NUTRITION IN ELDERLY

Dana Hrnčířová

Dpt. of Nutrition , 3rd Faculty of Medicine, Charles University

Number of people age 65 and over, projected 2010-2060

Slovakia

Germany

Czech Rep.

FranceSource: Eurostat

RISK FACTORS INFLUENCING NUTRITIONAL STATUS OF OLDER ADULTS

SocioeconomicMentalPhysiological

Polypharmacy Nutrient needs

SOCIO-ECONOMIC NUTRITIONAL RISK FACTORS

Lower educationLower incomeLiving aloneInfrequent social participation Low social support (e.g. no help with shopping, meals

or chores)Non-driver (transport)

PHYSICAL AND MENTAL HEALTH NUTRITIONAL RISK FACTORS

Mental ilness (depression)Disability (severe)Polypharmacy (2 and more mediactoins/day)Poor oral health (problems with chewing, swallowing

food)Pain

Other nutritional risk factors

Significant weight loss/gainSkipping meals almost every dayLittle/no intake of F/VLong periods without food/beverage

Reduction of No of taste buds (50%)Weakened taste and smell Teeth defects (false teeth, …)hyposalivationDecreased secretion of digestive juicesDecreased motility of GIT (tendency to obstipation)Decreased absorption of intestinesDecreased elasticity of colon – diverticulosisLow bone density - osteoporosis

Physiological changes in the elderly

Nutritional problems in the Elderly

o Obesity (overnutrition)

o Malnutrition (specific deficiencies, undernutrition)

o Dehydratation

Diet in older adults needs to be adjusted to changed nutritional needs and influence degenerative processes in older age

Decreased physical performance and mobilityDecreased BMRDecreased heat productionDecreased postprandial thermogenesis

Nutrition is often high in quantity and low in quality!

TENDENCY TO OBESITY IN THE ELDERLY

Contribution of organ/tissues to BMR of a non-obese man

Body composition phenotypes in pathways to obesity and the metabolic syndromeA G Dulloo, J Jacquet, G Solinas, J-P Montani and Y Schutz

Decrease of Muscle Mass in the Elderly

Recommended intake: 1,5-2 l /dayo Depends on physical activities, type of food consumed, physical

health, environment /weather

Lowered fluid intake:o Hyposalivationo Dry moutho Headacheso Worsened concentration, confusion, dizziness

FLUID NEEDS IN THE ELDERLY

CAUSES OF DEHYDRATION

cognitive impairmentchanges in functional abilitymedication such as laxatives, diuretics or hypnoticsillness stress (arising from other factors)

POSSIBLE SIGNS OF DEHYDRATION

Decrease in urinary output or dark urine.Sudden weight loss (e.g. 5% or more of body weight)Sunken eyesHollow cheekbonesDry mucous membranesCracked lipsSkin turgor is poorChange in state of alertness (in extreme dehydration)Deep, gasping breath

↓ BMR: Men over 65 yrs (compared to 20yrs old) - 25 % Women over 65 -15 %

Lowered physical activity

Decreased lean muscle mass

ENERGY NEEDS IN THE ELDERLY

oNeed is probably slightly increased oHigh intake o Kidney burdeno High intake of fats, cholesterol, purines

PROTEIN NEEDS IN THE ELDERLY

o ↓ tolerance to glucose o complex saccharides with low GIo Fibre 25-30 g/day

CARBOHYDRATES IN THE ELDERLY

CALCIUM osteoporosis

IRON Insufficient intake per os Impaired absorption (hypo- a achlorhydria) Gastrectomy, intestine resection Blood loss Vitamin C and meat protein increases absorption

MINERALS IN THE ELDERLY

Vitamin D ↓ exposition to sunrays

Vitamin B12 30-50 % of the elderly - atrophic gastritis Impaired production of intrinsic factor Decreased food intake

Folic acid Hypo -, achlorhydric patients (atrophic gastritis)

Vitamin C Impaired oral health (chewing, …), smoking

VITAMINS IN THE ELDERLY