Nutrition

Lecturer 5
The Importance of Nutrition for Older Adults
nutritionist Clinical /Dr. Hamas Swiaed
Nutrition and Ageing

For older people, who are

at increased risk of chronic disease, eating a healthy, balanced diet,
ideally starting from a young age, can help to decrease the incidence and
progression of disease and promote long-term healthy, independent living
However, the ageing process is accompanied
by various changes which can impair the ability to eat well, resulting in a
decrease in appetite and food intake as well as diet quality.

Malnutrition is the condition that develops when the body does not get the
right amount of vitamins, minerals, and other nutrients (e.g. energy, protein) it
needs to maintain health, promote cell and tissue growth and normal organ
function. Malnutrition may result from consuming too little food, a shortage of
key nutrients, or altered absorption or metabolism. Older adults are at
particular risk of malnutrition
Causes of Malnutrition Older persons
are particularly vulnerable to malnutrition. The process of aging affects
nutrient needs – some nutrient requirements increase while others decrease.
This often translates to the need for more nutrient dense food sources –
allowing one to receive the needed nutrients in less food volume. Decrease of
appetite, dental problems, psychosocial issues, illness and chronic disease
often result in lower energy intake and lower intakes of essential nutrients.
Recent data from the European Nutrition Day study showed that less than 40%
of patients eat all the food they are served in the hospital
Malnutrition: A Rising Issue
The World Health Organization (WHO) estimates that by 2015, malnutrition
will affect 1 in 6 of the global
population.2 In Europe alone the issue of malnutrition impacts more than 30
million citizens.
In the older adult population
- 50% eat less than the RDA for protein6
- 90% are Vitamin D defi cient7
- 30% are Vitamin B12 defi cient8
- 30% have inadequate Zinc and Selenium intake9,10
Malnutrition Impairs Outcome
-Malnutrition has been shown to correlate with higher rates of mortality, longer
length and increased cost of hospital
stay.12-15
-The presence of malnutrition puts individuals at risk of developing problems
such as an increased risk of infection,
-delayed wound healing, impaired respiratory function, muscle weakness, falls,
fractures and delayed recovery
Malnourished patients have a:
➞ 2-fold increased risk of long-term mortality15

➞ 3 times longer length of hospitalisation16,17

➞ 3 times higher risk of infection13

➞ Higher costs of hospital care18

➞ Greater likelihood of hospital readmission after discharge19

➞ Greater dependence in activities of daily living

 Unintentional Weight Loss

(Patients at risk for Nutritional

Dental referral
• Nutritional consultation
• Speech therapy referral for
dysphagia mgt
• Maximize disease mgt
• Remove offending drugs
Frailty
Identify Contributing factors
(nutritional screen, history, and mystical
exam)
Intervene based on Assessment
Promote Oral Intake
Remove dietary restrictions
• Enlist family support
• Vitamin/Liquid
supplements
• Appetite stimulant
• Feeding assistance
• Favorite/Familiar foods
• Minimize distractions
• Small frequent
meals/snacks

Nutritional Adequacy Achieved

Continued Nutritional Decline

Monitor/Promote Maintenance
Identify Nutritional Goals with
Patient & Family

Palliative Nutritional Support

(Appropriate when
Restore/Maintain: condition is terminal
Promote and/or intervention is
Restore/Maintain: undue burden)
oral intake
Utilize alternative
feeding methods

Identify contributing factors

• Try new interventions Provide food &
• Enteral Feeding
liquids as
• Parenteral Feeding
desired and
(Most appropriate in setting
accepted.
of acute/reversible illness.)
• Provide oral
hygiene
Obesity is defined as an unhealthy excess of body fat, which
increases the risk of
morbidity and premature mortality. Obesity is a growing concern
among adults. It
not only has increased in prevalence, but has also been associated
with significant
morbidity and mortality. Some of its medical risks include
hypertension, diabetes,
hyperlipidemia, coronary artery disease, and osteoarthritis. More
so in older adults
Philological of Obesity
Aging is associated with marked changes in body composition.
After 30 years.
of age, fat-free mass (FFM), which is comprised predominantly of
muscle progressively decreases, whereas fat mass increase
Adverse Effects of Obesity
Obesity is associated with a number of health hazards. Some
adverse effects include increased mortality, health complications,
poor quality of life, and disability.

