Transcript Vitamins
Nutrition For Older Adults Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist Increase In Aging Population U.S. population growing older Ratio of older people to young is increasing Age Categories 55 to 64: Approaching Old Age 65 to 74: Young Old 75 to 84: Old 85 and older: Oldest Old Increase In Aging Population 65 used to define transition between middle age and old age Number over 65 doubled since 1950 Fastest growing age group is over 85 years of age group Importance of Nutrition In Aging Aging is an inevitable and natural process Good nutrition and physical activity can improve the quality of life Healthy habits may lower disease risk Nutrient Needs For Older Adults Dietary Reference Intakes (DRI’s) provide dietary recommendations for people over 50 by two age groups 51 to 70 years 71 years and above Nutrient Needs For Older Adults Basic guidelines the same for older adults The USDA Daily Food Plan is the best tool to get the variety and amount of nutrients needed Older adults do need to pay special attention to the quality of foods eaten USDA Daily Food Plan The amount of food recommended from each USDA Daily Food Plan food group is based on calories Calorie recommendations for adults 56 years of age and older vary widely from 1,600 to 2,600 calories per day depending on gender, age and activity level Personalized nutritional recommendations based on gender, age and activity can be found at www.choosemyplate.gov USDA Daily Food Plan For a typical 2,000 calorie diet the USDA Daily Food Plan recommends: 2 cups of fruit 2 ½ cups of vegetables 6, 1-ounce equivalents of grains 5 ½ ounces of protein foods 3 cups of dairy 6 teaspoons of oil Limit calories from solid fats and added sugars to 260 calories per day Calories Calorie needs decrease about 5% per decade after age 50 Decrease in physical activity Decrease in muscle mass Decrease in metabolism Need careful meal planning to get adequate nutrients in fewer calories Calorie Imbalance Weight gain Risk for many health problems Estimate calories: Multiply weight in pounds by activity factor (10 sedentary or for weight loss; 12-13 moderately active; 15 active) Don’t go below 1200 calories Weight loss Risk for malnutrition Protein Protein is important for older adults Maintain healthy cells Sustain immune system Prevent muscle wasting Fight infections Wound healing Enzymes Hormones Protein needs may increase due to surgery, illness or disease Protein Adults need 0.8 g/kg Some studies report older adults may need more protein 1.0 to 1.25 g/kg Because calorie needs decrease make lower fat choices Don’t omit these food groups to lower fat Fat Fat concentrated source of energy Fat has some important roles Helps form cell membranes Carries fat-soluble vitamins Provides essential fatty acids Fat Too much fat increases disease risk Limit total fat to 20-35% or less of total calories and saturated fat to 10% or less of total calories Limit fat intake by choosing lean, cooking lean, and limiting added and hidden sources of fat Carbohydrate Carbohydrate foods provide energy for body cells and central nervous system Complex carbohydrate foods also provide vitamins, minerals and fiber 50 to 60% of total calories should come from carbohydrate Carbohydrate Most carbohydrate should come from complex carbohydrate foods Simple carbohydrates or sugar rich foods should be limited Fiber Two types of fiber Soluble and insoluble fiber Both types are beneficial Constipation Diarrhea Diverticulitis Heart Disease Colon Cancer Diabetes Food is only one factor Fiber Food is the best source of fiber 21g fiber daily for females and 30g fiber daily for males based on 14g fiber per 1,000 calories The USDA Daily Food Plan recommends ½ of all grains should be whole grains to help provide adequate fiber Fiber Increase dietary fiber slowly Drink plenty of fluids Check with physician before increasing dietary fiber Some older adults may need to limit dietary fiber if they have chewing, swallowing or other medical problems Vitamins and Minerals Vitamin and mineral needs are similar to younger adults, with some differences Vitamin A Iron Vitamin D Vitamin B12 Calcium Vitamin A Vitamin A needs decrease and vitamin A is stored more readily with age This makes over-dosing with vitamin A supplements more common among older adults Beta-carotene, vitamin A precursor, not a problem for over-dosing Vitamin A DRI for adults 51 years and older is 900 micrograms for males and 700 micrograms for females The Tolerable Upper Intake Level (UL) for Vitamin A is 3,000 micrograms/day Leading food sources are carrots, ready-to-eat cereal, and milk Iron Iron needs for women decrease after menopause Like vitamin A, iron is stored more readily in older adults Excess iron can increase oxidative stress Iron DRI for adults 51 years and older is 8 milligrams per day UL for iron is 45 milligrams per day Leading food sources of iron are ready-to-eat cereals, yeast bread and beef Vitamin D Vitamin D needed to absorb calcium Vitamin D needs increase with age Ability of the body to synthesize vitamin D precursor in skin decreases with age Older adults also tend to have less sunlight exposure Vitamin D DRI for vitamin D is 600 IU for people aged 51 to 70 DRI for vitamin D is 800 IU for people 71 years of age and older UL for vitamin D is 4,000 IU. Vitamin D Leading food sources of vitamin D are fortified cereals, milk, eggs, liver, salmon, tuna, catfish