Life Cycle Nutrition: Adulthood and the Later Years

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Life Cycle Nutrition Adulthood and the Later
Years

• Chapter 17

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Introduction

• Old / senior gt 65 yrs old
• Two motivating goals
• Promote health
• Slow aging
• The ratio of old people to young is increasing
• Growing old happens day by day
• projected to go from 1/8 to 1/5 between 2000 and
  2030
• Fastest-growing age group is gt85 yrs old
• 77-81 for women, 70-76 for men
• Factors influencing life expectancy

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Nutrition and Longevity

• Good nutrition and regular physical activity can
• Increase life expectancy. There are many healthy
  habits that can increase life span.
• Support good health, prevent or prolong the onset
  of disease
• Improve the quality of life.
• A persons physiological age and chronological
  age may be different

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The Aging of the U.S. Population
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Nutrition and Longevity

• Diversity of older adults lives and nutritional
  histories
• Nutritional influence on aging process
• How much aging is inevitable?
• Process can be slowed by adopting healthy
  lifestyles- nutritious diet and exercise
• 70-80 of life expectancy depends on
  health-related behaviors
• 20-30 of life expectancy depends on genetics

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Observation of Older Adults

• Healthy habits for longer life, less disability
• Physiological age vs. chronological age
• Lifestyle behaviors
• Eating well-balanced meals
• Engaging in physical activity
• Not smoking
• Abstinence or moderate use of alcohol
• Maintaining a healthy body weight
• Sleeping regularly and adequately

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Exercise and Older Adults

• Physical activity
• Benefits of physical activity in older adults
• Additional benefits
• Best types of exercise
• Aerobic activities
• Moderate endurance activities
• Strength training
• Resistance training
• Most powerful predictor of mobility in later
  years
• Physical limitations from inactivity not
  increasing age

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Many benefits ofPhysical Activity

• More lean body mass
• Greater flexibility, better balance
• Increased endurance and a longer life span
• Prevent or delay the decrease in muscle mass and
  strength that occur with age
• Quicker recovery from injury or surgery
• Active people benefit from higher energy and
  nutrient intakes (They can eat more without
  gaining unnecessary weight.)

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Manipulation of Diet for Longevity

• Energy restriction in animals-70 of normal
• Animals live longer have fewer age-related
  diseases
• Slows aging process
• Food intake
• Prevent malnutrition
• 70 of normal energy intake
• Increases antioxidant activity DNA repair
• Age of starting energy restriction

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Manipulation of Diet

• Energy restriction in human beings
• How to define energy restriction
• 30 yrs of energy restriction needed to increase
  life expectancy by 3 yrs
• Moderate restriction
• 10 to 20 percent reduction in energy intake
• Less food, less oxidative damage from food
  choices
• Benefits in body weight and fat, blood pressure,
  lipids, insulin response
• Versus nutritional adequacy that is essential to
  a long and healthy life

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The Aging Process

• Stress
• Stress response burns up nutrients and
  oxidizes/ages
• Psychological and physical stressors
• Bodily response
• Nervous and hormonal systems
• Prolonged or severe stress effects
• Men Fight-or-flight response (more stressful)
• Women Tend-and-befriend response (less stressful)

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The Aging Process

• Physiological changes
• Body weight
• 2/3 of older adults in U.S. are overweight or
  obese
• Being moderately overweight may not be harmful
• For adults gt65 yrs BMI up to 27 is OK
• Remember normal is 18.5-26
• Insist on measuring height before figuring BMI
• Annually updated height is required in LTC
• Obesity complications
• Risks associated with low body weight

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The Aging Process

• Physiological changes
• Body composition changes lose bone and muscle,
  gain fat
• Sarcopenia loss of muscle strength/quality
• Predisposes to falls
• Risk factors- smoking, inactivity, weight loss,
  obesity
• Optimal nutrition, sufficient protein, and
  regular physical activity

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The Aging Process

• Physiological changes
• Immunity and inflammation
• Immune system loses function
• Inflammaging
• Associated with Alzheimers, arthritis,
  atherosclerosis
• Inflammation critical in destroying
  bacteria/viruses and repairing tissue
• Compromised by nutrient deficiencies, antbx
• Regular physical activity improves immune system
  responses

