Nutrition in Elderly
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Questions and Answers

What is a socioeconomic characteristic that increases the risk of malnutrition in older adults?

  • Polypharmacy
  • Good dentition
  • Social isolation (correct)
  • High socioeconomic status

    • According to the cellular aging theory, aging is caused by the continuous use and reduction in division and maturation of new cells.

    True

    What is sarcopenia and how does it affect muscle mass?

    Sarcopenia is the decrease in muscle mass with age, characterized by a decrease in muscle fiber size and number in type 2 muscle fibers, and a decrease in myosin heavy chains IIa synthesis and IIx mRNA levels.

    With decreased physical activity, older adults are at higher risk of developing ____________________, dyslipidemia, and hypertension.

    <p>insulin resistance</p> Signup and view all the answers

    What is a risk factor for malnutrition in older adults?

    <p>Functional disability</p> Signup and view all the answers

    Aging causes progressive increases in muscle mass and bone density.

    <p>False</p> Signup and view all the answers

    Match the following age-related changes with their effects on older adults:

    <p>Decrease in sense of taste = Affects appetite and food intake Loss of muscle mass = Increases morbidity and health risk Changes in fat distribution = Affects mobility and functionality</p> Signup and view all the answers

    What is the significance of understanding the physiological changes that occur with aging?

    <p>Understanding the physiological changes that occur with aging is essential to address the health risks and morbidities associated with aging, and to develop effective interventions to promote healthy aging.</p> Signup and view all the answers

    What is the age defined as elderly according to the World Assembly on Aging in Vienna (1982) and the National Policy for the Older Persons (1995)?

    <p>60 years old and above</p> Signup and view all the answers

    According to the Department of Statistics Malaysia, the elderly population in Malaysia has been decreasing from 1990 to 2016.

    <p>False</p> Signup and view all the answers

    What is the average life expectancy for females in Malaysia according to the Department of Statistics Malaysia (2016b)?

    <p>77.2 years</p> Signup and view all the answers

    By the year of 2040, it is expected that the elderly population will be _________ of the total population.

    <p>16.3%</p> Signup and view all the answers

    What is a physiological change associated with aging that Miss K's uncle is experiencing?

    <p>Loss of appetite</p> Signup and view all the answers

    Match the following characteristics with the correct age group:

    <p>Physiological changes = 60 years old and above Elderly population =<br /> Average life expectancy =</p> Signup and view all the answers

    Miss K's uncle is experiencing knee pains due to a socioeconomic characteristic of aging.

    <p>False</p> Signup and view all the answers

    What is the percentage of the elderly population in Malaysia in 2016 according to the Department of Statistics Malaysia (2016a)?

    <p>9.80%</p> Signup and view all the answers

    What is a consequence of increased life expectancy and aging population?

    <p>Decreased mortality rates</p> Signup and view all the answers

    Aging is a disease.

    <p>False</p> Signup and view all the answers

    What is the primary consequence of cellular aging theory?

    <p>Aging and ultimately death (apoptosis preprogrammed cell death)</p> Signup and view all the answers

    At age 75, the average person has approximately __________% of maximum breathing capacity compared to age 30.

    <p>43%</p> Signup and view all the answers

    Match the risk factors for older adults with their corresponding descriptions:

    <p>Hunger, poverty = Diet-related acute or chronic diseases Lack of education = Depression, dementia, dependency Social isolation or living alone = Functional disability Polypharmacy = Poor dentition &amp; oral health</p> Signup and view all the answers

    What is a characteristic of mammalian aging?

    <p>Increased mortality with age</p> Signup and view all the answers

    Aging causes a decrease in brain weight.

    <p>True</p> Signup and view all the answers

    What is the consequence of changes in body composition due to aging?

    <p>Important consequences on health and physical functions</p> Signup and view all the answers

    What is a primary reason for the increased life expectancy and aging population?

    <p>Decreased mortality rates</p> Signup and view all the answers

    Aging is a disease.

    <p>False</p> Signup and view all the answers

    What is a characteristic of mammalian aging?

    <p>Cellular and physiologic deterioration</p> Signup and view all the answers

    At age 75, the average person has approximately __________% of brain weight compared to age 30.

