NUTRITION FOR ADULTS AND THE ELDERLY OBJECTIVES: At the end of the Unit the student should be able to: 1. Define Aging, Adulthood, Senescence and describe h body composition 2. Understand the theory of aging. 3. Identify the physiologic changes that occur with aging and describe how these changes affect nutrient needs of older adults. Identity the feeding problems encountered during elderly. Describe the characteristics and guidelines of the diet of the older persons }ow it influences changes in => Scanned with CamScannerNUTRITION FOR ADULTS AND THE ELDERLY INTRODUCTIO! Aging Is a normal process that begins at conception and ends to death. During period of growth, anat eed catabolic changes. Reaches physiologic maturity, the rate of roces ‘catabolic or degenerative change becomes greater than the rate of anabolic regeneration. Result in loss of cells leads to decreased efficiency and impaired organ functions. PURPOSE noe NUTRITION CARE - 1. To improve or maintain nutrtional health and quality of life. 2 To prevent or tre Strat Proof precbaresercod eth aging, DEFINITION: earals ¥ pulranecs, Perec, Marueity 1, Adulthood .The period of life when one has attained full growth and maturity. Proper Autrition needs during adulthood, since it is the longest peri Possibly the peak productive years. It pertains to the years | ‘stresses such as pregnancy, lactation and convalescence. 2. Chronological a: Person's age in years from his or her dates of birth, 3. Elderly. Generally refers to individuals over age 65 YECRVALESCEMCE = bime of reecsery |. Geriatrics. The branch of medicine concemed with health problems of the eldeny, ie.” "°°" Prolonging the prime period of life, delaying the onset of degenerative aspects of aging, and treating the diseases of the aged. . Gerontology. The study of phenomena of old age . Life expectancy. The average number of years lived by people in a given society. ‘The maximum number of years of life attainable by a member of a ‘species. |. Physiological age. probable life expectancy. 9. Sarcopenia. Loss of skeletal muscle, strength, and quality. 10. Senescence. The process of growing old or the period of old age. THEORIES OF AGING ‘The “clinker” theory which indicates that the accumulation of waste in the cells causes the loss of cell function with aging. The wear and tear theory which suggests that aging is due to the chemical and - _ mechanical exhaustion of the = The cross-linkage theory which attrib to the decrease in collagen due to an ee ol wi utes aging t decrease in « icals theory which suggests that maifunction/destruction of free radicals. = fSnoe Scanned with CamScannerTHE AGING PROCESS 4. Aging procast be b. Upon phystologic maturity the procons Is ravarsod whara cata joakdowin of Colle) far oxcoods nnabolisn rosulting to Inofficlaney of fu and In the functional capacity of tho tissuas and the organs, 6, Ench typo of coll Is capablo of limited number of coll division usually 60 ~ 65 in its Motime aftor which the coll typo Is unabla to rapalr or roplaco lisolt, d, Docroase In the officioncy of the organs Is caused by the decroase In the number of {unotoniag al father than by tho chango in the functioning lovols of the remaining colle, 2. Chronological ago Is not synonymous with biological or physiological ago, Human Sea ‘and thon doaino ox ren pea oy 3. Tho aging procoss Is Influenced by both genotic and environmental factors, a, wc aes ei tho momen tho bloodling tive long the Individual Is also iikoly lo havo a fong life span, b, Environmental factors: factors In tho onvironmont that affect longavity, for ‘oxamplo, nutrition festyle, pollution, poace and ordar, oconomic status and othora, 4, Lifo oxpectancy becomos longor, thus hoalth promotion, disoaze provontion and/or {realmont of disordors/disonso aro Important to onsure quality of fo to oxtondod yoare, CHANGES TAKING PLACE IN THE ELDERLY: ‘A. Gastrointostinal Tract In tho GI tract, the Intostinal wall osos strongth and elasticity with ago, and Gl hormone socrotion change. All