Nutrition and Aging in the Elderly

Intended Learning Outcomes

• Understand the physical and physiological changes in the elderly.
• Understand different nutrition and diet-related problems among the elderly.
• Formulate recommendations to address these problems.

Aging

• Complex process involving progressive changes across molecular, cellular, physiological, and psychosocial levels.
• Spanning from conception to death.

Elderly

• Individuals over 65 years old.
• Individuals over 75 years old are considered old persons.

Nutrition of the Elderly

• Geriatrics: Branch of medicine focused on prolonging life and delaying the degenerative aspects of aging, treating diseases.
• Gerontology: Broader field encompassing physiological, psychological, economic, and medical aspects of aging.
• Senescence: The process of physical and behavioral changes during aging.

Physiological Changes (Oral and Gastrointestinal Tract)

• Oral Health: Loss of teeth and periodontal disease lead to difficulty chewing, restricted food intake, decreased taste (hypogeusia) and smell (hyposmia).
• Gastrointestinal Tract: Decreased gastrointestinal secretions (less saliva, HCI, and intrinsic factor), affecting nutrient absorption. Decreased enzyme activity leads to digestive issues and inadequate nutrient absorption.
• Reduced gastric motility and peristalsis can cause abdominal distension and constipation.
• Loss of thirst sensation may lead to dehydration.

Physiological Changes (Renal)

• Reduced nephron function (lower glomerular filtration rate) impacts waste excretion.
• Lowered ability to activate vitamin D.
• Impaired bladder and urethral sphincter function may cause incontinence.

Physiological Changes (Cardiovascular)

• Decreased cardiac output and heart rate.
• Increased risk of atherosclerosis (thickening and decreased elasticity of blood vessels).

Physiological Changes (Respiratory)

• Reduced lung efficiency and vital capacity due to declining alveolar function.
• Short, shallow breathing patterns.

Physiological Changes (Neurological)

• Reduced brain cell count.
• Slowed reaction time, tremors, memory loss, and reduced cognitive abilities.
• Impaired nerve function impacting sensory and cognitive skills.
• Altered sleep-wake cycles.

Physiological Changes (Skeletal)

• Reduced bone density leads to increased osteoporosis risk.

Physiological Changes (Immune)

• Increased susceptibility to infections.

Body Composition and Energy Expenditure

• Reduced muscle mass and strength leading to decreased physical activity and range of motion.
• Increased fat mass.
• Reduced resting energy expenditure.

Nutritional Requirements

• Energy: Decreased basal metabolic rate (BMR) in the elderly, often 20-25% lower in those 60-69 years old versus those younger than 50.
• Protein: Allowance of 1.07 g/kg/day to maintain proper cellular function.
• Vitamins: Often require reduced amounts of certain B Vitamins (B1, B2, B3), but increased amounts of others (Vitamin D).
• Minerals: Increased calcium intake to support bone health (precautions against osteoporosis) or adjusted for iron needs.
• Water: Increased fluid intake is important.
• Fiber: Essential to maintain digestive health and prevent constipation.

Nutrition-Related Disorders/Diseases

• Anemia: Deficiency of red blood cells and/or hemoglobin resulting from poor intake, absorption or loss of blood.
• Megaloblastic anemia: caused by deficiencies of B vitamins.
• pernicious anemia: a form of vitamin B12 deficiency.
• Cardiovascular disease (CVDs): Hypertension (high blood pressure) and elevated homocysteine levels are common.
• Osteoporosis: Loss of bone mass and decreased bone density.