Nutrition and the Aging Adult Jamie Pope, Steve Nizielski, Alison McCook NUTRITION for a Changing World FIRST EDITION Chapter 21 Nutrition and the Aging Adult Live Long and Prosper © 2016 by W. H. Freeman and Company and Scientific American

Chapter 21 Objectives Discuss at least four age-related physiological changes Describe changes in the age structure of the population in the United States in the next 25 years Explain how skeletal muscle is needed to heal from illness and injury, the benefits of maintaining adequate muscle mass, and the benefits of exercise Discuss how physical, psychological , economic, and social factors may influence the ability of the aging adult to achieve the recommended nutrient intake Describe three nutrition-related conditions that are common in older adults, their precipitating factors, and potential consequences Identify at least five nutrients of concern in the aging adult and describe ways to obtain adequate intake of these nutrients Identify lifestyle dietary characteristics that may delay the onset of age-related disease

Live Long and Prosper Longevity Leonard Nimoy lived seven years beyond the average life expectancy for a man in the United States Research for secrets to a longer life Leonard Nimoy, known for his role as Mr. Spock on Star Trek, died in February 2015 at age 83. Mr. Spock as part Vulcan in the movie ate vegetarian diets and lived to be 200 hundred years old; hence the traditional salute “Live long and prosper.” Though science fiction, the secrets for longer life are a real focus of research.

What happens when we age? Aging Changes in cells and tissues Increased risk of disease and death Physiological changes Cardiovascular system Renal system Musculoskeletal system Nervous system Respiratory system Gastrointestinal system

Theories of Aging Programmed theories Damage or error theories Programmed longevity Endocrine theory Immunological theory Damage or error theories Free radicals Protein cross-linking DNA damage Epigenetic changes to DNA Programmed theories: contend that aging follows a biological timetable Programmed longevity: the switching on and off of specific genes that leads to aging Endocrine theory: age-related alterations in the regulation of the endocrine system control the rate of aging Immunological theory: suggests that the immune system is programmed to decline over time which causes increased vulnerability to disease Damage or error theories: suggest that aging is caused by an accumulation of molecular and cellular damage Free radicals: cause oxidative damage to proteins, lipids, and DNA Protein cross-linking: impairs protein function DNA damage: results in mutations that cause cells to malfunction Epigenetic changes to DNA: alters patterns of gene expression

Life Expectancy and Lifespan Average number of years individuals in a specific population are expected to live Increased dramatically over the twentieth century Lifespan Span of time between birth and death for an individual Modest gains in lifespan over the last century Life expectancy: number of years a person can be expected to live based on the statistical average; for men in the United States it is 76.4 years and for women it is 81.2 years. In 1900 life expectancy for a man was 46 years. The greatest difference between then and now is the change in the frequency of infant mortality with less children dying as a result of infectious and communicable diseases. Lifespan: number of years that any particular individual lives. The maximum number of years that any known person has lived is 122 years. Her name was Jeanne Calment; she lived in France and died in 1997. Since the 1900s, lifespan has increased about nine years for women and five years for men.

The Aging U.S. Population During the next 25 years, the population of Americans 65+ years old will double Longer lifespans Aging baby boomers

Factors that Influence Lifespan Disease Heart disease Cancer Diabetes Subtle influences Education Race Socioeconomic status

Blue Zones Areas with increased longevity Have a higher number of individuals who live to be at least 100 years old Also include Seventh-day Adventist communities

Seventh-day Adventist Community Live longer on average Men, seven additional years Women, four-and-a-half additional years Several key behaviors and lifestyle choices They don’t smoke They rarely drink alcohol Many are vegetarians or vegans Research on this group shows it is not genetics and that nutrition plays a big role.

Energy Needs and Physical Activity Energy needs decrease Less physically active Reduced activity leads to sarcopenia Physical activity can offset losses in muscle mass Other nutrient needs remain similar to younger adults Need more nutrient-dense foods

Active Aging

Special Nutritional Concerns Challenges making older adults vulnerable to malnutrition Olfaction: decline in sense of smell Gustation: decline in sense of taste Loss of teeth Periodontal disease Effect of medications on appetite and nutrient absorption Drug/nutrient interactions Age-related gastrointestinal changes Socioeconomic factors Psychological factors

Common Nutrition-Related Conditions in Older Adults

Nutrient Recommendations for Seniors

Nutrient Recommendations for Seniors

Nutrient Recommendations for Seniors Decreased absorption in the intestine Can lead to cognitive impairment

Nutrient Recommendations for Seniors Decreased absorption in the intestine Can lead to cognitive impairment

Nutrient Recommendations for Seniors Protein With resistance exercise, higher protein intake may improve functionality Consumption of plant proteins emphasized

Nutrient Recommendations for Seniors Fluids Added emphasis on getting enough Many older adults experience: reduced thirst sensation increased fluid loss difficulty meeting requirements Recommendations the same as for adults, but risk of dehydration adds emphasis on getting sufficient amounts

Nutrient Recommendations for Seniors Beneficial nutrients in some cases Zinc Supportive role in immunity Omega-3 fatty acids May reduce symptoms of rheumatoid arthritis May slow the progression of age-related macular degeneration May reduce the risk of Alzheimer disease

Best Diet to Delay Age-Related Disease Sufficient but not excessive calories Low in saturated fat High in whole grain cereals, legumes, fruits, and vegetables

Clues for Longevity from Studying Adventist Lifestyle Associated with clear benefits to longevity Being physically active Eating lots of nuts Being vegetarian Having a healthy BMI

Clues for Longevity from Studying Adventist Lifestyle

Maintaining Physical Strength Staying active and maintaining adequate skeletal muscle mass crucial for health

Other Blue Zone Secrets Nutrition Legumes and nuts Activity Psychosocial factors Social connectedness Having a plan or purpose

Summary Nutrition and physical activity play key roles in maintaining health and preventing chronic disease, as well as in potential longevity and quality of life, in the aging adult. There are physical, psychological, social, and economic factors that can influence and potentially compromise the dietary intake and nutritional status of the older adult. Energy needs in older adults generally decline because of decreased physical activity and metabolic rate; however, nutrient needs do not decrease (they may even increase), making it especially important to consume nutrient-dense foods. Age-related changes in body composition and body fat distribution occur to varying degrees, but physical activity helps offset losses in skeletal muscle mass (sarcopenia). Age-related gastrointestinal changes may occur, including the bacterial composition of the gut, diminished gastric acid secretion, and slower motility in the small intestine.

Summary (cont.) Nutrients of concern in older adults due to diminished intake or possible changes in absorption and utilization include protein, calcium, vitamin D, vitamin B6, vitamin B12, folate, iron, zinc, fiber, and omega-3 fatty acids. Although fluid requirements are the same for older adults, the risk of dehydration is higher than in younger adults due to diminished thirst sensation, increased fluid losses, and side effects of certain medications. Poor nutrition and physiological changes with advanced age, along with possible depressed immunity and a decreased ability to fight and recover from illness, surgery, or infection, can lead to suboptimal nutritional status or even malnutrition. Nutrient inadequacies may contribute to cognitive decline with age. In addition, some studies show that certain dietary nutrients, like omega-3 fatty acids and some phytochemicals, may reduce the risk of dementia. Based on current research, the best diet to delay age-related disease onset avoids excess calorie intake and is low in saturated fat and high in whole grains, legumes, nuts, fruits, and vegetables.