1. Life Cycle Nutrition: Adulthood and the Later Years
Chapter 17

3. Introduction “Old” / ”senior” > 65 yrs old Two motivating goals
Promote health
Slow aging
The ratio of old people to young is increasing
Growing “old” happens day by day
projected to go from 1/8 to 1/5 between 2000 and 2030
Fastest-growing age group is >85 yrs old
77-81 for women, for men
Factors influencing life expectancy

4. Nutrition and Longevity
Good nutrition and regular physical activity can
Increase life expectancy. There are many healthy habits that can increase life span.
Support good health, prevent or prolong the onset of disease
Improve the quality of life.
A person’s physiological age and chronological age may be different

5. The Aging of the U.S. Population

6. Figure 17.1: The Aging of the U.S. Population.
In general, the percentage of older people in the population has increased over the decades whereas the percentage of younger people has decreased.

7. Nutrition and Longevity
Diversity of older adults’ lives and nutritional histories
Nutritional influence on aging process
How much aging is inevitable?
Process can be slowed by adopting healthy lifestyles- nutritious diet and exercise
70-80% of life expectancy depends on health- related behaviors
20-30% of life expectancy depends on genetics

8. Observation of Older Adults
Healthy habits for longer life, less disability
Physiological age vs. chronological age
Lifestyle behaviors
Eating well-balanced meals
Engaging in physical activity
Not smoking
Abstinence or moderate use of alcohol
Maintaining a healthy body weight
Sleeping regularly and adequately

9. Growing old can be enjoyable for people who take care of their health and live each day fully.

10. Exercise and Older Adults
Physical activity
Benefits of physical activity in older adults
Additional benefits
Best types of exercise
Aerobic activities
Moderate endurance activities
Strength training
Resistance training
Most powerful predictor of mobility in later years
Physical limitations from inactivity not increasing age

11. Many benefits of Physical Activity
More lean body mass
Greater flexibility, better balance
Increased endurance and a longer life span
Prevent or delay the decrease in muscle mass and strength that occur with age
Quicker recovery from injury or surgery
Active people benefit from higher energy and nutrient intakes (They can eat more without gaining unnecessary weight.)

13. Manipulation of Diet for Longevity
Energy restriction in animals-70% of normal
Animals live longer & have fewer age-related diseases
Slows aging process
Food intake
Prevent malnutrition
70% of normal energy intake
Increases antioxidant activity & DNA repair
Age of starting energy restriction

14. Manipulation of Diet Energy restriction in human beings
How to define energy restriction
30 yrs of energy restriction needed to increase life expectancy by 3 yrs
Moderate restriction
10 to 20 percent reduction in energy intake
Less food, less oxidative damage from food choices
Benefits in body weight and fat, blood pressure, lipids, insulin response
Versus nutritional adequacy that is essential to a long and healthy life

15. The Aging Process Stress
Stress response burns up nutrients and oxidizes/ages
Psychological and physical stressors
Bodily response
Nervous and hormonal systems
Prolonged or severe stress effects
Men Fight-or-flight response (more stressful)
Women Tend-and-befriend response (less stressful)

16. The Aging Process Physiological changes Body weight
2/3 of older adults in U.S. are overweight or obese
Being moderately overweight may not be harmful
For adults >65 yrs BMI up to 27 is OK
Remember normal is
Insist on measuring height before figuring BMI
Annually updated height is required in LTC
Obesity complications
Risks associated with low body weight

17. The Aging Process Physiological changes
Body composition changes: lose bone and muscle, gain fat
Sarcopenia – loss of muscle strength/quality
Predisposes to falls
Risk factors- smoking, inactivity, weight loss, obesity
Optimal nutrition, sufficient protein, and regular physical activity

18. Figure 17.2: Sarcopenia.

19. The Aging Process Physiological changes Immunity and inflammation
Immune system loses function
“Inflammaging”
Associated with Alzheimers, arthritis, atherosclerosis
Inflammation – critical in destroying bacteria/viruses and repairing tissue
Compromised by nutrient deficiencies, antbx
Regular physical activity improves immune system responses

20. The Aging Process Physiological changes GI tract
Intestinal walls lose strength and elasticity
Slowing of motility
Diminished appetite
Atrophic gastritis- (inflamed stomach) affects 1/3 older adults, bacterial overgrowth in stomach, low HCl + intrinsic factor, impairs absorption of B12, biotin, folate, Ca, Zn. Antacids worsen it.
Dysphagia

