Nutrition in Older Adults PDF

Nutrition in Older Adults  Learning Objectives Outline how the process of aging alters gastrointestinal tract functioning and therefore the absorption of essential vitamins Describe how nutrition needs are affected by the physiological and biochemical changes that occur with aging Summ...

Nutrition in Older Adults  Learning Objectives Outline how the process of aging alters gastrointestinal tract functioning and therefore the absorption of essential vitamins Describe how nutrition needs are affected by the physiological and biochemical changes that occur with aging Summarize the short-term and long-term impacts of malnutrition on the physical and cognitive status in adults and the elderly Identify social, economic, and medical factors that may affect the nutrient intake in the elderly population Define sarcopenic obesity, and explain its risk factors and resulting health risks Describe nutritional interventions that help prevent malnutrition, sarcopenia, osteoporosis, and cognitive decline Evaluate medications and supplements (prescribed and OTC) to identify potential drug-nutrient interactions 2  Anorexia of Aging Decrease in appetite and/or food intake in old age Major contributing factor to under-nutrition and adverse health outcomes in the geriatric population Recognized as an independent predictor of morbidity and mortality in different clinical settings Not an unavoidable consequence of aging ◦ Advancing age often promotes its development through various mechanisms 3 4  Diminished Hunger and Altered Satiety Control Mechanism Ghrelin ↓ ◦ Chief driver of hunger released during fasting Satiety Hormones ↑ ◦ Cholecystokinin (CCK), glucagon like peptide-1 (GLP-1) and peptide YY (PYY) Leptin ↑ Insulin ↑ 5  Age-Related Gastrointestinal (GI) Changes GI tract is less likely to see effects of aging than other organ systems Changes generally seen ◦ ↓ or slowing of functions ◦ ↑ of digestive tract disorders Mouth1 ◦ Less saliva and decreased force from jaw muscles can cause difficulty in chewing or swallowing ◦ Taste perception changes Esophagus2 ◦ Strength of esophageal contractions and the tension in the upper esophageal sphincter ↓ 6 Age-Related Gastrointestinal (GI) Changes Stomach ◦ Stomach lining loses elasticity ◦ Gastric emptying can be ↑ ◦ Type of food can affect gastric emptying Small Intestine ◦ ↓ lactase levels can lead to dairy intolerance ◦ Excessive growth of certain bacteria can lead to ↓absorption of nutrients (B12, iron, calcium deficiencies) 7 Age-Related Gastrointestinal (GI) Changes Large Intestine ◦ Transit time could be prolonged and is significantly more pronounced in elderly with masticatory deficiency, reduced physical activity, and frailty syndrome ◦ Prevalence of constipation increases with age ◦ 30–40% of community-dwelling older adults and over 50% of nursing home residents experience chronic constipation Rectum ◦ Enlarges somewhat ◦ Constipation becomes more common due to ↓ in contractions when the rectum is filled with stool 8  Other Factors: Taste and Smell ↓ Smell and taste ◦ Taste and smell, plus sensors throughout the oral cavity that register temperature, and the mechanical feel of food, work together to make eating a pleasurable experience ◦ Zinc deficiency can lead to impaired taste sensitivity ◦ Dysphagia and poor mastication reducing taste sensation 9 Other Factors: Depression Loneliness and lack of companionship Functional impairment and lack of caregivers Difficulty in getting and/or preparing food Physical illnesses Endocrinal disturbances can also result in loss of appetite and depression Poor dentition and difficulty chewing Financial issues 10 Other Factors: Drugs System Drug Cardiovascular Amiodarone, furosemide, digoxin, spironolactone Neurological SSRIs, levodopa, lithium Gastrointestinal H2 antagonists, PPIs Antibiotics Metronidazole, griseofulvin Chemotherapies Any Musculoskeletal Colchicine, NSAIDs, methotrexate, penicillamine 11  Malnutrition and Cognitive Status Deficiencies of some micronutrients have been found to be significantly associated with cognitive impairment Vitamins B1, B2, B6, B12, C, and folate 12  Sarcopenia Progressive degenerative disorder affecting ≥40% of older adults over the age of 70 years Characterized by involuntary muscle loss ◦ Functional disability, weakness, and frailty in the elderly Potential contributors to sarcopenia onset ◦ Anorexia of aging ◦ Protein imbalances ◦ Oxidative stress Increased amounts of adipose tissue often accompany sarcopenia ◦ Sarcopenic obesity 13  Sarcopenia Farshidfar et al. Nutrition and Aging. 2015;3:(2)147–170 14 Changes in Body Fat With age, body fat ↑ and fat-free mass ↓ because of loss of skeletal muscle The cause of increase fat is multifactorial ◦ Reduced physical activity ◦ Reduced growth hormone secretion ◦ Diminished sex hormones ◦ Decreased resting metabolic rate The distribution of fat in older people is different from that of younger people ◦ Greater proportion of body fat is intra-hepatic and intra-abdominal ◦ Insulin resistance ◦ ↑ risk of ischemic heart disease, stroke and diabetes 15  Health Consequences of Sarcopenic Obesity Disability and institutionalization ◦ Low muscle strength and poor physical performance were associated with increased risks of hospitalization Mortality Metabolic disease ◦ Associated with insulin resistance, metabolic syndrome, dyslipidemia, inflammation (CRP) and vitamin D deficiency Comorbidities ◦ ↑ risk of falls ◦ ↑ risk of psychological health problems ◦ ↑ risk of knee osteoarthritis 16 Potential Therapies for Sarcopenic Obesity Calorie restriction ◦ Lose body fat and improve physical function Aerobic exercise ◦ Improve cardiorespiratory fitness Resistance exercise ◦ Improve muscle strength and mass; attenuate loss of muscle and bone during weight loss efforts Protein supplementation ◦ Mitigate loss of muscle mass and strength Calcium and Vitamin D supplementation ◦ Prevent potential disturbances in bone metabolism 17 Summary 18 19 Cachexia Complex metabolic process that is associated with several end-stage organ diseases Also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown 20 21