Nutrition for Older Adults

Nutrition for Older Adults Demographic Trends and Aging Population ●​ ●​ ●​ ●​ The 65+ age group is projected to nearly double from 52 million in 2018 to 95 million by 2060. Women outlive men, but have higher rates of chronic disease. Social Security is the primary source of income for most older adults. The baby boomer generation (born 1946–1964) is better educated and has higher expectations for healthcare and nutrition. Physiological Changes in Aging and Nutritional Needs ⇒ Aging leads to declining metabolic rate and physiological changes, requiring nutrient-dense diets. ●​ ●​ Declining Energy Needs ○​ Caloric requirements decrease due to: ■​ Lower metabolic rate ■​ Reduced physical activity ■​ Loss of lean body mass ○​ Maintaining muscle mass helps sustain metabolic rate. ○​ Consuming less calories means consumption of nutrient dense foods is critically important Protein Needs ○​ RDA: 0.8 k/kg/dayy (same for all ages) ■​ Men 51+ years: 56 g/day ■​ Women 51+ years: 46 g/day ○​ Increased protein intake may help counteract sarcopenia (muscle loss)? ○​ Elderly with compromised medical status may need more protein ⇒ 1-1.5 g/kg/day *** ○​ The oldest age groups are most at risk for protein deficiency ○​ Challenges: Difficulty chewing, loss of appetite, expense. ○​ Best sources: Meat, fish, poultry, dairy, legumes. ○​ Complementary proteins: Legumes + Starch ○​ ADMR: 10-35% of total calories ●​ Carbohydrate Needs ○​ AMDR: 45-65% of total calories.* ○​ Minimum to spare protein breakdown: 100 g/day. ○​ Minimum needed: 130 g/day.* ○​ Approximately half of kcals from carbohydrates should come from complex carbs: starch and fiber ○​ Fiber: 25-35 g/day* (prevents constipation, regulates blood sugar). ■​ Increased water intake to aid in intestinal motile ○​ Encourage whole grains, fruits, and vegetables. ●​ Fat Needs ○​ There is a decrease in the intake of fat and cholesterol with age ○​ AMDR: 20-35% of total calories.* ○​ Saturated fat: Less than 10% of total intake.* ○​ Omega-3 fatty acids (from fish, nuts, seeds) reduce inflammation and improve heart health. Physical Exam 1.​ Obtain height and weight at each visit to calculate BMI a.​ BMI < 22 ⇒ Underweight b.​ Best BMI for older adults is 25 c.​ Obtaining a correct BMI may be difficult due to alterations in height (kyphosis, etc..) 2.​ Signs and Symptoms to look for a.​ Muscle wasting (sunken temples) b.​ Ill-fitting dentures c.​ Mouth sores/abscesses 3.​ Very important to examine patients with cognitive impairment a.​ May not be able to verbalize constipation, urinary retention, abd discomfort Signs and Symptoms to look for: Key Micronutrient Requirements ⇒ Older adults require higher levels of certain vitamins and minerals. Nutrient RDA Importance ●​ ●​ ●​ Vitamin D 600 IU (51–70 years) 800 IU (71+ years) ●​ ●​ Males 51–70: 1,000 mg Calcium ●​ ●​ Males age 71+: 1,200 mg/day Females 51+: 1,200 mg ●​ ●​ Vitamin B12 2.4 µg/day 51 yrs+ ●​ ●​ Prevents osteoporosis Reduces fall risk In North America, it is estimated that 50% of the population is deficient in Vitamin D Vitamin D should be routinely assessed + supplements prescribed if needed Supplementation improves muscle strength, walking distance, functional ability Maintains bone density Prevents fractures, osteoporosis LARGE disparity between need and consumption B12 supplementation should be considered in this patient population Levels should be monitored regularly Low stomach acid secretion, secondary to atrophic gastritis, may seriously impair the absorption of Vitamin B12 in those over age 50 ●​ ●​ Folate 400 µg/day 51 yrs+ ●​ ●​ ●​ ●​ Iron 8 mg/day 51+ Inadequate folate statu ⇒ hyperhomocysteinemia⇒ increase the risk of CAD Folate supplementation likely not needed Stroke risk dec. after folic acid fortification ○​ Excessive consumption of fortified foods can mask a B12 deficiency Prevents anemia Supports oxygen transport When inadequate, appropriate supplementation should be prescribed ○​ Want to encourage a stool softener as constipation is a common side effect Hydration and Fluid Needs ●​ Older adults are at higher risk of dehydration due to: ○​ Reduced thirst response ○​ Impaired kidney function ○​ Fear of incontinence ○​ Cognitive decline (forgetting to drink) (increased risk of dehydration and UTIs) ●​ Hydration Guidelines ○​ Encourage 6-8 glasses of water/day. ○​ Monitor fluid intake in kidney or heart disease patients. ○​ Avoid sugary drinks for diabetics. Health Literacy in Older Adults ●​ ●​ Many struggle to understand health information, affecting: ○​ Medication use ○​ Food choices ○​ Label reading ○​ Cognitive decline