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The Aging Process

• Physiological changes
• GI tract
• Intestinal walls lose strength and elasticity
• Slowing of motility
• Diminished appetite
• Atrophic gastritis- (inflamed stomach) affects
  1/3 older adults, bacterial overgrowth in
  stomach, low HCl intrinsic factor, impairs
  absorption of B12, biotin, folate, Ca, Zn.
  Antacids worsen it.
• Dysphagia

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The Aging Process

• Physiological changes
• Tooth loss
• Difficult and painful chewing
• Limited food selections
• Less dietary variety
• Lower intakes of fiber and vitamins
• Sensory losses vision, hearing, taste, and smell
  
• Mobility- ability to shop, stand and cook

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The Aging Process

• Psychological changes
• Depression
• Lose appetite and motivation to cook
• Economic changes
• Living arrangements and income
• Low education level
• Social changes
• Hospital and nursing home malnutrition
• Community malnutrition- living alone and/or
  living in HUD

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Energy and Nutrient Needs of Older Adults

• Dietary Reference Intakes (DRI)
• Two age categories
• 51 to 70 years
• 71 and older
• Challenges with setting standards
• Individual differences are more pronounced with
  age
• Refusal to change
• Different chronic diseases
• Different medications

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Energy and Nutrient Needs of Older Adults

• Water
• Decreased sensitivity to thirst and dry mouth
• Dehydration
• Total body water decreases with age
• Risks associated with dehydration
• Urinary tract infections, pneumonia, pressure
  ulcers, confusion and disorientation.
• Prevention- 6 glasses water per day

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Energy and Energy Nutrients

• Energy needs decrease by 5 per decade
• Protein to protect muscle mass, boost the
  immune system, and optimize bone mass
• Carbohydrate for energy
• Fiber and water to reduce constipation

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Energy and Nutrient Needs of Older Adults

• Energy and energy nutrients
• Caloric needs/activity level/metabolic rate
  declines with age
• LBM and thyroid hormones decline
• Micronutrient needs remain high
• Modified food guide pyramid
• Protein
• Especially important
• Low-calorie sources
• Liquid nutritional formulas

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Energy and Nutrient Needs of Older Adults

• Energy and energy nutrients
• Decline 5 per decade
• Monthly weights/weight goals- are they gaining or
  losing? Set the kcal rate to wt goals/changes,
  not an arbitrary kcal/d
• Carbohydrate and fiber
• Recommendations
• Constipation
• Fat
• Moderate intake
• Disease risk

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Energy and Nutrient Needs of Older Adults

• Nutrient-dense vs. quality of life
• Weight gain and malnutrition common
• Vitamins and minerals
• Vitamin B12 - bacterial overgrowth uses it up.
  Supplement more bioavailable than food
• Calcium Vitamin D- milk avoidance
• Folate- eating less fruits/vegetables
• Iron- GI bleed, antacid use
• Zinc- depletion by meds

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Energy and Nutrient Needs of Older Adults

• Nutrient supplements
• More than half of older adults use supplements
• Supplements do not contain enough of certain
  nutrients
• Calcium
• Vitamin C
• Magnesium
• Food is still best source of nutrients

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Nutrition-Related Concerns of Older Adults

• Vision
• Cataracts
• Age-related clouding of the eyes lenses
• Lead to blindness if not surgically removed
• Risk factors- oxidative stress/UV, obesity
• Antioxidants C, E, carotenoids protective
• Macular degeneration- leading cause of vision
  loss
• Omega-3 DHA, lutein and zeaxanthin

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Lutein and zeaxanthin in eye
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Food sources of lutein and zeaxanthin
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Nutrition-Related Concerns of Older Adults

• Arthritis
• Osteoarthritis
• Deterioration of cartilage in the joints
• Tends to afflict weight-bearing joints
• Known connection with being overweight
• Benefits of aerobic activity and strength
  training
• Gout
• Deposits of uric acid crystals in joints
• Purines in meat, seafood start it. Alcohol makes
  it worse
• Milk products lower uric acid level in blood and
  risk of gout.