of those actions slow motility. + Docroasod tasto throsholds mako oating 1oss onjoyabo, * Docronsod motility + Diminishod socrotion of digestive onzymos Incroneod in gastric pH * Decronsod numbor of absorbing colls all rosull in constipation and poor nutrlant absorption, B, Circulatory + Docroasod myocardial ability to uso oxygon + Loss of olasticity of blood vossols, «Slow rato of blood flow through coronary artorios, kidnoy, GI tract and brain rosull In raducod cardiac output + Incroasod prossuro and systolic prossura, . Excrotory ‘Diminished amount of functioning nophrons and slow oxcrotion of wastes rotult In reduction in glomerular fitration rato, *Incroasad blood urea nitrogen . Endocrine + Reduced sensitivily to insulin reloaso * Docroased production of ostoyon and tostostorono, thyroxin and pitultary hormones rosullt In decreased collular motabolism and ability to withstand stress, a Scanned with CamScannerF. Respiratory G. Musculo-skoleta| In general, older} changes occur b less active with ai NUTRIENT ALLOWAN Energy. Decrease arcopenial ~ dec} The consumption of| Nervous + Diminished conductance of the nerve Impulso and decreased sensory sonsitivily result in si = Loss of p Loss of must older people © Decres © Decres © Stoop bw reflex reactions, Jmonary functional tissues and weakening of respiratory muscles [People tend to lose bone and muscle and gain fal, many of these {Cause some hormones that regulate appotito and metabolism become Je, while others become moro active, , known as sarcopenla, can be significant in the lator years making linerable to falls and immobllty, 88 in number and bulk of muscle fibers, se in muscular strength 'd posture and stiffened Joints.\tooth loss. E because of reduced basal motabolism and physical activity. ased physical activity and loss of muscle mass or lean body mass.) Sufficient energy to maintain satisfactory body welght is vital, FAO recommends a decrease 7.9% for each decade of 50 - 69 and 60-60 and 10% for 70 — years and above. Carbohydrates cet Protein Vitamins and Mine! 50-60% of thy starches rat 20-25% from Allowance fo protein utiliza For the preve Infection For elderly wi be used to p {otal kcal should come from carbohydrates primarily in the form of r than sugars fat (dietary fat) the aged Is maintained at 1.12 gm/kg body weight based on a net n of 63% Intion of progressive tissue wasting and susceptibilily to disease and 0 are unable to eat enough amounts of meat, liquid supplements may ide protein, Is, Vitamins A, E12, C and D are normally depleting during senescence alongside with minerals suc tron, zinc, calcium and folate. This occurs primarily because of tho physiological changes in the body that happens during this stage in life, Low Intake of meat, milk green lealy vegetables, and fruits further aggravate the situation. During agin ‘except for C: Dietary requi acidity that offen occurs with advancing age. When calcium Is Inade bones becor } the needs for vitamins and minerals generally remain constant Zn, VItC, ments for vitamin C and calcium may Increase due to lower stomach quately suppliod thin and fragile due to mineralization of the bony tissue and this results in ostdoporosis, % Osteopor sis , demineralization of the bony issue. More in women Scanned with CamScannerOsteomalacia or adult rickets, when calcium is poorly absorbed and metabolized because of lack of vit. D, bones fracture easily, Vitamin 86, which catalyzes tho synthesis of tho heme portion of the haemoglobin molecule. Vitamin E, which affects the stability of the rod blood cell membrana Vitamin 812 and Folacin, which aro essential for normal blood formation. Vitamin C, which increases iron absorption Copper, which faciitates haemoglobin formation. Zinc, due to impaired taste acuity occurs frequently in the elderty., also Recessary for ussue repair * Thiamin helps regulate the muscle tone of the GI tract and normal functioning of the nerve, = Vitamin D is also found to be deficient among elderty people, This is often Drought