Ageing Flashcards
Ageing
Ageing is a normal biological process which involves some
physiological changes and decline. These include:
* Lowered hormone levels, e.g. sex hormones, growth hormone.
* Immunity : dysregulation of innate and adaptive immune
* Loss of skin integrity due to ↓production of lipids, ↓desquamation.
* Decreased bone density and muscle mass.
* Heart valves and arteries stiffen (= less flexible).
* Decrease in renal function (GFR declines).
* Reduced chest wall compliance and alveolar recoil.
* Neurological function declines (with neuron atrophy).
Ageing: Normal vs disease
It is important to distinguish between the normal changes of ageing versus changes due to disease.
* E.g. atherosclerosis is becoming more common in teenagers.
* Ageing is normal, accelerated ageing is not.
* Ageing can be accelerated by:
- Lifestyle, poor diet and ↓physical exercise.
- Stress and not having a goal in life.
- The socioeconomics status.
- Diseases and medications.
* Genes contribute about 30% and lifestyle factors 70% to ageing.
* Biological age can differ from one’s chronological age.
Ageing: Telomeres
- Telomeres = the specific DNA protein structures found at both ends of each chromosome. As a normal cellular process, a small portion of telomeric DNA is lost with each cell division.
- When telomere length reaches a critical limit, the cell undergoes senescence and / or apoptosis . Telomere length can, therefore, serve as a biological clock to determine the lifespan of a cell and an organism.
- Certain lifestyle factors such as smoking and poor diet can increase the pace of telomere shortening.
- Studies show that shorter telomeres are a risk factor for cancer.
Energetics of Ageing
Mature years are dominated by dryness
* I.e. wrinkles, joint stiffness, decreasing physical strength.
* Increase: soups, stews and smoothies, sweet and high water content fruit and veg, root vegetables, nut milks, ‘mucilaginous’ okra, chia and linseeds, liquorice, most herbal teas. Old age is dominated by coldness
* I.e. digestive power weakens, circulation reduces, we feel colder, declining mobility, exhaustion and withdrawal.
* Increase: warm, cooked and mildly spiced food and drinks that increase body temperature, digestive power and circulation
Ageing: Sarcopenia
Body composition changes with age as follows:
* Fat mass and visceral fat increases.
* Lean muscle mass decreases.
Sarcopenia
* The age related loss of muscle mass, strength and function which can significantly impact an older adult’s quality of life by decreasing mobility,
increasing the risk of falls and fractures, lowering metabolic rates and increasing the risk of death.
* Accelerates with decreased physical activity. Weight bearing exercises slow its pace (whilst also supporting bone mineral density).
Contributing factors to sarcopenia
- Sedentary lifestyle, lack of exercise, prolonged bed rest : muscle disuse causes a large decline in muscle size and strength.
- Body composition changes with age.
- Poor nutritional status (reduced protein and energy intake).
- Hormonal changes (low testosterone, oestrogen, growth hormone, as well as insulin resistance have anabolic effects on muscle).
- Inflammation (↑interleukin 6 and CRP).
- Chronic diseases (e.g. cancer, heart failure)
Ageing: Energy Requirements
In the elderly there are two factors that can affect energy balance:
1. Age related loss of lean muscle mass affects body composition
and basic metabolic rate is lowered as physical activity declines.
2. Increase in fat mass increases the risk of cardiovascular disease, diabetes and obesity, which influences energy balance.
* Co-morbidities and infection may increase energy requirements, immobility may reduce them.
Ageing: Malnutrition
- Reduced intake of food: changes in taste and smell (sometimes due to medications, cigarette smoking or Alzheimer’s), alterations in gastric hormones regulating appetite and motility, depression and bereavement, as well as social isolation.
- Cachexia (side effect for cancer or COPD)
- Stroke / dementia can lead to dysphagia (difficulty eating / swallowing). Dysphagia may also lead to aspiration pneumonia (a leading cause of death amongst nursing home residents).
Ageing: Poor oral health
- A poor nutritional status (e.g. high refined sugars, low
- Dentures (problems chewing); amalgams (risk of dental
- Xerostomia: causing difficulty chewing and swallowing, whilst also impacting the oral microbiome and reducing salivary IgA. This increases the risk of oral thrush, which can reduce taste.
Ageing: Consequences of malnutrition
- Loss of muscle mass and strength.
- Loss of mucosal integrity malabsorption.
- Impaired immune function.
- Psychological impact: apathy / depression.
Factors affecting food choices in elderly:
- Physiological: decreased visual acuity, joint problems, hand tremors, hearing problems, anorexia, dementia.
- Social / psychological: reluctance to go shopping, isolation, depression, fear, bereavement.
- Economical: isolation, low income.
- Reduced appetite: could be due to increased levels of cholecystokinin with
ageing, resulting in increased satiation after meals and delayed gastric emptying.
These can make acquiring, preparing and eating food more difficult.
Ageing: Gastrointestinal
Changes occur in the GI tract with age:
* Parietal cell intrinsic factor production declines with age.
* Achlorhydria (reduced stomach acid) can lead
- Poor digestion , absorption and biliary excretion (low HCl also impairs bile flow and pancreatic
- Vitamin B12 deficiency (HCl and intrinsic factor are needed).
- SIBO and other intestinal bacterial infections.
- Iron deficiency (due to impaired absorption).
* Gastric motility and gastric emptying can also be impaired.
* To support these clients: avoid drinking with meals, chew well / eat fewer solid foods, eat bitter greens, supplement where appropriate.
Ageing: Cardiovascular
- Cardiovascular diseases are not ‘diseases of ageing’ as such; they are often diseases of unhealthy choices.
Changes include: - Decreased arterial wall compliance, thickening / stiffening of arteries : ↑ systolic blood
- Decreased maximum heart rate
- Increased left ventricular muscle mass (also due to hypertension): can be a predictor for cardiovascular disease.
- Focus client’s dietary intake on whole foods, rich in antioxidants. Increase bitter foods and heart nourishing foods / herbs such as garlic and rosemary. Encourage regular aerobic exercise.
Ageing: Renal
Renal function decreases with age.
Significant changes in structure and function of the kidney occur, including:
* Kidney cortex volume decreases.
* Number of renal cysts increase with age.
* Nephrosclerosis increases with age, with a decline in nephron numbers and the GFR. Decreased renal function may lead to:
* Problems with urinary excretion and difficulties regulating sodium concentration in the body. Poor glomerular filtration is reflected by a low GFR on a blood test.
Ageing: Neurological
Neurological function declines and cognitive impairment and dementia increase with age.
* Cognition, steadiness, coordination, gait, sensations and daily living tasks.
* Depression in older people is often undiagnosed as symptoms can be confused with other medical illnesses. Loneliness, losses, not having a goal and purpose of life are the foundation of depression and need to dealt with by the Naturopathic Nutritionist.
* Deficiency of B vitamins (folate, B12, B6) have been linked to cognitive impairment, and can contribute to raised homocysteine -> a risk factor in the pathogenesis for Alzheimer’s.
