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 Physical growth in size levels off but continues in the constant cell growth and reproduction necessary to maintain human bodies.  Food and nutrition continue to provide essential support during the adult aging process  Life expectancy is lengthening, so health promotion and disease prevention are even more important as quality of life is ensured throughout the extended years. 2

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 Key Concepts  Gradual aging throughout the adult years is an individual process based on genetic heritage and life experience  Aging is a total life process, with biological, nutritional, social, economical, psychological, and spiritual aspects 4

 Describe nutrition in adulthood  Describe nutritional needs in the aging process  Identify clinical needs of the older adult  Identify community resources for older Americans 5

Population and age distribution – by 2050 according to the US Census Bureau the US population will have grown to 439 million people The older segment of the population will grow significantly By 2050 people over 65 will more than double 6

The report from the USDHHS Healthy People 2020 presents national goals for helping all people make informed decisions about their health. 7

Life expectancy and quality of life – increased from 47 yrs old in 1900 to 79.5 yrs in By 2020, life expectancy will be 79.5 years 77 years old for men 82 years old for women Impact on health care: Career opportunities in disease prevention and health promotion are at an all time high Community and private classes on health lifestyle and nutrition target the prime concerns for this growing adult population 8

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4 basic areas of adult life shape its general growth and development: Physical Psychosocial Socioeconomic Nutritional 10

1. Physical growth Overall physical growth of the human body levels off in the early adult years Physical growth is no longer a process of increasing numbers of cells and body size but is the vital growth of new cells to replace old ones Once physical maturity is established, energy requirements decline 11

2. Psychosocial development Three stages of development: Young adults (20 to 44 years) – Increasingly independent. Form new relationships, adopt new roles, make choices concerning education, career, jobs, marriage and family. - Stress related problems sometimes develop Firm establishment of lifestyle behaviors occur during this period E.g. regular exercise, choosing balanced meals Important for maintaining quality of life long-term 12

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Middle adults (45 to 64 years) – Expand personal growth – “Its my turn now”; coming to terms with what life has offered, a “refocusing of ideas”, life directions, and activities. Early evidence of chronic disease appears in some middle adults Focus: wellness, health promotion, and reduction of disease risks are becoming the focus of health care 14

Older adults (65 years and older) – sense of wholeness and completeness vs increasing withdrawal from life. New classification: Young old = Elderly = Old old = 85+ If the outcome of their life experiences has been positive,  Rich with wisdom, enjoy life and health. Some arrive at these years poorly equipped to deal with the adjustments of aging and the health problems that may arise 15

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Socioeconomic status – In today’s economic and social shifts and pressures, these pressures directly influence food security and health. Some elderly need help with food assistance. 17

Social and financial pressures along with decreasing sense of acceptance and productivity may lead elderly persons to feel unwanted and unworthy – depression is clinical syndrome and not part of normal aging Basic needs common to older persons are: economic security, personal effectiveness, suitable housing, constructive and enjoyable activities, satisfying social relationships, and spiritual freedom. 18

Nutritional needs – vary according to living and working situation Older Adult populations still under study for their nutrient requirements. Most recent DRIs distinguish the nutrient needs of the 50 – 70 years olds from those 71+ years 19

General Physiologic Changes: Biologic Changes: Human growth and then decline extends over entire life span Middle and older adults: Gradual loss of functioning cells with reduced cell metabolism; starts at about 30 -> body organ systems gradually lose some capacity to do their jobs and maintain their reserves The rate of this decline accelerates in later life 20

 About 25% Americans sedentary  60 minutes moderate exercise recommended/day - NIM 21

Biologic Changes cont. Hormonal changes in aging process: Decline in insulin production Decrease melatonin (hormone to regulate body rhythms) Decrease growth hormone Decrease sex hormones- estrogen and testosterone 22

Menopause = the end of a woman’s menstrual activity and capacity to bear children Involves a decrease -> cessation of estrogen or progesterone production  Increase fat, increase risk of chronic disease such as heart disease and osteoporosis. 23

Effect on food patterns – secretion of digestive juices and motility of gastrointestinal muscles gradually diminish  decreased absorption and use of nutrients 24

Other conditions commonly affecting the elderly and their food intake: Decreased hand function Decreased eye-hand coordination Concern over body functions Decreased taste, smell, and vision Decreased ability to cook and prepare food 25

Other conditions commonly affecting the elderly and their food intake: More social stress, personal losses and fewer social opportunities to maintain self esteem Lack of sufficient nourishment is primary nutritional problem of older adults 26

Individuality of the aging process (senescence) - older persons get old at different rates and in different ways depending on genetic inheritance and health and nutritional resources over past years 27

