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Life Cycle Nutrition: Adulthood and the Later Years

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Title: Life Cycle Nutrition: Adulthood and the Later Years


1
Life Cycle Nutrition Adulthood and the Later
Years
  • Chapter 17

2
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3
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

4
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

5
The Aging of the U.S. Population
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7
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

8
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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10
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

11
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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13
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

14
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

15
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)

16
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

17
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

20
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

21
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

22
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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24
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

27
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

28
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

29
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30
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

31
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

32
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

33
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

34
Lutein and zeaxanthin in eye
35
Food sources of lutein and zeaxanthin
36
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.

37
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

38
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

39
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41
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.

42
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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45
Strategies for Growing Old Healthfully
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47
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

48
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

49
Buy only what you will use.
50
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

51
Highlight 17
  • Nutrient-Drug Interactions

52
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53
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

54
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

55
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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58
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

59
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

60
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

61
Folate
Methotrexate
62
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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64
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

65
The Inactive Ingredients in Drugs
  • Sugar, sorbitol, and lactose
  • Diabetics and sugar
  • Sorbitol and diarrhea
  • Lactose intolerance
  • Sodium
  • Hypertension
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