1. NS 325 U NIT 8 S EMINAR C HAPTERS 12 & 13 Nutrition Issues in the Older Adult

2. O VERVIEW Unique physiological changes that occur with aging that affect nutrient intake and nutritional status. Key psychosocial changes associated with aging that can affect the desire or ability to consume an adequate diet. Consequences of age-related malnutrition and nutrient deficiencies on overall health status and quality of life.

3. U.S. C ENSUS : N UMBER OF O LDER A MERICANS

4. CDC: C HRONIC H EALTH IN O LDER A DULTS

5. N UTRITION I SSUES : O LDER A DULTS Malnutrition Nutrient deficiencies Decreased appetite Ability to eat Chronic diseases/health problems

6. A GE - RELATED RISKS FOR M ALNUTRITION Impaired appetite Appetite assessment Diet modification Physiological changes Cognitive changes Psychosocial changes Medication use

7. I MPAIRED APPETITE & A SSESSMENT Appetite associated with well-being Conditions that may take away appetite: changes in GI tract, decreased taste and smell acuity, medication side effects, diet modifications, depression or altered mental status. (Table 13.1 page 411) Early detection--nutrition screening tools important to prevent decrease in nutrition. Risk assessment: DETERMINE your nutritional health checklist Mini Nutrition Assessment (MNA: Discussion Board)

8. R ISK A SSESSMENT 15 - 8 D isease E ating poorly T ooth loss or mouth pain E conomic hardship R educed social contact and interaction M ultiple medications I nvoluntary weight loss or gain N eed for assistance with self-care E lder at an advanced age http://www.eatright.org/ad a/files/Checklist.pdf Food intake Weight loss Mobility Psychological stress Neuropsychological problems BMI http://www.mna- elderly.com/forms/mini/mn a_mini_english.pdf DETERMINE Your Nutritional Health Mini Nutrition Assessment

9. P HYSIOLOGICAL CHANGES “Anorexia of aging” Changes in GI tract: Dentition, swallowing, diarrhea, constipation, GI secrections Sensory loss: decrease smells and taste Food-borne illness: risk higher Cognitive changes: impaired cognition, Alzheimer’s, Parkinsons, cancer

10. P SYCHOSOCIAL C HANGES Nutritional risk is associated with economic hardship, loneliness, and depression. Elderly nutrition programs Benefits of nutrition programs?

11. P HARMACOLOGICAL C ONSIDERATIONS Medication use: increased disease leads to increased medication use. Polypharmacy Older adults use more than 30% of all medications prescribed Meds may interact with nutrient absorption May affect appetite and weight

12. I NTERVENTIONS FOR I MPAIRED A PPETITE Liberalized diet Eating with others Congregate meals Providing assistance Specialized utensils Flavor enhancers Adding nutrients to food Nutrient-dense snacks, commercial supplements, Pleasant eating environment Praise Individual approach: figure out issues related to appetite & provide intervention appropriate for that person

13. O RAL H EALTH P ROBLEMS NHANES--oral health is an increasing problem with age; compounded by poor income status and lower education level Endentulous, dentures, tooth decay, chewing issues, mouth pain, xerostomia (dry mouth) Oral hygiene after each meal can decrease some oral health issues; regular dental check- ups

14. S WALLOWING D IFFICULTY (D YSPHAGIA ) May result from dementia, stroke, Parkinson’s, MS, head/neck CA, weakened muscles due to aging. May lead to decreased food intake, malnutrition, dehydration, aspiration. Look for signs & symptoms of dysphagia. Refer to Speech Pathologist for swallow evaluation. National Dysphagia Diet: pureed, mechanical soft, thin or thickened liquids.

15. M ALNUTRITION Estimated that 40% of nursing home residents and 50% of hospitalized elderly patients are malnourished. Malnutrition: Any insufficient dietary intake of essential nutrients Protein-energy malnutrition

16. W EIGHT LOSS Risk factors for weight loss? Older adult must be evaluated for unintended weight loss. Significant loss considered 5% or more in 1 month or 10% or more in 6 months Calories: energy intake declines with age, reduction in BMR, reduction in lean body mass and decreased physical activity. Protein: chronic deficiency may result in poor skin healing, decreased immune function, loss of muscle strength.

17. N UTRIENT D EFICITS Vitamin D—for those institutionalized or homebound Thiamin--poor intakes, not increased need Vitamin B6--age-related changes related to the metabolism and absorption Vitamin B12--due to pernicious anemia and gastritis Fluid--risk of dehydration

18. T UFTS : F OOD G UIDE P YRAMID FOR O LDER A DULTS

19. F UTURE D IRECTIONS FOR H EALTH C ARE P ROFESSIONALS How do we ensure older adults are receiving quality nutrition to maintain a quality of life? Are there other nutrition services that should be offered in the community, home, acute, or long-term care settings?