about by liver injury, antibiotic therapy, poor intestinal absorpten, and in adequate ‘exposure to sunight Food tems thal are fortéied with vitamins A and D as weil as ‘consumption of foods rich in Inoleic acid and a-tinolensc acid are beneficial = Vitamin A deficiency disorder Is the micronutrient deficiency disorder most prevalent in the older adult. Water For some reasons, many older people do not get thirsty when their body is depleted with water therefore adequate fuid intake i$ essential ‘a. Older adults are often at risk of dehydration. Dehydrated older aduts seem to be more prone to unnary act infections, pneumonia, and pressure ulcers. b. Helps control constpation e Approumately 11 qupsiday Is needed for women and 18 cupsiday for men. To promote normal bowel movement and prevent dehydration d. Elderty people confined to bed need water intake as high as four Miers a day t0 prevent kidney stone formation @. Avoid alcohol er caffeine beverages because of tei duuretc effect 1. Water is the component of the diet that most often needs reexamination during olier years -FECTING ADEQUATE FEEDING CAE ean, problems, such 33 poor food choices and tack of appetite atte! he overad nutriture of the elderly. hological Factors = eer ney. worries about one's envronment, Pestn, and financial problems ren aeeeary teeing, expressed in compisints agsinsi food, in retural to eat or in sei indulgence on * empty calode” fooss. alone to eat at The best approach for this Lind of peeson is to leave hime 3. Susp ton pace. Let bem seit ter favours foods and Sons Scanned with CamScanner4. Confusion. The confused state may result from a head trauma, diabetic or hepatic coma, or from a stroke. Confusion may lead to anxiety, depression, or suspicion. He should be helped to see, hear, and understand what is going on and what is being served to him. A rehabilitation program under professional supervision is needed. 5, Loss of Memory. This can range from forgetfulness to dementia of various degrees. ‘Two kinds are: Dementia and Delirium * Dementia : gradual onset and irreversible prognosis = Delirium: sudden onset and reversible prognosis B. Physical Factor. ‘© Poor teeth and gums, inferior quality dentures, difficulty in swallowing, lack of motor coordination affects the choice of foods and appetite. Physical discomforts, such as heartburn and gas pain may reduce food intake. + Adiminished sense of taste and smell takes away the pleasure of eating. = Cumbersome handing of eating utensils may be a source of frustration and loss of interest in food. + Physical inactivity renders the aged person completely dependent and lowers selt- esteem. * Limited mobility due to physical handicaps, ines, and lack of transportation restricts. the elderly in buying and preparing their meals. C, Cultural Factor. Cultural pattems also play a significant role in determining human behaviour. Upon reaching old age, many elderly tend to lose interest in proper grooming, dining out, and other activiies they used to enjoy with the attitude that they are already too old fori. Family support reassurance, hopefully, will change their negative altitude. D. Socio-economic-cultural factors. = Lack of money most often is the cause of selection of inexpensive “emply calorie” foods ‘and reduced intake of meat, milk, and eggs. Low income may also mean poor quality of dentures or none at all. "= Many elderly persons are easy prey to food fallacies and superstitious beliefs. Some do not drink milk because of the erroneous view that it is only for babies, and that it has constipation and/or diarrhea, and gas-producing effects. Ith Factors. = Illness in the aged, the high incidence of metabolic diseases, and the fifetime accumulation of the results of physical stresses are among the causes of variability in nutritive requirements. Ex. Infections, injuries, gastrointestinal symptoms, obesity, diabetes, gout, etc. + Unfavourable effects of drug-diet inter-relationship especially in the aged affect nutrient absorption, gastrointestinal