21. The Aging Process Physiological changes Tooth loss
Difficult and painful chewing
Limited food selections
Less dietary variety
Lower intakes of fiber and vitamins
Sensory losses: vision, hearing, taste, and smell
Mobility- ability to shop, stand and cook

22. The Aging Process Psychological changes Economic changes
Depression
Lose appetite and motivation to cook
Economic changes
Living arrangements and income
Low education level
Social changes
Hospital and nursing home malnutrition
Community malnutrition- living alone and/or living in HUD

23. Shared meals can brighten the day and enhance the appetite.

24. Energy and Nutrient Needs of Older Adults
Dietary Reference Intakes (DRI)
Two age categories
51 to 70 years
71 and older
Challenges with setting standards
Individual differences are more pronounced with age
Refusal to change
Different chronic diseases
Different medications

25. To ensure adequate hydration, keep a glass of water next to you at home, drink from water fountains whenever you walk by, and put a bottle of water in your car.

26. Energy and Nutrient Needs of Older Adults
Water
Decreased sensitivity to thirst and dry mouth
Dehydration
Total body water decreases with age
Risks associated with dehydration
Urinary tract infections, pneumonia, pressure ulcers, confusion and disorientation.
Prevention- 6 glasses water per day

27. Energy and Energy Nutrients
Energy needs decrease by ~5% per decade
Protein to protect muscle mass, boost the immune system, and optimize bone mass
Carbohydrate for energy
Fiber and water to reduce constipation

28. Energy and Nutrient Needs of Older Adults
Energy and energy nutrients
Caloric needs/activity level/metabolic rate declines with age
LBM and thyroid hormones decline
Micronutrient needs remain high
Modified food guide pyramid
Protein
Especially important
Low-calorie sources
Liquid nutritional formulas

29. Figure 17.3: Modified MyPyramid for Older Adults.

30. Energy and Nutrient Needs of Older Adults
Energy and energy nutrients
Decline 5% per decade
Monthly weights/weight goals- are they gaining or losing? Set the kcal rate to wt goals/changes, not an arbitrary kcal/d
Carbohydrate and fiber
Recommendations
Constipation
Fat
Moderate intake
Disease risk

31. Energy and Nutrient Needs of Older Adults
Nutrient-dense vs. “quality of life”
Weight gain and malnutrition common
Vitamins and minerals
Vitamin B12 - bacterial overgrowth uses it up. Supplement more bioavailable than food
Calcium + Vitamin D- milk avoidance
Folate- eating less fruits/vegetables
Iron- GI bleed, antacid use
Zinc- depletion by meds

32. Energy and Nutrient Needs of Older Adults
Nutrient supplements
More than half of older adults use supplements
Supplements do not contain enough of certain nutrients
Calcium
Vitamin C
Magnesium
Food is still best source of nutrients

33. Nutrition-Related Concerns of Older Adults
Vision
Cataracts
Age-related clouding of the eyes’ lenses
Lead to blindness if not surgically removed
Risk factors- oxidative stress/UV, obesity
Antioxidants C, E, carotenoids protective
Macular degeneration- leading cause of vision loss
Omega-3 DHA, lutein and zeaxanthin

34. Lutein and zeaxanthin in eye

35. Food sources of lutein and zeaxanthin

36. Nutrition-Related Concerns of Older Adults
Arthritis
Osteoarthritis
Deterioration of cartilage in the joints
Tends to afflict weight-bearing joints
Known connection with being overweight
Benefits of aerobic activity and strength training
Gout
Deposits of uric acid crystals in joints
Purines in meat, seafood start it. Alcohol makes it worse
Milk products lower uric acid level in blood and risk of gout.

37. Nutrition-Related Concerns of Older Adults
Arthritis
Rheumatoid arthritis- bone coverings under attack
Autoimmune disorder
Omega-3 fatty acids
Heart-healthy diet
Antioxidant vitamins C, E, carotenoids
Treatment
Dietary and traditional medical intervention
Popular supplements glucosamine, chondroitin

38. Nutrition-Related Concerns of Older Adults
The Aging Brain
Responds to genetic and environmental factors
Characteristic changes with age
Loss of neurons
Decreased blood supply
Nutrient deficiencies
Ex: serotonin made from tryptophan
Loss of memory and cognition
Senile dementia

41. Nutrition-Related Concerns of Older Adults
The aging brain
Alzheimer’s disease- abnormal deterioration of the brain
Prevalence in U.S. 10% adults > 70 yrs
Symptoms- memory and reasoning loss
Possible causes- free radicals and beta-amyloid.
Senile plaques and neurofibrillary tangles
Acetycholine breakdown may affect memory.
Cardiovascular disease risk factors
Treatment drugs are useful, but are not a cure.
Maintaining body weight is important; Alzheimer’s patients forget to consume foods.

