Chapter 19: Nutrition Through the Life Cycle: The Later Years © 2017 Pearson Education, Inc.

Older Adults Age 65 years and older Age ≥85 years: "Very elderly" or "oldest of the old" Fastest growing U.S. population subgroup Average U.S. life expectancy = 78.8 years Life span is the age to which the longest-living member of the species has lived © 2017 Pearson Education, Inc.

Aging Process: Theories Aging occurs at the molecular, cellular, and tissue levels Programmed theories of aging Error theories of aging Cell damage from environmental insults Linked to nutrient or energy status © 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Aging Process: Lifestyle Factors Biological age can be influenced by personal choices Smoking Excessive alcohol Obesity Sedentary © 2017 Pearson Education, Inc.

Sensory Perception Senescence: age-related processes that increase risk of disability, disease, and death Systems begin to slow and degenerate Declined odor, taste, and visual perception Dysgeusia: abnormal taste perception Loss of visual acuity Support of family and friends helps older adults with food selection and preparation techniques © 2017 Pearson Education, Inc.

Gastrointestinal Function Xerostomia: declined salivary production Dysphagia: difficulty swallowing foods Achlorhydria: low gastric HCl production, limits calcium, iron, folate, vitamin B12 absorption Gut microbiota changes ("aging gut"), resulting in Increased inflammation Decreased immune function of GI tract Impaired functioning of gut mucosal cells "Anorexia of aging" Lactose intolerance © 2017 Pearson Education, Inc.

Body Composition Increased body fat, sarcopenic obesity Decreased muscle and lean tissue Decreased production of hormones: testosterone and growth hormone Bone mineral density declines Adequate dietary intake and regular physical activity (strength/resistance training) help maintain muscle mass and strength © 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Organ Function Less adaptable to environmental or physiologic stressors Kidneys: less able to concentrate waste Liver: less efficient in breaking down drugs Pancreas: reduced blood glucose control Bladder control may decline Connective tissues and blood vessels become increasingly stiff and less pliable Neurons in the brain decrease: impaired memory, reflexes, coordination, learning ability © 2017 Pearson Education, Inc.

Factors That Accelerate Aging Biologic age is influenced by lifestyle: Smoking habits Alcohol consumption Sun exposure Weight status Level of physical activity © 2017 Pearson Education, Inc.

Macronutrients Decreased energy needs from loss of muscle mass and lean tissue: Lower basal metabolic rate Reduced activity levels Recommendations for fat, carbohydrate, proteins: same as for younger adults Older adults can eat slightly less fiber © 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Micronutrients Calcium and vitamin D requirements increase: poor calcium absorption and reduced vitamin D production in the skin Iron needs decrease: reduced muscle mass; cessation of menstruation in women Zinc recommendations stay the same Vitamins C and E recommendations stay the same Adequate intake of B-vitamins (B12, B6, and folate) is a special concern Vitamin A should not be consumed in excess of RDA © 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Supplements Older adults benefit from multivitamin/multimineral supplement Single nutrients in some cases Vitamin B12 Calcium Vitamin D High-potency supplements pose risks © 2017 Pearson Education, Inc.

Fluid AI for fluid: same as for younger adults Men: 3.7 liters/day Women: 2.7 liters/day Impaired thirst mechanism Hypernatremia (elevated blood sodium levels) © 2017 Pearson Education, Inc.

Overweight and Obesity Increases severity and consequences of osteoarthritis Limits mobility Causes functional declines in daily activities Weight loss improves functional status © 2017 Pearson Education, Inc.

Underweight Fewer protein reserves Risk for poor wound healing and a depressed immune response Geriatric failure-to-thrive: "the dwindles" © 2017 Pearson Education, Inc.

The nine Ds of geriatric weight loss. © 2017 Pearson Education, Inc.

Osteoporosis Diagnosed after menopause as estrogen levels sharply decline Males: linked to declining testosterone levels, steroid therapy, and alcohol abuse Most serious risk: hip fracture Osteoporosis treatment: vitamin D and calcium supplementation, resistance training, medications © 2017 Pearson Education, Inc.

Arthritis One of the most prevalent chronic diseases Osteoarthritis: a disease of "wear and tear" Rheumatoid arthritis (RA): typically strikes younger adults, not associated with obesity or overuse syndromes Nontraditional treatments (glucosamine) © 2017 Pearson Education, Inc.

Additional Concerns Constipation—fluid and insoluble fiber Dental health issues may cause older adults to avoid healthful foods Vision disorder studies show beneficial effects of antioxidants Cognitive impairment (demetia): lower risk with antioxidants, certain unsaturated fatty acids, folate, vitamin B12, healthy weight © 2017 Pearson Education, Inc.

Medications Interactions can be harmful, should be monitored Polypharmacy: more than five prescription medications at once Appetite effects Alters nutrient digestion and absorption Appropriate use of nutrient supplements can enhance the nutritional status of older adults © 2017 Pearson Education, Inc.

© 2017 Pearson Education, Inc.

Social Concerns Elder abuse and neglect Food insecurity and hunger Social isolation © 2017 Pearson Education, Inc.

Community Programs Supplemental Nutrition Assistance Program (SNAP) Senior Farmer's Market Child and Adult Care Program Commodity Supplemental Food Nutrition Services Incentive Program Emergency Food Assistance Program End-of-life care © 2017 Pearson Education, Inc.

Minority Elderly Require adaptations in current medical and social service interventions Increased risk for nutrition-related chronic diseases and complications Cultural awareness Flexible meal plans Effective communication © 2017 Pearson Education, Inc.