Nutritional Care of Older Adults
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Transcript of Nutritional Care of Older Adults
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Nutritional Care of Older AdultsLaurie B. Steenwyk M.Ed, RD, LDN
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Class Overview
Assessing Nutritional StatusNutritional Needs of the ElderlyNutrition InterventionsEating Lifestyles
Meal planning for optimal health
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Assessing Nutritional Status
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Factors Impacting Nutritional Status in the Elderly
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Assessing Weight Status
BMI <23 considered underweight >65 yrs
Percent Weight Loss (unintended) >5% in 1 month (quadruples risk of death) > 7.5% in 3 months >10% in 6 months
Cachexia Severe wasting accompanying diseases such as cancer
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Mini Nutrition Assessment
6 question screening tool
Complete in <5 minutes Validated for age >65 More sensitive than BMI Available at:
http://www.mna-elderly.com/
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Sarcopenia
Sarcopenia Loss of skeletal muscle associated with aging Affects 8-40% of adults >60 yrs 50% of adults >75 yrs
Sarcopenic ObesityCoexisting loss of skeletal muscle mass
and strength with excess body fat
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Nutritional Needs of the Elderly
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Energy
Energy (calorie) needs decrease with age, mostly due to decreased physical activity
LBM declines with age and influences energy needs
Protein and vitamin/mineral needs remain the same or increase
Challenge: adequate micronutrients within caloric requirement
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Nutrients of Concern
Risk for deficiency with age WaterFiberProteinCalcium and Vitamin DVitamin B12Vitamin C and E – antioxidants
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Water
Dehydration is a form of malnutritionKidneys’ decreased ability to
concentrate urineAdverse effects of medicationMobility disordersFear of incontinence25-30 mL/kg actual body wt
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Fiber
Fiber Goals for adults over 50: Men: 30 g per day Women: 21 g per day
Insoluble: Tough, fibrous plant material that does NOT absorb water Most grains and vegetables
Soluble: Plant fibers capable of absorbing water and become gummy or gel-like Oats, fruit, legumes, pectin, inulin, psyllium
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Sources of Fiber
OatsBarleyWheatQuinoa
FlaxBrown Rice
BranLegumes
SeedsFruits
Vegetables
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Protein
Muscle mass (LBM) decreases 15% per decade after age 70
Needs increase with illness, injurySurgery, wounds, CHF, COPD, Cancer
Optimal intake: 25-30 gm/mealEven distribution most effective in preventing
muscle loss during illness
1-1.6 gm/kg IBW may prevent sarcopenia
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PROTEINSources:
Animal Proteins Egg, Turkey, Fish, Beef…
Dairy Milk, Cheese, Yogurt, Cottage Cheese…
Legumes and Nuts Black Beans, Red Beans, Lentils, Walnuts…
Some from grains/breads/plants Quinoa, Greens, Broccoli, Oats, Pasta…
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Vitamin D
800 IU >70 years Safe upper limit
4000 IU Supplements are
recommended for older adults
Sources Fortified milk Fatty fish, fish oil Liver Egg yolk Some enriched
beverages Exposure to sunshine
during Spring, Summer, early Fall
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Calcium
1000 mg Men <70 years1200 mg Men >701200 mg Women >50Safe upper limit 2000 mg/dayA large recent study suggests that
calcium supplements don’t prevent hip fractures
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Calcium
Dairy Sources 1 cup milk – 300 mg 4 oz yogurt – 200 mg 1 oz cheese – 200 mg ½ cup cottage cheese –
65 mg ¼ cup ricotta cheese -
200 mg
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Non-Dairy Calcium Sources
1 cup Calcium fortified orange or apple juice (240 mg)
Enriched, GF almond, soy or rice milk – 300 mg
3 oz Sardines – 370 mg 3 oz Canned Salmon w/
bones – 180 mg Almonds ½ cup Broccoli (90 mg) 2 oz Tofu (made w/
calcium sulfate Firm Tofu (385 mg) Regular Tofu (200 mg)
1 T Blackstrap Molasses – 135 mg
1 T Tahini – 65 mg
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Other Nutrients in Bone Health
Vitamin KLeafy greens, broccoli, soybean oil
ManganeseSpinach, peanuts, almonds, brown rice,
green teaExcesses of sodium, protein and
phosphorus decrease calcium availability.