    <p>92</p> Signup and view all the answers

    What is a risk factor for older adults?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a socioeconomic characteristic that increases the risk of malnutrition in older adults?

    <p>Poverty</p> Signup and view all the answers

    Cellular aging theory hypothesizes that continuous cell division and maturation of new cells causes aging and death.

    <p>False</p> Signup and view all the answers

    What is the effect of sarcopenia on muscle mass?

    <p>decrease in muscle fiber size and number in type 2 muscle fibers, decrease in myosin heavy chains IIa synthesis and IIx mRNA levels</p> Signup and view all the answers

    Aging causes progressive ______________________ in muscle mass and increase in body fat.

    <p>decreases</p> Signup and view all the answers

    Match the following physiological changes with their effects on older adults:

    <p>Sarcopenia = decrease in resting energy expenditure (REE) secondary to decreased fat-free mass Age-related changes in sense organs = affect appetite, food intake and nutritional status Decreased physical activity = higher prevalence of insulin resistance, type 2 diabetes mellitus, dyslipidemia, and hypertension</p> Signup and view all the answers

    What is a risk factor for older adults?

    <p>All of the above</p> Signup and view all the answers

    Aging causes a decrease in brain weight.

    <p>True</p> Signup and view all the answers

    What is the consequence of increased life expectancy and aging population?

    <p>higher risk of malnutrition and health morbidities</p> Signup and view all the answers

    What is the definition of the elderly population according to the World Assembly on Aging in Vienna (1982)?

    <p>Individuals aged 60 years old and above</p> Signup and view all the answers

    The elderly population in Malaysia has been decreasing from 1990 to 2016.

    <p>False</p> Signup and view all the answers

    What is the expected percentage of the elderly population in Malaysia by the year 2040?

    <p>16.3%</p> Signup and view all the answers

    The average life expectancy for males in Malaysia is approximately _________ years.

    <p>72.6</p> Signup and view all the answers

    Match the following physiological changes with their effects on older adults:

    <p>Appetite loss = Reducing food intake Knee pains = Reducing physical activity Sarcopenia = Increasing muscle mass Dyslipidemia = Increasing risk of heart disease</p> Signup and view all the answers

    What is a socioeconomic characteristic of the aging population?

    <p>All of the above</p> Signup and view all the answers

    Aging causes a decrease in brain weight.

    <p>True</p> Signup and view all the answers

    What is a risk factor for older adults?

    <p>Decreased physical activity</p> Signup and view all the answers

    When unintended weight loss occurs, older adults are losing muscle which:

    <p>decreases their level of independence</p> Signup and view all the answers

    Protein-Energy malnutrition (PEM) amongst the elderly population is more prevalent in community settings than in long-term care facilities.

    <p>False</p> Signup and view all the answers

    What is a common consequence of malnutrition in older adults?

    <p>Increased severity of disease</p> Signup and view all the answers

    Older adults are at increased risk of inadequate diet/malnutrition from _______________.

    <p>Amarya S et al (2015)</p> Signup and view all the answers

    Match the following consequences of Protein-Energy malnutrition (PEM) with their descriptions:

    <p>Increases severity of disease = Reduces immune response Impairs wound healing = Decrease functional status Can increase drug effects = Impairs cognitive function</p> Signup and view all the answers

    What is the prevalence of Protein-Energy malnutrition (PEM) amongst hospitalized patients?

    <p>30-61%</p> Signup and view all the answers

    What is the phenomenon where elevated BMI is associated with lower all-cause and cardiovascular mortality in the elderly population?

    <p>Obesity Paradox</p> Signup and view all the answers

    Aging causes progressive increases in muscle mass and bone density.

    <p>False</p> Signup and view all the answers

    What is the term for the progressive loss of skeletal muscle mass?

    <p>Sarcopenia</p> Signup and view all the answers

    In the elderly population, a higher BMI may be associated with _______________ all-cause and cardiovascular mortality.

    <p>lower</p> Signup and view all the answers

    Match the following health risks with their corresponding descriptions:

    <p>Unintentional Weight Loss = A condition where an elderly person loses weight unintentionally, which can lead to malnutrition. Malnutrition = A condition where an elderly person does not consume enough nutrients, leading to health problems. Sarcopenic Obesity = A condition where an elderly person has both sarcopenia and obesity. Protein-energy Malnutrition = A condition where an elderly person does not consume enough protein and energy, leading to malnutrition.</p> Signup and view all the answers

    What is a risk factor for malnutrition in older adults?