and herring Vitamin B12 15% of older adults are deficient in vitamin B12 People with atrophic gastritis are particularly vulnerable to vitamin B12 deficiency B12 deficiency can result in irreversible nerve damage Vitamin B12 Older adults lose to ability to absorb the naturally occurring form of B12 in food To absorb naturally occurring B12 from food must split it from a protein carrier Older adults may absorb vitamin B12 better in synthetic form, which is not bound to a protein carrier Vitamin B12 Synthetic vitamin B12 is found in fortified foods such as cereals Protein-bound B12 is found in all animal products Vitamin B12 DRI for vitamin B12 for adults 51 years of age is 2.4 micrograms per day Leading food sources of vitamin B12 are beef, milk, fish and shellfish Calcium Calcium requirements increase with age Many older adults do not consume enough calcium An adequate calcium intake is one way to help protect against osteoporosis Calcium DRI for calcium for men 51 to 70 years of age is 1,000 milligrams per day. 71 years of age and older is 1,200 milligrams per day DRI for calcium for women 51 years of age and older is 1,200 milligrams per day. The UL for calcium is for adults 51 years of age and older is 2,000 milligrams per day Calcium Leading food sources of calcium are milk, yogurt, cheese and other dairy products, dark green leafy vegetables, such as broccoli and canned salmon Vitamins and Minerals Older adults tend to have low dietary intakes of some vitamins and minerals Vitamin E Folate Magnesium Zinc Vitamin E Vitamin E plays an important role in the health of older adult due to its antioxidant functions, such as decreasing the development of cataracts and heart disease Vitamin E is also associated with increased immune function Vitamin E The DRI for vitamin E for adults age 51 years of age and older is 15 milligrams or 15 IU alpha-tocopherol equivalents (TE) The UL for vitamin E is 1,000 mg or IU Vitamin E Leading food sources of vitamin E are salad dressings/mayonnaise, margarine, and readyto-eat cereals Other good sources of vitamin E are oils, especially sunflower and safflower oils, fats, whole grains, wheat germ, leafy green vegetables, tomatoes, nuts, seeds and eggs Folate Adequate folate can decrease blood homocysteine levels, which are a risk factor for heart disease DRI for folate for people 51 years of age and older is 400 micrograms per day The UL for folate is 1,000 micrograms from supplements and fortified foods Folate Leading food sources of folate are ready-to- eat cereals, yeast bread, orange juice and grapefruit juice Magnesium Magnesium is needed for bone and tooth formation, nerve activity, and metabolism of carbohydrates, protein and fat DRI for magnesium for adults 51 years of age and older is 420 milligrams for males and 320 milligrams for females per day UL for magnesium is 350 milligrams from supplements and medications Magnesium Leading food sources of magnesium are milk, yeast bread, coffee, ready-to-eat cereal, beef and potatoes Zinc Zinc deficiency is related to delayed wound healing, decreased taste acuity and immune response, and increases risk of dermatitis DRI for zinc for adults 51 years of age and older is 8 milligrams for females and 11 milligrams for males per day The UL for zinc is 40 milligrams per day Zinc Leading food sources of zinc are beef, ready- to-eat cereals, milk and poultry Water Water is more critical to life than food Older adults need 6-8 cups water daily Easy guide is 1 ml water/calorie with a minimum of 1500 ml or 6 cups Water can be in many forms Caffeine containing beverages can increase water loss Water Older adults are at increased risk for dehydration Body water decreases with age Many medications increase water loss Thirst mechanism not as effective Self limit fluid intake Decreased mobility to reach fluids Dehydration Signs 0-1% Thirst 2-5% Dry Mouth, Flushed Skin, Fatigue, Headache 6% Increased Body Temperature, Breathing, Pulse Rate 8% Dizziness, Increased Weakness, Labored Breathing 10% Muscle Spasms, Swollen Tongue, Delirium 11% Poor Blood Circulation, Failing Kidney Function Vitamin/Mineral Supplements Older adults can get the nutrients they need by eating a wide variety of foods following the USDA Daily Food Plan Variety is the key Vitamin/Mineral Supplements While it is possible to get all the nutrients needed from food, many older adults do not do so Many factors can interfere with consuming a well-balanced diet Some older adults may benefit from a multivitamin/multi-mineral supplement Vitamin/Mineral Supplements Don’t take isolated nutrients unless recommended by a physician Don’t take large doses Overdoses easier with supplements Supplements can’t make up for a poor diet “Supplements” not “Replacements” Medications It is important to follow recommendations regarding medications and eating Some medications need to be consumed with food, some need to be consumed on an empty stomach Medications Some medications can interact with certain foods, or can affect appetite Some foods can interact with medications Some medications can cause water loss Some medications can cause depression Factors That Affect Intake Many factors can affect food intake among older adults Physical Social Emotional Mental Status Economic Physical Changes Physical changes can affect food intake Body composition Saliva Teeth Digestion Stomach acid Fat intolerance Lactose intolerance Physical Changes Physical changes