Older Adult Nutrition Flashcards
What defines “old” ?
- DRI category
- U.S. Census Bureau
- Eligibility for Medicare
- World Health Organization
- Older American Act Nutrition Program
- 70
- 65
- 65
- 60
- 60
CDC suggest that longevity depends on:
◦____% lifestyle factors
◦_____% environmental factors (pollution, etc.)
◦____% genetics
◦____% access to high-quality health care
51%
20%
19%
10%
More Americans are living longer
◦Currently, _____% are >65 yrs
◦ By 2030, it is expected that ~____% will be >65 yrs
Persons ≥____ are the fastest growing population group
16.8%
19%
85
Average number of years of life remaining for persons in a population cohort or group
life expectancy
Maximum number of years someone might live;
is projected to range from 110-120 years
life span
life expectancy is higher in the ______ of the US
lowest in ____ area of US
which gender is living longer?
west and northeast
south
females
Animal studies show that an energy- restricted diet that meets micronutrient needs can prolong healthy life
▪Caloric restriction defined as: decreasing energy intake by_______% while meeting protein and micronutrient needs
▪Studies of caloric restriction (CR) in primates have shown conflicting results
25-30%
cardiovascular changes with age:
◦ Reduced stroke volume
◦ Increased arterial stiffening, increased BP
Endocrine changes with age:
◦ Reduced levels of estrogen & testosterone
◦ Decreased secretion of growth hormone
◦ Increased cortisol
◦ Reduced glucose tolerance
◦ Decreased ability to convert provitamin D to previtamin D in the skin
GI changes with age:
◦ Reduced secretion of saliva & mucus
◦ Missing or poorly fitting teeth
◦ Dysphagia
◦ Damaged, less-efficient mitochondria produce less ATP, less energy
◦ Reduced secretion of HCl & digestive enzymes
◦ Slower peristalsis
◦ Reduced vitamin B12 absorption
Renal changes with age:
◦ Reduced number of nephrons
◦ Slowed glomerular filtration rate
Neurological changes with age:
◦Reduced nerve conduction velocity=>
affecting cognition and sense of smell, taste, & touch
Respiratory changes with age:
◦ Reduced breathing capacity
◦ Reduced work capacity & endurance
Musculoskeletal changes with age:
◦ Reduced LBM
◦ Increased fat mass
◦ Decreased RMR
◦ Reduced work capacity & strength
LBM and Fat decline on average ____% per decade from age _____
this results in lower ____, _____, and ______
2-3%
30-70
lower
- mineral
- muscle
- water reserves
Loss of skeletal muscle mass & strength associated with aging
sarcopenia
sarcopenia’s cause is multifactorial including _____________
muscle disuse
nutritional deficiencies
hormone changes
chronic diseases
inflammation
sarcopenia is a precursor to ______.
Which results in worsening disease burden, nutritional inadequacies, increased disability, increased fall risk, functional dependency, and death.
Older adults with reported decline in function, strength, or with recurrent falls should be assessed for sarcopenia
frailty
Coexistence of age-related loss of muscle mass & strength and excess body fat
sarcopenia obesity
Sarcopenia obesity results in _____ outcomes and declines in function than sarcopenia or obesity alone
worse
protein recommendations for sarcopenia is _________
when during the day?
also, consume _____ HBV protein source at each meal
healthy diet with dietary sources of __________.
Exercise with emphasis on __________.
1.0-1.5 g/kg/day
evenly throughout the day
25-35 g
antioxidants
resistance strength training
as age increases, body fat increases, especially in the ______ region
lost muscle mass is replaced with fat.
For women, lack of ______ promotes fat accumulation
visceral
estrogen
Wt & BMI gradually increase with aging, peaking between _______ yrs
◦ Physical activity moderates weight gain, increases LBM, & decreases body fat
- Weight then stabilizes and starts to slowly drop around age ____
50-59 yrs
70
Taste & smell decline with age
* Declining number of _________ receptors
* Blunted sense of smell decreases sense of taste
* Women retain their sense of smell _____ than men do
* Disease & medications affect taste & smell _____ than aging
olfactory
better
more
Poor dietary habits can lead to dental caries & tooth loss
* Frequent consumption of sugary foods & beverages provide a continuous substrate for bacteria
* Oral bacteria ferment _______ producing acids that erode tooth enamel
* The acid in _____________ also corrodes enamel
*Poor oral hygiene, lack of saliva, loss of teeth, and a diet deficient in vitamin ___ contribute to periodontal disease
sucrose
carbonated beverages
C
Appetite
◦ Hunger & satiety cues _______ with age
◦ Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted
Thirst
◦ Thirst-regulating mechanisms ________ with age
weaken
decrease
Methods for identifying risk
◦ Before chronic illness: total saturated fats, fruits, vegetables, whole-grains, and poor habits leading to obesity
◦ Leading to malnutrition: Compare dietary intake to nutrient intake recommendations
◦ Population-based risk screening: Factors that lead to interventions to prevent or delay onset of chronic disease
◦ _____________________: DETERMINE Checklist
◦ ________________________
◦ __________________________
Nutrition Screening Initiative (NSI)
Mini Nutritional Assessment (MNA)
Malnutrition Universal Screening Tool (MUST)
DETERMINE Checklist was developed by the _______________________ and is a list of earning sign of _________ in older adults
American academy of family physicians
academy of Nutrition and dietetics
national council on aging
poor nutrition
Mini-Nutritional Assessment (MNA)
* The MNA short form uses ____ screening items:
( over period of ____)
What are the screening items?