    <p>All of the above</p> Signup and view all the answers

    Thinness carries a lower risk of mortality than overweight in the elderly population.

    <p>False</p> Signup and view all the answers

    What is the term for the redistribution of body fat and muscle mass that occurs with aging?

    <p>Redistribution of body composition</p> Signup and view all the answers

    Why is the norm BMI cut off for obesity not recommended for the elderly population?

    <p>Obesity paradox-lowest mortality when BMI range 24-28kg/m2</p> Signup and view all the answers

    Weight reduction is recommended for the elderly population.

    <p>False</p> Signup and view all the answers

    What are the consequences of malnutrition in the elderly population?

    <p>Increased severity of disease, decreased functional status, and increased mortality risk</p> Signup and view all the answers

    The Katz Activities of Daily Living (ADL) Scale assesses functional status by rating the level of assistance required for tasks such as __________.

    <p>bathing, dressing, toileting, transfer, grooming, and feeding</p> Signup and view all the answers

    What is a consequence of unintentional weight loss in the elderly population?

    <p>Increased risk of mortality</p> Signup and view all the answers

    Malnutrition screening tools such as DETERMINE and MNA are used to identify individuals at risk of malnutrition.

    <p>True</p> Signup and view all the answers

    Match the following malnutrition risks with their descriptions:

    <p>Increase severity of disease = Malnutrition risk Decrease functional status = Malnutrition risk Can increase drug effects due to changed metabolism = Malnutrition risk</p> Signup and view all the answers

    What is sarcopenic obesity?

    <p>Weight loss in the elderly accompanied by reductions in muscle and bone mass</p> Signup and view all the answers

    When unintended weight loss occurs, older adults are losing muscle which:

    <p>all of the above</p> Signup and view all the answers

    Protein-Energy malnutrition (PEM) amongst the elderly population is more prevalent in community settings than in long-term care facilities.

    <p>False</p> Signup and view all the answers

    What is a common consequence of malnutrition in older adults?

    <p>decreased functional status, impaired wound healing, and increased risk of mortality</p> Signup and view all the answers

    Older Adults are at increased risk of inadequate diet/malnutrition from ___________________.

    <p>Amarya S et al (2015)</p> Signup and view all the answers

    Match the following consequences of Protein-Energy malnutrition (PEM) with their descriptions:

    <p>Decreased functional status = Impaired wound healing Increased severity of disease = Increased risk of mortality Reduced immune response = Increased drug effects due to changed metabolism</p> Signup and view all the answers

    Older adults are at increased risk of malnutrition due to:

    <p>inadequate diet</p> Signup and view all the answers

    What is the 'obesity paradox' in the elderly population?

    <p>Elevated BMI is associated with lower mortality</p> Signup and view all the answers

    Unintentional weight loss is a common consequence of malnutrition in older adults.

    <p>True</p> Signup and view all the answers

    What is Protein-Energy Malnutrition (PEM)?

    <p>A condition characterized by a lack of protein and energy, leading to muscle wasting and poor overall health.</p> Signup and view all the answers

    Sarcopenic obesity is characterized by the loss of ______________ mass.

    <p>skeletal muscle</p> Signup and view all the answers

    Match the following malnutrition risks with their descriptions:

    <p>Sarcopenic obesity = Loss of skeletal muscle mass Unintentional weight loss = Loss of muscle mass and decreased body fat Protein-Energy Malnutrition = Lack of protein and energy, leading to muscle wasting Obesity paradox = Elevated BMI associated with lower mortality</p> Signup and view all the answers

    Malnutrition is only a risk in institutionalized older adults.

    <p>False</p> Signup and view all the answers

    What is a common consequence of sarcopenic obesity?

    <p>Frailty and poor overall health.</p> Signup and view all the answers

    What is a risk factor for malnutrition in older adults?

    <p>Social isolation</p> Signup and view all the answers

    Why is the WHO BMI cut off for obesity not recommended for the elderly population?

    <p>Due to obesity paradox, where mortality is lowest when BMI is between 24-28 kg/m2</p> Signup and view all the answers

    Weight reduction is recommended for elderly individuals.

