Older Adult Flashcards
What counts as “old”?
Typical classifications:
- 65-74 y.o.: “young old”
- 75-84 y.o.: “middle old”, “aged”
- over 85 y.o.: “oldest old”
Explain the theory of programmed aging
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
Explain the Wear and Tear theory
Oxidative stress => oxidative stress due to free radicals
Rate of living => higher metabolic rate and energy expenditure leads to greater cell turnover
CDC suggests that longevity depends on:
10% access to health care
19% genetics
20% environment
51% lifestyle (not smoking, healthy diet and ample exercise)
Which population group is growing the fastest?
Persons aged 85 and up
Difference between life expectancy and life span
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
What do we need to consider when estimating energy needs for older adults?
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)
DRI for older adults in CHO and fiber
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
DRI for older adults in PRO
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+
Do majority of older adults get their protein intake?
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
Questions to ask as a dietitian when considering protein adequacy of older adults
- 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?
DRI for older adults in Fats and Cholesterol
Fat => AMDR: 20-35% of calories/day
Cholesterol => less than 10% from saturated and trans fat, limit cholesterol intake
What can someone eat alongside eggs to decrease the effect of cholesterol?
Oatmeal - soluble fiber will bind to cholesterol and will excrete it as opposing to absorbing it
What impacts blood cholesterol more? Saturated and trans fat or dietary cholesterol?
Dietary saturated and trans fat!
More detrimental to atherosclerosis than cholesterol
DRI for older adults for fluids
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
Nutrients of concern with age-associated changes (do more research in textbook)
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
Nutrients of concern in older adults with low dietary intake
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)
Nutrients of concern in older adults with age-associated changes in metabolism
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
Supplements may be useful with those who:
- 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
Body Composition Changes in older adults
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
How do taste and smell change in older adults?
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!
What does oral health depend on
- Secretions (saliva) => tends to thicken with age
- Skeletal systems (teeth and jaws)
- Mucus membrane
- Muscles (tongue and jaw)
- Taste buds
- Olfactory nerves
How does thirst and appetite change with age?
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
What are some nutritional risk factors?
- 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
