Chapter 17

    “Old” / ”senior” > 65 yrs old Two motivating goals ◦ ◦ Promote health Slow aging The ratio of old people to young is increasing ◦ ◦ Growing “old” happens day by day projected to go from 1/8 to 1/5 between 2000 and 2030 ◦ Fastest-growing age group is >85 yrs old ◦ 77-81 for women, 70-76 for men Factors influencing life expectancy

 Good nutrition and regular physical activity can ◦ Increase life expectancy. There are many healthy habits that can increase life span.

◦ ◦ Support good health, prevent or prolong the onset of disease Improve the quality of life.  A person’s physiological age and chronological age may be different

  Diversity of older adults’ lives and nutritional histories ◦ ◦ ◦ ◦ Nutritional influence on aging process How much aging is inevitable? Process can be slowed by adopting healthy lifestyles- nutritious diet and exercise 70-80% of life expectancy depends on health related behaviors 20-30% of life expectancy depends on genetics

 ◦ ◦ Healthy habits for longer life, less disability Physiological age vs. chronological age Lifestyle behaviors   Eating well-balanced meals Engaging in physical activity     Not smoking Abstinence or moderate use of alcohol Maintaining a healthy body weight Sleeping regularly and adequately

 ◦ ◦ ◦ ◦ ◦ Physical activity Benefits of physical activity in older adults Additional benefits Best types of exercise    Aerobic activities Moderate endurance activities Strength training  Resistance training Most powerful predictor of mobility in later years Physical limitations from inactivity not increasing age

      More lean body mass Greater flexibility, better balance Increased endurance and a longer life span Prevent or delay the decrease in muscle mass and strength that occur with age Quicker recovery from injury or surgery Active people benefit from higher energy and nutrient intakes (They can eat more without gaining unnecessary weight.)

 ◦ ◦ ◦ Energy restriction in animals-70% of normal Animals live longer & have fewer age-related diseases  Slows aging process Food intake   Prevent malnutrition 70% of normal energy intake  Increases antioxidant activity & DNA repair Age of starting energy restriction

 ◦ ◦ ◦ ◦ Energy restriction in human beings How to define energy restriction 30 yrs of energy restriction needed to increase life expectancy by 3 yrs Moderate restriction   10 to 20 percent reduction in energy intake Less food, less oxidative damage from food choices  Benefits in body weight and fat, blood pressure, lipids, insulin response Versus nutritional adequacy that is essential to a long and healthy life

 Stress ◦ ◦ ◦ Stress response burns up nutrients and oxidizes/ages Psychological and physical stressors Bodily response  Nervous and hormonal systems ◦  Prolonged or severe stress effects Men Fight-or-flight response (more stressful)  Women Tend-and-befriend response (less stressful)

 ◦ Physiological changes Body weight  2/3 of older adults in U.S. are overweight or obese  Being moderately overweight may not be harmful    For adults >65 yrs BMI up to 27 is OK  Remember normal is 18.5-26  Insist on measuring height before figuring BMI  Annually updated height is required in LTC Obesity complications Risks associated with low body weight

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Physiological changes

 Body composition changes: lose bone and muscle, gain fat Sarcopenia – loss of muscle strength/quality    Predisposes to falls Risk factors- smoking, inactivity, weight loss, obesity Optimal nutrition, sufficient protein, and regular physical activity

 ◦ Physiological changes Immunity and inflammation    Immune system loses function “Inflammaging” Associated with Alzheimers, arthritis, atherosclerosis    Inflammation – critical in destroying bacteria/viruses and repairing tissue Compromised by nutrient deficiencies, antbx Regular physical activity improves immune system responses

 ◦ Physiological changes GI tract      Intestinal walls lose strength and elasticity Slowing of motility Diminished appetite Atrophic gastritis- (inflamed stomach) affects 1/3 older adults, bacterial overgrowth in stomach, low HCl + intrinsic factor, impairs absorption of B 12 , biotin, folate, Ca, Zn. Antacids worsen it. Dysphagia

 ◦ ◦ ◦ Physiological changes Tooth loss   Difficult and painful chewing Limited food selections  Less dietary variety  Lower intakes of fiber and vitamins Sensory losses: vision, hearing, taste, and smell Mobility- ability to shop, stand and cook

   ◦ ◦ ◦ Psychological changes Depression  Lose appetite and motivation to cook Economic changes ◦ Living arrangements and income ◦ Low education level Social changes Hospital and nursing home malnutrition Community malnutrition- living alone and/or living in HUD

  ◦ Dietary Reference Intakes (DRI) Two age categories ◦ ◦ ◦ ◦  51 to 70 years  71 and older Challenges with setting standards Individual differences are more pronounced with age Refusal to change Different chronic diseases Different medications

 ◦ ◦ Water Decreased sensitivity to thirst and dry mouth Dehydration  Total body water decreases with age   Risks associated with dehydration  Urinary tract infections, pneumonia, pressure ulcers, confusion and disorientation.