    <p>False</p> Signup and view all the answers

    What is a consequence of malnutrition in older adults?

    <p>Increased mortality risk</p> Signup and view all the answers

    Malnutrition can increase the severity of ______________________ and mortality risk.

    <p>disease</p> Signup and view all the answers

    Match the following malnutrition risks with their descriptions:

    <p>Malnutrition = Increased mortality risk Unintentional weight loss = Loss of muscle mass and bone density Sarcopenic obesity = Muscle loss and increased fat mass</p> Signup and view all the answers

    Malnutrition is more prevalent in long-term care facilities than in community settings.

    <p>False</p> Signup and view all the answers

    Unintended weight loss in older adults is often accompanied by losses in ______________________ and bone mass.

    <p>muscle</p> Signup and view all the answers

    What is a common consequence of Protein-Energy malnutrition (PEM) in older adults?

    <p>Increased risk of falls and mortality</p> Signup and view all the answers

    What is the recommended daily protein intake for older adults?

    <p>1.25g/kg body wt</p> Signup and view all the answers

    Adequate protein intake can be achieved by the inclusion of low-quality proteins.

    <p>False</p> Signup and view all the answers

    What is the recommended frequency of fish consumption to prevent cognitive decline?

    <p>1-2 times per week</p> Signup and view all the answers

    Fat is a concentrated source of energy and aids absorption of _______________________ vitamins.

    <p>fat-soluble</p> Signup and view all the answers

    Match the following nutrients with their functions:

    <p>Protein = Repair and renewal of muscles, synthesis of enzymes and hormones Fat = Concentrated source of energy, absorption of fat-soluble vitamins</p> Signup and view all the answers

    According to WHO (2002), what is the recommended maximum percentage of energy intake from fat for sedentary older adults?

    <p>30%</p> Signup and view all the answers

    Saturated fats should be restricted for all older adults.

    <p>False</p> Signup and view all the answers

    What is the recommended intake of protein to achieve nitrogen balance?

    <p>High-quality protein, adequate calories, resistance training</p> Signup and view all the answers

    What percentage of Malaysian elderly did not meet the recommended intake of vitamin D?

    <p>80%</p> Signup and view all the answers

    Malaysian elderly typically have a sufficient intake of vitamin E.

    <p>False</p> Signup and view all the answers

    What is the average intake of calcium in Kelantanese women?

    <p>Around 500mg/day</p> Signup and view all the answers

    Vitamins B, such as folate, are often deficient in the elderly population due to ______________________ intake.

    <p>inadequate</p> Signup and view all the answers

    Match the following vitamins with their corresponding deficiencies in the elderly population:

    <p>Vitamin D = 13-70% of elderly Vitamin E = 80% of elderly Folacin = 13-70% of elderly Calcium = 90% of Kelantanese women</p> Signup and view all the answers

    What percentage of elderly are at high risk of riboflavin, folic acid, vitamin D, and vitamin E deficiencies?

    <p>13-70%</p> Signup and view all the answers

    What is a common reason for Vitamin D deficiency in elderly individuals?

    <p>Limited exposure to sunlight</p> Signup and view all the answers

    Vitamin B12 absorption increases with age.

    <p>False</p> Signup and view all the answers

    What is the recommended energy intake for the elderly to maintain body weight at different levels of physical activity?

    <p>1.41.8 x BMR</p> Signup and view all the answers

    Vitamin A toxicity can lead to potential liver damage in older adults due to _______________.

    <p>lower clearance from the blood and excretion from the body</p> Signup and view all the answers

    Match the following nutrients with their age-associated changes in metabolism:

    <p>Vitamin D = Decreased absorption due to limited exposure to sunlight and lower efficiency in epidermis receptor for UVA/UVB absorption Vitamin B12 = Decreased absorption due to lower production of intrinsic factor Vitamin A = Increased plasma levels and liver stores</p> Signup and view all the answers

    Nutrient-drug interactions can lead to GI disturbances such as nausea and diarrhea.

    <p>True</p> Signup and view all the answers

    What is a common consequence of nutrient-drug interactions in elderly individuals?

    <p>GI disturbances such as nausea, constipation, and diarrhea</p> Signup and view all the answers

    What percentage of older adults have low serum Vitamin B12 levels?

