1. Nutrition

2. Dual role in aging Nutritional components are involved in physiological and anatomical changes that lead to destruction and cell regeneration Plays role in course of degenerative diseases such as heart disease, cancer, stroke, etc.

3. Minimal vs. Optimal Minimal requirements - minimal level of nutritional status that needs to be met to sustain life Optimal requirements - nutritional status that promotes optimal health

4. RDA Not minimal or optimal, but set reference points for planning diets for all groups to provide greatest health benefits Revised every 5 years Classifications for RDA: –I - 25 - 50 year olds –II - 51 & older

5. Limitations of RDA Heterogeneity among aging people physiological changes associated with the aging process individual health status & presence of chronic disease heavy use of prescription & over-the- counter drugs by this age group Not realistic to assume that all older adults over 50 gave similar nutrient requirements.

6. Calories Overall caloric intake should decrease with age Basal metabolic rate decreases Muscle (lean body) mass decreases Overall activity level may decrease

7. Protein Some controversy over whether older adults need more or less protein Most Americans get plenty Complete proteins - supply all 8 amino acids (animal products) Incomplete proteins - low in 1 or more amino acids (vegetables) Major sources are: nuts, legumes, fish, meat, eggs & dairy products

8. Protein for Older Adults Changes in body composition can influence protein needs (protein requirements are related to protein synthesis and breakdown in skeletal muscle and body organs) Emotional stress, infection & chronic disease increase protein requirements Factors can compromise protein status and make older adults vulnerable to protein loss

9. Still, recommended protein is same for all people over 25 years of age: –10 - 15% of daily caloric intake –Older men need about 93 grams of protein a day –Older women need about 73 grams of protein a day –Those with stress, wounds, etc. should double their recommended daily intake –Those with osteoporosis & kidney disease should consume a low protein diet

10. Carbohydrates Simple sugars - sucrose, fructose & lactose Complex sugars - starches & fiber which are difficult to digest

11. Older adults with advanced cardiac or renal disease, should not have very low carbohydrate diets Those trying to lose weight should be advised to avoid these low carb diets as well. Complex carbohydrates are becoming food of choice for healthy lifestyles & a person should have a diet with about 55% of total coming from carbs

12. Fats Most Americans consume an average of 40% of calories in fats, but RDA is 25-30% Two major classifications of fats: triglycerides & cholesterol AHA - 15-20% instead of 30% of fats needed Low animal fat diet to reduce cholesterol

13. Vitamins Water soluble - excess excreted in urine, includes B complex & C Fat soluble - vitamins absorbed in small intestine & carried by digested dietary fats, includes A, D, E, & K

14. Minerals Marginal magnesium deficiency - common - may damage heart and sometimes supplemented after heart attacks (whole grain cereals, nuts, molasses) Deficiencies more common than vitamins

15. Assessment of Nutritional Status Much broader assessment than just dietary status Biochemical measures of body fluids lab measures of cholesterol levels serum levels of protein physical symptoms - dry “flaky paint” skin, easily plucked hair anthropometric measurements medical history

16. Malnutrition Primary - diet is sole cause for poor nutritional status Secondary - factors besides diet contribute

17. Malnutrition can be too much food or not enough food.

18. Additional Risks for Malnutrition Loss of coordination (feeding & cooking) Not eat in front of others Loss of smell, taste Chronic disease Socio-cultural factors

19. Factors Affecting Nutritional Status Physiological factors Psychological factors Educational factors Economic factors Living arrangements Cultural attitudes & behaviors Environmental factors

20. DETERMINE Nutrition Checklist with following warning signs: –Disease –Eating poorly –Tooth loss/mouth pain –Economic hardship –Reduced social contact –Multiple medicines –Involuntary weight loss/gain –Needs assistance in self care –Elder years above age 80