Kilocalories: Energy Because of the gradual loss of functioning body cells and reduced physical activity, adults generally require less energy intake as they grow older Kilocalories: energy – Basal Metabolic Rate decreases 1- 2 % each decade. More rapid decline at 40 for men and 50 for women Basic fuel necessary to supply these energy needs: Primarily CHO Moderate fat 28

29 Carbohydrate = 45 % to 65 % of the total diet kcals the majority should be complex CHO [e.g. whole grains] Note: there is a tendency for decreased glucose tolerance with aging. Balanced meals can help avoid excessively high blood glucose concentrations and help delay or avoid the onset of Diabetes

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Fat = 30 % of total kcals; provides back-up energy source, fat-soluble vitamins, and essential fatty acids Fat digestion and absorption may be delayed in the elderly Avoid large quantities Emphasize the quality of the fat used May help food taste better -> improved appetite and may provide needed kcals for those who have wt. loss Protein = 10 – 35 % of the total kcals Increased need for protein during illness,,convalescence, or wasting disease 31

Vitamins and Minerals Some essential nutrients may need special attention in relation to possible health problems with aging: Osteoporosis - Vitamin D and Calcium Bone mineral density is low and bones are brittle and easily broken. Risk increases with age 10 x more common in women than men Contributing factors: less use of calcium-rich foods; loss of appetite and lack of adequate body fat; less outdoor physical exercise; decreased capacity of the skin to produce Vitamin D with exposure to sunlight; decreased estrogen 32

Anemia – the poor diet of many older adults lacks sufficient iron to prevent iron- deficiency anemia Give list of high iron foods and high Vit C-rich foods (Vit C helps with absorption) Nutrient supplementation – 44 % of women and 35 % of men take vitamin supplements regularly Use of supplements on a Often recommended for persons in debilitated states or malabsorption 33

Health Promotion and Disease Prevention The emphasis of adult health care: Reduction of Risk for chronic disease Nutritional Status: Many problems of older adults come from general aging and states of malnutrition – i.e. undernourishment. May be due to: Poor food habits/lack of appetite/ loneliness Oral problems Economic hardship GI problems Multiple medicines Needs assistance in self care 34

Dehydration: Decreased thirst sensation + decreased kidney function  overall decrease in body water status Weight management – Excessive Wt loss or gain can be signs of malnutrition Obesity among adults has been on the rise in all subgroups of the elderly population. Physical Activity – a major contributor to weight management Can prevent many debilitating conditions of old age 35

Individual Approach - In all cases, personal and realistic planning with every person is essential – e.g. a malnourished older person needs much personal, sensitive support to build improved eating habits. 36

Maintain ability to live independently and decreases risk of falling or fracturing bones Reduce blood pressure Help people with chronic, disabling conditions improve stamina and muscle strength Reduces symptoms of anxiety and depression Maintain healthy bones, muscles, and joints Helps control joint swelling an pain associated with arthritis 37

Chronic diseases of aging – E.g. Heart disease, renal disease, arthritis, HTN, CVA, diabetes, cancer, asthma, emphysema Health experts believe that chronic disease is not an inevitable consequence of aging and estimate that the majority of these cases could have been prevented by lifestyle modification. Diet Modifications and nutritional support are an important part of therapy for chronic disease 38

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 Medications: Multiple medication use (polypharmacy) can affect overall nutritional status because:  many drug-nutrient interactions can occur  Can affect appetite, absorption, and use of nutrients  malnutrition  Check use of dietary supplements and herbs since these may interact with medications 40

 Medications that may affect nutritional status:  Blood Pressure meds  Antacids  Anticoagulants  Laxatives  Diuretics  Decongestants 41

 Government Programs for Older Americans  Adults living below the national poverty level had a higher incidence of multiple chronic diseases than any other socioeconomic group Health care providers must be aware of community resources and refer when appropriate  Older Americans Act  Nutrition Services Incentive Programs provide cash and/or commodities to supplement meals.  Services include congregate and home-delivered meals  Nutrition Education 42

 US Dept. of Agriculture provides both research and services for older adults – including the Food Stamp Program  Public Health Service:  Skilled health professionals work in the community through local and state public health depts.  Public health nutritionists provide nutrition counseling, education, and help food assistance programs 43

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 Professional Organizations and Resources  The American Geriatric Society  The American Gerontological Society  Local medical societies and nursing organizations  Volunteer Organizations 45

 Alternative Living Arrangements offer options for seniors for living and meal provision:  Congregate Care: focuses on keeping the elderly in their own homes for as long as possible with outside assistance including home-delivered meals  Continuing Care Retirement Communities: provide a continuum of residential long-term care from independent living to nursing facilities with dietary assistance available  Assisted Living Facilities: provide meals and snacks  Nursing Home: provide the most medical, nursing and nutritional support 46