Prevention- 6 glasses water per day

    Energy needs decrease by ~5% per decade Protein to protect muscle mass, boost the immune system, and optimize bone mass Carbohydrate for energy Fiber and water to reduce constipation

 ◦ ◦ ◦ Energy and energy nutrients Caloric needs/activity level/metabolic rate declines with age  LBM and thyroid hormones decline Micronutrient needs remain high  Modified food guide pyramid Protein   Especially important Low-calorie sources  Liquid nutritional formulas

 ◦ ◦ ◦ ◦ Energy and energy nutrients Decline 5% per decade Monthly weights/weight goals- are they gaining or losing? Set the kcal rate to wt goals/changes, not an arbitrary kcal/d Carbohydrate and fiber  Recommendations  Constipation Fat  Moderate intake  Disease risk

   Nutrient-dense vs. “quality of life” Weight gain and malnutrition common Vitamins and minerals ◦ ◦ Vitamin B food 12 - bacterial overgrowth uses it up. Supplement more bioavailable than Calcium + Vitamin D- milk avoidance ◦ ◦ ◦ Folate- eating less fruits/vegetables Iron- GI bleed, antacid use Zinc- depletion by meds

 ◦ ◦ ◦ Nutrient supplements More than half of older adults use supplements Supplements do not contain enough of certain nutrients   Calcium Vitamin C  Magnesium Food is still best source of nutrients

 ◦ ◦ ◦ Vision Cataracts   Age-related clouding of the eyes’ lenses Lead to blindness if not surgically removed  Risk factors- oxidative stress/UV, obesity  Antioxidants C, E, carotenoids protective Macular degeneration- leading cause of vision loss Omega-3 DHA, lutein and zeaxanthin

Food sources of lutein and zeaxanthin

 ◦ ◦ Arthritis Osteoarthritis   Deterioration of cartilage in the joints Tends to afflict weight-bearing joints  Known connection with being overweight  Benefits of aerobic activity and strength training Gout    Deposits of uric acid crystals in joints Purines in meat, seafood start it. Alcohol makes it worse Milk products lower uric acid level in blood and risk of gout.

 ◦ ◦ Arthritis Rheumatoid arthritis- bone coverings under attack  Autoimmune disorder   Omega-3 fatty acids Heart-healthy diet  Antioxidant vitamins C, E, carotenoids Treatment   Dietary and traditional medical intervention Popular supplements glucosamine, chondroitin

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The Aging Brain

Responds to genetic and environmental factors Characteristic changes with age  Loss of neurons  Decreased blood supply Nutrient deficiencies Ex: serotonin made from tryptophan   Loss of memory and cognition Senile dementia

  The aging brain ◦ Alzheimer’s disease- abnormal deterioration of the brain  Prevalence in U.S. 10% adults > 70 yrs   Symptoms- memory and reasoning loss Possible causes- free radicals and beta-amyloid.

   Senile plaques and neurofibrillary tangles Acetycholine breakdown may affect memory.

Cardiovascular disease risk factors  Treatment drugs are useful, but are not a cure.

Maintaining body weight is important; Alzheimer’s patients forget to consume foods.

    Older people are an incredibly diverse group ◦ ◦ Quality of life has improved Chronic disabilities have declined Use strategies for growing old healthfully Spend more money on foods to eat at home and less money on foods away from home Influential factors in food choices

 Nutrition Screening Initiative ◦ Identify and treat nutrition problems in older persons   Older Americans Nutrition Program, formerly called Elderly Nutrition Program DETERMINE (next slide)  www.aafp.org/afp/980301ap/edits.html

  Older Americans Act Nutrition Program ◦ ◦ ◦ ◦ Congregate meals at group settings Meals on Wheels Eligibility Senior Farmers Market Nutrition Program Supplemental Nutrition Assistance Program

Buy only what you will use.

   Challenges for older adults living alone ◦ ◦ Purchasing, storing, and preparing food Small kitchens and cupboards Foodborne illness ◦ ◦ ◦ ◦ Risk is greater for older adults- less HCl, weaker immune systems Letting the meals-on-wheels lunch sit around to be picked at until bedtime Spend wisely Wise shoppers Be creative

Nutrient-Drug Interactions

   Use of over-the-counter and prescription drugs ◦ ◦ Average 13 prescriptions per year Vitamin and mineral supplements Numerous doctors Physiological changes that may impact drug usefulness

   ◦ Drug Any substance that modifies one or more of the body’s functions Consequences ◦ ◦ Desirable Undesirable- Are the side-effects worth it? Example of aspirin: 1) thins the blood, doubles bleeding time, 2) dulls pain- not always ideal

   Interactions can: ◦ ◦ Lead to nutrient imbalances Interfere with drug effectiveness Factors that increase risk for adverse nutrient-drug interactions ◦ Look them up one by one Methods of nutrient and medication interactions

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Drugs alter food intake

Eating may be difficult or unpleasant May stimulate appetite and cause weight gain May suppress appetite and promote weight loss

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Drugs alter nutrient absorption

Most likely occurs with medications that damage the intestinal mucosa May bind with nutrients in GI tract, preventing nutrient absorption May reduce stomach acidity May interfere with intestinal metabolism or transport of nutrients into mucosal cells

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Diets alter drug absorption

Most drugs are absorbed in upper small intestine Influences on drug absorption  Stomach acidity and emptying rate     Direct interactions with dietary components Drug formulation Binding with nutrients and nonnutrients Compete for absorption sites

Folate Methotrexate

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Drugs alter nutrient metabolism

◦ Some drugs may enhance or inhibit activities of enzymes needed for nutrient metabolism (folate and methotrexate) ◦ Compete for transport proteins

Diet alters drug metabolism

Some foods affect the activities of enzymes that metabolize drugs May counteract the drugs’ effects Some food and drug interactions can cause toxicity and exacerbate side effects

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Drugs alter nutrient excretion

Interfere with nutrient reabsorption in kidneys ◦ ◦  Mineral depletion

Diets alter drug excretion

May lead to toxicity Urine acidity

  ◦ Sugar, sorbitol, and lactose ◦ ◦ ◦ Diabetics and sugar Sorbitol and diarrhea Lactose intolerance Sodium Hypertension