Six
3 months
food intake
weight loss
mobility
psychological stress or acute disease
neurophysiology problems (dementia or depression)
BMI
latrogenic nutrition risk factors include _________
Prolonged NPO status
Delays in addressing nutritional needs
overly restrictive therapeutic diets
Food-Based Guidance: MyPlate
◦ MyPlate for older adults’ adaptations
◦ _______: video, shopping tips, physical activity, recipes
◦ ___________: fortified foods, text to describe food groups, food pattern with range of calories
Tufts
University of Florida
modified my plate changes
pictures
softer foods
canned and packaged foods
soup included in drinks
shows type of excercises
Considerations for Nutrition Education Materials for Older Adults
- Larger type size
- Serif lettering (such as Times Roman)
- Bold Type
- High contrast (black on white)
- Non-glossy paper to decrease glare
- Reading level of 5th to 8th grade
Nutrient Recommendations
*DRIs for macronutrients, fiber, & water are available for age >___ years
*RDA/AI and UL available for micronutrients for age >___ years
50
70
Goal is to maintain a healthy body weight
*DRI EER equations; Mifflin-St. Jeor equation
*___________ report the lowest intake and are especially at risk for malnutrition
Women age >70
Average intake for adults aged 70 and older
Vitamin A:
◦DRI: ______
◦Average intake:______
900 mcg/d males, 700 mcg/d females
689 mcg/d males, 599 mcg/d females
Vitamin E:
◦DRI: _______
◦Average intake: _______
15 mg/d
8.9 mg/d males, 7.5 mg/d females
Vitamin D:
◦DRI: _______
◦Average intake: ________
20 mcg/d
5.4 mcg/d males, 4.2 mcg/d females
Calcium:
◦DRI: ______
Average intake: ______
1200 mg/d
935 mg/d males, 761 mg/d females
Sodium:
◦ UL: ______
◦ Average intake: __________
2300 mg
3351 mg/d males, 2517 mg/d females
Magnesium
◦ DRI: _____________
◦ Average intake: _______________
420 mg/d males, 320 mg/d females
294 mg/d males, 238 mg/d females
Potassium
◦DRI: ______
◦ Average intake: ________________
4700mg/d
2758 mg/d males, 2171 mg/d females
Fiber
* Need to increase whole grains & vegetables to meet fiber needs and increase nutrient density
◦ DRI: _______________
◦Actual intake for age > 70 yrs : _____________
30 g/d males, 21 g/d females
19g/d males, 15g/d females
On average, older adults in the U.S. ________ the RDA for protein
Older adults living alone, living in poverty, or who have functional limitations may have low protein intakes
◦ Contributes to sarcopenia, weakened bones, decreased immune status, & poor wound healing
Optimal amount of protein needed for older adults is unclear
◦ Some studies have indicated that protein intake of ____may be beneficial to older adults as compared to the RDA of _____
meet or exceed
1- 1.5 g/kg
0.8 g/kg
considerations for Protein Adequacy of Older Adults
* Are enough _____ 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 (e.g., _________)?
