lecture 9: nutrition for older adults

Question 1

what is considered an ‘older adult’?

Answer 1

65 years +

Question 2

what are factors surrounding “the golden years”?

Answer 2

• retirement
• increasing in eating out and alcohol consumption
• connectivity to community
• social groups
• volunteering
• provision of childcare

Question 3

what are important factors with advancing years?

Answer 3

• increasing illness and injury
• home support required to complete daily tasks
• transition into aged care home if care needs are too great

Question 4

what are the physiological changes with age?

Answer 4

senescence: cellular deterioration with ageing
- signals an increased risk of disability, disease and death
- systems begin to slow and degenerate

sensory loss
- alteration to sight, hearing, smell and taste (less taste buds)
- dysgeusia: abnormal taste perception
- medication use can alter these senses

neurological function
- reduced cognition due to ageing or dementia
- depression

Question 5

what are the physical changes with age - gastrointestinal?

Answer 5

xerostomia: declined salivary production
dysphagia: difficulty swallowing foods
poor dentition: difficulty swallowing foods

achlorhydria: low gastric HCL production, limits calcium, iron, folate, vitamin B12 absorption

gut microbiota
- increased inflammation
-decreased immune function of GI tract
- impaired functioning of gut mucosal cells
- bacterial growth

Question 6

what are the gradual body composition changes?

Answer 6

DECREASED
- mineral and water reserves
- fat free mass
- bone mineral density

INCREASED
- fat mass

from 20-70 the average man loses 11kg of muscle and gains 10kg fat

Question 7

what are the changes to organ function with age?

Answer 7

• less adaptable to environmental or physiologic stressors
• kidneys: less able to concentrate waste (loss of nephrons)
• liver: less efficient in breaking down drugs
• pancreas: reduced blood glucose control
• bladder control may decline
• respiratory - declining vital capacity
• connective tissue and blood vessels become increasingly stiff and less pliable (increasing blood pressure)
• neurons in the brain decrease: impaired memory, reflexes, coordination
• decreased production of hormones: testosterone and growth hormone

independent on the person not everyone experiences all these - depends on life style prior to being an older adult

Question 8

what are the changes to BMR?

Answer 8

• decreased energy needs from loss of muscle mass and lean tissue
• lower basal metabolic rate
• reduced activity levels

Question 9

what are the macronutrient requirements for older adults

Answer 9

protein, carbohydrate and fat within acceptable macronutreint distribution range (AMDR) as per adulthood recommendations

protein requirements INCREASES 70+
- 1-1.2g/kg/day
- 1.5g/kg/day is they have an acute or chronic conditions
- 25-30g per meal <- IMPORTANT less HCL production + more trouble breaking down food so space protein consumption throughout the day to appropriately absorb

fibre as per adulthood recommendations - important to help relive constipation caused by medication

water - same as adult recommendations. reduced thirst perception, decline kidney function and use of medication means its very important for elderly to stay hydrated

Question 10

what are the micronutrients requirements for older adults

Answer 10

• iron decreases for women after 51 years - because of menopause
• calcium increases for women after 51 and mean after 70 - effect of menopause has on bone mineral density
• requirements for B2, B6 and D increase - challenges with absorption in older adults
• vitamin B12 - requirements dont change but there can be impaired absorption

Question 11

why is there a call for new dietary guidelines for people over 70?

Answer 11

• current guidelines are inappropriate
• difficulty for food providers to plan appropriate meals
• nutrition for older people is not discussed in public health campaigns
• little data on nutritional intake for older adults

Question 12

how do the current Australian dietary guideline relate to older adults

Answer 12

all apply but particularly…

guideline 1: eating nutritious foods and keeping physically active to help maintain muscle strength and a healthy weight

guideline 5: care for your food; prepare and store is safely

Question 13

who do the guidelines NOT apply to

Answer 13

people with medical conditions requiring specialised advice, or to frail elderly people who are at risk of malnutrition

Question 14

what are the physical activity guidelines for older adults

Answer 14

requirements same but exercise looks different - do what they can and encouraged

Question 15

do older adults meet recommended nutrient requirements? and biggest areas on concern

Answer 15

no

protein and calcium
overweight, obesity, chronic disease

Question 16

what are nutrient concerns surrounding age and physiology

Answer 16

sensory loss
- less interest/ enjoyment in food

neurological function
- ability to shop/ prepare food safely
- loss of interest in eating (depression)

dentition, salivary glands, dysphagia
- avoidance of tough foods, e.g. meat
- dry mouth - increased difficulty eating
- alteration of the texture of foods - can decrease intake

early satiety
- potential decreased sensitivity to grehlin
- changes in the function of cholecystokinin (CCK)
- abnormalities in gastric motility
- overwhelmed by the amount of food on the plate

Question 17

what are the major problems with not consuming enough food? and why is it important?