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Vitamin B-12
6-15% of older adults are deficientAnother 20% have marginal statusCompromised absorption
Pernicious anemiaLack of intrinsic factorAtrophic gastritisLong-term use of PPIs
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Vitamin B-12 Deficiency
Symptoms Folate Deficiency Numbness, tingling of arms, legs Difficulty walking Memory loss Disorientation Dementia Sore tongue Poor appetite Constipation Possibly depression
Sources Meat Poultry Fish Dairy Products
Supplement Recs: Adults 2.4 mcg/day >50 yrs should take supplement >65 yrs 100-400 mcg/day
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Anti-Oxidants (C and E)
Vitamin C RDI 75 mg females
and 90 mg males 400 mg may be
beneficial to older adults
UL is 2,000 mg The role of anti-
oxidants in macular degeneration and dementia is unclear
Vitamin E RDI: 15 mg for adults UL is 1000 mg Supplements can
increase risk of bleeding in patients on anti-coagulant therapy
Sources: oils, nuts, peanuts, avocado
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Nutritional Interventions
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Increasing Calories
5-6 small meals/between meal snacks Calorically dense foods
Nut butters, dried fruits, fruit purees, starchy vegetables, legumes, cheese, yogurt
Drink calories Milk, juice, smoothies, soups
Increase fats butter, sour cream, cream cheese, oils,
mayonnaise, avocado
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Oral Nutrition Supplements
Use 1.5 -2.0 cal/mL Ensure Plus, Ensure Clinical Strength, TwoCal,
Boost Plus, etc Serve 3-4 oz portions several times Use as a “med pass” Dilute with whole milk or serve frozen to
reduce sweetness Encourage 1 sip every 5 minutes to reduce
early satiety
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Texture
Meats: chopped, ground, pureed Use puree molds or small colorful
dishes Piping soft foods, garnish with
sauce Cut hard fruits, vegetables into
bite sized pieces Finger foods work well with
dementia or severe arthritis
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The Dining Experience
Buffet service, family style serviceEncourage selectionAvoid social isolationMusicAromaAppearance and presentation
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Home Meals
Financial limits Eggs, peanut butter, canned beans, tuna,
turkey, frozen veggies, rice Limited cooking ability
Weight Watchers, Healthy Choice, Kashi Meals Precut fruits and veggies Prepared soups, crackers, whole grain bread,
bagels, quick oatmeal, cheese, yogurt, cottage cheese, frozen veggies, bananas, grapes, hummus
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Appetite Stimulants
Limited evidence of effectiveness in the elderly
Megace Remeron Eldertonic Marinol Periactin Oxandrin
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Eating Lifestyles
The Mediterranean DietThe DASH DietThe New American PlateMyPlate for Older Adults
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2009 Version
Fruits, Vegetables, grains, olive oil, beans, nuts and seeds are grouped together at the base
Herbs and Spices are added at base
Fish is promoted over poultry and dairy
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Benefits
9% decrease in overall mortality9% decrease in death from
cardiovascular disease6% decrease in death from cancer13% decrease in incidence of
Parkinson’s and Alzheimer’s Disease
Safi, F. et al, Adherence to Mediteranean Diet and Health Status: Meta-analysis. British Journal of Medicine, 2008: 337:a1344.
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Key Mediterranean Principles
Generous amounts of fruits and vegetables
Healthy fats: olive oilSmall portions of nutsRed wine in moderation, for someVery little red meatFish on a regular basis
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DASH Diet PyramidDietary Approaches to Stop Hypertension
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DASH Benefits
Reduces blood pressure, especially in older adults.
Also protective againstOsteoporosisCancerHeart DiseaseHeart FailureStrokeDiabetes
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Key DASH Principles
Limits sodium to <2300 or <1500 mg/day Generous amounts of fruits & vegetables Whole Grains Emphasizes low fat dairy Monounsaturated Fats
<27% of calories from fat Legumes, nuts or seeds daily Lean protein: fish, poultry, soy products High in calcium, potassium and magnesium
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New American Plate Proportions:
2/3 plate should be plant based Whole grain Vegetables Fruit Legumes
1/3 from protein Fish Lean Beef Poultry Dairy
1/3
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2007 Expert Report on Cancer Prevention
Joint effort of AICR and World Cancer Research Fund
7000 global scientific studies reviewed
10 lifestyle recommendations for cancer prevention
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Diet Recommendations
Limit sugary drinks and energy dense foods Eat more of a variety of fruits, vegetables,
grains, legumes Limit red meat and processed meats Limit salt and foods processed with sodium
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MyPlate for Older Adults
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MyPlate for Older Adults
Bright-colored vegetables such as carrots and broccoli. Deep-colored fruit such as berries and peaches. Whole, enriched and fortified grains and cereals such as brown rice
and 100% whole wheat bread. Low- and non-fat dairy products such as yogurt and low-lactose
milk. Dry beans and nuts, fish, poultry, lean meat and eggs. Liquid vegetable oils, soft spreads low in saturated and trans fat,
and spices to replace salt. Fluids such as water and fat-free milk. Physical activity such as walking, resistance training and light
cleaning.
http://now.tufts.edu/news-releases/tufts-university-nutrition-scientists-unveil-
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Resources
Food & Nutrition Information Centerhttp://
fnic.nal.usda.gov/lifecycle-nutrition/agingTufts Human Nutrition Research
Center on Aginghttp://hnrca.tufts.edu/
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Resources
DASH Eating Plan Booklet, free on the web: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
Mayo Clinic http://www.mayoclinic.com Use their search engine and type in “DASH Diet” or
“Mediterranean Diet” to view numerous consumer friendly articles.
Oldways: Mediterranean diet info http://www.oldwayspt.org/med_pyramid.html
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Resources
AICR: The New American PlatePrintable brochures, Cookbook, recipes
http://www.aicr.org/site/PageServer?pagename=reduce_diet_new_american_plate
Linus Pauling Institute micronutrient information centerhttp://lpi.oregonstate.edu/infocenter/
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Questions???