can affect food intake (cont.) Constipation Thirst Taste and smell Eyesight Strength, energy and coordination Body Composition Many adults lose muscle, bone mineral and body water with aging At the same time, many older adults gain body fat Muscle loss can cause people to lose their ability to move and maintain balance, making falls likely Body Composition A loss of muscle is not inevitable Good nutrition and regular physical activity can help maintain muscle mass and strength Body Composition Strength training can increase muscle and decrease body fat Weight bearing and resistance activities also increase muscle and bone density Since muscle contains more water than fat, building muscle also helps increase body water Saliva Production of saliva may decrease with age Saliva moistens food and makes swallowing easier Foods may be dry and more difficult to swallow Teeth Loss of teeth makes eating and chewing some foods difficult Many older adults unable to adjust to dentures or have dentures that do not fit Very hot or very cold foods may be painful for people with dental problems Teeth People with tooth loss, gum disease, or poor fitting dentures tend to eat softer foods or limit food intake which can lead to a poor diet Poor chewing can also increase the risk of choking Digestion Many older adults do not digest foods as well as when they were younger Intestinal secretions change with age Serving four to six smaller meals may be more acceptable Many older adults do not tolerance of high fat or dairy foods Digestion Atrophic gastritis affects almost 1/3 of people over 60; characterized by inflamed stomach, bacterial overgrowth, and lack of hydrochloric acid and intrinsic factor. This results in impaired digestion and absorption of vitamin B12, biotin, folate, calcium, iron and zinc Stomach Acid Production and secretion of stomach acid tends to decrease with age This causes decreased digestion and a feeling of indigestion Fat Tolerance Many older adults do not tolerate high fatty foods Fat intolerance can result in abdominal pain and diarrhea Decrease the amount of fat added to foods, choose low-fat foods and use low-fat preparation methods Lactose Tolerance Many older adults do not tolerate milk and milk products due to lactose intolerance Some can tolerate small amounts of milk, or fermented milk products such as buttermilk, yogurt and cheese Lactaid or Dairy Ease can help with digestion of milk or milk products Constipation Constipation is a common problem among older adults The intestinal wall tends to lose strength and elasticity with age which results in slower intestinal motility Many medications can also cause constipation Constipation Sufficient fiber and fluids are important to combat constipation Physical activity is also important in reducing constipation Fiber supplements may be needed as a last resort Thirst The combined effects of decreased thirst sensation, decreased body water, increased water loss, incontinence and decreased mobility put older adults at greater risk for dehydration Keep fluids close at hand to encourage increase fluid intake Taste and Smell Taste and smell tend to decline with age The number of taste buds and olfactory cells decrease with age Medicines can also interfere with taste and smell Changes in taste and smell may decrease appetite and food intake Eyesight Eyesight tends to decline with age This can make shopping, cooking, and possibly eating become more difficult Problems reading small print recipes or seeing oven temperatures may result in less meal preparation Strength, Energy and Coordination Strength and energy often decline with increasing age Food shopping, carrying heavy groceries, choosing from a wide variety of foods and preparing meals may become difficult Strength, Energy and Coordination Decreased strength and coordination can affect ability to eat Keep a reserve food supply on hand for sick days or when the weather is bad Social Changes Loneliness is a major problem for may older adults who live and eat alone Can decrease appetite and motivation to cook or eat Monotonous meals, snacking, and eating easily prepared and softer foods, which can result in a poor diet Social Changes Doesn’t necessarily relate to living alone Physical isolation may be far less important than the frequency of communication Emotional Changes Feelings or worthlessness can cause a loss of interest in food As people age they continually give up parts of their lives; jobs, home, spouse and peers. May suffer overwhelming grief with the loss of a spouse, friend or family member Emotional Changes Depression is common among older adults, which can decrease appetite and decrease motivation to cook or eat Some medications and nutritional deficiencies including B6, B12, folate, and iron can cause symptoms of depressions Mental Status Changes Dementia is a leading cause of weight loss and nutritional problems for older adults Memory loss, disorientation, impaired judgment, apathy, combative feeding behavior, and appetite disturbances are factors identified with weight loss Mental Status Changes In beginning stages impaired memory and judgment can lead to Not completing meals Forgetting to eat Eating the same meal twice Mental Status Changes In intermediate stages agitation can result in increased calorie needs Individuals seldom consume sufficient calories to meet increased needs and often begin to lose weight Individuals may require assistance