequate dietary intake
  • Associated with:
  • Social isolation
  • Limited ability to purchase food
  • Chronic disease and medications
  • Malignancy and depression
  • Dysphagia
  • Dementia
  • Chewing difficulty related to poor dental health

Screening (14 of 20)

  • Physiologic changes of aging that can result in anorexia or decreased appetite:
  • General reduction in gastrointestinal motility
  • Declines in senses of taste and smell
  • Decreased basal metabolic rate
  • Impaired hormonal regulation of food intake
  • Certain drugs and medications can also reduce taste and smell acuity

Screening (15 of 20)

Screening (16 of 20)

  • Decreased absorption of nutrients
  • Lactose intolerance
  • Consumption of dairy products causes intestinal gas, diarrhea, and cramping
  • Caused by decreased intestinal lactase production
  • Severe form can:
  • Decrease the absorptive capacity of the intestinal cells
  • Cause malabsorption of many nutrients
  • Risk of inadequate calcium intake

Screening (17 of 20)

  • Celiac disease
  • Sensitivity to gliadin, a component of gluten found in wheat and some other grains
  • Consumption of gluten causes:
  • Damage to intestinal villi
  • Malabsorption of fats, fat-soluble vitamins, and minerals such as calcium and iron

Screening (18 of 20)

  • Vitamin B12 deficiency
  • Vitamin B12 absorption requires the gastric secretion of acid and intrinsic factor, which decreases with age
  • Absorption can be further compromised by medications for heartburn, gastroesophageal reflux, or diabetes
  • Deficiency can also contribute to age-related cognitive decline

Screening (19 of 20)

  • Vitamin D deficiency
  • Ability to synthesize vitamin D with exposure to sunlight decreases with aging
  • Many older adults reduce sunlight exposure
  • Low vitamin D levels:
  • Decrease muscle strength
  • Increase the risk of falls
  • Contribute to the development of osteoporosis

Screening (20 of 20)

  • Dehydration
  • Aging is associated with:
  • Decrease in total body water
  • Decline in thirst perception
  • Decrease in renal water conservation capacity
  • Risk factors:
  • Cognitive impairment
  • Issues with incontinence or mobility

Treatment of Weight Loss and Other Nutritional Problems Related to Aging
(1 of 23)

  • Weight loss
  • Healthcare providers need to identify the cause when an older adult loses:
  • 5% or more of body weight in 1month
  • 10% or more in 6months
  • Treatable causes of weight loss:
  • Anorexia
  • Dysphagia

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (2 of 23)

  • Use the MEALS ON WHEELS mnemonic to identify the general causes of weight loss in older adults:
  • M: medications
  • E: emotional (depression)
  • A: alcoholism, anorexia nervosa, or abuse
  • L: late-life paranoia
  • S: swallowing disorders

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (3 of 23)

  • O: oral factors
  • N: no money
  • W: wandering and dementia-related behaviors
  • H: hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoadrenalism
  • E: enteric problems, malabsorption
  • E: eating problems
  • L: low-salt, low-cholesterol diet
  • S: shopping and meal preparation problems

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (4 of 23)

  • Treatment of gastrointestinal problems
  • Constipation
  • Treated by increasing fluid and dietary fiber intake
  • Must increase both dietary fiber and fluid to avoid the risk of fecal impaction
  • Ensuring adequate fiber intake may also reduce the incidence of diverticulosis and the risk of certain types of colon cancer

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (5 of 23)

  • Malabsorption
  • Most common causes in older adults are lactose intolerance and celiac disease
  • Eliminating lactose treats lactose intolerance
  • Avoiding gluten treats celiac disease
  • There are a number of food products designed for people with each of these conditions

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (6 of 23)

  • Inadequate intake or absorption of vitamins and minerals
  • Little clinical evidence to support routine multivitamin and mineral supplementation in the absence of compromised nutritional status
  • Older adults can benefit from supplemental B12
  • Vitamin D supplements should be considered for older adults at risk for vitamin D deficiency
  • Calcium supplement may also be appropriate

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (7 of 23)

