BASIC NEED FOR

GERIATRICS

ARYANTI R. BAMAHRY
The Older Population
The Older Population
Physiologic Changes
• Aging is a normal biologic process  ↓ physiologic function.
• Organs change with age.

Body • Fat mass and visceral fat ↑

• Lean muscle mass ↓
composition • Sarcopenia  the age-related loss of
changes muscle mass, strength,and function,

Sedentary • Life-threatening health problems

Lifestyle

Sensory • Dysgeusia, loss of taste, and hyposmia

• ↓ sensory stimulation may impair metabolic
Losses processes.
…Physiologic
Changes
• Tooth loss, use of dentures, and xerostomia (i.e., dry
mouth) can lead to difficulties chewing and
0ral Health swallowing.
• Side effect of medication (ex: Dry mouth)

• ↓ taste sensation and saliva production  eating

less pleasurable and more difficult.
Gastro • Dysphagia due to weakened tongue or cheek
muscles  chewing and swallowing both difficult
intestinal and dangerous  Pneumonia Aspiration
• Gastric changes  cancer, ulcers, and infections
• Diverticulosis and constipation

Cardiovascular • Heart diseases and stroke

…Physiologic
Changes
• ↓ renal function
Renal • Renal function is also impacted by dehydration,

Disease diuretic use, and medications, especially antibiotics.

• ↓ Cognition, steadiness, reactions, coordination,

Neurologic gait, sensations, and daily living tasks
• Dementia, Alzheimer's d isease, Parkinson's
Function disease or any mental disorder

• Can cause mental impairment that is both

Depression transient and treatable
…Physiologic Changes

• Bedsores or decubitus ulcers

Pressure
• Paralysis, sensory losses & rigidity
Ulcers
can all contribute to the problem
• 4 syndomes : impaired physical functioning,
malnutrition, depression, and cognitive impairment
Frailty & Failure to • Include weight loss, decreased appetite, poor
Thrive nurrition,dehydration, inactivity, and impaired
immune function.

• Presbycusis  hearing loss

• Cataract, Age-related macular degeneration
Hearing & Eyesight
(A MD), Glaucoma , Diabetic Retinopathy 
vision loss

Immune response is slower & less efficient.

Immunocompetence
 ↑ infection and cancer
Quality of Life
 NUTRITION SCREENING

to evaluate nutrition status in older adults

Mini Nutritional Assessment (MNA)

An efficient, innovative, noninvasive method

to detect risk for malnutrition using questions
and anthropometric measures to determine
a malnutrition indicator score
 NUTRITION ASSESSMENT

• With aging, fat mass increases & height

decreases as a result of vertebral compression /
osteoporosis.
• Measuring arm span or knee height  to
determine HEIGHT
• Mid-arm muscle circumference measures 
more accurate and sensitive to weight change
than overall body composition / BMI
 NUTRITION NEEDS

• Many older adults have special nutrient requirements

because aging affects absorption, use, and excretion

• Studies sugges that older persons have low intakes of

calories total fat; fiber; calcium; magnesium, zinc;
copper; folate; and vitamins B12, C, E, and D (USDA,
2004; USDHHS NHANES III,2006; USDHHS, 2004)
NUTRITION REQUIREMENT

 BASED ON

 NUTRITIONAL STATUS

 HEALTH STATUS
 NUTRITIONAL NEEDS
 Energy
 Decreased requirement (changes in body composition,
↓ BMR, ↓ physical activity)
 Calculation Energy need BW, BEE, REE/TEE, actual BW
 Average calories intake:
♂ 2000 kcal/day
♀ 1600 kcal/day

• Protein
- Protein intake 1g /kg BB
- Stress-full physical & psychological stimuli negative
nitrogen balance
- Infection altered GI function & metabolic changes
reduce efficiency of dietary nitrogen and ↓ nitrogen
excretion
 Biomarker
 Albumin indicator of protein status
 Pre-albumin and RBP evaluate response to
therapy

 Carbohydrate
 Needed to protect protein from being used as
energy source
 Approximately 45 -65% of total energy
 Complex carbohydrate legumes, vegetables,
whole grains & fruits to provide phylochemical &
essential vitamins & mineral

 Lipid
 25-35% of total energy
 Reduced SFA
 Reduced fat weight control & cancer prevention
 Consumption of fat < 10%  affect quality of diet
and negatively affect taste, satiety & intake.
 Mineral
 Poor mineral status inadequate dietary intake, physiologic
changes affect the need for a nutrient & medications
 Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need
dietary modification
 Decrease Ca transport osteoporosis & hypochlorhydria
 Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)

 Vitamins
 Oxidative mechanism play an important role in the aging
process
 Antioxidant vitamins : tocopherols, carotenoids, vit C
 Cell damaged accumulate certain disease, e.g cataract,
heart disease, cancer (Ausman & Mayer, 1999)
 Vitamin A
 Fescanich et al,2002:
High losses of vitamin A  hip fracture
 Sources of vitamin A  dark green, leafy & yellow-
orange fruits and vegetables provide adequate
food excessive β-carotene  precursor vitamin A

