PTN - Nutrition and Aging (Boger)

Question 1

Why is it important to evaluate each individual’s nutritional needs separately?

Answer 1

Age does not necessarily correlate with health status and nutritional needs

Question 2

What are the 3 main nutritional goals you should set for elderly patients?

Answer 2

1. Ensure nutrient adequacy
2. Optimize lean body mass
3. Reduce health risks

Question 3

Why are older adults more likely to experience food insufficiency, a leading cause of under-nutrition?

Answer 3

• Older adults may have decreased access to food (no car, can’t walk, etc.)
• Senses of taste and smell decline with increasing age, making food intake less pleasurable

Question 4

What causes sarcopenia (decreased muscle mass) in the elderly?

Answer 4

Lack of exertion of muscles and low energy/nutrient stores lead to muscle wasting

Question 5

Why are the elderly more likely to become obese?

Answer 5

Elderly patients tend to be more inactive than younger people. They also tend to have a decreased energy expenditure, but have the same energy intake. This leads to fat deposition and impaired micronutrient status.

Question 6

True or False: Over-nutrition is a very common problem within the elderly population.

Answer 6

True.

Excess energy intake with decreased energy consumption leads to fat deposition and obesity, which increase risk of cardiovascular disease, cancer, diabetes, and osteoarthritis

Question 7

Which of the following changes most significantly during the transition from middle age to advanced age?

A. Bone mass

B. Muscle mass

C. Fat mass

D. Organ mass

Answer 7

C. Fat mass

Wear and tear of aging causes destruction of muscle and bone tissue, decreasing these masses. Fat deposition occurs at a faster rate, leading to increased body mass index and fat depositon.

Question 8

What is the primary cause of muscle loss in the middle-aged population?

Answer 8

Decrease in sex hormone production

Question 9

What are some of the nutritional risks of aging?

Answer 9

1. Obesity
2. Excess saturated and trans-fats
3. Low nutrient intake (vitamins C, D, K, B12; folate, calcium)
4. Inadequate energy intake

Question 10

What are 3 major changes that occur in the GI tract with aging?

Answer 10

1. Blunted taste and smell of food
2. Difficulting digesting foods - decreased gastric acid secretion
3. Burning mouth syndrome - increased pain receptors in the mouth cause irritation and pain after eating

Question 11

Which main organ systems undergo functional changes during aging?

Answer 11

1. Skin - decreased vitamin D
2. GI - pain, maldigestion, lack of taste/smell
3. Oral - tooth decay/loss and gum sores –> pain
4. Renal - dysfunction causes dehydration and electrolyte imbalance
5. Musculoskeletal - decreased bone mass and muscle strength
6. Immune system - blunted cellular and humoral response

Question 12

What is the advantage of doing a mini-nutritional assessment for your elderly patients?

Answer 12

Determines individuals at risk due to poor intake of nutrients caused by:

Changes in food intake

Weight

Mobility

Psychological distress

Question 13

An 82-year-old woman who lives alone broke her wrist in a fall three weeks ago. Her recovery since then has been slow. She has thin arms and legs and appears frail.

What are the likely causes for her frailty?

Answer 13

1. Inadequate energy/protein intake
2. Lack of physical exertion

Question 14

Indicate 2 dietary recommendations that you should advise your patients on.

Answer 14

1. Increase water and fiber intake
2. Take supplements to increase nutrients in blood: B12, calcium, vitamin D

Question 15

What are the protein requirements for a healthy 75-year-old man who weighs 150 lb (68 kg)?

Answer 15

54.4 g protein/day

Use the formula below to calculate:

Protein = 0.8 x body mass in kg

Remember that if the patient is experiencing wound healing, infection, or fractures, you need to increase this intake by 20%

Question 16

What are the protein requirements for a 68-year-old woman who weighs 115 lb (52 kg) who has come into your office after breaking her wrist?

Answer 16

~50 g protein/day

Remember that wound healing, infection, and fractures all require an increase in daily fiber intake by 20%. Her normal fiber intake (without injury) would be about 42 g/day. However, her fracture requires an extra 20% (0.2 x 42 = 8.4), so 8.4 + 42 = ~50 g/day

Question 17

What are some of the hallmarks of dehydration and why are the elderly prone to this condition?

Answer 17

Signs and Symptoms:

• Sunken eyeballs
• Dry mucosa
• “Tented” skin when pinched
• Hypernatremia

Elderly people are more prone to dehydration because they have a decreased thirst response (main reason), reduced fluid intake, and some medication side-effects can cause dehydration

Question 18

What is the advantage of promoting a nutrient-dense diet over an energy-dense diet?

Answer 18

Nutrient-dense diets favor energy balance by providing sufficient nutrients with a modest amount of calories (patient does not over-consume).

Energy-dense diets favor fat deposition due to increased calories from added sugar and fat.

Question 19

Which micronutrients should be decreased in aging men?

Answer 19

Chromium

Question 20

Which micronutrients should be increased in aging men and women?

Answer 20

Calcium, vitamin B6, and vitamin D

Question 21

Which micronutrients should be decreased in aging women?

Answer 21

Chromium and iron

Question 22

Why should aging women be instructed to decrease intake of iron?

Answer 22

Iron intake is generally higher in younger women because of blood loss due to menstruation. Post-menopausal women do not experience this blood loss, which decreases their iron intake requirements

Question 23

Why should elderly patients be instructed to increase intake of vitamin B6?

Answer 23

Vitamin B6 is required in transamination of amino acids, a process that is important for growth and production of hormones.

Low B6 levels can lead to slow growth, neuronal degeneration, and depression

Question 24

Why is adequate intake of chromium so important in the elderly?

Answer 24

Chromium is involved in utilization of carbohydrates and is responsible for activation of insulin. Lack of chromium can lead to insulin resistance.

Chromodulin - requires chromium to activate insulin

Question 25

Why is it important to maintain adequate levels of vitamins D, A, C, copper, magnesium and phosphate in relation to bone health?

Answer 25

These vitamins are required for production and mineralization of collagen scaffolding required in bone formation.

Bones are constantly being made and broken down, so inadequate vitamin levels can lead to weaking of the bone.

Question 26

Which type of physical activity is best for the elderly: cardiovascular or strength training?

Answer 26

Moderate cardiovascular exercise for at least 150 minutes/week is highly recommended.

Strength training is also very beneficial because it slows progressive weakening of bone and muscle and promotes lean muscle mass.

Question 27

Mr. Lamb is a 71-year-old man who lives independently and has been healthy and physically active up until his wife died 3 months ago. Since then he has been depressed, and mostly stays indoors. He is lactose intolerant and eats very little meat as he feels it’s too much bother to cook for one. Instead he eats hot cereal, soup and salads, fruit and fruit juices, and snack bars. He is 175 cm (5’9”) tall and weighs 68.9 kg (151 lbs).

Given the previous information, what nutrients(s) would you be concerned about?

Answer 27

Calcium and vitamins B12 and D

Lactose intolerance and staying indoors –> decreased vitamin D and calcium

Little meat intake –> decreased B12 intake