flora, and electrolyte balance. Laxatives like mineral oil decreases absorption of fat-soluble vitamins. Analgesics can cause gastrointestinal disturbances. Antibiotics, such as tetracycline, reduce dietary iron absorption and decrease vitamin K synthesis. Scanned with CamScanner‘SPECIFIC HEALTH PROBLEMS : 1, Arthritis. Inflammation of a joint, usually accompanied by pain, swelling, and structural changes. + Osteoarthritis. The most common type of arthritis. A painful, chronic disease of the joints that occurs when the cushioning cartilage in a joint breaks down. Also called degenarative arthritis. + Rheumatoid Arthritis. A disease of the immune system involving painful inflammation of the joints and related structures. In rheumatoid arthritis, the immune system mistakenly attacks the bone coverings as if they were made of foreign tissue. : = Weight control or weight loss in the obese adult can improve symptoms. | associated with arthritis because the joints affected are often weight-bearing joints that are stressed and irritated by having to cary excess poundage. 1 = Physical and occupational therapies along with dietary interventions may improve nutritional status. 2. Constipation. Physiologic changes that often accompany a | motility, increased transit time, and a decreased urge to defecate. | | | i 1g, such as decreased Factor + decreased fluid intake immobility Parkinson's disease diabetes melitus use of iron supplements, calcium channel blockers, anti-depressants 3. Dehydration. The aging process produces physiological changes that can affect fluid ' balance in the older adult, increasing the risk of dehydration. { 4. Osteoporosis. Is a condition in which the amount of calcium in bones is reduced, j making them porous. Is a major underlying cause of bone fractures in the older adult 1 especially in postmenopausal women. 1 * Adequate calcium and vitamin D intake, along with weight bearing exercise (e.g. walking, aerobic exercise) and hormone replacement therapy (HRT) may prevent ‘or retard the development of osteoporosis. 5. Dysphagia or difficulty swallowing, poses a major health threat for older adults if itis Not recognized and treated. ‘Dest assessed and treated in teams that include a speech-language pathologist, ‘occupational therapists, and dietitians. ce Modifications in food texture and positioning and swallowing techniques, 8. Hypertension. Associated with diets high in salt or possibly low in calcium. 7. Cataracts. Are age-related thickening in the lenses of the eyes that impair vision. If not surgically removed, they can ultimately lead to blindness. Cataract occur even in well-nourished individuals as a result of ultraviolet light exposure, oxidative stress, injury, viral infections, toxic substances, and genetic disorders, 8, Muscular degeneration. A deterioration of the muscular region of the retina, Scanned with CamScannerLike cataracts, risk factors for muscular degeneration Include oxidative stress from sunlight. Dietary fat may also be a risk factor for muscular degeneration, but the omega fatty acids of fish oils may be protective. Similarly, foods rich in antioxidant nutrients and wine, with its protective phytochemicals, seem to reduce the risk of developing muscular degeneration. 9. Alzheimer's Disease. A degenerative disease of the brain involving memory loss and major structural changes in neuron networks; also known as senile dementia of the Alzheimer's type (SDAT). = Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. = Alzheimer's disease accounts for 50 to 80 percent of dementia cases. Genetic factors are involved, free radicals may also involve, nerve cells in the brains of people with Alzheimer's disease show evidence of free-radical attack— damage to DNA, cell membranes, and proteins. They also evidence of the minerals that tigger free-radical attacks—iron, zinc, and aluminum, + Research suggests that cardiovascular disease tisk factors such as high blood . pressure, diabetes, and elevated of homocysteine may be