Unit-8- NUTRITION, AGING AND THE ELDERLY

• NUTRITION, AGING AND THE ELDERLY

• 8.1 Introduction.
• 8.2 The aging process.
• 8.3 Impact on physiological systems.
• 8.4 Barriers to healthy nutrition in the elderly
• 8.5 Common nutrition-related health problems
Learning objectives
• By the end of this chapter, you should be able to:
• Show an awareness of the changing demographic
profile of the population and impact of aging on
trends in health and disease.
• Describe the process of aging and its impact on
physiological decline.
• Describe how changes in nutrition, particularly
caloric restriction, may impact upon aging and
longevity.
Learning objectives
• Discuss the Nutritional requirements of the elderly
population.
• To know about the factors affecting nutritional
status of the elderly population.
• Describe the nutrition-related disorders of the
elderly and the interrelationship between
malnutrition and chronic disease.
• Discuss the role of specific nutrients, including
vitamin D, calcium, folic acid, and vitamin B12 in
prevention of health issues.
NUTRITION, AGING AND THE ELDERLY

• The elderly population are generally considered

aged 65 and over
• It is important to avoid stereotypes of elderly
people as being :
a. frail,
b. mentally incapable,
c. dependent on others,
d. and plagued by chronic disease.
NUTRITION, AGING AND THE ELDERLY

• Elderly make up a high proportion of the population

in hospital and receiving long-term medical care
• But the vast majority of elderly people are healthy,
free living, and active.
• However, the elderly years are inevitably the years
of decline and ultimately aging.
• The development of disease and the loss of
physiological functions will lead to death.
NUTRITION, AGING AND THE ELDERLY

• Global life expectancy at birth is about 72.0

years (74.2 years for females and 69.8 years for
males),
• Ranging from 61.2 years in the WHO African
Region to 77.5 years in the WHO European Region
• Women live longer than men all around the world.
• The life expectancy for Pakistan in 2019 was 67.17
years.
The aging process (Impact on physiological systems)
• Aging brings about a progressive decline in the
functioning of all organs and systems.
• The function of the gastrointestinal tract is
particularly vulnerable to the negative effects of
aging.
• Loss of teeth throughout life means that many
elderly people will rely on dentures, which provide
reduced power to masticate food.
• Periodontal disease afflicts many elderly people
and contributes to further tooth loss.
The aging process (Impact on physiological
systems)
• Reductions in salivary flow reduce the sense of
taste and make it more difficult to swallow food.
• Production of stomach acid is reduced and this
impacts upon the bioavailability of several nutrients
including folic acid, vitamin B6, vitamin B12, and
iron.
• Lower down the tract, bacterial overgrowth of the
small intestine limits nutrient uptake, and losses of
colon motility lead to constipation and diverticular
disease.
The aging process (Impact on physiological
systems)
• Some organs progressively lose function due to
reductions in the numbers of functional units.
• For example, in the lungs, alveolar numbers fall
with aging and this reduces vital capacity and
makes it harder for the elderly to partake in
vigorous exercise.
• In the kidneys, loss of nephrons contributes to
declining homeostatic functions, which can drive
problems with fluid balance and lead to higher
blood pressure.
The aging process (Impact on physiological
systems)
• Skeletal mass is also lost with age,
• Lean body mass declines,
• Fat mass tends to increase.
• Changes in body composition can increase the
tendency of older people to fall and sustain injury,
• The loss of lean body mass is generally a product of
sarcopenia.
The aging process (Impact on physiological
systems)

• Both cellular immunity and passive immunity (e.g.,

the skin barrier to infection) being compromised.
• The general level of chronic illness is also at its
greatest within this group
• There may also be psychological and cognitive
changes, including depression and dementia.
• Sensory impairments also accumulate with aging,
including loss of taste, smell, sight, and hearing
The aging process (Mechanisms of cellular
senescence)

• The decline in physiological function and general

degeneration of organs and systems that occurs
during aging is the physical manifestation of
processes taking place at the cellular level.
• Aging is the product of programmed cell death
(apoptosis),
• Most cells enter a phase of senescence and can
remain in that state for a considerable period of
time before their destruction via apoptotic
pathways.
The aging process (Mechanisms of cellular
senescence)

• The accumulation of senescent cells will impact

upon the functions of organs and tissues with
aging, as generally these cells have altered
phenotypes.
• Although they retain their differentiated state they
will tend to under- or overexpress the enzymes,
receptors, cell-signaling proteins, and adhesion
molecules that are necessary for their normal
function.
Nutritional modulation of the aging process

• Study of role of Nutrition in aging process is difficult and

time consuming on humans, therefore animal studies are
available.
• Caloric restriction and lifespan:
• It was first reported in 1935 that feeding rats a diet of
reduced caloric content throughout their lives, significantly
extended their lifespan.
• In mammalian models, protocols that reduce caloric intake
by 60% will increase lifespan by approximately 30–40%,
• In extreme cases, the extension of longevity is closer to
50%.
Nutritional modulation of the aging process

• Human CR might be beneficial in aging and

avoidance of age-related disease,
• Considerable caution is needed in translating the
data from CR studies in animals into humans.
• CR in humans have a number of adverse health
effects that would offset many of the benefits.
• BMI of less than 20 is associated with menstrual
irregularities and infertility, osteoporosis, poor
wound healing, and reduced capacity to
metabolize drugs and toxins.
Nutritional modulation of the aging process

• Underweight is also associated with impaired

immunity and hence excess levels of illness and
reduced capacity for work.

