Older Adult

Question 1

What counts as “old”?

Answer 1

Typical classifications:
- 65-74 y.o.: “young old”
- 75-84 y.o.: “middle old”, “aged”
- over 85 y.o.: “oldest old”

Question 2

Explain the theory of programmed aging

Answer 2

Limited cell replication => cells have a limited # of times they can divide, once at max cells begin to die
Molecule clock theory => telomeres (cap ends of chromosomes) get shorter each division, once lost, stop replication

Question 3

Explain the Wear and Tear theory

Answer 3

Oxidative stress => oxidative stress due to free radicals
Rate of living => higher metabolic rate and energy expenditure leads to greater cell turnover

Question 4

CDC suggests that longevity depends on:

Answer 4

10% access to health care
19% genetics
20% environment
51% lifestyle (not smoking, healthy diet and ample exercise)

Question 5

Which population group is growing the fastest?

Answer 5

Persons aged 85 and up

Question 6

Difference between life expectancy and life span

Answer 6

Life expectancy: average number of years of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth

Life span: Maximum number of years someone might live; human life span is projected to range from 110 to 120 years

Question 7

What do we need to consider when estimating energy needs for older adults?

Answer 7

Decrease in physical activity and basal metabolic rate from early to late adulthood results slightly decreased caloric needs

But we still use EER calculations for healthy adults (however, decreasing approximately 7-10 calories/day for each year of age over ~ 70 years)

Question 8

DRI for older adults in CHO and fiber

Answer 8

CHO => AMDR: 45 to 65% of calories
Fiber => AI: Males > 50 y.o.: 30g/day, Females > 50 y.o.: 21g/day

Avoid/limit refined carbohydrates

Question 9

DRI for older adults in PRO

Answer 9

AMDR: 10-35% of calories
RDA: 0.8g/kg/d (Some researchers report protein needs for older adults are 1-2.0g/kg/day)
In Canada, typically use ~1.0-1.2g/kg/day for 65+

Question 10

Do majority of older adults get their protein intake?

Answer 10

Estimated that ~38% older men and 41% older females consume below the RDA of 0.8g/kg/day

Inactive, older adults living alone may have low protein intakes

Question 11

Questions to ask as a dietitian when considering protein adequacy of older adults

Answer 11

• Based on total energy requirements, how much protein will meet the individual’s needs?
• Are enough calories eaten so that protein does not have to be used for energy?
• If marginal amounts of protein are eaten, is the protein of high quality?
• Are there additional needs?
• Is the individual exercising?

Question 12

DRI for older adults in Fats and Cholesterol

Answer 12

Fat => AMDR: 20-35% of calories/day

Cholesterol => less than 10% from saturated and trans fat, limit cholesterol intake

Question 13

What can someone eat alongside eggs to decrease the effect of cholesterol?

Answer 13

Oatmeal - soluble fiber will bind to cholesterol and will excrete it as opposing to absorbing it

Question 14

What impacts blood cholesterol more? Saturated and trans fat or dietary cholesterol?

Answer 14

Dietary saturated and trans fat!
More detrimental to atherosclerosis than cholesterol

Question 15

DRI for older adults for fluids

Answer 15

Females: 2.7 L/day
Males: 3.7 L/day

The total amount of water in the body decreases with age, resulting in a smaller margin of safety for staying hydrated

6 glasses of fluid or more per day will prevent dehydration in most older adults

Question 16

Nutrients of concern with age-associated changes (do more research in textbook)

Answer 16

Vitamin A
- RDA => Males: 900 mcg/day; Females 700 mcg/day
- Plasma levels and liver stores increase with age
- May be linked to decrease clearance from the blood
- Older adults more vulnerable to toxicity and possible liver damage than deficiency
- Cod liver oil supplementation has been known to cause toxicity

Vitamin D
- RDA: 800 IU/day
- Factors that put older adults at risk for deficiency: Limited exposure to sunlight, institutionalization or homebound, certain medications (eg. laxatives) decrease absorption, decreased ability to convert provitamin D into previtamin D in the skin