42. Food Choices & Eating Habits of Older Adults
Older people are an incredibly diverse group
Quality of life has improved
Chronic disabilities have declined
Use strategies for growing old healthfully
Spend more money on foods to eat at home and less money on foods away from home
Influential factors in food choices

43. Taking time to nourish your body well is a gift you give yourself.

44. Social interactions at a congregate meal site can be as nourishing as the foods served.

45. Strategies for Growing Old Healthfully

47. Food Assistance Programs
Nutrition Screening Initiative
Identify and treat nutrition problems in older persons
Older Americans Nutrition Program, formerly called Elderly Nutrition Program
DETERMINE (next slide)

48. Food Assistance Programs
Older Americans Act Nutrition Program
Congregate meals at group settings
Meals on Wheels
Eligibility
Senior Farmers Market Nutrition Program
Supplemental Nutrition Assistance Program

49. Buy only what you will use.

50. Meals for Singles Challenges for older adults living alone
Purchasing, storing, and preparing food
Small kitchens and cupboards
Foodborne illness
Risk is greater for older adults- less HCl, weaker immune systems
Letting the meals-on-wheels lunch sit around to be picked at until bedtime
Spend wisely
Wise shoppers
Be creative

51. Nutrient-Drug Interactions
Highlight 17
Nutrient-Drug Interactions

53. Introduction Use of over-the-counter and prescription drugs
Average 13 prescriptions per year
Vitamin and mineral supplements
Numerous doctors
Physiological changes that may impact drug usefulness

54. The Actions of Drugs Drug Consequences
Any substance that modifies one or more of the body’s functions
Consequences
Desirable
Undesirable- Are the side-effects worth it?
Example of aspirin: 1) thins the blood, doubles bleeding time, 2) dulls pain- not always ideal

55. The Interactions between Drugs and Nutrients
Interactions can:
Lead to nutrient imbalances
Interfere with drug effectiveness
Factors that increase risk for adverse nutrient-drug interactions
Look them up one by one
Methods of nutrient and medication interactions

58. The Interactions between Drugs and Nutrients
Drugs alter food intake
Eating may be difficult or unpleasant
May stimulate appetite and cause weight gain
May suppress appetite and promote weight loss

59. The Interactions between Drugs and Nutrients
Drugs alter nutrient absorption
Most likely occurs with medications that damage the intestinal mucosa
May bind with nutrients in GI tract, preventing nutrient absorption
May reduce stomach acidity
May interfere with intestinal metabolism or transport of nutrients into mucosal cells

60. The Interactions between Drugs and Nutrients
Diets alter drug absorption
Most drugs are absorbed in upper small intestine
Influences on drug absorption
Stomach acidity and emptying rate
Direct interactions with dietary components
Drug formulation
Binding with nutrients and nonnutrients
Compete for absorption sites

61. Folate Methotrexate Figure H17.1: Folate and Methotrexate.
By competing for the enzyme that activates folate, methotrexate prevents cancer cells from obtaining the folate they need to multiply. This interference with folate metabolism creates a secondary deficiency of folate that deprives normal cells of the folate they need as well. Notice the similarities in their chemical structures.
Methotrexate

62. The Interactions between Drugs and Nutrients
Drugs alter nutrient metabolism
Some drugs may enhance or inhibit activities of enzymes needed for nutrient metabolism (folate and methotrexate)
Compete for transport proteins
Diet alters drug metabolism
Some foods affect the activities of enzymes that metabolize drugs
May counteract the drugs’ effects
Some food and drug interactions can cause toxicity and exacerbate side effects

64. The Interactions between Drugs and Nutrients
Drugs alter nutrient excretion
Interfere with nutrient reabsorption in kidneys
Mineral depletion
Diets alter drug excretion
May lead to toxicity
Urine acidity

65. The Inactive Ingredients in Drugs
Sugar, sorbitol, and lactose
Diabetics and sugar
Sorbitol and diarrhea
Lactose intolerance
Sodium
Hypertension