related to the j development of Alzheimer's disease, 5 ‘Symptoms include: sL Trouble leaming new tasks s$ May altempt to conceal loss by avoiding situations that require new tasks s+ Social withdrawal “4 Vague or repetitive detail in speech 4 Impaired judgment i ‘Poor impulsive control { 4 Disregard for social norms or rules of social conduct oS Wanders, get lost +4 Neglect of hygiene or appearance, inappropriate dress st Poverty of speech, foe ex., gives "I don’t know" answers 5 Memory impairment ( short term first then long term) Treatment involves ; + Providing care to clients and support to their families. + Drugs are used to improve or at least to slow the loss of the short-term memory and cognition, but they do not treat the disease. 4 Maintaining appropriate body weight may be the mos! concem for the person with Alzheimer's disease. 410. Delirium: sudden onset and reversible prognosis "= Symptoms include: +4 Reduced abilty to maintain attention to extemal stimuli + Questions have to be repeated because attention wanders 4 Perseverated answers to previous questions ++ Disorganized thinking +4 Confusion developed over a short period of time + Fluctuating level of confusion Scanned with CamScannerReduced level of consciousness Perceptual disturbances Disturbance of sleep-wake cycle Increased or decreased psychomotor activity Disorientation to time, place or person Memory impairment. DESCRIPTION OF THE DIET = The diet is lower in energy value than the regular diet since energy requirement are reduced due to decrease in the rate of metabolism and physical activity. eeeeee ‘+ Dietary modifications for texture, consistency and composition may be necessary if there is an existing nutritional or medical problem. GUIDELINES IN FEEDING THE ELDERLY ‘Small frequent feedings of easy to digest foods = Include multiple servings of fruits, vegetables, and whole grains daily for fiber and as sources of vitamins and minerals + Reduce sodium intake by avoiding salt at the table. FDA defines low sodium food as having 140mg or less of sodium per serving. + Consider the weather Finger foods or eating out in patio or park Served the food attractively for bedridden elderly Avoid high seasoned foods, unless the person is used to spices Serve and encourage plain water drinking at least 6-8 glasses a day (elderly diminished thirst sensation) Avoid any esophageal reflux by letting them sit up or stand or walk around slowly in the living room while watching tv or listening to music, They can lie down, at least an hour after eatin Choose a diet with no more than 30% calories from fat with less than 10% of total daily calories from saturated fats. Maintain adequate calcium intake of at least 800-1000 mg per day to reduce the incidence of metabolic bone disease especially among women. Choose low calorie sources of high quality protein like lean meats, poultry, fish , eggs, and low fat mitk and milk products. Gas-forming foods such as dried beans, cabbage, cauliflower, and radish may be ed or limited if these can cause abdominal discomforts. ‘and hard pieces of foods may be chopped. wih ile nuive value such as sweets, clear broths, and carbonated beverages \¢ limited, ne-containing foods and beverages should be restricted if these cause sness and sleeplessness. ge vitamin D fortified foods when there is limited sunlight exposure. Aging the skins capacity to make vitamin D and the kidney's ability to convert to its Scanned with CamScanner1d Dally Servings of Food Groups for Adults and 6 EVALUATION OF NUTRITIONAL STATUS. + Nuttition Assessment = Anthropometric measures include height, weight, and skinfold measures that physical atinbutos = Blochemical assesement may include serum albumin because tow serum albumin levels aro associntod with increased morbidity and mortality in the older. + Diotary assessment detects porsons who = Avoid cortain ood groups = Adhero to unutual dietary practicos ~ Consume excessive or insufficient amounts of essential nutrients tional assessment measures fn basic