Question 17

Nutrients of concern in older adults with low dietary intake

Answer 17

Vitamin E, Vitamin K
- both fat soluble
- antioxidant properties of vit E important in this age group
- blood coagulation, bone health - vit K
- Interact with many medications (eg. vit K will prevent blood thinning meds)

Question 18

Nutrients of concern in older adults with age-associated changes in metabolism

Answer 18

Vitamin B12
- Despite adequate intake, ~30% of older adults have decreased serum B12 levels
- Synthetic or purified B12 is not protein bound and is much better absorbed for elderly population

Folate, folic acid
- absorption may be impaired
- some medications can impact folate metabolism
- Folate deficiency can mask B12 deficiency, which is a more common problem in elderly

Iron
- RDA: Adults older than 70 y.o.: 8 mg/day
- Iron needs decrease after menopause
- Excess iron contributes to oxidative stress
- Reasons that some older adults may have iron deficiency include: iron loss from disease or medications, decreased gastric acid secretion, decreased calorie intake

Calcium
- RDA: Adults older than 70 y.o.: 1200mg/day
- Need adequate intake for bone health and to reduce hypertension
- UL has been lowered because of toxic effects

Magnesium
- Need adequate intake for bone health, nerve activity, glucose utilization
- Excessive intake from supplements can cause overdose

Question 19

Supplements may be useful with those who:

Answer 19

• Lack appetite resulting from illness, loss of taste or smell, or depression
• Have diseases in GI tract
• Have a poor diet due to food insecurity, loss of function, or disinterest
• Avoid specific food groups
• Take medication or other substances that affect absorption or metabolism

Question 20

Body Composition Changes in older adults

Answer 20

Sarcopenia => loss of muscle through aging period, can be exacerbated for those who are sedentary and/or low PRO

Older people have lower mineral, muscle and water reserves (lower lean body mass)
- Weight bearing and resistance exercise increase lean muscle mass and bone density and regular physical activity helps maintain functional status

Question 21

How do taste and smell change in older adults?

Answer 21

Taste and smell senses decline age ~60
- Reduced blood flow to nasal area and increased thickness of nasal mucus
- by age 80, ~75% have some olfactory impairment
- decline in ability to identify smells varies within people

Disease and medications impact taste and smell decline more than aging process!

Question 22

What does oral health depend on

Answer 22

• Secretions (saliva) => tends to thicken with age
• Skeletal systems (teeth and jaws)
• Mucus membrane
• Muscles (tongue and jaw)
• Taste buds
• Olfactory nerves

Question 23

How does thirst and appetite change with age?

Answer 23

Thirst => thirst-regulating mechanisms decrease with age
Appetite => hunger and satiety cues weaken with age, older adults may need to be more conscientious of food intake levels since senses may be blunted

Question 24

What are some nutritional risk factors?

Answer 24

• Hunger, poverty, low food and nutrient intake
• Functional disability
• Social isolation or living alone
• Urban and rural demographic area
• Depression, dementia
• Poor dentition and oral health
• Diet-related acute or chronic diseases
• Polypharmacy
• Minority, advanced age

Question 25

leading Hazardous practices to foodborne illnesses

Answer 25

Improper holding temperatures
poor personal hygiene
Contaminated food preparation equipment
Inadequate cooking time

Question 26

Considerations for Educational materials for older adults

Answer 26

Larger type size
Bold Type
High contrasts (black on white)
Non-glossy paper
Avoid blue, green & violet color as they are more difficult to see clearly

Question 27

Nutrition Programs serving older adults in Canada

Answer 27

Meal/grocery delivery services:
- VON dinners
- Meals on wheels
- Sobeys: order over phone, sobeys delivers
- Grocery curbside and instore pick up

Question 28

Community programs for seniors

Answer 28

McCormick dementia services
Seniors maintaining active roles together (SMART) program
Veterans Affairs program