1. Nutrition and the Aging Adult
Jamie Pope, Steve Nizielski, Alison McCook
NUTRITION
for a Changing World
FIRST EDITION
Chapter 21
Nutrition and the Aging Adult
Live Long and Prosper
© 2016 by W. H. Freeman and Company and Scientific American

2. Chapter 21
Objectives
Discuss at least four age-related physiological changes
Describe changes in the age structure of the population in the United States in the next 25 years
Explain how skeletal muscle is needed to heal from illness and injury, the benefits of maintaining adequate muscle mass, and the benefits of exercise
Discuss how physical, psychological , economic, and social factors may influence the ability of the aging adult to achieve the recommended nutrient intake
Describe three nutrition-related conditions that are common in older adults, their precipitating factors, and potential consequences
Identify at least five nutrients of concern in the aging adult and describe ways to obtain adequate intake of these nutrients
Identify lifestyle dietary characteristics that may delay the onset of age-related disease

3. “Live long and prosper”
Longevity
The length or duration of life
Generally refers to longer than population average
Leonard Nimoy lived seven years beyond the average life expectancy for a man in the United States
Research ongoing for secrets to a longer life
Leonard Nimoy, known for his role as Mr. Spock on Star Trek, died in February 2015 at age 83. Mr. Spock, as part Vulcan in the movie, ate vegetarian diets and lived to be 200 hundred years old; hence the traditional salute “Live long and prosper.” Though science fiction, the secrets for a longer life are a real focus of research.

4. A person’s lifespan may or may not exceed (or achieve) their life expectancy.
Average number of years individuals in a specific population are expected to live
Increased dramatically over the twentieth century
Primarily due to change in frequency of infant mortality
Lifespan
Span of time between birth and death for an individual
Modest gains in lifespan over the last century
Life expectancy: number of years a person can be expected to live based on the statistical average; for men in the United States it is 76.4 years and for women it is 81.2 years.
In 1900 life expectancy for a man was 46 years. The greatest difference between then and now is the change in the frequency of infant mortality with less children dying as a result of infectious and communicable diseases.
Lifespan: number of years that any particular individual lives. The maximum number of years that any known person has lived is 122 years. Her name was Jeanne Calment; she lived in France and died in Since the 1900s, lifespan has increased about nine years for women and five years for men.

5. Life expectancy in the United States has increased 64% since 1900.
Increased from 47.3 to 78.8 years (2013)
Varies based on sex and race
Females 81.2 years
Males 76.4 years
(includes life expectancy calculator)
These life expectancy estimates are for people born in 2012 and represent "the average number of years that a group of infants would live if the group was to experience throughout life the age-specific death rates present in the year of birth," the report says.
Life expectancy varies: Women have greater life expectancy than men.
African American men have shortest life expectancy.
United States ranks 21st for life expectancy.
Gender difference related to behaviors:
Males smoke more, use alcoholic beverages more, pay less attention to diet, and seek medical care less often.
Gains attributable to:
decreased infant deaths
decreased deaths from infectious disease - vaccines
improved nutrition
improved medical advances - Medical treatments and surgery added five years to overall life expectancy.
©2007 Thomson Higher Education

6. Life Expectancy at Birth, by Race and Sex: United States, 1970–2009

7. Aging is the accumulation of diverse harmful changes in cells and tissues.
Consequences of aging
Decreased physical and mental capacity
Increased risk of disease and death
Physiological changes
Cardiovascular system
Renal system
Musculoskeletal system
Nervous system
Respiratory system
Gastrointestinal system
The human body experiences some signs of deterioration or decline that we recognize as aging. Aging is a complex multifaceted process that varies from person to person; however, over time it affects the cells and all of the major organ systems of the body. Aging is the accumulation of diverse harmful changes that occur in cells and tissues that are responsible for decreased physical and mental capacity and an increased risk of disease and death.
Aging is a complex multifaceted process that varies from person to person; however, over time it affects the cells and all of the major organ systems of the body.

