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 • HETEROGENEOUS POPULATION

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

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

8. 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.

9. 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.

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

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

12. Geriatric Problems What geriatric problems impact nutritional status?

13. Sensory Changes with Aging

14. Sensory Changes with Aging Decreased sense of smell due to decreased olfactory cells Decreased vision Hearing loss Tactile loss

15. Sensory Changes with Aging Decreased number of taste buds i Loss of sweet and salty Less loss of bitter and sour ? Umami ? Piquant Dry mouth prevents adequate tasting

16. Psycho-Social Changes of Aging

17. 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)

18. 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

19. 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.

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

22. Optimal Weight Weight is Primary Parameter Standard Tables vs. TRENDS Identify unintentional weight change Attention to trends Optimal Weight Maximize function and quality of life Minimize disease risk

23. Usual Weight Trends Gradual Weight Gain – Middle Age Peak Weight at 75 years Gradual Weight Loss after age 75 Epidemiology

24. Unintentional Weight Loss Weight loss >5% in 30 days >7.5% in 90 days (three months) >10% in 180 days (6 months) Example: 5% 7-8# in 154# = 146# 10% 15# in 154# = 139# Long Term Care Guidelines American Healthcare Association

25. Identifying Weight Change Weight History Change in Clothing Fit Decrease in Functional Ability Dietary Intake Records These methods are readily accessible and cost effective

26. Impact of Weight Loss Most indicative screening parameter Greater clinical significance Less reserve capacity Difficulty regaining weight Loss of functional ability

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

28. Strategies: Calories Energy needs are dependent on activity and physiologic stress levels 25-30 kcal/kg Basal Energy Equation X factor of 1-1.5 Harris Benedict Equation Mifflin St-Jeor Equation (Currently recommended) Rule of Thumb

29. Strategies: Calories Avoid unnecessary dietary restrictions Encourage use of nutrientdense foods Use more frequent meals plus supplements or snacks

30. Strategies: Calories Use foods that are well liked frequently Provide double portions of favorite foods Add calories by using sauces, gravies, toppings, and fats Emphasize calorie containing liquids to meet fluid needs Practical Suggestions

31. Obesity • h numbers reaching older age as obese (30.5% in NHANES) • h physical and cognitive disability • h risk of dependency and institutionalization • hhealth care costs, poor health outcomes, mortality Houston, et al, JADA, Nov. 2009

32. Obesity Treatment • Goal: To better manage health and maintain independence longer • Minimize loss of muscle mass • Adequate protein • Exercise (aerobic and resistance) • Minimize loss of bone density • Adequate calcium, Vitamin D • Exercise (weight bearing) • Adequate nutrient intake

33. 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

38. 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

40. 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

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

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

43. 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

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

45. 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

46. Fluids • Which fluid is the best fluid?

47. Fluid:Nutrient Comparison

48. Fluids What about caffeine for the elderly person? Have a balanced approach. Caffeine naivety. Journal American College of Nutrition, 2003

49. 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

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