1. Successful Aging Sorosh Roshan, MD, MPH International Health Awareness Network www.ihan.org

2. Who is Old? Second childhood - Shakespeare late 16 th century “sans teeth, sans eyes, sans taste, sans everything” Second childhood - Shakespeare late 16 th century “sans teeth, sans eyes, sans taste, sans everything” The United Nations defines older people as those 60 years of age and over, and The United Nations defines older people as those 60 years of age and over, and The oldest old as those over 80 years of age The oldest old as those over 80 years of age

3. The Human Rights of Older Women Equal access to health and social services Equal access to health and social services Eliminate gender, age, race and income related inequalities Eliminate gender, age, race and income related inequalities Life long training opportunity Life long training opportunity Involving older workers right across the company’s activities e.g., training, worker involvement in redesigning the work place, etc. Involving older workers right across the company’s activities e.g., training, worker involvement in redesigning the work place, etc. Access to the labor market Access to the labor market Elimination of elder abuse Elimination of elder abuse

4. Aging “A process of gradual and spontaneous change, resulting in maturation through childhood, puberty and young adulthood and then decline through middle and late age” “A process of gradual and spontaneous change, resulting in maturation through childhood, puberty and young adulthood and then decline through middle and late age”

5. Senescence “The process by which the capacity for cell division, growth, and function is lost over times, ultimately leading to an incompatibility with life; i.e., the process of senescence terminates in death” “The process by which the capacity for cell division, growth, and function is lost over times, ultimately leading to an incompatibility with life; i.e., the process of senescence terminates in death”

6. Successful Aging A process by which deleterious effects are minimized A process by which deleterious effects are minimized Healthy lifestyle from preconception though out life cycle Healthy lifestyle from preconception though out life cycle Nutrition and an active physical, mental and spiritual life Nutrition and an active physical, mental and spiritual life

7. Accelerated Aging Progeroid syndrome Progeroid syndrome Warner syndrome Warner syndrome Wiedmann-Rautenstrauch syndrome and Hutchinson-Gilford syndrome Wiedmann-Rautenstrauch syndrome and Hutchinson-Gilford syndrome Down syndrome Down syndrome

8. Physiology of Aging Aging is a normal process in which the rate of catabolic changes become greater than the rate of anabolic cell regeneration. Aging is a normal process in which the rate of catabolic changes become greater than the rate of anabolic cell regeneration. Loss of cells and body mass can lead to varying degree of decreased efficiency and impaired organ function. Loss of cells and body mass can lead to varying degree of decreased efficiency and impaired organ function.

9. Physiological Changes Sensory losses Sensory losses Oral health problems Oral health problems Gastrointestinal and metabolic abnormalities Gastrointestinal and metabolic abnormalities Cardiovascular diseases Cardiovascular diseases

10. Physiological Changes (con’t) Reduction of pleasure of eating due to hyposmia (the ability to taste and smell reduced) and dysgeusia (the capability to digest foods is reduced) Reduction of pleasure of eating due to hyposmia (the ability to taste and smell reduced) and dysgeusia (the capability to digest foods is reduced) Reduced ability to detect odor can cause Reduced ability to detect odor can cause food poisoning food poisoning Dry mouth (xerostomia), hyposalivation; difficulties in chewing and swallowing; constipation Dry mouth (xerostomia), hyposalivation; difficulties in chewing and swallowing; constipation

11. Gastrointestinal Changes Constipation due to inadequate intake of fiber, fluid, sedentary life style Constipation due to inadequate intake of fiber, fluid, sedentary life style Glucose intolerance Glucose intolerance Increase in plasma levels of 1.5mg/dl per decade Increase in plasma levels of 1.5mg/dl per decade Deficient insulin production or function Deficient insulin production or function Diet modification and exercise are the treatment of choice Diet modification and exercise are the treatment of choice

12. Gastrointestinal Changes (con’t) Hypochlorhydria (Lower levels of digestive enzymes) Hypochlorhydria (Lower levels of digestive enzymes) Diminished absorption of nutrients such as B12, iron and calcium Diminished absorption of nutrients such as B12, iron and calcium Metabolism of calcium and vitamin D is altered during aging Metabolism of calcium and vitamin D is altered during aging These factors and poor dietary intake will accelerate bone loss and osteoporosis These factors and poor dietary intake will accelerate bone loss and osteoporosis

13. Nutritional Requirements Age, gender, level of activity, food allergies, environment and medical conditions Age, gender, level of activity, food allergies, environment and medical conditions Caloric requirements begin to decline from 55-60, (500kcal per for men and 300 kcal for women) Caloric requirements begin to decline from 55-60, (500kcal per for men and 300 kcal for women) Protein requirements increase slightly Protein requirements increase slightly 20-30 kcal per kg of body weight-depending on the person’s weight. 20-30 kcal per kg of body weight-depending on the person’s weight.

