Elderly I_2021.pdf

NDT 2234 Lifespan Nutrition Nutrition in the elderly I Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating w...

NDT 2234 Lifespan Nutrition Nutrition in the elderly I Dr Megan Chong Hueh Zan Division of Nutrition and Dietetics International Medical University Miss K visited her uncle recently. Her uncle is a 65 years old retired teacher living with his wife. Her uncle told K he hasn’t been eating well but his weight remains stable over the years. He is not as strong as before. He used to go hiking every Sunday but lately he cant as he experienced some pains in the knees. K wonders if it’s normal for older people to have appetite loss and knee pains. What do you think? Learning outcomes At the end of lecture, students would be able to : Define the elderly population Discuss the changes in life expectancy and aging trend Discuss the socioeconomic characteristics of the aging population Discuss the physiological changes associated with aging Elderly World Assembly on Aging in Vienna (1982) was also adopted in the National Policy for the Older Persons (1995) (2011)- elderly is defined as individuals aged 60 years old and above. Changes in life expectancy and aging trend Elderly population in Malaysia has been steadily rising from 5.70% (1990) to 8.35% (2013) and further increased to 9.80% (2016) (Department of Statistics Malaysia, 2016a). By the year of 2040, it is expected to be 16.3% of total population (Department of Statistics Malaysia, 2016a). Changes in life expectancy and aging trend The average life expectancy for male and female is 72.6 and 77.2 years, respectively (Department of Statistics Malaysia, 2016b). Changes in life expectancy and aging trend Increased life expectancy and ageing population resulted from declined in fertility decreased mortality rates improvement in health care system (Ambigga et al., 2011) Changes in life expectancy and aging trend http://populationpyramid.net/malaysia/2060/ Socioeconomic characteristics of the aging population Risk factors for older adults are: Diet-related acute or chronic Hunger, poverty diseases Lack of education Depression, dementia, dependency Social isolation or living alone Poor dentition & oral health Functional disability Polypharmacy (Ambigga et al., 2011) Physiological Changes associated with Aging Aging is not a disease Occurs gradually, at different rates among individuals; within individuals Does not generally cause symptoms Cellular aging theory Continuous use and reduction in division and maturation of new cells causes aging and ultimately death (apoptosis preprogrammed cell death) Free radicals and oxidative stress cause DNA damage  reduces viable cell number Physiological Changes associated with Aging Characteristics of Mammalian Aging cellular and physiologic deterioration increased mortality with age increased vulnerability to disease decreased ability to adapt to stress impaired homeostasis Physiological Changes associated with Aging At age 75, the average person, compared to age 30: 92% of brain weight 84% of basal metabolism 70% kidney filtration rate 43% of maximum breathing capacity Changes in body mass and composition Aging causes various changes in body composition, which have important consequences on health and physical functions. There is a progressive decrease in lean body mass. 30% loss in muscle mass 3rd to 8th decade  sarcopenia. Changes in body mass and composition Sarcopenia Sarcopenia is characterized by decrease in muscle mass and strength, starting as early as the third/fourth decade of life in humans. Distinct muscle changes:  decrease muscle fiber size and number in type 2 muscle fibers  decrease in myosin heavy chains IIa synthesis and IIx mRNA levels  decrease in whole body protein turnover Karakelides H and Nair KS (2005). Changes in body mass and composition Sarcopenia Lead to consequent loss in strength, function  Poorer mobility, functionality, quality of life  morbidity, increase health care costs Metabolic effects of sarcopenia include a decrease in resting energy expenditure (REE) secondary to decreased fat-free mass With decreased physical activity  higher prevalence of insulin resistance, type 2 diabetes mellitus, dyslipidemia, and hypertension (Karakelides and Nair, 2005) Changes in body mass and composition Sarcopenia Accelerates with decreased activity Exercise does not reverse all age-related changes but weight bearing activity can slow the pace Exercise shown to increase strength, aerobic capacity, and muscle protein synthesis, muscle mitochondrial enzyme activity (Karakelides and Nair, 2005) Changes in body mass and composition Aging causes progressive increase in