NUTRITION IN ELDERLY Dana Hrnčířová Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University

Number of people age 65 and over, projected Slovakia Germany Czech Rep. France Source: Eurostat

RISK FACTORS INFLUENCING NUTRITIONAL STATUS OF OLDER ADULTS Socioeconomic Mental Physiological  Polypharmacy  Nutrient needs

SOCIO-ECONOMIC NUTRITIONAL RISK FACTORS Lower education Lower income Living alone Infrequent social participation Low social support (e.g. no help with shopping, meals or chores) Non-driver (transport)

PHYSICAL AND MENTAL HEALTH NUTRITIONAL RISK FACTORS Mental ilness (depression) Disability (severe) Polypharmacy (2 and more mediactoins/day) Poor oral health (problems with chewing, swallowing food) Pain

Other nutritional risk factors Significant weight loss/gain Skipping meals almost every day Little/no intake of F/V Long periods without food/beverage

Reduction of No of taste buds (50%) Weakened taste and smell Teeth defects (false teeth, …) hyposalivation Decreased secretion of digestive juices Decreased motility of GIT (tendency to obstipation) Decreased absorption of intestines Decreased elasticity of colon – diverticulosis Low bone density - osteoporosis Physiological changes in the elderly

Nutritional problems in the Elderly o Obesity (overnutrition) o Malnutrition (specific deficiencies, undernutrition) o Dehydratation Diet in older adults needs to be adjusted to changed nutritional needs and influence degenerative processes in older age

Decreased physical performance and mobility Decreased BMR Decreased heat production Decreased postprandial thermogenesis Nutrition is often high in quantity and low in quality! TENDENCY TO OBESITY IN THE ELDERLY

Contribution of organ/tissues to BMR of a non-obese man Body composition phenotypes in pathways to obesity and the metabolic syndrome A G Dulloo, J Jacquet, G Solinas, J-P Montani and Y Schutz

Decrease of Muscle Mass in the Elderly

Recommended intake: 1,5-2 l /day o Depends on physical activities, type of food consumed, physical health, environment /weather Lowered fluid intake: o Hyposalivation o Dry mouth o Headaches o Worsened concentration, confusion, dizziness FLUID NEEDS IN THE ELDERLY

CAUSES OF DEHYDRATION cognitive impairment changes in functional ability medication such as laxatives, diuretics or hypnotics illness stress (arising from other factors)

POSSIBLE SIGNS OF DEHYDRATION Decrease in urinary output or dark urine. Sudden weight loss (e.g. 5% or more of body weight) Sunken eyes Hollow cheekbones Dry mucous membranes Cracked lips Skin turgor is poor Change in state of alertness (in extreme dehydration) Deep, gasping breath

↓ BMR:  Men over 65 yrs (compared to 20yrs old) - 25 %  Women over % Lowered physical activity Decreased lean muscle mass ENERGY NEEDS IN THE ELDERLY

o Need is probably slightly increased o High intake o Kidney burden o High intake of fats, cholesterol, purines PROTEIN NEEDS IN THE ELDERLY

o ↓ tolerance to glucose o complex saccharides with low GI o Fibre g/day CARBOHYDRATES IN THE ELDERLY

CALCIUM  osteoporosis IRON  Insufficient intake per os  Impaired absorption (hypo- a achlorhydria)  Gastrectomy, intestine resection  Blood loss  Vitamin C and meat protein increases absorption MINERALS IN THE ELDERLY

Vitamin D  ↓ exposition to sunrays Vitamin B12  % of the elderly - atrophic gastritis  Impaired production of intrinsic factor  Decreased food intake Folic acid  Hypo -, achlorhydric patients (atrophic gastritis) Vitamin C  Impaired oral health (chewing, …), smoking VITAMINS IN THE ELDERLY