1. Chapter 18 Nutrition and Older Adults
“Nutrition is one of the major determinates of successful aging.”

2. Generalizations relative to health status changes with aging are unwise because “older adults” are a heterogeneous population
Diseases and disabilities are not inevitable consequences of aging
Functional status is more indicative of health in older adults than chronological age

3. Introduction
In “normal” aging, inevitable & irreversible physical changes occur over time
We will look at
nutrient requirements
dietary recommendations
food & nutrition programs designed to support healthy aging

4. What Counts as Old? There is no one age that defines “old”
50—Eligibility for AARP
60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program
65—Eligibility for full Social Security
U.S. Census Bureau uses:
65 to 74—“young old”
75 to 84—“aged”
85 & older—“oldest old”

5. Food Matters: Nutrition Contributes to a Long and Healthy Life
Cumulative effects of lifelong dietary habits determine nutritional status in old age
CDC suggest that longevity depends on:
10% access to health care
19% genetics
20% environment (pollution, etc.)
**51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)

6. A Picture of the Aging Population: Vital Statistics
More Americans are living longer
Currently, ~12.4% are >65 yrs
By 2050, ~20% will be >65 yrs
Persons ≥85 are the fastest growing population group

7. Global Population Trends: Life Expectancy and Life Span
Average number of yrs of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth
Life span
Maximum number of yrs someone might live; human life span is projected to range from 110 to 120 yrs

8. Range of Life Expectancy for 15 of 37 Countries Reported in Health, United States 2005, for 2001, According to Gender

9. Three Groups of Aging Theories
1) Programmed aging
Hayflick’s theory of limited cell replication
Modular clock theory
2) Wear and tear theories of aging
Oxidative stress theory
Rate of living theory
3) Calorie restriction & longevity

10. Physiological Changes
Body composition changes
Lean body mass (LBM) & fat
Muscles: use it or lose it
Weight gain
Changing sensual awareness
Taste & smell
Oral health: chewing & swallowing
Appetite & thirst

11. Body Composition Changes
Lean body mass (LBM)
Sum of fat-free tissues, mineral as bone, & water
Sarcopenia
Term used for loss of LBM associated with aging
Fat-free mass decreases ~15% from age 20 to 70
Older people have lower mineral, muscle, & water reserves

12. Muscles: Use It or Lose It
In older adults, weight-bearing & resistance exercise increase lean muscle mass & bone density
Regular physical activity helps maintain functional status

13. Weight Gain Weight gain accompanies aging, but is not inevitable
Mean body weight gradually increases with aging, peaking between 50 & 59 yrs
Physical activity moderates weight gain & increases in body fat
Lack of estrogen promotes fat accumulation

14. Changing Sensual Awareness: Taste and Smell
Taste & smell senses decline with age
Decline in ability to identify smells varies by gender
In men, decline begins ~age 55
In women, decline is >age 60
Disease & medications affect taste & smell more than aging

15. Changing Sensual Awareness: Oral Health—Chew and Swallow
Oral health depends on:
GI secretions
Skeletal systems
Mucus membrane
Muscles
Taste buds
Olfactory nerves (smell & taste)
Healthy People 2010 Objective:
Reduce % of people aged who have lost all their teeth from 26% to 20%

16. Changing Sensual Awareness: Appetite and Thirst
Hunger & satiety cues weaken with age
Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted
Thirst
Thirst-regulating mechanisms decrease with age
Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective with advancing age

17. Nutritional Risk Factors
Risk factors for older adults are:
Hunger, poverty, low food & nutrient intake
Functional disability
Social isolation or living alone
Urban & rural demographic areas
Depression, dementia, dependency
Poor dentition & oral health
Diet-related acute or chronic diseases
Polypharmacy
Minority, advanced age

19. Tufts University’s Modified Food Pyramid for 70+ Adults
Note supplements at the top & water at the base
Illustration 18.2 Tufts University modified food pyramid for 70+ adults.