• Mortality associated with all causes and in

particular cardiovascular disease among high BMI.

• CR is also likely to result in depression and other

psychological disorders.
Supplementary antioxidants
• Antioxidants are the molecules that reduce the
chance of ageing by diminishing or maintaining the
level of oxidants with or without free radical
activity.
• Therefore, to many people, “antioxidants” and
“anti-aging” go hand-in-hand.
• There is no scientific evidence that antioxidants
slow down aging.
Nutrient requirements of the elderly

• Older persons are particularly vulnerable to

malnutrition.
• Moreover to provide them with adequate nutrition
encounter many practical problems.
• First, their nutritional requirements are not well
defined.
• Since both lean body mass and basal metabolic rate
decline with age, an older person’s energy
requirement per kilogram of body weight is also
reduced.
Energy  
• Energy requirements decline with increasing age but
it is essential that the nutrient density of the diet
remains the same.
• An energy intake reduced to less than the energy
needs of the older person can result in poor
nutritional status. 
• Every person has specific energy requirements.
• Underweight requires an increase in energy intake
• Overweight elderly person requires a decrease in
energy intake.  
Protein 
• The recommended intake is difficult to apply to all
older people but a figure of 0.75-0.8g of protein per
kilogram of body weight should meet all
requirements.
• It is essential that any older patient with a medical
condition requiring an increase in protein is
provided with an adequate intake. 
• Protein rich sources?
Micro nutrients
• Folic acid
• Vitamin –C
• Vitamin D
• Iron
• Calcium
Dietary fibre 
• It is important for an older person to maintain an
adequate intake of dietary fibre, especially the bulk
forming cereal fibre.
• It is of importance in the prevention of constipation
and lack of dietary fibre may be a contributory
factor to the development of large bowel cancer. 
• Fibre intake should be increased gradually as a
sudden change from a low to high fibre diet can
cause diarrhoea, cramps, flatulence and/or
constipation. 
Fluid 
• Older people are particularly at risk of dehydration
due to a diminished ability to sense thirst,
particularly those of a very advanced age or illness.
• Adequate fluid intake is important. 
• A minimum intake each day of six to eight cups of
fluid is required.
• Additional fluid will be required if the elderly
person increases their fibre intake.  
Malnutrition and older persons

• Many of the diseases suffered by older persons are

the result of dietary factors, some of which have
been operating since infancy.
• These factors are then compounded by changes
that naturally occur with the ageing process.
• Micronutrient deficiencies are often common in
elderly people due to a number of factors
• For Example reduced food intake and a lack of
variety in the foods they eat.
Malnutrition and older persons

• The price of foods rich in micronutrients is high ,

which further discourages their consumption.
• This is the reason that the older people often suffer
from decreased immune function, which
contributes to increased morbidity and mortality.
• Other significant age-related changes include the
loss of cognitive function and deteriorating vision,
• This hinders good health and dietary habits in old
age.
Barriers to healthy nutrition in the
elderly
• Malnutrition
• Poverty
• Social Isolation
• Nutritional knowledge/ Education
• Physical Changes
Common nutrition-related health problems

• Bone disorders/ Osteoporosis: The major

nonmodifiable risk factors for osteoporosis include
female gender, early menopause, and increasing age.
• Immunity and infection: Nutrition, infection, and
immunity are closely related.
• Digestive tract disorders: These are an important
contributor to undernutrition in the elderly population.
• There are a wide variety of different disorders that
impact upon gastrointestinal function, and these affect
the whole length of the tract
Anemia
• Anemia is a hematological condition characterized by
abnormalities of the red blood cells.
• It is defined on the basis of hemoglobin
concentrations, and the WHO sets cutoff values for
adults at 13 g/dL hemoglobin for men and 12 g/dL for
women.
• Iron deficiency anemia
• Vitamin B12 deficiency
• Folic acid deficiency
• Cognitive impairment and anemia
Sum Up
• Consume more liquids. As you age, your sense of
thirst becomes lessens.
• Eat a variety of foods. ...
• Plan your meals. ...
• Minimize your use of table salt. ...
• Season with herbs and spices. ...
• Read nutrition labels. ...
• Follow recommended servings. ...
• Reduce sugar consumption