    <p>~40%</p> Signup and view all the answers

    What is a common cause of vitamin D deficiency in the elderly population?

    <p>Lower efficiency in epidermis receptor for UVA/UVB absorption from sunlight</p> Signup and view all the answers

    Vitamin A toxicity is more common in the elderly population due to lower clearance from the blood.

    <p>True</p> Signup and view all the answers

    What percentage of older adults have low serum vitamin B12 levels?

    <p>~40%</p> Signup and view all the answers

    Elderly people require lesser energy because of a reduced _______________________ rate (BMR) due to loss of fat-free mass.

    <p>basal metabolic</p> Signup and view all the answers

    What is a common consequence of nutrient-drug interactions in older adults?

    <p>GI disturbances such as nausea and constipation</p> Signup and view all the answers

    Vitamin B12 deficiency is more common in the elderly population due to atrophic gastritis or H pylori infections.

    <p>True</p> Signup and view all the answers

    Match the following age-related changes with their effects on older adults:

    <p>Vitamin D deficiency = Increased risk of osteoporosis Vitamin A toxicity = Possible liver damage Vitamin B12 deficiency = Fatigue and shortness of breath Energy requirement reduction = Weight loss</p> Signup and view all the answers

    What is the recommended energy intake for the elderly population?

    <p>1.4-1.8 x BMR</p> Signup and view all the answers

    What percentage of Malaysian elderly did not meet the recommended intake of vitamin D?

    <p>80%</p> Signup and view all the answers

    Most Malaysian elderly have adequate calcium intake.

    <p>False</p> Signup and view all the answers

    What is the consequence of inadequate vitamin B intake among the elderly?

    <p>Deficiency</p> Signup and view all the answers

    According to Suriah et al., 2004, __________% of elderly are at high risk of riboflavin deficiency.

    <p>13%-70%</p> Signup and view all the answers

    Match the following vitamins with their corresponding deficiencies among the elderly:

    <p>Vitamin D = 13%-70% deficiency Vitamin E = 80% deficiency Folate = Riboflavin deficiency Calcium = Inadequate intake</p> Signup and view all the answers

    Vitamin D deficiency is rare among the Malaysian elderly population.

    <p>False</p> Signup and view all the answers

    What is the recommended daily protein intake for older adults?

    <p>1.25g/kg body weight</p> Signup and view all the answers

    Aging causes a decrease in fat-free mass, leading to an increase in muscle strength.

    <p>False</p> Signup and view all the answers

    What is the importance of adequate protein intake in older adults?

    <p>Adequate protein intake is essential for repair and renewal of muscles, as well as metabolic processes such as enzymes and hormones synthesis.</p> Signup and view all the answers

    Fat is a concentrated source of energy and aids in the absorption of _______________ vitamins.

    <p>fat-soluble</p> Signup and view all the answers

    Match the following nutrients with their functions:

    <p>Protein = Repair and renewal of muscles, metabolic processes Fat = Concentrated source of energy, aids in absorption of fat-soluble vitamins</p> Signup and view all the answers

    What is the recommended percentage of energy intake from fat for sedentary older adults?

    <p>30%</p> Signup and view all the answers

    Saturated fats are recommended for older adults.

    <p>False</p> Signup and view all the answers

    Why is it essential to consume nutrient-dense foods in older adults?

    <p>It is essential to consume nutrient-dense foods in older adults because energy intake is reduced, and they require more nutrients to maintain their health.</p> Signup and view all the answers

    Study Notes

    Changes in Life Expectancy and Aging Trend

    • Increased life expectancy and aging population result from declined fertility, decreased mortality rates, and improvement in the healthcare system.
    • Life expectancy in Malaysia has increased, with an average life expectancy of 72.6 years for males and 77.2 years for females.
    • The elderly population in Malaysia has been steadily rising, from 5.70% in 1990 to 8.35% in 2013, and is expected to reach 16.3% of the total population by 2040.