RECOMMENDATIONS
-Initial assessment
A thorough medical history, physical examination, appropriate
laboratory tests, and review of medications should be conducted
to assess the patient’s current health and comorbidity risks
_ Additional information such as the patient’s readiness to lose
weight, previous
attempts at weight loss, and current lifestyle habits should be
collected before
Clinicians should help obese older adults set their personal goals
and welcome
participation by family members and care providers.
_ Clinicians should individualize the weight-loss plan after taking
into account the
special needs of this population
-Diet therapy
_ Advocate a modest reduction in energy intake (500–750
kcal/day) containing1.0 g/kg
high-quality protein/day, multivitamin, and mineral supplements
(including 1500 mg
Ca and 1000 IU vitamin D/day).
_ Consider referrals to a registered dietitian for appropriate
nutritional counseling and
education.
_ Behavior therapy should highlight both diet and exercise – the
integral parts of
The self-monitoring of nutrient intake and better understanding of
physical activity accomplishes this task
_ Consider referring to a behavioral therapist for counseling.
_ Stress management, stimulus control, problem solving,
contingency management,
and social support should be addressed.
-Exercise therapy
Clinicians should assess the need for stress test before any
physical activity.
Advocate an exercise program that is gradual, individualized, and
monitored.
A multicomponent exercise program including stretching, aerobic
activity, and
strength exercises are recommended
Osteoporosis is a disease characterized by low bone mass and an
increased risk of fracture. It is typically a chronic multi-factorial
disease occurring in late adulthood, following menopause in
women and a decade or so later in men. Osteoporosis may appear
in younger individuals who may be at high risk because of
hypogonadism,
malabsorptive gastrointestinal disorders, and exposure to
excessive glucocorticoids or other drugs capable of causing a
negative calcium balance.
Osteoporosis results
when too much bone resorption occurs, too little formation exists,
or a combination of both co-exists. The most common cause of
increased bone resorption results from estrogen deficiency
associated with menopause in normal women. Accelerated bone
loss continues for about 10 years after menopause; then the rate
of decline subsides to near the rate that exists for normal aging.
Estrogen replacement in the postmenopausal period reduces the
rate of resorption and stabilizes bone mass
- Men with hypogonadism have accelerated bone loss similar to
that of postmenopausal women.
- Other conditions that cause increased bone resorption include
hyperparathyroidism and hyperthyroidism.
Age-related bone loss is characterized by low rates of bone
-formation. This type
of osteoporosis affects both men and women. Although the
causation of age-related bone loss is poorly understood.
It may be related in part to decreased intestinal absorption of
- calcium.
-may cause impaired bone formation including exposure to
certain drugs, such as glucocorticoids, and immobilization or lack
of mechanical stress on bone itself.
Genetic factors undoubtedly play a major role in determining both
the peak bone
mass of young adults and the rate of bone loss in older individuals

Risk factors: non-dietary

_ Thinness with low lean body mass
_ Cigarette smoking
_ Excessive alcohol consumption
_ Insufficient physical activity
_ Drugs—over-the-counter and prescription
_ Decline of sensory perceptions
_ Falls
_ <18.5 BMI for low lean body mass
Risk factors: dietary
_ Poor overall diet quality
_ Low calcium intake
_ High phosphorus intake
_ Low vitamin D status
_ High animal protein and acid load
_ High-sodium sun

. Primary and secondary prevention of osteoporosis emphasize

(1) increased calcium intake to 1,000 mg/day or more
(2) intake of sufficient vitamin D to assure optimal calcium
absorption (at least 800 IU/day if sun exposure is limited). The
adequacy of vitamin D intake may be assessed clinically by
measurement of serum.
25-hydroxyvitamin D. Adequate intakes of calcium and vitamin D
are essential
parts of any anti-osteoporotic regime. Vitamin K may also be
included in this recommendation.
3. Drug therapy is usually indicated when osteoporotic fractures
occur or when
BMD declines into the osteoporotic range. Most available drugs
are anti-resorptive,
but anabolic, bone-forming agents are also available and have
proven to be effective Maintaining physical activity is also a key
component of any regimen aimed at
preventing osteoporosis or treating osteoporotic patients
4-Good nutrition from foods, including recommended amounts of
calcium and
vitamins D and K, should accompany the use of drugs or other
therapeutic modalities.
If sufficient calcium or vitamin D or vitamin K cannot be obtained
from
foods, supplements will be necessary