Nutrition and the Elderly

1. Nutrition and theElderly Sandra Stork MS, RD, LMNT

2. Nutrition and the Elderly • Why study nutrition and the elderly?

3. Definition of Terms • OLD – usual categorization • Young Old – 65 – 74 • Middle Old – 75 – 84 • Old Old – 85 and older

4. IQ Pre-Test • IQ = Inquiry Quotient • Test your knowledge and stimulate your interest and inquiry.

6. Topics • Changes of Aging Related to Nutrition • Geriatric Problems • What’s “new” in the “old”?

7. Objectives After presentation, discussion, and completing practice problems, you will be able to: • Describe the “Guiding Principles” of Nutritional status and care in the elderly. • Identify nutrients pertinent to elderly. • Review the physiologic changes of aging which impact nutritional status and care.

8. Objectives • Identify the association between selected Geriatric Problems and nutrition: • Sarcopenia -Weight Loss • Dehydration -Swallowing • Dementia -Pressure Ulcers • Constipation -Depression • Develop strategies for the treatment of these problems.

9. Guiding Principles • Reduced Nutrient Reserves • Reduced Response to Stress

10. Nutritional Care in Geriatrics LOW and SLOW L O N G E R

11. Case Study

12. Case Study • Emily Elder (85 y.o.) was walking with her neighbor Oliver Older (87 y.o.) to the Senior Center. On the way Emily slipped on ice and broke her hip. She was taken by ambulance to the hospital. You are the health care provider responsible for Emily’s care.

13. What information is needed to evaluate Emily’s current nutritional status and determine how to provide for her nutrition?

14. Given the following, would you be concerned about Emily’s nutrition? Height: 5’6” (167.6 cm) Weight: 110# (50 kg) Previous Wt 140# (63.6 kg) Body Mass Index 17.8 kg/m2 Albumin 3.2 gm/dL Recent Poor Oral Intake

15. Geriatric Problems What geriatric problems impact nutritional status?

17. Sensory Changes with Aging Decreased sense of smell due to decreased olfactory cells Decreased number of taste buds i Loss of sweet and salty Less loss of bitter and sour Decreased vision Hearing loss

19. Psycho-Social Changes of Aging • Economic • Less income; less money for food • Social – Lack of Socialization • Loss of mobility; can’t drive • Loss of friends and loved ones • Psychological • Loss self-worth; value • Depression; BIG problem (Bayer quote)

20. Depression …………… The attitude that: “Of course he/she is depressed, I’d be depressed too if I were that old and had all those problems…..” puts elderly at risk of not receiving clinical attention for a very treatable disorder. Just because it is “understandable”, does not mean that depression is inconsequential or normal as people age. Barb Bayer, RN, MSN, CS

21. Depression …………… is the most common psychiatric condition affecting the elderly, but it is often unrecognized and untreated. The myth that depression is just a natural part of aging is widespread in our youth-oriented society. It is also a belief held by many elderly themselves, their families, and unfortunately, many health care professionals.

23. Geriatric Problems • Weight Loss • Sarcopenia • Dehydration • Swallowing • Dementia • Pressure Ulcers • Constipation • Depression

24. Weight and Mortality Potter, et al, 1988 Corrada, et al, 2006

25. Weight Primary Parameter Standard Tables TRENDS

26. Weight Loss Practical Considerations 5% in one month 7.5% in three months 10% in six months Long Term Care Guidelines American Healthcare Association

27. Weight • Normal Trends in Aging • Peak Weight at 75 years old • General Trend of Weight Loss after 75 • Abnormal (Unintentional) Weight Loss • Depression • Practical Application • Nutrient Dense Food • Foods from Food Guide Pyramid

28. Sarcopenia • Definition: Loss of muscle mass in aging. • Results: Lower basal metabolic rate • Weakness -Decreased Functional Status • Reduced Activity Level • Decreased Bone Density • Practical Application • Progressive Resistance Exercises • Adequate Protein

32. Protein Higher protein intake required to maintain nitrogen balance Contributors: Lower energy intake Impaired insulin action Decreased efficiency of protein utilization J.Nutr.Healthy Aging, 2006

34. Protein 1.0-1.25 gm/kg/day At least one high protein food at each of three meals Physical activity to maintain muscle mass -Exercise against resistance

35. Practical Suggestions Protien Add nonfat dried milk solids Add cheese, peanut butter, eggs and nuts (if dentition permits) Use commercial protein powders or supplements

36. Geriatric Problems • Weight Loss • Sarcopenia • Dehydration • Swallowing • Dementia • Pressure Ulcers • Constipation • Depression

37. Dehydration: Causes • Decreased thirst sensation with aging • More dependent on others to obtain fluid • Decreased ability to concentrate urine • Increased incidence of incontinence with self-imposed fluid restriction • Increased use of medications contributing to dehydration • Increased losses: vomiting, diarrhea, fever

38. Dehydration: Symptoms • Decreased Skin Turgor • Dry Mouth and Mucosal Membranes • Decreased Urine Volume • Darker Urine • Constipation • Acute Weight Loss • CONFUSION

39. Dehydration Practical Application • Treat Cause • Set Fluid Goal • Goal: 30 cc/kg or 1 cc/Kcal • Replace Additional Fluid Losses • Drink Fluid At and Between Meals • Use Foods Which Have Fluid Value

40. Fluids • Which fluid is the best fluid?

41. Fluid:Nutrient Comparison

42. Fluids What about caffeine for the elderly person? Have a balanced approach. Caffeine naivety.

43. Swallowing Problems Swallow is difficult or hard to initiate Wet sounding voice Aspiration pneumonia in history S W A L L O W I N G Loss of fluid through the nose Leakage of food or liquid out of mouth when eating Overt coughing or choking with oral intake Weight loss with inadequate nutritional intake Involve Speech Pathologist and others Nutrient Density Go for Least Restrictive

44. Swallowing Practical Application • Be Alert to Symptoms • Consult Speech Pathologist • Involve Dietitian/Nutrition • Fluid and Nutrient Density

45. Geriatric Problems • Weight Loss • Sarcopenia • Dehydration • Swallowing • Dementia • Pressure Ulcers • Constipation • Depresssion

46. Dementia • Weight Loss Primary Nutritional Problem • Stage of Disease Important • Eating Behaviors

47. Eating Behaviors: Overview • Eating is NOT just food • Barometer of well being • Social interaction • Symbolic of life

48. Eating Behaviors: Examples • Distracted at meal times • Eat non-finger foods with hands • Consume non-food items • Eat pieces that are too big • Incorrect use of utensils • Resistive to eating

49. Principles of Management • Assess problems • Utilize creative strategies to address individual problems • Think OUT OF THE BOX • Alternate strategies • Continue reassessment process • Multidisciplinary approach

50. Eating Behaviors: Questions? • What is being said by behaviors? • Are behaviors harmful? • What precipitated the behaviors? • Is there an unmet need? • What are potential causes?