© 2011 Pearson Education, Inc. 18 Nutrition Through the Life Cycle: The Later Years

© 2011 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 = 78.1 years Life span is the age to which the longest-living member of the species has lived

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Aging Process Aging occurs at the molecular, cellular, and tissue levels Senescence: processes that increase risk of disability, disease, and death Programmed theories of aging Error theories of aging Cell damage from environmental insults Linked to nutrient or energy status

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Physiologic Changes Systems begin to slow and degenerate Declined odor, tactile, and visual perception Dysgeusia, abnormal taste perception secondary to disease or medication use Loss of visual acuity Food selection and preparation techniques

© 2011 Pearson Education, Inc. Gastrointestinal Function Xerostomia, declined salivary production Dysphagia, difficulty swallowing foods Atrophic gastritis Achlorhydria, low gastric HCl production, limits calcium, iron, folate, vitamin B 12 absorption Lactose intolerance

© 2011 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

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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

© 2011 Pearson Education, Inc. Factors Accelerate Aging Biologic age is influenced by lifestyle: Smoking habits Alcohol consumption Sun exposure Weight status Level of physical activity

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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

© 2011 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 Adequate intake of B-vitamins (B 12, B 6, and folate) is a special concern

© 2011 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)

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Overweight and Obesity Increases severity and consequences of osteoarthritis Limits mobility Causes functional declines in daily activities Weight loss improves functional status

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Underweight Fewer protein reserves Risk for poor wound healing and a depressed immune response Geriatric failure-to-thrive: “the dwindles”

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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

© 2011 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)

© 2011 Pearson Education, Inc. Additional Concerns Constipation—fluid and insoluble fiber Dental health issues may cause older adults to avoid healthful foods Eye disorder studies show beneficial effects of antioxidants Dementia: lower risk with antioxidants, certain unsaturated fatty acids, folate, vitamin B 12, healthy weight

© 2011 Pearson Education, Inc. Medication Polypharmacy: more than five prescription medications at once Affects appetite Alters nutrient digestion and absorption Food–drug interactions Appropriate use of nutrient supplements can enhance the nutritional status of older adults

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Social Concerns Elder abuse and neglect Food insecurity and hunger Social isolation

© 2011 Pearson Education, Inc. Community Programs Supplemental Nutrition Assistance Program (SNAP)—former Food Stamp Program Child and Adult Care Program Commodity Supplemental Food Nutrition Services Incentive Program Emergency Food Assistance Program End-of-life care

© 2011 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