    Socioeconomic Characteristics of the Aging Population

    • Risk factors for older adults include:
      • Hunger and poverty
      • Lack of education
      • Social isolation or living alone
      • Functional disability
      • Depression, dementia, and dependency
      • Poor dentition and oral health
      • Polypharmacy

    Physiological Changes Associated with Aging

    • Aging is not a disease, but a gradual process that occurs at different rates among individuals.
    • Cellular aging theory suggests that continuous use and reduction in division and maturation of new cells cause aging and ultimately death.
    • Free radicals and oxidative stress cause DNA damage, reducing viable cell numbers.
    • Characteristics of mammalian aging include:
      • Cellular and physiologic deterioration
      • Increased mortality with age
      • Increased vulnerability to disease
      • Decreased ability to adapt to stress
      • Impaired homeostasis
    • At age 75, the average person experiences:
      • 92% of brain weight compared to age 30
      • 84% of basal metabolism
      • 70% of kidney filtration rate
      • 43% of maximum breathing capacity

    Changes in Body Mass and Composition

    • Aging causes changes in body composition, including:
      • Decreased muscle mass
      • Increased body fat
      • Changes in fat distribution
      • Decreased mineral content in bones
    • Sarcopenia can affect mobility and functionality, increasing morbidity and health risk, such as:
      • Type 2 diabetes mellitus
      • Dyslipidemia
      • Hypertension

    Nutrition and Aging

    • Aging can affect appetite, food intake, and nutritional status due to:
      • Loss of sense of taste, smell, and touch
      • Decreased physical activity
      • Increased risk of malnutrition and health morbidities

    Changes in Life Expectancy and Aging Trend

    • Increased life expectancy and aging population result from declined fertility, decreased mortality rates, and improvement in the healthcare system.
    • Life expectancy in Malaysia has increased, with an average life expectancy of 72.6 years for males and 77.2 years for females.
    • The elderly population in Malaysia has been steadily rising, from 5.70% in 1990 to 8.35% in 2013, and is expected to reach 16.3% of the total population by 2040.

    Socioeconomic Characteristics of the Aging Population

    • Risk factors for older adults include:
      • Hunger and poverty
      • Lack of education
      • Social isolation or living alone
      • Functional disability
      • Depression, dementia, and dependency
      • Poor dentition and oral health
      • Polypharmacy

    Physiological Changes Associated with Aging

    • Aging is not a disease, but a gradual process that occurs at different rates among individuals.
    • Cellular aging theory suggests that continuous use and reduction in division and maturation of new cells cause aging and ultimately death.
    • Free radicals and oxidative stress cause DNA damage, reducing viable cell numbers.
    • Characteristics of mammalian aging include:
      • Cellular and physiologic deterioration
      • Increased mortality with age
      • Increased vulnerability to disease
      • Decreased ability to adapt to stress
      • Impaired homeostasis
    • At age 75, the average person experiences:
      • 92% of brain weight compared to age 30
      • 84% of basal metabolism
      • 70% of kidney filtration rate
      • 43% of maximum breathing capacity

    Changes in Body Mass and Composition

    • Aging causes changes in body composition, including:
      • Decreased muscle mass
      • Increased body fat
      • Changes in fat distribution
      • Decreased mineral content in bones
    • Sarcopenia can affect mobility and functionality, increasing morbidity and health risk, such as:
      • Type 2 diabetes mellitus
      • Dyslipidemia
      • Hypertension

    Nutrition and Aging

    • Aging can affect appetite, food intake, and nutritional status due to:
      • Loss of sense of taste, smell, and touch
      • Decreased physical activity
      • Increased risk of malnutrition and health morbidities

    Health Risks of the Elderly Population

    • Unintended weight loss in older adults increases their fall risk, decreases their ability to do daily tasks, and decreases their level of independence, ultimately increasing their risk of mortality.

    Malnutrition Risks Amongst the Elderly

    • Protein-Energy malnutrition (PEM) affects 5-12% of elderly individuals in the community, 30-61% of hospitalized patients, and 40-85% in long-term care facilities.
    • PEM can increase the severity of disease, reduce immune response, impair wound healing, decrease functional status, and increase drug effects due to changed metabolism.

    Nutritional Risks of the Elderly Population

    • Older adults are at increased risk of inadequate diet/malnutrition due to various factors.
    • The aging process is associated with significant changes in body weight and body composition, including progressive loss of skeletal muscle mass and body fat increase and redistribution.