8. Theories of aging tend to fall in to two categories.
Programmed theories
Programmed longevity
Endocrine theory
Immunological theory
Damage or error theories
Free radicals
Protein cross-linking
DNA damage
Epigenetic changes to DNA
Programmed theories: contend that aging follows a biological timetable
Programmed longevity: the switching on and off of specific genes that leads to aging
Endocrine theory: age-related alterations in the regulation of the endocrine system control the rate of aging
Immunological theory: suggests that the immune system is programmed to decline over time which causes increased vulnerability to disease
Damage or error theories: suggest that aging is caused by an accumulation of molecular and cellular damage
Free radicals: cause oxidative damage to proteins, lipids, and DNA
Protein cross-linking: impairs protein function
DNA damage: results in mutations that cause cells to malfunction
Epigenetic changes to DNA: alters patterns of gene expression

9. The Frenchwoman Jeanne Louise Calment lived to a verified age of 122
The Frenchwoman Jeanne Louise Calment lived to a verified age of 122. She was famous for her sense of humor and her love of eating chocolate. She died in 1997.

10. Older adults will comprise an estimated 20% of the U. S
Older adults will comprise an estimated 20% of the U.S. population by 2030.
During the next 25 years, the population of Americans 65+ years old will double.
Longer lifespans plus aging baby boomers
For those surviving to adulthood, the gains in life expectancy have been more modest over the same period: about nine additional years for women and five additional years for men. Major factors that are responsible for recent increases in the life expectancy are a decrease in the prevalence of smoking and improved medical care.
During the next 25 years, two factors—longer life spans and aging baby boomers—will combine to double the population of Americans 65 years or older to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population.

11. A number of factors influence lifespan.
Disease
Heart disease
Cancer
Diabetes
Other influences
Education
Race
Marital status
Socioeconomic status
A number of factors can influence how long a person lives.
Disease: chronic diseases, such as heart disease, cancer, and diabetes. Anything that increases one’s odds of getting these diseases, such as smoking or obesity, will have a correspondingly negative impact on one’s life expectancy.
Other influences: people with higher levels of education have a higher life expectancy than those with lower levels. Decreased life expectancy is also associated with being unmarried, low socioeconomic status, and part of some racial groups.

12. The “Blue Zones” are areas in the world with increased longevity.
Have a higher number of individuals who live to be at least 100 years old
Include parts of Japan, Italy, Canada, and Costa Rica
Also include Seventh-day Adventist communities
“Blue Zones” are areas with a higher than average number of individuals who live to be at least 100 years old. Blue Zones have been identified in parts of Japan, Italy, Canada, and Costa Rica.
The Blue Zone concept was popularized by journalist Dan Buettner, in his book The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest.
Many of the so-called Blue Zones are isolated island or mountain communities, such as the archipelago of Okinawa in Japan and the highlands of Sardinia in Italy, where age-old customs remain intact and where migration into and out of the area is rare.

13. Seventh-day Adventist Community
Live longer on average
Men, seven additional years
Women, four-and-a-half additional years
Several key behaviors and lifestyle choices
They don’t smoke.
They rarely drink alcohol.
Many are vegetarians or vegans.
They emphasize fresh, minimally processed foods.
They regularly consume nuts.
The Adventist community, by contrast, is not found in a geographically restricted area, but that turns out to be a plus for longevity researchers. Unlike the other Blue Zones, where the geographic isolation of gene pools might imply a genetic reason for increased longevity, the Adventist are linked only by behavior.
Research on this group shows it is not genetics and that nutrition plays a big role.

14. Aging adults need fewer calories to maintain weight and power activities.
Energy needs decrease
Less physically active
Reduced activity leads to sarcopenia (reduced muscle mass)
Age-related hormonal changes and cellular aging
Physical activity can offset losses in muscle mass
As people age, they require fewer calories to maintain their weight and power their activities. That’s because total and resting energy expenditure decrease progressively with age. There are several contributing factors to this decline, but the biggest one is a decrease in physical activity—older adults are less physically active. Reduced activity leads to reduced muscle mass, a phenomenon called sarcopenia, which further reduces resting energy expenditure.
Some of the changes in muscle mass that occur with aging are independent of activity levels, and relate to changes in hormone levels and cellular aging, both of which lead to predictable age-related changes in body composition and body fat distribution. But to a large extent, physical activity can offset losses in muscle mass.