Answer 17

unintentional weight loss and malnutrition = loss of subcutaneous fat and muscle wasting

skin integrity
- slow or non-healing wounds
- increased risk of pressure ulcers

increased frailty
- reduced mobility
- increased disability

impaired immune function
- delayed recovery
- recurrent infections

hospitalisation
- increased hospitalisation rates
- increased length of stay
increased risk of mortality

Question 18

signs someone is malnourised

Answer 18

pinch test - just feel skin no fat
sunken in eyes
visible collar and shoulder bones

Question 19

what are the different types of malnutrition and explain each

Answer 19

starvation
- protein-energy malnutrition
- inadequate intake of food
- loss of lean muscle mass and fat mass
- within Australia, generally caused by reduced appetite, difficulty eating, early satiety, cognitive decline and inability to prepare food

cachexia
* Inflammation causing catabolic processes resulting in muscle and fat loss
* Known to also occur in cancer, HIV/AIDS and COPD
* Can lead to anorexia- impacts on appetite and dietary intake and symptoms like
nausea and vomiting
* Associated with decreased quality of life, functional capacity and mortality
* Treatment- medication to reduce inflammation and adequate intake of protein and
energy

Question 20

how do we detect and treat malnutrition

Answer 20

• MST is a screening tool (flags a patient for dietetic review)
• SGA – tool to diagnose malnutrition

Treating malnutrition
* Increase protein and energy intake - like sustagen
* Fortify foods or use of supplements - adding more cheese, butter, mayo, cream, oil
* Look for a potential cause; texture modification, diet liberalisation

Question 21

explain sarcopenia

Answer 21

Age related loss of muscle mass, strength and function
* Significantly impact on quality of life by decreasing mobility, increasing risk of falls and altering
metabolic rates
* Exercise is important for slowing down sarcopenia
* Accelerates with a decrease of physical activity, weight bearing exercise can slow its pace
* Sarcopenic obesity-loss of lean muscle mass with excess adipose tissue
* Together excess weight & decrease muscle mass compound to further decrease physical activity,
accelerating sarcopenia

Question 22

explain osteoporosis, risk factors and prevention/ management

Answer 22

• Bone loss faster than replacement rate leading to low bone density
• Higher risks of breaks- pain, loss of function, independence
• Common sites of fractures; hip, spine & wrist
• Calcium requirements increase
  →For women 51 years +; hormonal changes associated with menopause. Causes calcium balance to deteriorate, decline in intestinal absorption and increase in urinary calcium excretion.
  →Males requirements increase over 70 due to calcium absorption efficiency decreasing

Risk factors
* Non modifiable: genetics, age, gender and menopausal status
* Modifiable: inadequate calcium and Vitamin D status, physical inactivity, smoking, alcohol misuse,
* Corticosteroids and low socioeconomic status
Prevention and Management
* Adequate calcium intake and adequate exposure to sunlight OR supplementation
* Weight-bearing physical activity

Question 23

challenges with hospitalisation in terms of nutrition

Answer 23

• Increased rates of hospitalisation
• Patients can become malnourished or even more malnourished
• Being unwell- decreased oral intake
• Dislike of hospital food
• Set meal times
• Hospital environment not conducive to eating
• Fasting for medical procedures

Question 24

challenges with polypharmacy in terms of nutrition

Answer 24

• Taking five or more medications daily
• Older people have more chronic condition that require medication
• Potential side effects;
• Nausea/vomiting
• Decrease appetite
• Constipation
• Decreased nutrient bio-availability

Question 25

examples of chronic diseases associated with malnutrition and how we prevent/ go about them

Answer 25

* Prolonged health conditions * Rarely cured completely * Focus is appropriately managing symptoms, preserving function and minimizing further damage Examples Diabetes Heart Disease Arthritis High blood pressure Cancer Low Vision Depression Kidney Disease

Question 26

why is it important to focus on chronic disease (individual level and what can public health do)

Answer 26

Most prevalent and disabling conditions facing older people * Can reduce quality of life * Expensive for health care systems- account for 75% of medical care costs On an individual level * Loss of function * Loss of mobility * Loss of Independence * Disability * Pain * Death What can public health do? * Prevent the development of chronic diseases throughout the lifespan. * Reduced incidence of chronic diseases * Delayed onset of chronic diseases

Question 27

factors that accelerate ageing

Answer 27

* Smoking habits * Alcohol consumption * Sun exposure * Weight status * Level of physical activity

Question 28

definition of healthy ageing

Answer 28

* As the process of developing and maintaining the functional ability that enables wellbeing in older age” * Focus on a healthy life span rather than increasing life expectancy