    Health Risks of the Elderly Population

    • Body weight and BMI gradually increase during adult life and usually reach their peaks at 50s, but tend to decrease after the age of 60.
    • In the elderly, elevated BMI may demonstrate lower all-cause and cardiovascular mortality compared to those with normal weight, known as the "obesity paradox".
    • Thinness carries a greater risk of mortality than overweight.

    Assessing Functional Status

    • Katz Activities of Daily Living (ADL) Scale is used to assess functional status, comprising components such as bathing, dressing, toileting, transfer, grooming, and feeding.
    • The scale is rated by level of assistance required, with a scoring system of 6 (high, independent) to 0 (low, very dependent).

    Malnutrition and Mortality

    • Malnutrition can increase mortality risk for the elderly by increasing the severity of disease, decreasing functional status, and increasing drug effects due to changed metabolism.
    • Weight reduction is not recommended for the elderly, as it is usually accompanied by reductions in muscle and bone mass.

    Screening Tools

    • DETERMINE checklist and MNA are malnutrition screening tools used to identify individuals at risk of malnutrition.
    • IADL and ADL can be used to assess functional status.

    Health Risks of the Elderly Population

    • Unintended weight loss in older adults increases their fall risk, decreases their ability to do daily tasks, and decreases their level of independence, ultimately increasing their risk of mortality.

    Malnutrition Risks Amongst the Elderly

    • Protein-Energy malnutrition (PEM) affects 5-12% of elderly individuals in the community, 30-61% of hospitalized patients, and 40-85% in long-term care facilities.
    • PEM can increase the severity of disease, reduce immune response, impair wound healing, decrease functional status, and increase drug effects due to changed metabolism.

    Nutritional Risks of the Elderly Population

    • Older adults are at increased risk of inadequate diet/malnutrition due to various factors.
    • The aging process is associated with significant changes in body weight and body composition, including progressive loss of skeletal muscle mass and body fat increase and redistribution.

    Health Risks of the Elderly Population

    • Body weight and BMI gradually increase during adult life and usually reach their peaks at 50s, but tend to decrease after the age of 60.
    • In the elderly, elevated BMI may demonstrate lower all-cause and cardiovascular mortality compared to those with normal weight, known as the "obesity paradox".
    • Thinness carries a greater risk of mortality than overweight.

    Assessing Functional Status

    • Katz Activities of Daily Living (ADL) Scale is used to assess functional status, comprising components such as bathing, dressing, toileting, transfer, grooming, and feeding.
    • The scale is rated by level of assistance required, with a scoring system of 6 (high, independent) to 0 (low, very dependent).

    Malnutrition and Mortality

    • Malnutrition can increase mortality risk for the elderly by increasing the severity of disease, decreasing functional status, and increasing drug effects due to changed metabolism.
    • Weight reduction is not recommended for the elderly, as it is usually accompanied by reductions in muscle and bone mass.

    Screening Tools

    • DETERMINE checklist and MNA are malnutrition screening tools used to identify individuals at risk of malnutrition.
    • IADL and ADL can be used to assess functional status.

    Nutritional Concerns Amongst the Elderly Population

    • Narrowed/limited food intake due to food avoidance based on food beliefs
    • Age-associated changes in metabolism affect vitamin D levels, with:
      • Limited exposure to sunlight due to institutionalization or being homebound
      • Lower efficiency in epidermis receptor for UVA/UVB absorption from sunlight
      • Lower conversion to active vitamin D
      • Drug interactions (e.g. barbiturates, cholestyramine, laxatives)
    • Age-associated changes in metabolism also affect vitamin B12 levels, with:
      • ~40% of older adults having low serum B12 levels
      • Vitamin B12 being less absorbed with increasing age due to less intrinsic factor being produced in the stomach
      • Atrophic gastritis or H pylori infections reducing levels of HCL and pepsin
    • Age-associated changes in metabolism also affect vitamin A levels, with:
      • Plasma levels and liver vitamin A stores increasing with age
      • Possible link to lower clearance from the blood and excretion from the body
      • Older adults being more vulnerable to toxicity and possible liver damage
    • Nutrient-drug interactions are a concern, with:
      • Average patient taking 3-7 medications at one time
      • Medications altering food intake, absorption, metabolism, and excretion of nutrients
      • GI disturbances (e.g. nausea, constipation, diarrhea) occurring in 10% of cases