15. Older adults should emphasize nutrient-dense foods.
Nutrient needs remains similar to younger adults.
Fewer calories means little room for empty calories.
Need for specific macro- and micronutrients does not decrease (and may even increase because of other bodily changes). As a consequence, older adults must make sure to consume a diet that is more nutritionally dense than the diet they may have eaten when they were younger. There is less room for empty calories.

16. Staying active has significant benefits for adults as they age.

17. Older adults may experience physical challenges that impair their ability to meet nutrient requirements.
Olfaction: decline in sense of smell
Gustation: decline in sense of taste
Loss of teeth
Periodontal disease
Effect of medications on appetite and nutrient absorption
Drug/nutrient interactions
Age-related gastrointestinal changes
Many older people experience a decline in the senses of smell (olfaction) and taste (gustation), which can make food less palatable and therefore affect appetite because food just isn’t as appealing as it once was. Aging causes a more dramatic decline in the sense of smell than it does in taste. More than 60% of individuals between the ages of 65 and 80 have a major loss of smell, increasing to more than 75% of those who are older than 80 years. A reduction in mucus production that traps and transfers odorants, and a decrease in olfactory receptors and neurons that detect those odorants, are thought to be major factors leading to this age-related loss of smell.
Diminished taste is caused by age-related decreases in the number, size, and sensitivity of taste buds. With these declines in taste and smell, visual cues play an increasingly important role in stimulating appetite. It has been found that enhancing the dining room and the presentation of food increases food intake in nursing home residents. In addition to changes in taste and smell, loss of teeth and periodontal disease can compromise one’s ability to chew, which can also make obtaining adequate nutrition a challenge. Nutritional status may be further compromised by the effects of medications on appetite and nutrient absorption.
According to the Centers for Disease Control, more than 75% of older Americans (60 years and older) use two or more prescription drugs and 37% use five or more! This prevalence of drug use, both prescription and over-the-counter medications, combined with age-related alterations in physiological function, is a special concern for seniors. Healthcare providers must consider the implications of interactions among medications, dietary supplements, and food. Some drugs can affect the metabolism, absorption, or excretion of certain nutrients. Age-related gastrointestinal changes may occur, especially with regard to the bacterial composition of the gut, which can affect nutrient absorption. Diminished gastric acid secretion and slower motility in the small intestine can result in overgrowth of intestinal bacteria that interferes with absorption of nutrients.

18. Psychologically healthy individuals with a sense of purpose have better quality of life and overall health.
Psychological and socioeconomic challenges
Loss and loneliness
Lack of social support
Elderly living in community have lower incidence of malnutrition
Increased risk of depression
Psychosocial factors have an impact on elderly individuals’ ability and motivation to obtain adequate and appropriate nourishment. Loss, loneliness, and lack of social support may result in increased risk of depression and suboptimal intake when eating alone. Research shows that individuals who are psychologically healthy, resilient, and have a sense of purpose in their lives are more likely to age successfully and experience better quality of life and overall health. This echoes the characteristics found in the Blue Zone populations. It has been reported that about 60% of hospitalized adults 65 years or older and up to 85% of residents of nursing homes are malnourished. Elderly living in the community fare better, but many are still at risk for malnourishment, with slightly fewer than 40% being malnourished or at risk of malnourishment.

19. Common Nutrition-Related Conditions in Older Adults

20. Nutrient Recommendations for Seniors
Calcium
Reduced absorption
DRI increased to 1,200 mg in adults 51 years and older
Vitamin D
Synthesis compromised
DRI increased to 800 IUs
Both important to prevent osteoporosis
The physiological changes with increasing age can alter how the body absorbs and utilizes nutrients, thus the Daily Reference Intake values (DRIs) for certain vitamins and minerals are different for older adults. In particular, the requirements for calcium and vitamin D—both important for the prevention of osteoporosis (Chapter 13)—are higher. Calcium absorption is reduced in older adults, and vitamin D synthesis can be compromised because of reduced exposure to sunlight. The RDA for calcium is increased from 1,000 mg to 1,200 mg in women 51 and older and in men older than 70. The RDA for vitamin D increases from 600 IUs to 800 IUs in adults (men and women) over the age of 70. There is also a higher requirement for vitamin B6 with age. A deficiency of this vitamin can lead to cognitive impairment.

