Sue Roberts, MPH MS RD/CN

Relationship between body mass and survival Importance of nutritional assessment

Declines in mortalities from infectious diseases Increases in technologies to detect diseases New pharmacotherapies Increased awareness of disease risk factors Better access to health care Overall better nutrition and sanitation Technological enhancements and/or preventive measures

Graying” of America is health crisis By 2050, one in four persons in the US will be over the age of 65 Women will be dominant demographic 10% of the elderly live alone 23% households contain an elderly person

Caloric content, protein intake, high complex carbohydrate consumption Decreased total fat intake, high proportion of mono- unsaturates, long chain omega-3 fatty acids, low trans and saturated fats Increased intake of antioxidants Antioxidants, including phytochemicals, selenium, and Vit. C, E, A, the carotenoids and zinc Increased calcium, vit.D, vit. K, adequate magnesium and lower intakes of phosphorus

Adequate protein for prevention of muscle mass losses, pressure ulcers and immunocompetence Sarcopenia Protein and calcium intake Socioeconomics and institutionalization Provision of protein supplements

Physical activity prevents functional decline-- balance improvement, less sarcopenia, better moods and sleep Visceral adiposity is strong risk factor for disease and metabolic syndrome associations; insulin resistance; waist circumference

Cigarettes are considered deleterious to health over long term; chronic diseases are correlated with tobacco product use. Oral health is important to consume nutrient- dense foods such as fruits and vegetables; saliva and the bacteriostatic effect

Pet ownership--lowers blood pressure, risk of cardiovascular disease, decreased depression, and increased immune response. Declines in circulating sex steroids Marital status and healthy aging--in men

Depression, declines in cognitive function and neurodegenerative disease Mental activity delays cellular senescence Socioeconomics impacts nutritional status and overall health Increased education is associated with more successful aging

Polypharmacy and the elderly The use of herbals, botanicals and amino acid supplements Older adults use more than 30% of all medications prescribed Overweight and obesity in the elderly

Estimated that 40% of nursing home residents 50% of hospitalized elderly patients are malnourished Malnutrition Malnutrition--protein-energy undernutrition (PEU)

Older adult must be evaluated for unintended weight loss; height and weight; BMI Calories: energy intake declines with age, reduction in BMR, reduction in lean body mass and decreased physical activity Protein-energy malnutrition (PEM)

An 80 year old male, F. H., is present with advanced stage Alzheimer’s; he is not eating that well. His son is present and reports that his father is currently living with him and his wife because he does not have the heart to put his father in a nursing home knowing that his life is almost over. He reports that his father was eating very well 1 year ago, but then all of a sudden he stopped eating. They do have home health nurses come in when he and his wife are at work and the nurses have tried feeding him, but he will only take a few bites of food and will sometimes start choking on it.

The son reports they have tried giving him Ensure, but his father really does not like it no matter if they add ice cream to it or not. His son is very concerned, knows his father does not have that much longer to live, but also wants to make sure his father eats. Height: 5’8” Weight: 150 lbs Weight history: 180 lbs (1 year ago)

Is the father’s weight loss severe? What is his current BMI? What would you do in this situation? What type of nutrition information would you provide to them? Would you establish goals or a follow up appointment with them?

A 60 year old male, M. D., is present with liver cirrhosis due to a 30 year history of alcohol abuse. Reportedly the doctor told him he probably has less than 1 year to live and should have stopped drinking a long time ago. He also reports that his doctor told him he is malnourished, yet he cannot understand how he can be malnourished when he eats 2 good meals a day.

M.D. has also been gaining fluid and does not know why or what to do to stop this from happening. He reports going out to eat at least 2 times per week, drinking iced tea with sugar throughout the day and is still smoking. Height: 6’0” Weight: 200 pounds

What is his BMI? Do you believe his weight as recorded is reliable? What other information would you obtain from him? What type of nutrition information would you provide for him? How much fluid would you tell him to drink? What goals would you establish with him? Would you schedule a follow up with him?