14. Nutritional Requirements (con’t) 1.25g of protein per kilogram of body weight is appropriate for the elderly (12 - 16% of total daily calories). 1.25g of protein per kilogram of body weight is appropriate for the elderly (12 - 16% of total daily calories). The US RDA for adults is.8g of protein per kilogram of body weight. The US RDA for adults is.8g of protein per kilogram of body weight. Need varies depending on illness, stress, Need varies depending on illness, stress, open wounds, burns, vigorous exercise, infection and altered GI function.

15. Carbohydrate Intake Limited to 55% of total daily calories. Limited to 55% of total daily calories. 40% of it from complex carbohydrate, whole grains, vegetables and fibers. 40% of it from complex carbohydrate, whole grains, vegetables and fibers. Fibers help reduce cholesterol and plasma Fibers help reduce cholesterol and plasma glucose level. glucose level.

16. Dietary Fat 30% of daily calories. 30% of daily calories. Reduce saturated fats. Reduce saturated fats. Increase intake of monounsaturated and Increase intake of monounsaturated and polyunsaturated sources including Omega 3 fatty acids (salmon, tuna fish, walnuts and flaxseed powder) polyunsaturated sources including Omega 3 fatty acids (salmon, tuna fish, walnuts and flaxseed powder)

17. Nutrients and Vitamins –Calcium intake 800-1200mg/day –Phosphorus intake to be reduced to 700mg/day. –Vitamin D for the homebound with limited sun exposure. –Iron store tends to increase with age. The recommended dose is 10mg/ day for men and women. (50% of the required dose for under the age of 50)

18. Anemia in the Elderly Is due gastrointestinal bleeding and malignant disease. Is due gastrointestinal bleeding and malignant disease.

19. Zinc Zinc deficiency causes: Zinc deficiency causes: –Impaired immune function –anorexia –dysgeusia –delayed wound healing –development of pressure ulcers Treat with Zinc supplements Treat with Zinc supplements

20. Antioxidants Vitamin E enhances immune function. Vitamin E enhances immune function. 400 IU daily. 400 IU daily. Vitamin C may help to protect against cataract, 150-250 mg/day. Vitamin C may help to protect against cataract, 150-250 mg/day. B12, B6 and folate may help to improve nutritional status and energy, protects against elevated serum homocysteine, a risk factor for depression, cardiovascular and neurological deficits. B12, B6 and folate may help to improve nutritional status and energy, protects against elevated serum homocysteine, a risk factor for depression, cardiovascular and neurological deficits.

21. Hydration and Fluid Intake Dehydration is the most important cause of fluid and electrolyte disturbances in the elderly. Dehydration is the most important cause of fluid and electrolyte disturbances in the elderly. A daily fluid intake of 30-35 ml per kilogram of body weight, or a minimum of 1.0-1.5 ml per kilogram's necessary. A daily fluid intake of 30-35 ml per kilogram of body weight, or a minimum of 1.0-1.5 ml per kilogram's necessary.

22. Daily Fluid Requirements Fluid requirements increase with: Fluid requirements increase with: –Exercise –Use of laxative or diuretics –Hot environment –Increase protein or fiber intake –Fever The elderly often experience reduced thirst sensation The elderly often experience reduced thirst sensation

23. The Menu The food should be prepared for the individual needs. The food should be prepared for the individual needs. Good presentation, fresh, nutritious, tasty Good presentation, fresh, nutritious, tasty and nutrient dense. Be considerate of those who wear dentures or suffer from dysphasia. Add supplements if you must. and nutrient dense. Be considerate of those who wear dentures or suffer from dysphasia. Add supplements if you must. Serve the food with bouquet of tender loving care. Serve the food with bouquet of tender loving care.

24. Special Thanks Azi Ahmadi, MS Nutrition Azi Ahmadi, MS Nutrition Laura DiClementi, MS Health Education Laura DiClementi, MS Health Education Courtney Essary, MBA Courtney Essary, MBA Hewitt Simon, Age in Action-S. Africa Council for the Aged Hewitt Simon, Age in Action-S. Africa Council for the Aged