21. Nutrient Recommendations for Seniors
Higher requirements for vitamins B6 and B12
Decreased absorption in the intestine
Can lead to cognitive impairment
There is also a higher requirement for vitamin B6 with age. A deficiency of this vitamin can lead to cognitive impairment while supplements have been shown to re-duce the occurrence of late-life depression. Reduced gastric acid production also causes malabsorption of naturally occurring vitamin B12, because gastric acid must release the vitamin from food proteins for it to be absorbed. It is estimated that at least 25% of those older than 60 years are deficient or marginally deficient in vitamin B12, and low B12 levels are associated with cognitive impairment and dementia. For this reason, it is strongly recommended that the elderly receive their vitamin B12 from fortified foods or supplements.

22. Nutrient Recommendations for Seniors
Protein
Slightly higher protein intakes might reduce loss of lean body mass (1.0 to 1.5 g/kg/day).
With resistance exercise, higher protein intake may improve functionality.
Consumption of plant proteins is emphasized.
Protein intake is of particular concern, as one-third of older adults are not meeting the Recommended Dietary Allowance for protein. Furthermore, a number of studies demonstrate that slightly higher protein intakes (approximately 1.0 to 1.5 g/kg/d) in adults older than 65 years can effectively reduce the loss of lean body mass that occurs with age. This may improve functionality, and reduce the risk of disability and death, particularly when combined with resistance exercise. Several studies have also shown that consuming 25 to 30 grams of protein at each meal slows age-associated loss of muscle mass and improves gains in muscle mass in response to resistance training in older individuals.

23. Nutrient Recommendations for Seniors
Fluids
Added emphasis on getting enough
Many older adults experience:
Reduced thirst sensation
Increased fluid loss
Difficulty meeting requirements
Recommendations are the same as for adults, but the risk of dehydration adds emphasis on getting sufficient amounts.
Fluid recommendations are the same for older adults, but because older adults may experience reduced thirst sensation and increased fluid loss through diminished kidney function and as a side effect from certain medications, they may have a harder time meeting these requirements. With an increased risk of dehydration, food guides for aging adults have added emphasis on sufficient fluid intake.

24. Nutrient Recommendations for Seniors
Other beneficial nutrients in some cases
Zinc
Supportive role in immunity
Omega-3 fatty acids
May reduce symptoms of rheumatoid arthritis
May slow the progression of age-related macular degeneration
May reduce the risk of Alzheimer disease
In addition to those nutrients that are specifically altered in the DRIs, there are several other nutrients that may provide benefits in some cases. These include zinc, which plays a supportive role in immunity, and omega-3 fatty acids, which may reduce symptoms of rheumatoid arthritis, slow the progression of age-related macular degeneration, and reduce the risk of Alzheimer’s disease.

25. Best Diet to Delay Age-Related Disease
Sufficient but not excessive calories
Low in saturated fat
High in whole grain cereals, legumes, fruits, and vegetables
On the basis of current research, the best diet to delay age-related disease onset is one that provides sufficient, but not excessive, calories; is low in saturated fat and high in whole-grain cereals, legumes, fruits and vegetables; and maintains a lean body weight.

26. MyPlate for Older Adults emphasizes nutrient-dense foods.
In consideration of the unique nutritional and physical activity needs associated with advancing years, there is a MyPlate for Older Adults, developed by nutrition scientists at the Jean Mayer USDA Human Nutrition Research Center on Aging, to complement the federal government’s MyPlate for adults.

