Nutrition in Older Adults

Nutrition in Older Adults

• Older adults experience changes in gastrointestinal (GI) tract function, affecting the absorption of essential vitamins.
• Physiological and biochemical changes due to aging impact nutritional needs.
• Malnutrition significantly impacts older adults' physical and cognitive status, both short- and long-term.
• Social, economic, and medical factors all influence the dietary intake of older adults.
• Sarcopenic obesity is a condition where muscles decrease while body fat increases, posing health risks.
• Interventions are crucial for preventing malnutrition, sarcopenia, osteoporosis, and cognitive decline in older adults.
• Drug-nutrient interactions from prescriptions and over-the-counter medications should be evaluated.

Anorexia of Aging

• Decreased appetite and food intake are major contributing factors to undernutrition in older adults.
• Anorexia of aging significantly predicts morbidity and mortality.
• Age-related changes in appetite and satiety signals don't automatically mean it's an unavoidable consequence of aging.

Diminished Hunger and Altered Satiety Control

• Ghrelin levels decrease during fasting, a key hunger hormone.
• Key satiety hormones (cholecystokinin, GLP-1, PYY) increase in older adults.
• Other satiety hormones (leptin and insulin) experience changes in older adults.

Age-Related Gastrointestinal (GI) Changes

• The GI tract is less affected by aging compared to other organ systems.
• Digestive tract functions, like motility, may slow with age.
• Digestive issues like disorders also increase with age.
• Reduced saliva, decreased jaw strength, and altered taste perception can lead to chewing and swallowing difficulties.
• Changes in esophageal contractions and tension in the upper esophageal sphincter occur with age.
• Stomach elasticity decreases, and gastric emptying can increase and be affected by diet type.
• Lactase levels decrease, leading to dairy intolerance.
• Microbial growth in the small intestine leads to nutrient absorption issues (like iron, calcium, and B12).
• Transit time through the large intestine prolongs. Prevalence of constipation increases with age.
• Rectal enlargement and reduced contraction intensity may also be issues.

Other Factors: Taste and Smell

• Taste and smell receptors undergo age-related decline.
• Zinc deficiency may impair taste.
• Issues like dysphagia and reduced ability to chew food impacts taste sensation.

Other Factors: Depression

• Loneliness and lack of caregivers may prevent proper nutrition.
• Difficulty getting or preparing foods can lead to inadequate nutrition.
• Medical problems like endocrine disorders can also lead to appetite loss and depression.
• Challenges with existing dentition impact oral health and the ability to chew effectively.
• Financial struggles limit access to ample, nutritious foods.

Other Factors: Drugs

• Certain medications like amiodarone, SSRIs, H2 receptor antagonists, and antibiotics can impact nutrient absorption, or cause deficiencies.
• These medications should be reviewed and possibly adjusted or substituted for the safety and health of an older adult.

Malnutrition and Cognitive Status

• Micronutrient deficiencies can have a notable effect on older adult cognitive function.
• Deficiencies in B1, B2, B6, B12, C, and folate vitamins can cause cognitive impairment.

Sarcopenia

• A progressive degenerative disorder impacting older adults, characterized by involuntary muscle loss, weakness, and frailty, affecting over 40% of those 70+
• Anorexia of aging, protein imbalances, and oxidative stress contribute to sarcopenia.
• Increased adipose tissue often accompanies sarcopenia.

Changes in Body Fat

• Body fat increases with age, while fat-free mass (muscle) decreases, partly due to decreased physical activity, reduced growth hormone, and decreased sex hormones.
• Fat distribution shifts to intra-hepatic and intra-abdominal areas in older adults, increasing health risks.
• Insulin resistance is also connected and risk factors for ischemic heart disease, stroke, and diabetes.

Health Consequences of Sarcopenic Obesity

• Sarcopenic obesity is associated with increased disability, higher hospitalization risks, and mortality.
• It's linked with metabolic issues like insulin resistance, metabolic syndrome, dyslipidemia, inflammation, and vitamin D deficiency.
• This can lead to various comorbidities (other medical problems) increasing risk of falls, psychological issues (like depression), and further issues like knee osteoarthritis.

Potential Therapies for Sarcopenic Obesity

• Calorie restriction and improving physical activity may combat excess body fat and improve physical function.
• Aerobic and resistance exercises are useful in restoring muscle mass and function.
• Protein supplementation is often needed as a way to help mitigate muscle loss.
• Calcium, vitamins (like vitamin D), help in bone health.

Summary

• Physiological factors with decreased taste/smell, impaired metabolism, dysregulation of satiety, delayed gastric emptying, decreased gastric acid, and decreased lean body mass are common in older adults.
• Pathological issues like dental problems, digestive disorders (cancer, CHF, COPD, diabetes), medications (diuretic, antihypertensive, or anti-depressants), alcoholism, and dementia can impact older adult nutrition profoundly.
• Sociologic impacts like decreased ability to shop, prepare food, financial problems, lack of companions, and difficulty with daily living tasks impacting their nutritional intake.
• Psychological factors like depression, anxiety, loneliness, emotional stress, grief, and dysphoria, play a significant role in an older adult's nutritional behaviors.

Case Study Role Play

• A 86-year-old female presented with unintentional weight loss and various health conditions such as hypertension, cardiovascular disease, diabetes, transient ischemic attack, mild dementia, impaired vision, and hearing.
• She has experienced various medical conditions, including taking multiple medications such as blood thinners, diabetes medications, cholesterol medications, and more.
• The patient's daughter is present during the clinical encounter to assist in her health assessment.
• She indicated a change in appetite.