and past education levels influence literacy. ○​ Nutrition education programs can improve dietary habits. Education does NOT guarantee the ability to read Social and Economic Barriers to Nutrition ●​ ●​ Common Barriers ○​ Economic Hardship: Fixed incomes limit food choices. ○​ Physical Limitations: Contributes to food insecurity ○​ Social Isolation: eating alone and inadequate assistance with shopping and preparing meals can lead to poor dietary intake ○​ Food Insecurity: Many older adults lack consistent access to nutritious food. Always inquire about these issues and refer to social workers and community agencies when appropriate! Identifying and Managing Malnutrition Who is at Risk? ●​ ●​ ●​ ●​ Hospitalized patients for serious illnesses Nursing home residents Homebound older adults Individuals over 70 in urban areas Causes of Malnutrition ●​ ●​ ●​ ●​ ●​ Oral health issues (poor dentition, dentures) Swallowing difficulties (dysphagia) Chronic diseases (cancer, COPD, diabetes) Polypharmacy (multiple medications affecting appetite) Depression, grief, dementia Screening for Malnutrition ●​ ●​ ●​ BMI < 22 = Underweight Significant weight loss: 5% in 1 month or 10% in 6 months signals malnutrition. Nutritional screening tools available online (e.g., Mini Nutritional Assessment). Risk Factors for Poor Nutritional Status Chronic Conditions Info ●​ ●​ ●​ ●​ Oral Health Problems ●​ ●​ ●​ Most older adults have 1 + Prevalence increases with increasing age Most common: ○​ Hypertension ○​ Heart disease ○​ Arthritis ○​ Osteoporosis ○​ Diabetes ○​ COPD ○​ Old surgery Tumor burden Chewing and swallowing ~ 26% of US older adults are edentulous Higher among minorities, smokers, uninsured, those with less schooling and those who reside in nursing homes Cognitive and Emotional Impairment ●​ ●​ ●​ ●​ Memory loss Dementia Depression Grief/Mourning Isolation - social aspect of eating ●​ ●​ Loneliness, hearing/visual impairment Having someone to eat with has been shown to significantly increase food consumption Alcohol and Drug Use ●​ “Risky” alcohol use ○​ More than 3 drinks per day or > 7 per week (age 65 and older) ○​ Utilizing in office questionnaires can be beneficial AUDIT and CAGE questionnaires ●​ Socioeconomic Status ●​ ●​ Functional Status ●​ ●​ ●​ ●​ ●​ ●​ ●​ ADLs Bathing Dressing and undressing * Eating Transferring from bed to chair and back Voluntarily control of urination/defecation Using the toilet * Walking (not bedridden) Polypharmacy Many older adults have financial challenges and live on a fixed income Having less or choosing to spend less makes it very hard to get the foods you need to stay healthy Ability to perform activities related to self-care and daily living ○​ ADLs reflect an individual’s capacity for self-care ○​ IADLs reflect more complex tasks, allows a person to live independently in the community ○​ Many older adults have disabilities which limit their ability to perform ADLs ○​ Always ask about functional status when taking a medical history **HAVE A DIRECT LINK TO NUTRITIONAL STATUS ** ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ ●​ IADLs (Instrumental) Using the phone * Shopping Laundry Food preparation Housekeeping Handling finances * Medication adherence The use of multiple drugs by a single patient to treat one or more conditions 5+ medications increase risk of: ○​ Appetite loss ○​ Gastrointestinal issues ○​ Taste changes ○​ Weakness and dizziness Nutritional Frailty & Dietary Modifications Nutritional Frailty ●​ ●​ ●​ Defined by: Low functional reserve, decreased strength, increased disease susceptibility, physical weakness. Due to Sarcopenia ⇒ Loss of lean muscle mass Results in: ○​ Falls, reduced independence, increased mortality risk ○​ Decreased overall functioning Dietary Strategies ●​ ●​ ●​ Lift unnecessary dietary restrictions (low-sodium, low-fat) to improve appetite. Use flavor enhancers (butter, oil) to increase calorie intake. Offer nutrient-dense meals and snacks. Supplements for Malnutrition ●​ ●​ Commercial liquid nutrition (Ensure, Boost) Should be given between meals to maximize intake. Interdisciplinary Approach to Senior Nutrition Healthcare Team Involvement ●​ ●​ ●​ ●​ ●​ Dietitians: Create meal plans, manage malnutrition. ○​ Identifying and treating disease-related malnutrition and in conducting medical nutrition therapy Nutritionist: Individuals with a broad range of credentials and training in nutrition. Speech-Language Pathologists (SLPs): Assist with swallowing issues. Social Workers: Help navigate financial and community resources. Pharmacists: Assess medication side effects on appetite and digestion