 Vitamin C
 Older adult have lower serum level of vitamin C
 Vitamin C requirement increase : stress, smoking,
medication
 Encouraging the consumption of vitamin C-rich food
 most effective
Vitamin D
 Depend on concentration of calcium and
phosphorus in the diet.
 Age, sex, degree of exposure to sunlight
(decreased 60%)
 Function– heal skin lesions—psoriasis,
hyperproliferative disorder of cancer, actinic
keratoses
 Need moderate supplementation of vitamin D and
calcium—improve bone density and prevent bone
fracture
Vitamin E
 Vit E reduce the risk of CVD by reducing
the susceptibility of LDL to oxidation  ↓
vascular endothelial cell expression of
proinflammary cytokine (Meydani, 2001)
 Vit E  cancer prevention
Vitamin B6
 Many studies older adults do not consume
enough B6
 Atrophic gastritis, alcoholism & liver dysfunction
 ↑ requirement
 Severe deficiency ↑ homocysteine level 
anemia & risk for cardiac disease
 Encouraged  folate rich food  liver, dried
beans, broccoli, avocado, asparagus & spinach
Vitamin B12
 Elderly need screening for B12
 Prevalence 10-15% in age 60 cause: athropic
gastritis, bacteria overgrowth, anemia
pernicious, crohn’s disease, ileal resection,
malabsorbtion syndrome.
 Supplement vit.B12 or injectable for all older
adults
Water
 Daily fluid replacement is essential
 Exercise regularly
 Consume large amount of protein
 Use laxative or diuretics
 Live in areas wit high temperatures
 Need 30-35 ml/kg BB (actual body weight) or
minimum 1500 cc/d
 Increased age  total body water decreases
(≠50%) associated with a corresponding
decrease LBM
Older risk for dehydration
 Reduced thirst sensation
 Reduced fluid intake
 Limited access to fluid
 Disminished renal function
 Urinary inconvenience
Symptoms of dehydration
 Electrolyte disturbance
 Altered drug affected
 Headache
 Constipation
 Thirst, Loss of skin elasticity
 Weight loss
 Cognitive status deterioration
 Dizziness
 Dry mouth & nose mucous membranous
 A swollen or dry tongue
 Change blood pressure
 Rosessed or sunken eyes
 Change in urine color or output
 Speech difficulties
 An insufficient fluid intake with frequent
diarrhea or vomiting, fever, illness, organ
failure or chronic disease requiring
hospitalization

 Careful monitoring of fluid intake & output is

important
Dietary Planning
 Food with nutrient density

 Sufficient fluid, Ca, Fiber, Iron, Protein, Folic acid &

vitamins (A, D, B12 & C)

 Food is the best source of vitamins

 Kauffman et al, 2002-- Supplements is often

unnecessary; Vitamins, minerals, herbal supplements
used for non specific reason to stay healthy aware
potentially toxic doses

 Basic diet planning principles for older based on RDA

 4 or 5 smaller meals
NUTRITIONAL NEEDS
IN CERTAIN DISEASES
OF GERIATRICS
 Nutrition Issues

Older risk of malnutrition

 Lack of education
 Financial constraints
 Decreasing physical & psychological abilities
 Social isolation
 Treatments for multiple
 Concomitant disorder/diseases
Secondary causes of malnutrition
 Feeding impairment
 Anorexia
 Malabsorption (GIT dysfunction)
 Increased nutrient needs injury or disease
 Drug nutrient interactions
Disease Issues Older Population
 Dysphagia
 Pressure ulcers
 Alzheimers
 Parkinsons
 Geriatric failure
 DM type II
 Hypertension & constipation
Dysphagia
 Food can chopped, ground or pureed ---
eating regular consistencies
 The consistency of liquids can be modified
to thin, nectar, honey or pudding
consistency– thickening agent
 Appropriate body positioning– reduced the
risk of chocking
Pressure ulcers
 Most common
 Location below the waist, but can develop any
where
 Especially: DM, CV (peripheral), chronic illness,
cognitive impairment, mobility problems,
incontinence, neurologic impairments.
 Inadequate food; kilocalories, protein, zinc and
vitamin C.
 Frequent monitoring of BW, skin integrity, lab.
value for nutritional status
Management of Pressure Ulcers
 Based on stage and depth of damage

 Therapy; frequent repositioning, use of support

surfaces, moisture reduction, debridement and
nutritional support

 Risk factors:  BW 15%, serum albumin level

<3,5mg/dl, total lymphocyte count <1800/L

 Nutrition therapy; high protein, high energy, vitamin

C & zinc supplementation, adequate fluid intake
spare protein and tissue epithelialization.
Commercial oral supplements or tube feeding –
meet higher nutrient need.
Alzheimer’s
 Alzheimer’s – degenerative brain disorder–
irreversible memory loss and intellectual
and personality deterioration--- malnutrition
 Fluctuate food intake –emotional state,
confusion level
 Strategic to improve care can involve
providing a simple, predictable environment
and frequent cues relating to daily activities
Parkinson diseases
 Neurodegenerative disease that affects
voluntary movement
 Characterized by loss of brain cells that
produce dopamine (a chemical that help direct
muscle activity)
 Intervention includes; medication, exercise,
nutrition management, particularly in the
coordination of dietary protein adequacy and
timing of intake with medication
FAILURE TO THRIVE

Malnutrition—compromises the immune

system--contribute to development:
 Infection/sepsis
 Delayed wound healing
 MODF
 disability
Key Factors For Assessing Those At Risk
For Malnutrition
 Weight loss
 BMI < 21
 Serum albumin <3,5g/dl
 Cholesterol <160mg/dl
 Decreased food, fluid &
nutrient intake
 Loss of interest in food
 or  desire to eat
 Anorexia
 Early satiety
 Oral health
 Dysphagia
 functional status
 Cognitive and emotional
status
 Medications
 Alcohol intake
 institutionalizations
 Poverty
 Presence of infectious
disease
 Early Alzheimer’s
disease
  loss of ingested
nutrients through stools
or urine
  metabolic rate from
CHF
TERIMA
KASIH