    Nutrient Requirements for the Elderly

    • Energy requirements:
      • Elderly people require less energy due to reduced basal metabolic rate (BMR) and loss of fat-free mass
      • Recommended energy intake is 1.41.8 x BMR to maintain body weight at different levels of physical activity
    • Protein requirements:
      • Protein is necessary for repair and renewal of muscles and metabolic processes
      • Protein needs for older adults are 1-1.25g/kg body weight (higher than the DRI of 0.8g)
      • Older persons are vulnerable to protein-energy malnutrition (PEM) associated with progressive decline in body protein
    • Protein sources and quality:
      • Adequate protein intake can be achieved by including good quality proteins (e.g. milk, eggs, meat, fish, chicken, pulses, nuts)
      • Intake of fish 1-2x per week is specifically recommended to prevent cognitive decline
    • Fat requirements:
      • Fat is a concentrated source of energy and aids absorption of fat-soluble vitamins
      • Fat and oil make food more palatable
      • No need to restrict fat intake beyond 30% EI for sedentary and 35% EI for active older persons (except in cases of overweight or obesity)
      • Saturated fats should be limited

    Nutrient Requirements for the Elderly

    • Protein needs for older adults: 1.25g/kg body weight, higher than the DRI of 0.8g
    • Protein is essential for repair and renewal of muscles, and required for metabolic processes such as enzymes and hormones synthesis
    • Older adults are vulnerable to Protein-Energy Malnutrition (PEM) associated with progressive decline in body protein, manifested by declining fat-free mass, loss of skeletal muscle, and reduced muscle strength
    • Nitrogen balance is easier to achieve when consuming high-quality protein, adequate calories, and participating in resistance training

    Protein Sources and Protein Quality

    • Inclusion of good quality protein sources such as milk, milk products, eggs, meat, fish, chicken, pulses, and nuts can achieve adequate protein intake
    • Fish intake of 1-2 times per week is recommended to prevent cognitive decline

    Fat

    • Fat is a concentrated source of energy and aids in the absorption of fat-soluble vitamins
    • There is no need to restrict fat intake beyond 30% EI for sedentary and 35% EI for active older persons, except in cases of overweight or obesity
    • Saturated fats should be limited

    Nutritional Concerns amongst the Elderly Population

    • Narrowed/limited food intake and food avoidance due to food beliefs are common concerns
    • Age-associated changes in metabolism, such as limited exposure to sunlight, lower efficiency in epidermis receptor for UVA/UVB absorption, and lower conversion to active Vitamin D, contribute to nutritional concerns

    Age-Associated Changes in Metabolism

    • Vitamin D: Limited exposure to sunlight, lower efficiency in epidermis receptor for UVA/UVB absorption, and lower conversion to active Vitamin D
    • Vitamin B12: ~40% of older adults have low serum B12 levels, and Vit B12 is less absorbed with increasing age due to less intrinsic factor being produced in the stomach
    • Vitamin A: Plasma levels and liver Vit A stores increase with age, which may be linked to lower clearance from the blood and excretion from the body, making older adults more vulnerable to toxicity and possible liver damage

    Nutrient-Drug Interactions

    • Average patient takes 3 to 7 medications at one time, which can alter food intake, absorption, metabolism, and excretion of nutrients, causing GI disturbances such as nausea, constipation, and diarrhea

    Energy

    • Elderly people require lesser energy due to a reduced basal metabolic rate (BMR) due to loss of fat-free mass, resulting in lower resting energy expenditure
    • Recommended energy intake for the elderly is 1.41.8 x BMR to maintain body weight at different levels of physical activity

    Dietary Intake of Malaysian Elderly

    • Low intake of vitamins such as Vit E, Vit D, and Vitamin Bs, and inadequate intake of minerals such as calcium, magnesium, and zinc
    • High risk of deficiencies, particularly among Kelantanese women, who have a mean calcium intake of ~500mg/d, which is below the recommended intake of 800-1000mg/day

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    Description

    This quiz covers the factors contributing to increased life expectancy and aging population, including declining fertility rates, decreased mortality rates, and improved healthcare systems. It also touches on socioeconomic characteristics of the aging population and risk factors for older adults.

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