27. Adequate skeletal muscle mass is important for recovery from illness and injury, and to reduce the risk of some chronic diseases.
Adequate muscle mass is important for mounting an adequate response to various stresses and reducing the risk of several chronic diseases. Muscle serves as a reservoir of amino acids that can be used during periods of physiological stress such as illness, injury, or surgery to synthesize antibodies as part of an immune response. Adequate muscle mass is also essential for successful recovery from these conditions.
Maintaining adequate skeletal muscle mass (and preventing sarcopenia) also reduces the risk of developing type 2 diabetes, since muscle is the primary site of insulin- stimulated glucose uptake from blood and the major means of clearing excess glucose from the blood. Adequate skeletal muscle mass and strength allows for continued physical activity, which is required to maintain bone density and reduce the risk of osteoporosis.
Finally, studies continue to confirm that maintenance of muscle mass and strength not only helps prevent falls and injury but can help keep aging adults independent and promote longer, healthier lives.

28. Clues for Longevity from Studying Adventist Lifestyle
Associated with clear benefits to longevity
Being physically active
Eating lots of nuts
Being vegetarian
Having a healthy BMI

29. Both male and female Seventh-day Adventists have longer life expectancies than the average Californian man and woman.
Survival of Men and Women Adventists Compared with Californians: Both male and female Seventh-day Adventists have longer life expectancies than the average Californian man and woman, possibly due to lifestyle choices such as abstaining from eating meat, smoking, and drinking.

30. Californian Adventists have a life expectancy greater than that of the populations of most nations.
Expected Length of Life (Californian Adventists Compared with International Populations): Californian Adventists have a life expectancy greater than that of the populations of most nations, with only a select few (such as Iceland and Japan) that approach similar numbers. Californian Adventists who follow a vegetarian diet have even longer life expectancies.

31. Diet and exercise are certainly important, but there are other features that contribute to longer life.
Plant-heavy diet
Nuts and legumes
Active lifestyle
Psychosocial factors
Social connectedness
Having a plan or purpose
There are also particular classes of foods that tend to be embraced in Blue Zone diets—in particular, legumes and nuts. The Japanese tend to eat a lot of tofu, made from soybeans (a legume), while Adventists eat a lot of both legumes and nuts.
There are some other features of Blue Zones that seem to contribute to longer life. Most important of these are psychosocial variables like social connectedness and having a “plan” or a “purpose.” Residents of Blue Zones are distinctive in the way they value their elders, making them important members of the community.

32. Summary
Nutrition and physical activity play key roles in maintaining health and preventing chronic disease, as well as in potential longevity and quality of life, in the aging adult.
There are physical, psychological, social, and economic factors that can influence and potentially compromise the dietary intake and nutritional status of the older adult.
Energy needs in older adults generally decline because of decreased physical activity and metabolic rate; however, nutrient needs do not decrease (they may even increase), making it especially important to consume nutrient-dense foods.
Age-related changes in body composition and body fat distribution occur to varying degrees, but physical activity helps offset losses in skeletal muscle mass (sarcopenia).
Age-related gastrointestinal changes may occur, including the bacterial composition of the gut, diminished gastric acid secretion, and slower motility in the small intestine.

33. Summary (cont.)
Nutrients of concern in older adults due to diminished intake or possible changes in absorption and utilization include protein, calcium, vitamin D, vitamin B6, vitamin B12, folate, iron, zinc, fiber, and omega-3 fatty acids.
Although fluid requirements are the same for older adults, the risk of dehydration is higher than in younger adults due to diminished thirst sensation, increased fluid losses, and side effects of certain medications.
Poor nutrition and physiological changes with advanced age, along with possible depressed immunity and a decreased ability to fight and recover from illness, surgery, or infection, can lead to suboptimal nutritional status or even malnutrition.
Nutrient inadequacies may contribute to cognitive decline with age. In addition, some studies show that certain dietary nutrients, like omega-3 fatty acids and some phytochemicals, may reduce the risk of dementia.
Based on current research, the best diet to delay age-related disease onset avoids excess calorie intake and is low in saturated fat and high in whole grains, legumes, nuts, fruits, and vegetables.