Nutrition for Older Adults - Chapter 18

Nutrition and Older Adults

• Older adults are defined as individuals 65 years and older, based on traditional retirement age
• Age groups for Dietary Reference Intakes (DRIs): 19-30 years, 31-50 years, 51-70 years, and >70 years

Ageing

• Ageing is a natural, heterogeneous process
• Theories of ageing include:
  • Chronological age vs. functional status/physiological age
  • Causes of death have changed over time, with cardiovascular disease now a leading cause
• Behaviors that influence health and physiological age:
  • Following a healthy, plant-based eating pattern
  • Engaging in physical activity daily
  • Not smoking or using alcohol in moderation
  • Maintaining a healthy body weight
  • Sleeping regularly and adequately
  • Having a sense of purpose
  • Relieving stress
  • Belonging to a community of loving family and friends

Life Expectancy and Life Span

• Life expectancy: average number of years of life remaining for persons in a population cohort or group
• Life span: maximum number of years someone might live; human life span is projected to range from 110 to 120 years

Physiological Changes

• Normal ageing is associated with changes in most physiological systems, which may eventually lead to functional and structural deterioration
• Body composition:
  • Decline in fat-free or lean body mass of 2-3% per decade from age 30-70
  • Increase in fat (gradual) – visceral fat provides some advantages
• Muscles: regular physical activity, including strengthening and flexibility exercises, contributes to maintenance of functional status
• Weight gain:
  • BMI peaks at 50-59 years and starts decreasing at 70 years
  • Decreased resting metabolic rate
• Sensory changes:
  • Taste
  • Smell
  • Sight
  • Hearing

Psychological Changes

• Appetite and thirst: hydration issues
• Keep using the brain to maintain cognitive function

Supplements Use

• When to use supplements
• Why use supplements
• Who uses supplements
• What supplements to use
• How much to take
• Older age is associated with herbal supplement use in Saudi Arabia (all under 60 years)

Nutritional Screening and Assessment

• Screening tools are available:
  • Mini Nutritional Assessment (MNA)
  • Malnutrition Universal Screening Tool (MUST)

Psychological Changes

• Developmental tasks for the elderly, according to Havighurst:
  • Adjusting to decreased physical strength and health
  • Adjusting to retirement and decreased income
  • Adjusting to death of spouse
  • Establishing an explicit affiliation with one's age group
  • Establishing satisfactory physical living arrangements

Food Selection

• Factors affecting food selection:
  • Psychological factors:
    • Loneliness
    • Bereavement
    • Social isolation
    • Food aversion
    • Food symbolism
  • Physiological factors:
    • Age
    • Gender
    • Appetite
    • Sense of taste
    • Dental health
  • Socioeconomic factors:
    • Ethnicity
    • Income
    • Cooking facilities
    • Daily schedule
    • Retirement/leisure time
    • Education
    • Distance to store
    • Transportation
    • Food availability
    • Social interaction

Drug Use

• Common among the elderly, with 77% of those 65+ using one drug and usage increasing with age
• Polypharmacy (use of multiple medications) is common, with potential for toxicity and interactions
• Most common prescription drugs:
  • Cardiovascular medications
  • Tranquilizers and sedatives
  • Diuretics
  • Analgesics
  • Vit/min supplements
• Use of over-the-counter drugs is substantial, mainly analgesics, laxatives, and supplements
• Reasons for concern:
  • Chronic conditions require long-term medication use
  • Potential for toxicity and interactions due to multiple medications and OTC medications