calories
wound healing
Keep total fat between _____ of calories
Limit saturated fat to <____ of total kcal
<___ of kcal if hyperlipidemia, atherosclerosis, CHD, or DM
Minimize intake of trans fat
20-35%
<10%
<7%
The amount of total body _____ decreases with age, resulting in a smaller margin of safety for staying hydrated
* ____ glasses of fluid/d will prevent dehydration in most older adults
* Symptoms of dehydration=> __________
* To individualize fluid recommendations, ____ of fluid per kcal needed or 25 ml/kg with a minimum of 1500 mL/d
water
≥6
confusion, weakness
1 mL
Vitamin A
◦__________ dietary intake for both older men & women
◦However, plasma levels & liver stores _______ with age
◦ May be linked to _________ clearance from the blood
◦Older adults are more vulnerable to toxicity & possible liver damage than deficiency
Inadequate
higher
lower
Vitamin D
◦ Factors that put older adults at risk for deficiency:
o Four-fold decrease in ability of ________ to synthesize vitamin D
o _____=> institutionalization, homebound, sunscreen, more clothing
o ______ (Phenobarbital, cholestyramine, Dilantin)
o Poor _____ intake
aged skin
Limited exposure to sunlight
Medications
dietary
Vitamin E
* Potent _____
* Associated with enhanced immune function and cognitive status
* Dietary intake is _________ for older adults
* At higher doses, vitamin E is linked to _____ and risk of _____
antioxidant
inadequate
longer blood-clotting times
hemorrhage
Vitamin B12
◦Serum levels ______ with age even in healthy adults with adequate intake
◦______ levels of HCL, pepsin, & intrinsic factor (from atrophic gastritis) in older persons leads to______ serum B12
◦Synthetic or purified B12 is _____ and is much _____ absorbed
decrease
lower
lower
not protein-bound
better
Folate
◦Some medications used can affect folate ___________ (methotrexate, phenytoin)
◦Deficiency caused by ______
◦Folate supplementation can mask ____ deficiency, which is a more common problem in elderly
absorption or metabolism
alcoholism
B12
Iron
◦Iron needs _____ after menopause for women
◦Most older adults consume ______ iron than is needed
◦Excess iron contributes to _______
◦Reasons that some older adults may have iron deficiency include:
◦ _____ from disease or medications
◦ Poor absorption due to __________
◦ ______ calorie intake
lower
more
oxidative stress
Blood loss
lower acid secretion
less calories
Calcium
◦Need adequate intake for ______ health
◦RDA for men & women >70 yrs: _______
◦UL: ______
bone
1200 mg/d
2000 mg/d
Magnesium
◦Need adequate intake for _______
◦ Involved in over 300 ______ systems
◦Deficiency can occur due to:
◦ Inadequate intake
◦ Malabsorption due to _________
◦ Chronic ______
◦ _______ (Lasix, cyclosporine)
bone health, nerve activity, glucose utilization
enzyme
GI disorders
alcoholism
Medications
When to Consider Supplements
◦ Lack _______ resulting from illness, loss of taste or smell, or depression
◦Diseases of _____
◦Have a _______ due to food insecurity, loss of function, or disinterest
◦Avoids specific ______
◦Take _________ or other substances (alcohol) that affect absorption or metabolism
appetite
GI tract
poor-quality diet
food groups
medication
Nutrient Supplements
* Usage_______ with age
* The individuals most likely to take supplements are _____
*Among older adults, the most frequently used micronutrient supplements are: ___________________
* Important to assess use in older adults since they are on more medications=> potential DNI
increases
non-Hispanic white females
MVM, vitamin D, calcium, & vitamin C
Academy Position on Micronutrient Supplements
◦The routine & indiscriminate use of micronutrient supplements for the prevention of chronic disease _______ recommended, given the lack of available scientific evidence
is not
Food Safety Recommendations
▪Older adults with compromised immune systems are vulnerable to foodborne illness
▪Leading hazardous practices:
◦ Improper holding _______
◦ Poor personal _______
◦ Contaminated-food preparation ______
◦ Inadequate ______ time
▪Limited vision, decreased sense of smell, or forgetfulness can contribute to poor food-handling practices
temperatures
hygiene
equipment
cooking
PA for Older Adults
▪PA builds LBM, helps to maintain _______
▪Brain health: improved _____, reduced _____, reduced risk of _____, and improved _____
▪Lowers the risk of several chronic diseases
▪Initial screening by physician to identify
potential contraindications or problem areas
balance & flexibility
cognition
anxiety
depression
sleep
Physical Activity Recommendations
The PA guidelines for ______ also apply to older adults
* All adults should avoid inactivity. Some PA is better than none.
- For substantial health benefits, adults should do at least ______ of moderate-intensity, or _______ of vigorous-intensity aerobic PA, or an equivalent combination of _________ intensity aerobic activity
- Adults should also do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on _____days a week
adults
150min/wk
75-150 min/wk
moderate- and vigorous
2 or more
Additional PA Guidelines for Older Adults
* When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week due chronic conditions, they should be as physically active as their _______
* Weekly PA for older adults should include _______
* Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely
abilities and conditions allow
balance training