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Nutrition-Related Concerns of Older Adults

• Arthritis
• Rheumatoid arthritis- bone coverings under attack
• Autoimmune disorder
• Omega-3 fatty acids
• Heart-healthy diet
• Antioxidant vitamins C, E, carotenoids
• Treatment
• Dietary and traditional medical intervention
• Popular supplements glucosamine, chondroitin

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Nutrition-Related Concerns of Older Adults

• The Aging Brain
• Responds to genetic and environmental factors
• Characteristic changes with age
• Loss of neurons
• Decreased blood supply
• Nutrient deficiencies
• Ex serotonin made from tryptophan
• Loss of memory and cognition
• Senile dementia

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Nutrition-Related Concerns of Older Adults

• The aging brain
• Alzheimers disease- abnormal deterioration of
  the brain
• Prevalence in U.S. 10 adults gt 70 yrs
• Symptoms- memory and reasoning loss
• Possible causes- free radicals and beta-amyloid.
• Senile plaques and neurofibrillary tangles
• Acetycholine breakdown may affect memory.
• Cardiovascular disease risk factors
• Treatment drugs are useful, but are not a cure.
• Maintaining body weight is important
  Alzheimers patients forget to consume foods.

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Food Choices Eating Habits of Older Adults

• Older people are an incredibly diverse group
• Quality of life has improved
• Chronic disabilities have declined
• Use strategies for growing old healthfully
• Spend more money on foods to eat at home and less
  money on foods away from home
• Influential factors in food choices

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Strategies for Growing Old Healthfully
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Food Assistance Programs

• Nutrition Screening Initiative
• Identify and treat nutrition problems in older
  persons
• Older Americans Nutrition Program, formerly
  called Elderly Nutrition Program
• DETERMINE (next slide)
• www.aafp.org/afp/980301ap/edits.html

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Food Assistance Programs

• Older Americans Act Nutrition Program
• Congregate meals at group settings
• Meals on Wheels
• Eligibility
• Senior Farmers Market Nutrition Program
• Supplemental Nutrition Assistance Program

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Buy only what you will use.
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Meals for Singles

• Challenges for older adults living alone
• Purchasing, storing, and preparing food
• Small kitchens and cupboards
• Foodborne illness
• Risk is greater for older adults- less HCl,
  weaker immune systems
• Letting the meals-on-wheels lunch sit around to
  be picked at until bedtime
• Spend wisely
• Wise shoppers
• Be creative

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Highlight 17

• Nutrient-Drug Interactions

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Introduction

• Use of over-the-counter and prescription drugs
• Average 13 prescriptions per year
• Vitamin and mineral supplements
• Numerous doctors
• Physiological changes that may impact drug
  usefulness

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The Actions of Drugs

• Drug
• Any substance that modifies one or more of the
  bodys functions
• Consequences
• Desirable
• Undesirable- Are the side-effects worth it?
• Example of aspirin 1) thins the blood, doubles
  bleeding time, 2) dulls pain- not always ideal

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The Interactions between Drugs and Nutrients

• Interactions can
• Lead to nutrient imbalances
• Interfere with drug effectiveness
• Factors that increase risk for adverse
  nutrient-drug interactions
• Look them up one by one
• Methods of nutrient and medication interactions

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The Interactions between Drugs and Nutrients

• Drugs alter food intake
• Eating may be difficult or unpleasant
• May stimulate appetite and cause weight gain
• May suppress appetite and promote weight loss

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The Interactions between Drugs and Nutrients

• Drugs alter nutrient absorption
• Most likely occurs with medications that damage
  the intestinal mucosa
• May bind with nutrients in GI tract, preventing
  nutrient absorption
• May reduce stomach acidity
• May interfere with intestinal metabolism or
  transport of nutrients into mucosal cells

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The Interactions between Drugs and Nutrients

• Diets alter drug absorption
• Most drugs are absorbed in upper small intestine
• Influences on drug absorption
• Stomach acidity and emptying rate
• Direct interactions with dietary components
• Drug formulation
• Binding with nutrients and nonnutrients
• Compete for absorption sites

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Folate
Methotrexate
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The Interactions between Drugs and Nutrients

• Drugs alter nutrient metabolism
• Some drugs may enhance or inhibit activities of
  enzymes needed for nutrient metabolism (folate
  and methotrexate)
• Compete for transport proteins
• Diet alters drug metabolism
• Some foods affect the activities of enzymes that
  metabolize drugs
• May counteract the drugs effects
• Some food and drug interactions can cause
  toxicity and exacerbate side effects

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The Interactions between Drugs and Nutrients

• Drugs alter nutrient excretion
• Interfere with nutrient reabsorption in kidneys
• Mineral depletion
• Diets alter drug excretion
• May lead to toxicity
• Urine acidity

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The Inactive Ingredients in Drugs

• Sugar, sorbitol, and lactose
• Diabetics and sugar
• Sorbitol and diarrhea
• Lactose intolerance
• Sodium
• Hypertension