body fat, changes in fat distribution Fat mass and visceral fat increase Lack of estrogen promotes fat accumulation Decreased physical activity lead to decreased energy intake with aging associated with changes in physiological functions that affect metabolism, nutrient intake, physical activity, and risk for chronic diseases How sarcopenia increases risk of obesity & poor metabolic health? Sarcopenic obesity: Loss of LBM in older person with excess adipose tissue Physical activity moderates weight gain & decreases body fat NEAT: Nonstructured free living physical activity (physical activity not associated with exercise training) REE: Resting energy expenditure TEE: Total energy expenditure (Source: Hunter et al, 2019) Changes in body mass and composition Aging causes alteration in bone density that results from a decrease in mineral content. Osteopenia and osteoporosis-decreased activity, dietary calcium, estrogen withdrawal. 80% women >65 yo are osteopenic Osteopenia --> Osteoporosis: Severe osteoporosis can cause Gradual loss of bone that reduces skeletal mass bones in legs to bow under the weight of the body. This bowing, For many, it is asymptomatic together with changes of the spine, Bones most critically involved: vertebra, wrist, hip makes measurement of height unreliable increased risk of fractures 19 Physiological Changes associated with Aging Age related losses of sense of taste, smell and touch Dysgeusia- loss of taste Hyposmia - decreased sense of smell Changes in taste perception (by age 70s yo number of taste buds falls by 65% and sensitivity to salty and bitter tastes decrease) Disease & medications affect taste and smell more than Changes in sense of smell can reduce pleasure of eating aging  May influence appetite, food choices, food intake and nutritional status Physiological Changes associated with Aging Impaired dentition Poorer eyesight and arthritis may make food preparation difficult Increased risk of chronic disease, cognitive impairment and dementia  May influence appetite, food choices, food intake and nutritional status Physiological Changes associated with Aging  difficulty in swallowing  indigestion, reduced nutrient bioavailability Physiological Changes associated with Aging  poor appetite, food choices, decrease food intake 1. What are the risk factors that put older adults at higher risk for malnutrition and health morbidities? 2. Which theory is used to explain the ageing process? 3. How sarcopenia effect muscle mass? 4. How sarcopenia effect health risks? 1. What are the risk factors that put older adults at higher risk for malnutrition and health morbidities? Poverty, social isolation, functional disability, depression, dementia, poor dentition, polypharmacy 2. Which theory is used to explain the ageing process? Cellular aging theory 3. How sarcopenia effect muscle mass? decrease muscle fiber size and number in type 2 muscle fibers decrease in myosin heavy chains IIa synthesis and IIx mRNA levels decrease in whole body protein turnover 4. How sarcopenia effect health risk? Sarcopenia decrease in resting energy expenditure (REE) secondary to decreased fat-free mass  weight gain With decreased physical activity  higher prevalence of insulin resistance, type 2 diabetes mellitus, dyslipidemia, and hypertension Summary Elderly are at higher risk for malnutrition and health morbidities Cellular aging theory hypothesize that continuous use, reduction in division and maturation of new cells causes aging and death Aging causes progressive decreases in muscle mass, increase in body fat, changes in fat distribution and decrease mineral content in the bones. Sarcopenia can affect mobility and functionality, increases morbidity and health risk eg DM, dyslipidemia, and hypertension Age related losses of sense of taste, smell and touch may affect appetite, food intake and nutritional status References Ambigga (2011). Bridging the Gap in Ageing: Translating Policies into Practice in Malaysian Primary Care. Asia Pacific Family Medicine 10 (2): 1–7. WHO (2013). In: World population ageing 1950-2050. From http://www. wpro.who.int/topics/ageing/ageing_fs_malaysia.pdf. [Retrieved 18 July 2017]. Krause’s Food & Nutrition Therapy. Saunders Elsevier (2008) Nutrition Through the Life Cycle. Peter Marshall (2008) Karakelides H and Nair KS (2005). Sarcopenia of Aging and Its Metabolic Impact. Current Topics in Developmental Biology 68:123-48. Hunter GR et all (2019). Sarcopenia and Its Implications for Metabolic Health. Journal of Obesity. Amarya S et al (2015). Changes during aging and their association with malnutrition. Journal of Clinical Gerontology & Geriatrics 6:78-84 THANK YOU