functions 0 " changes fectcnry to maintain = Activites of dally ving - set-care actives euch ws bathing, dressing, and - Instrumental activities of daily tiving - a tevel of ng: incige actvtes. wth “as meal preparston, fesl ‘management a tion assessment notes Te types and doves of prescription and over-the- ‘drugs and evaluates possibie nutrent-crug interactions, I assessment examines fmancial resources, tiving arrangements, and secial ‘Scanned with CamScannerNutrient Requirements for Adults and Elderly MALE FEMALE Age 49-28 | 30-49 50-64 [65+ | 19 -29 | 30-49 | 50 -64 | 65+ Weight, kg 59 59 59 59 | 54 51 51 St Energy/Nutrient | RENT |RENI_| REN! | RENI|RENI [RENI_|RENI_| RENI Energy/kcal 2490 | 2420 | 2170 | 1890 | 1860 [1810 | 1620 _| 1410 Protein.g 67 (6767 |67 (58 [58 58 58 Vitamin A, meg RE [550 [550 | 550 | 650 [600 | 500 | 500 _| 800 VitaminC,mg__[75___|75 175 | 75 [70 |70 70 | 70 Thiamin, mg 12 [4212 [42 att fat ft Riboflavinmg [13 [1.3 [13 [43 [4.1 [4a [at [tt Niacin, mgNE [16 [16 |16 [16 [14 [44 14 | 44 Folate,meg DFE [400 | 400 | 400 [400 | 400 [400 | 400 _| 400 Calcium, mg 750_[750__| 750 | 00 | 750 | 750 [00 | 800 Iron, mg 12 [42 [a2 [a2 [27 a7 27/10 lodine, meg. 150_| 160 | 120__| 150_|150__| 150 | 150 | 150 ‘Magnesium,mg | 235 [235 [235 _|2a5 [205 [205 | 205 | 205 Phosphorus,mg | 700 {700 | 700__|700_| 700 | 700 | 700 | 700 Zine, mg e464 [64 [64 [45 [45 [45 [45 Selenium,mog 131 [31 |31__[31_ [31 [31 31__[3t Fluoride,mg |30_ [30 (30 [30 125 |28 [25 [25 Manganese,mg [23 |23 [23 [23 [18 [18 [18 118 Vitamin D, meg | 5. 5 10 [1515 5 41045 Vitamin E,meg [12 [12 | 42 [12 [42/42 12/12 VitaminK.meg [59 [59 [59 [59 |$1__ | 51 5151 Vitamin B6,mg [1.3 [413 [47 [4.7 [43 [43 [45 [45 Vitamin B12,mog_|24 [24 [24 [24 [24 [24 |24 [24 Scanned with CamScanner‘Wolght For Helght For Filipinos 26 ~ 66 Years ‘WEIGHT (Light Clothing) Scanned with CamScanner or) rKiLos— 129 204-350 130 300-207 131 06-374 132 312-384 133 wo-38 1m 4-10 300-57 135 330-403 307-376 138 338-410 314-384 137 waca7 321-393 138 ura} 322-402 139 353-433 335-410 40 350-430 343-459 a wescaar 350-427 142 Wisasa 357-436 13 wy-as Banas 144 yea-a72 3112453, 145 u9-47s 378-482 rr pos-ass |e ur 5- 1056 ae #301076 ta |ovs-aens 295-1093 430 | 922-1129 oriaann3 i | oa7-1144 926-1133 52 | o4e- 1159 42-151 489 | wan 8975 57-1170 1% | 975-1100 922-5170 1708 938-1208 1001-1223 1003-1228 s014= 1241 1010-1239 1027-1256 wo-sro | to4-1784 tat =1272 1052-1785 1084-1287 1003-1302 1067-1305 so80- 1222 Yon 0= 1320 10 | ap-eo8 1093-1335 wosren7 07-1354 si2-025 18-1368 a19-m6 43 11384 1144-1309 \s33-259 WST~ 1455 0-858 M70- 1430 foes, | Toe Mba tae lezzr-seu2 | tsa-a77 [imecans tatoos Bota) (gale jimqotias [474-702 waa-tae | 22-712 liens | | ae-me (Gracias | sesame lyupcseze = 09-737 0 taarsad — [eto-745 10 10-68 " aT wet " | 1280-9705 ole - J ssa s720 “Developed by tne Food and Nutrition Research Insttute, OST a2breathe deeply J Think posiwely Emotional Well-Being, Soclal Health reduce sess © Be socaly tive ‘ Learn elarton techniques» Voluntee fora speci cause * Cultivate a garden + Make new friends '* Seck out laughter + Enroll in lifelong learning ‘Take time for spintual growth» Be active in your + Adopt and love a pet community + Take tine off ‘Nuttitlonal Health Physical Health + Choose nutrient-dense foods “De physicaly active *Fat5t09 fuls and vegelables + Get adequate sleep J every day « Challenge your mental skils Drink plenty of water + Keep fat intake at a healthful level Get adequate iver + Do aerobic and stenglh- training exercises atleast3 bes aweek | Seth or etiy rs ifelong Habits fr Sucessful Aging + chesih yourpesond valves and goa Manage tne ‘Develop good communication sls |» Lea em mistakes ‘= Balance diet and exerdse lo maintain; * Nurture ‘eclationships with family and friends a healthful weight + © Enjoy, respect, and protect nature + Practice preventive health care } +» Accept change as inevitable | * Develop sis and hobbies toenjoy | * Pan ahead for financial security for 1B Scanned with CamScanner