Older Adults

Question 1

List negative consequences of malnutrition and frailty in the older adult.

Answer 1

Malnutrition
o Longer hospital stays
o More complications (pressure ulcers, falls, hip fractures)
o Effects morbidity, mortality, quality of life
o Increased hospital costs

Frailty (form of failure to thrive)
o Progressive physiologic decline in multiple body systems
o Loss of function, loss of physiologic reserve, increased vulnerability to disease and death
o Need hospitalization
o Increased risk of becoming disabled

Question 2

Identify and discuss risk factors for poor nutritional status in the older adult.

Answer 2

• Chronic disease
• Oral health problems
• Cognitive or emotional impairment
• Isolation and loneliness
• Alcohol and drug use
• Socioeconomic status
• Functional status
• Sensory changes

Question 3

Describe nutritional screening tools for older adults.

Answer 3

• Process to identify an individual who is malnourished or at risk for malnutrition
• Used to determine if need a detailed nutrition assessment

Mini Nutritional Assessment (MNA)
o Self-MNA version available for patient use
o Criteria: food intake, weight loss in past 3 months, mobility, acute disease or psychological stress, dementia, depression, BMI
o Score predicts nutrition risk → proceed to full MNA assessment

Malnutrition Universal screening tool (MUST)
o Used by health care workers in hospital or community
o Criteria: BMI, weight loss, acute disease
o Next steps based on nutrition risk

Question 4

Discuss changes in body composition, calorie requirements, and BMI recommendations for older adults

Answer 4

Decreased lean body mass and body water, increased adipose
o Sarcopenic obesity: reduced skeletal muscle combined with increased body fat, often abdominal → more physical disability, increased risk of disease

Decrease in REE (1-2% per decade) and decreased activity → decreased daily caloric requirement
o About 100 kcal/decade past 30 years
o Energy (depending on activity level):
• Females: 1600-2200 kcal/day
• Males: 2000-2800 kcal/day
o Protein: RDA 0.8 g/kg, may actually need up to 1-1.2 g/kg to maintain positive nitrogen balance

Optimal BMI for adults >65 years is controversial
o Lowest risk of hospital admission: BMI 22-24
o Lowest mortality: BMI: 25-27

Question 5

Describe atrophic gastritis and its relation to Vitamin B 12 deficiency and bacterial overgrowth.

Answer 5

• Atrophy of parietal cells → reduced HCl production, intrinsic factor, pepsin
• Less acidic environment so increased survival of swallowed bacteria, increased fermentation of CHO in intestine
• Can reduce folate and B12 absorption
• Decreased bioavailability of minerals, vitamins, and protein

Question 6

List dietary risk factors and describe nutritional treatment for osteoporosis.

Answer 6

Risk factors:	
o	Female
o	Increased age
o	Less exposure to estrogen (late menarche, early menopause)
o	White race
o	Low weight and BMI
o	Family history of osteoporosis
o	Smoking
o	History of prior fracture
o	Sedentary lifestyle/immobilization
o	Lifelong low calcium and/or Vitamin D intake
o	Excessive alcohol or caffeine use 
Nutritional treatment
o	Adequate calcium: 1000-2000 mg/day
o	Adequate Vitamin D: 600-800 IU/day (or enough to maintain plasma 25(OH)D of 30 ng/ml or more
o	Moderate sodium: 1500-2300 mg/d
o	Moderate alcohol and caffeine
o	Potential Magnesium, Vitamin K, Vitamin C supplement

Question 7

Discuss recommendations for food or supplemental sources of vitamin B12, vitamin D, and calcium in older adults.

Answer 7

Vitamin B12
o Food sources: bacterial synthesis, present in animal products
o Liberated from protein by gastric acid, then combines with intrinsic factor to be absorbed in terminal ileum
o Recommend supplements for people with absorption problems or >50 years
Calcium
o RDA for males: 51-70 years: 1000mg
o Males >70 year: 1200 mg
o Females 51 and older: 1200 mg
o Supplements vary by type of calcium salt
• Carbonate best with meals (acid helps absorption)
• Citrate can be taken anytime, works best with atrophic gastritis, PPIs
• No more than 500 mg at a time
• Take at different times than other minerals
Vitamin D
o RDA: 600 IU/day until age 70
o 800 IU/day >70 years
o Or enough to maintain plasma 25(OH)D of 30 ng/ml
o Major dietary source is fortified milk (1 cup ~100 IU)

Question 8

List food/nutrient/drug interactions that are common in the older adult population.

Answer 8

• Since many take >1 drug
• Dietary K+ in relation to diuretics or ACE inhibitors
• Vitamin K limit while taking anticoagulants
• Milk intake (calcium) and tetracycline and doxycycline
• Food and nutrient interaction with anticonvulsants
• Chronic use of laxatives can interfere with nutrient absorption
• PPIs on absorption of nutrients
• Foods like grapefruit or cranberry juice

Question 9

Describe nutrition programs for older Americans.

Answer 9

National nutrition program for the elderly
o Part of Older American Act, available to all 60 and older
o Targets those with greatest economic or social need
o Meals can be congregate (churches, community centers) or home-delivered (Meals on Wheels)
o Participants have higher nutrient intakes than non-participants
o Fewer volunteers, higher gas prices taking toll
Senior farmer’s market nutrition program
o Coupons to older adults with low incomes
SNAP
o Helps qualified people buy groceries
Commodity Supplemental food program
o Provides some foods to older people to supplement own food
Emergency food assistance program
o Provides food to low-income older adults
Child and adult care food program
o Meals and snacks to eligible older adults taking part in adult day care programs