  • Dehydration
  • Signs and symptoms:
  • Dry mouth
  • Dark urine
  • Fatigue and lethargy
  • Important to develop prevention strategies
  • Older adults should try to:
  • Consume at least 6 cups of fluid per day
  • Consume fluids with meals and between meals

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (8 of 23)

  • Overnutrition
  • Excess nutrient and energy intake over time
  • Form of malnutrition when it leads to morbid obesity
  • Associated with an increase in:
  • All causes of mortality
  • Morbidity related to hypertension, dyslipidemia, type 2 diabetes, and other chronic diseases

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (9 of 23)

  • Best weight for height in older adults may be higher than that for younger adults
  • Weight loss recommendations must be made on an individual basis
  • Any weight loss should be pursued cautiously

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (10 of 23)

  • Cardiovascular disease
  • Evidence suggests dietary changes can help prevent cardiovascular disease in older adults
  • PREDIMED trial
  • Found a relative risk reduction for men and women consuming Mediterranean diet
  • Participants had type 2 diabetes or at least three major risk factors for cardiovascular disease
  • Diet was energy unrestricted and participants did not lose significant amounts of weight

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (11 of 23)

  • Diabetes
  • Necessitates evaluation by a dietician
  • Older diabetics may need regular help adhering to a diet to manage blood glucose levels
  • Plan should emphasize foods low on the glycemic index
  • Obese older people with diabetes may benefit from modest weight loss

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (12 of 23)

  • Dietary patterns that support persons with diabetes:
  • Mediterranean diet
  • DASN (Dietary Approach to Stop Hypertension) diet

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (13 of 23)

  • General nutrition recommendations
  • Dietary Guidelines for Americans 2015–2020 provide food-based guide to help individuals:
  • Improve and maintain overall health
  • Reduce their risk of chronic disease
  • Overarching focus is on making food choices to support healthy eating patterns

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (14 of 23)

  • General guidelines for older adults:
  • Follow a healthy eating pattern across the lifespan
  • Focus on variety, nutrient density, and amount
  • Limit calories from added sugars and saturated fats and reduce sodium intake
  • Shift to healthier food and beverage choices
  • Support healthy eating patterns for all

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (15 of 23)

Reproduced from U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 2015-2020 Dietary Guidelines. www.health.gov/dietaryguidelines/2015/

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (16 of 23)

  • Diet plans consistent with the recommendations in the Dietary Guidelines:
  • Healthy U.S.-Style Eating Pattern
  • DASH dietary pattern
  • Health Mediterranean-Style Eating Pattern
  • Healthy Vegetarian Eating Pattern

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (17 of 23)

  • Appropriate caloric level varies based on the individual’s specific caloric needs
  • Recommended Daily Allowance (RDA) for energy for individuals over the age of 50:
  • 1900 kcal for females
  • 2300 kcal for males

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (18 of 23)

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (19 of 23)

  • MyPlate
  • Part of a communications initiative from the USDA to encourage healthier eating habits
  • Uses a graphic of a dinner plate to illustrate serving size in the five food groups
  • ChooseMyPlate.gov offers a special section focused on older adults

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (20 of 23)

Data from Choose My Plate. U.S. Department of Agriculture. www.choosemyplate.gov/myplate-mywins

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (21 of 23)

  • Drug and nutrient interactions
  • Many drug–drug interactions involve interactions between medications and dietary supplements
  • Examples:
  • Antihyperlipidemic drugs can interact with niacin
  • Grapefruit affects the metabolism of statins
  • Garlic interacts with warfarin, increasing its effects
  • Leafy greens may decrease warfarin’s effectiveness

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (22 of 23)

  • Alcohol
  • Not patently discouraged unless it:
  • Directly inhibits or exacerbates effectiveness of medications
  • Contributes to loss of balance and mobility
  • Interferes with health and nutrition due to abuse
  • Focus by healthcare professionals should be on whether drinking has increased and why

Treatment of Weight Loss and Other Nutritional Problems Related to Aging (23 of 23)

  • Nutritionally, alcohol abuse compromises health and can lead to malnutrition by:
  • Adding calories to the diet, leading to weight gain
  • Replacing nutrient-rich food in the diet
  • Interfering with the normal absorption and metabolism of vitamins