with eating such as cutting food Mental Status Changes During final stages individuals may be unable to swallow and may require tube feedings Others may simply refuse to eat Nutritional supplements are very important in meeting the needs of individuals with advanced dementia Economic Changes Many older adults have limited incomes which can decrease diet quality Less money for food Housing facilities for storing and preparing food Transportation to shop Tips For A Healthy Diet Include a variety of food following the USDA Daily Food Plan food groups Avoid empty calorie foods Use fresh fruits for desserts Encourage snacks if food intake is low Encourage adequate water, fiber and physical activity to prevent constipation Tips For A Healthy Diet Include a variety of foods and spices, unless specific foods or spices aren’t tolerated Current recommendations suggest limited benefits of special diets for people over 75 years of age. Therapeutic benefits need to be weighed against affect on dietary intake Tips If Appetite Declines Eat meals at regular times Have the main meal earlier in the day Plan 5-6 smaller meals Have special event meals Ask people what are some food they enjoy Tips If Appetite Declines Keep the physical surroundings pleasant and calm Allow enough time for meals Encourage daily physical activity to increase appetite Remember medications can affect appetite Tips If Smell and Taste Decline Use herbs and spices Use a variety of flavors Use a variety of visual clues Colors Shapes Temperature Textures Tips If Chewing and Swallowing Decline Use gravies and sauces to moisten food Serve a beverage with the meal Eat slowly and chew thoroughly Be sure dentures fit properly Maintain as normal of a diet as possible Ground meats are dry and difficult to swallow, try soft high protein foods Tips If Chewing and Swallowing Decline Precut foods and use in casseroles, soups or gelatin Mash foods if it is an acceptable form Shred raw vegetables or fruits for salads, gelatins or stir-fry Watch for signs of choking Tips If Emotional & Social Factors Decrease Food Intake Serve food attractively Use a variety of flavors, colors, temperature, shapes and texture Don’t serve same foods every day Make the surroundings pleasant Invite friends or relatives over Eat Out Occasionally Tips If Emotional & Social Factors Decrease Food Intake Encourage other activities to increase feelings of self-worth and self-esteem Seek individuals participation in meal planning and preparation Start a garden and use produce in salads Watch for signs of depression Tips if Strength, Energy or Coordination Decline Special eating utensils, cups and plate guards are available Some foods take a lot of effort to eat if coordination is a problem such as peas, rice, salads, soup Some foods need something to help them stick together Tips if Strength, Energy or Coordination Decline Finger foods are ideal because they require less effort to eat Some modifications can help such as soup in a mug or spaghetti pre-mixed with sauce and melted cheese on top to help hold together Tips if Strength, Energy or Coordination Decline Provide assistance with tasks requiring hand and finger dexterity, such as opening packages of crackers or cartons of milk, and cutting meat Plan the dining room for safety, allowing space to accommodate wheelchairs, walkers, and canes Tips If Mental Status Declines Make mealtime a routine that occurs at the same time and place to avoid confusion Serve familiar foods in familiar ways Have the main meal at noon when appetite is larger and mental abilities are at their peak Tips If Mental Status Declines May help to offer fewer choices and smaller portions with snacks as needed Serving one food at a time may be less confusing Make physical surrounds pleasant and calm and avoid unnecessary distractions Tips If Mental Status Declines Set aside enough time for meals Check food temperature to prevent burns Food consistency may need to be modified to prevent choking Individual may not know what should and should not be eaten Tips If Mental Status Declines Be aware that messiness and spills may occur due to loss of coordination If disruptive behavior occurs, try discontinuing mealtime for a few minutes or have someone else try feeding Tips If Mental Status Declines Individual may spit out food not because they are being difficult, but because they are having a difficult time eating Don’t continue feeding if person is choking Consult with a physician if the individual refuses to eat or is not eating enough Tips For The Caregiver Preserve the dignity of the person being fed Allow sufficient time for feeding Position the person being feed Offer small amounts of food at a time Feeding food too rapidly can increase the risk of choking and food aspiration Tips For The Caregiver Don’t use straws that supply liquid more rapidly than it can be swallowed Infant rice cereal is an inexpensive and effective thickener for thin liquid Foods should be nutrient dense because individuals may tire quickly and consume only limited amounts of food Nutritional Support is “Mealtimes” M - Maintain a routine E - Eat well-balanced meals A - Alertness to any nutritional problems L - Light and frequent meals T - Teach the caregiver how to deal with the older adult I - Interactions between drugs and nutrients M - Minimize confusion for the older adult E - Encourage older adult to eat S - Supplement the diet when necessary