Chapter 5

1. Chapter 5 Nutrition and the Elderly

2. Introduction Screening & Intervention Basic Nutrition Overview Special Considerations Physiological Impact of Aging on Nutrition Summary Outline

3. Physiological Health Status Chronic Disease Changes in appetite Physical disability Sensory acuity Physical activity Use of alcohol or other drugs Lifelong diet habits Socioeconomic Culture/ethnicity Income Education Lifestyle Nutrition knowledge & practice Cooking skills Susceptibility to food fads Institutionalization Summary of Factors that Influence Nutrition in the Elderly

4. Psychological Belief system Motivation-Self-image Mental state Degree of independence Feeling of usefulness Presence or absence of spouse Social contacts-loneliness Environmental Type & location of housing Adequacy of cooking facilities Proximity of family & friends Availability, accessibility, & adequacy of food supply Health service More factors:

5. Screening and Intervention • Nutrition Screening Initiative: the premise of the initiative is that nutrition status is a “vital sign” that is just as important in evaluating a person’s health & well-being as the traditional vital signs of blood pressure & pulse.

6. Basic Nutrition Overview: • Essential Nutrients: 6 classes of nutrients • Carbohydrates • Proteins • Fats • Vitamins • Minerals • Water • These nutrients are essential for promoting growth,, maintenance, & repair of our bodies.

7. Carbohydrates: • Simple carbohydrates: sugars • Complex carbohydrates: starches • At least 50% or more of our calories should come from eating foods that are good sources of complex carbohydrates because they are nutrient rich & have fiber. • Include grains, legumes (dried beans & peas), fruits & vegetables, cereals, pasta, & rice.

8. Simple carbohydrates:Sugar Cane • High in simple sugars, (monosaccharides-cakes, candies, cookies, & sodas (empty calorie foods)= high in calories & low in nutrient value. Fruit & fruit juices also have simple sugars, but they come packaged from Nature with many essential nutrients. No more than 20% of total carbohydrates. Simple sugars: Glucose (the sugar in blood);Fructose(the sugar in fruit-honey); • Galactose (sugar made from milk sugar)

9. Major sources=whole grains,fruits, legumes, vegetables, nuts & seeds. Much of the fiber in our diet is processed away when whole grains are refined & the bran portion is removed. Not an essential nutrient, necessary to keep our intestinal tract healthy. Binds water, causing softer, bulkier stools that move through the intestinal tract more quickly. Fiber: complex carbohydrate

10. Fiber: • Researchers believe diets with adequate fiber help reduce risk of colon cancer. • Fiber also thought to bind carcinogens, or cancer-causing agents, & stools with more water lessen the potency of the cancer-causing agents in the waste material. • Adequatefiber helps prevent constipation, diverticular disease, & hemorrhoids. Soluble fiber(legumes,oats,rice,fruit)may  cholesterol levels.

11. Protein: • Proteins are the main substances that the body uses to build & repair tissues such as muscle, blood, internal organs, hair, nails,& bones. Proteins are part of hormones, antibodies, & enzymes. Enzymes are proteins that catalyze the biochemical reactions that take place in the metabolism of the body.

12. Primary function of fats, or lipids, in the body is as a rich source of energy. Fat helps insulate & regulate body temperature, it surrounds internal organs & protects them from external injury, & it is the carrier of the fat-soluble vitamins A,D,E,& K.There are two essential fatty acids-linoleic & linolenic acid. Fat calories should account for no more than 30% of total calories. Fats:

13. Vitamins: • Vitamins are substances that are needed by the body to maintain metabolism, growth, & development. • There are 13 vitamins, 2 categories. Water-soluble=Vitamins C &B complex.Fat soluble-A,D,E,K.

14. Minerals: • There are 23 minerals that are essential for human nutrition. • Perform numerous functions in the body, including metabolism, maintenance of fluid balance,bone & teeth formation,blood clot-ting,muscle& nerve function&red cells.

15. Planning meals-good nutrition • Adequacy • Balance • Calorie Control • Moderation • Variety

16. Food Guide Pyramid: • Foundation= bread, cereal, rice, & pasta. • Next=fruits & vegetables • Next=milk, yogurt, & cheese • Next=meat, poultry, fish, dry beans, eggs & nuts. • Top=fats,oils,sweets.

17. Food Preparation for the Elderly: • Small, frequent meals • Low in fat,sugar, cholesterol, & salt. • Convenience foods that are healthy. • Quick & easy snacks. • Cheerful environment. • Regular exercise. • Shop & eat with neighbors.

18. Ensure Sustacal Boost Choice DM 250cal-9g.protein6gfat 240cal-14.5gprotein 9g fat 240cal.-10.2g.protein 4.1g.fat 250cal.-10.6g.protein 12 g.fat. Liquid Nutritional Supplements:

19. Drugs that affect appetite: • Decongestant • Amphetamines • Appetite suppressant drug • Appetite stimulant • Lithium • Tranquilizers • Steroids

20. Dental Health: • Total loss of teeth in 55% in adults older than 85 • 44% age 75-84 • 30% age 65-74.

21. Thirst, Dehydration, GI Tract • Dehydration: Dry lips; Sunken eyes; Swollen tongue; Increased body temperature; Decreased blood pressure; Constipation; Decreased urine output; Nausea • GI Tract: Increase dietary fiber

22. Liver-GB, Pancreas, Cardiovascular • Liver function complicated with alcohol abuse. • Gallbladder malfunction = gallstones. • Cardiovascular:Heart healthy diet and exercise. • Drug & Nutrient Interactions

23. Value of Appropriate Nutrition: • The value of appropriate nutrition screening & intervention cannot be underestimated in providing quality care for the elderly.Good nutrition not only optimizes health & well-being, it helps prevent the onset of many chronic diseases.