Lifestages - The Effects of Ageing Flashcards
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 include:
* 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).
Sarco = muscle, penia = lack
interleukin-6 = a pro-inflammatory cytokine
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
Malnutrition is caused by many factors, such as:
* 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).
* Poor oral health can be associated with:
o A poor nutritional status (e.g. high refined sugars, low antioxidant).
o Dentures (problems chewing); amalgams (risk of dental infections).
o 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.
* The consequences of malnutrition are extensive and include:
o Loss of muscle mass and strength.
o Loss of mucosal integrity malabsorption.
o Impaired immune function.
o Psychological impact: apathy / depression.
* Factors affecting food choices in elderly:
o Physiological: decreased visual acuity, joint problems, hand tremors, hearing problems, anorexia, dementia.
o Social / psychological: reluctance to go shopping, isolation, depression, fear, bereavement.
o Economical: isolation, low income.
o 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.
Xerostomia = dry mouth (lack of saliva)
Ageing: Gastrointestinal
Changes occur in the GI tract with age:
* Parietal cell intrinsic factor production declines with age.
* Achlorhydria (reduced stomach acid) can lead to:
o Poor digestion, absorption and biliary excretion (low HCl also impairs bile flow and pancreatic function).
o Vitamin B12 deficiency (HCl and intrinsic factor are needed).
o SIBO and other intestinal bacterial infections.
o 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:
o Decreased arterial wall compliance, thickening / stiffening of arteries: ↑ systolic blood pressure.
o Decreased maximum heart rate.
o Increased left ventricular muscle mass (also due to hypertension): can be a predictor for cardiovascular disease.
o 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:
o Kidney cortex volume decreases.
o Number of renal cysts increase with age.
o Nephrosclerosis increases with age, with a decline in nephron numbers and the GFR.
* Decreased renal function may lead to:
o 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 & 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.
Ageing: Immune System
- Ageing is associated with dysregulation of both innate and adaptive immune functions, including:
o A progressive decline in T-lymphocyte function.
o A decline in cell mediated immunity. - This increases the risk and severity of infections and cancer incidences amongst the elderly.
- Poor nutritional status further exacerbates impaired immune function. Key considerations are:
o Protein energy malnutrition = reduced lymphocyte proliferation increased risk of infection.
o Micronutrient deficiencies (A, C, E, Zn, Se, Fe) that ↓ immunity. - Optimise the intake of these nutrients to support immunity.
Ageing: Skeletal
Various skeletal changes occur with ageing:
* Bones: Bone Mineral Density (BMD) gradually declines with increasing age and is a risk factor for osteoporosis (and fractures). BMD decline is accelerated in women following the reduction of oestrogen associated with the menopause.
* Cartilage: Decreases its water content, changes to the extracellular matrix structure with collagen fibres cross-linking (making the cartilage stiffer), and a reduced delivery of nutrients to cartilage. Intervertebral discs lose their height limiting movement.
* Regular weight-bearing exercise can support bone density and cartilage health. Also optimise vitamin C status to support cartilage.
Ageing: NAD+
NAD+ is an essential co-factor in all living cells that is involved in fundamental biological processes.
* NAD+ depletion is associated with the hallmarks of ageing and may underlie a wide range of age-related diseases, such as metabolic disorders, cancer and neurodegenerative diseases.
* You can increase NAD+ levels by:
o Exercising regularly.
o Getting adequate sleep.
o Fasting / periodic calorie restriction.
o Eating a nourishing diet which includes avocados, green leafy vegetables, fish, nuts, cremini mushrooms, fermented foods.
NAD+ = Coenzyme Nicotinamide Adenine Dinucleotide
Ageing: Melatonin
- Melatonin is a hormone secreted by the pineal gland that regulates the circadian rhythm. It also:
o Serves as a potent antioxidant, a chemotoxicity reducing agent, and an anti-ageing substance.
o Modulates immune defense (e.g. NK cells).
o Acts as a tumour surveillance agent. - Optimise melatonin levels by: increasing natural sunlight exposure, having a regular bedtime in a dark room, avoiding artificial light at night and stimulants (e.g. caffeine), eating Montmorency cherries and B6-rich foods for melatonin synthesis.
NK cells = Natural killer cells
Nutritional Tips for Healthy Ageing
The elderly often have diets lower in calories, fat, fibre and certain nutrients.
* Encourage clients to consume nutrient dense diets.
* Protein:
o A higher protein intake (1g/ kg body weight) can increase bone mineral density and preserve muscle mass. However, high protein diets can pose stress on the kidneys and increase urinary calcium excretion.
* Carbohydrates:
o 50–70% of calories should come from vegetables, fruits, whole grains, legumes; these will provide micronutrients as well as fibre to counteract constipation.
* Lipids:
o Important for cognitive functions, skin and joint health especially.
o Include polyunsaturated and monounsaturated fats.
o Include omega 3 fatty acids for neurological cognition and joint health: oily fish, chia, flax and hemp seeds.
o Reduce saturated fats (trans-fats atherosclerosis).
* Cooked foods are easier to chew and digest than raw foods:
o Focus on soups, stews, well-cooked grains and legumes, small amounts of stewed fruits (high in sugar).
o Ensure adequate hydration by including liquid foods / herbal teas.