Question 29

micronutrients that promote genomic stability

Answer 29

Omega 3 fatty acids and antioxidants (vitamins C and E, selenium, carotenoids and polyphenols) in DNA oxidation * Niacin , zinc and folate in DNA repair * Suggestive of a positive role of the Mediterranean Diet

Question 30

explain nutrition challenges of older people living at home who have lost their partner

Answer 30

* Implications for shopping and cooking * Females → may have greater nutrition knowledge and cooking skills, change in cooking style, no longer needing to meet the preferences of others →Men- may lack these skills, either develop skills or rely on ready made foods * Eating alone- known to decrease intake and quality of food consumed * Potential for social isolation- loss of quality of life, increased depression * Potential reduced independence as health deteriorates

Question 31

individual factors affecting elderly food security

Answer 31

*Disability, perceived disability, chronic illness *Carry or lift groceries *Female *Low socioeconomic status or of a different cultural background

Question 32

social environmental factors affecting elderly food security

Answer 32

*Living alone *Lack of supportive networks *Reluctance in accepting help from external providers

Question 33

physical environmental factors affecting elderly food security

Answer 33

*Renting *Living rurally/ food deserts *Lack of access to public transport or private transport

Question 34

macro level factors affecting elderly food security

Answer 34

*Financial support *Appropriateness of emergency food relief

Question 35

public health initiatves to increase food security in older adults living at home

Answer 35

- home care packages - meals on wheels - lets do lunch - beehive industries - live up australia

Question 36

what are home care package services? home and community based

Answer 36

Community based → Centre-based day respite → Care, company and group activities in the centre, and may include short trips away from the centre. → Transport (day centre, shopping & appointments) → Social support (shopping, banking, appointments, just a chat) Home based → Domestic assistance (cleaning, clothes washing and ironing) → Personal care (bathing or showering, dressing, hair care and toileting) → Home maintenance (General repair and care of a client's house or yard) → Home modification (install safety aids like alarms, ramps and support rails) → Community nursing (provided by a qualified nurse) → Food services (provide meals, help with shopping, preparing & sorting food, delivering meals to the home) → Respite Care → Support Services for carers

Question 37

what is meals on wheels

Answer 37

* Government supported services to keep older people in their homes for longer * Meals on Wheels- service that delivers prepared meals to people in the community daily

Question 38

what is lets do lunch

Answer 38

Targeting social isolation and loneliness in older adults * Intervention- Volunteers have lunch with clients every 3 weeks * Volunteers trained to assess client wellbeing

Question 39

what is beehive industries

Answer 39

Low Cost for Seniors Meal Program * Noticed the older people always ate a large breakfast * Identified that most were not eating a substantial dinner meal * Designed a cooking school that increases cooking skills using low cost ingredients * Simple language * Every recipe takes less than 20 minutes * Uses readily available foods

Question 40

what is live up australia

Answer 40

Not-for-profit that is funded by the Australian Government * Provide information on → Exercise classes → Product suggestions → Local groups to engage with

Question 41

critical area of concern found by royal commission into residential aged care in australia

Answer 41

poor nutrition

Question 42

recent advances in the political space towards aged care

Answer 42

12.9 million dollars towards nutrition in aged care * Fund a 15% pay increase for aged care workers * Improve provider regulation through a new regulatory model * Improve access to high quality aged care for First Nations elders and boost provider support and worker training to build care capacity. * New Aged Care Act legislated 12/09/24

Question 43

challenges in nutrition in aged care homes

Answer 43

Residents can be malnourished when entering a home Inadequate intakes can occur due to; * Potentially unappetising foods * Lack of choice in foods-lack of flexibility * Rigid mealtimes- lunch is the biggest meal of the day * Unappealing texture modified foods * Limited staff to assist residents with eating * Sole source of food for many residents- important to get it right Healthy Eating guidelines don’t apply to the frail elderly. Limiting salt and sugar in this group in unnecessary and can do more harm than good

Question 44

results of increasing food choice in aged care

Answer 44

increased food service satisfaction food consumption: - 5g increase protein foods - 22g increase vegetable consumption - 39g decrease carbohydrate foods increased food servce costs enablers: - staff champions - driving practice change - engagement of staff and residence in intervention design barriers: - lack of consistent and skilled staff - lack of flexibility in meal products to meet resident preferences

Question 45

explain research project supporting residents with dementia to participate in mealtime decisions

Answer 45

co design of AI generated images and interview prompts with residents in RAC

Question 46

from a public health perspective what are the goals of the decade of healthy aging

Answer 46

age friendly environments combatting ageism integrated care long term care overall goal: ensure that older people can fulfil their potential in dignity and equality and in a healthy environment.