20. Caloric Intake Comparison of Younger and Older Adults by Gender

21. Eating Occasions Eating Out Snacking
Older adults eat out less than younger persons
Snacking
Older adults snack less than other groups

22. Nutrient Recommendations
Nutrient recommendations change as scientists learn more about effects of foods on human functions
Specific DRI for those >51 yrs were 1st established in 1997
Estimating Energy Needs
Decrease in physical activity & BMR from early to late adulthood results in ~20% fewer calories needed

23. Protein
Inactive, older adults living alone may have low protein intakes
Several researchers report protein needs for older adults are 1 to 1.25 g/kg body wt (higher than the DRI of 0.8 g)
Nitrogen balance is easier to achieve when:
Protein is a high quality
Adequate calories are consumed
Elders participate in resistance training

24. Considerations for Protein Adequacy of Older Adults
Based on ht & wt, how much protein will meet individual’s needs?
Are enough calories eaten so that protein does not have to be used for energy?
If marginal amounts of protein are eaten, is the protein of high quality?
Are there additional needs: wound healing, tissue repair, surgery, fracture, infection?
Is the individual exercising? (Nitrogen balance is harder to achieve while sedentary.)

25. Fats and Cholesterol
Minimize saturated fat & keep total fat between 20 to 35% of calories----same as young & middle-aged adult
Even though eggs are high in cholesterol, they are a nutrient-dense, convenient, & safe food for older adults that do not have lipid disorders

26. Recommendations for Fluid
The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated
≥6 glasses of fluid/day will prevent dehydration in most older adults
To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL

27. Age-associated Changes in Metabolism: Vitamin D, Calciferol
Factors that put older adults at risk for deficiency:
1. Limited exposure to sunlight
2. Institutionalization or homebound
3. Certain medications (barbiturates, cholestyramine, Dylantin, laxatives)

28. Age-associated Changes in Metabolism: Iron
Iron needs  after menopause
Most older adults consume more iron than needed
Excess iron contributes to oxidative stress
Reasons that some older adults may have iron deficiency include
Iron loss from disease or medications
 acid secretion
 calorie intake

29. Low Dietary Intake: Nutrients of Concern
Vitamin E
Folate, folic acid
Calcium
Magnesium
Zinc

30. Nutrient Supplements: When ?
May be useful with those who:
Lack appetite resulting from illness, loss of taste or smell, or depression
Have diseases in GI tract
Have a poor diet due to food insecurity, loss of function, or disinterest
Avoid specific food groups
Take medication or other substances that affect absorption or metabolism

31. Dietary Supplements Potentially Used by Older Adults for Health Conditions

32. Nutrient Recommendations: Using the Food Label
In nutrition labeling & dietary guidance, “one size does not fit all”
Nutrient amounts for older adults are slightly different than those for younger
Main differences:
Need more calcium & vitamins D & C
Need less iron & zinc

33. Food Safety Recommendations
Older adults are vulnerable to foodborne illness because they have compromised immune systems
Leading hazardous practices:
Improper holding temperatures
Poor personal hygiene
Contaminated food preparation equipment
Inadequate cooking time

34. Physical Activity Recommendations
Exercise: the “true fountain of youth”
Exercise guidelines
Keep Moving—Fitness after 50 screening tool
Resistance or weight-bearing activities
Aerobic exercise

35. Nutrition Policy and Intervention for Risk Reduction
Nutrition Education
4 C’s:
-Commitment
-Cognitive processing
-Capability
-Confidence

36. Considerations for Educational Materials for Older Adults
Larger type size
Serif lettering (such as Times Roman)
Bold Type
High contrasts (black on white)
Non-glossy paper
Avoid blue, green & violent
Reading level of 5th to 8th grade

37. Community Food and Nutrition Programs
Elderly Nutrition Programs
Government programs include:
USDA’s food stamp & extension programs
Adult Day Services Food Programs
Nutrition Assistance Programs for Seniors
Meals-on-Wheels
Senior Nutrition Program of the Older Americans Act

38. The Promise of Prevention: Health Promotion
Good nutrition habits make a greater impact when started early in life
Many not motivated to make changes until later in life or when health problems occur
The belief that an 80 y/o is too old to learn and practice health promotion strategies is an outdated myth