GERIATRIC NUTRITION

Department of Nutrition
Medical Faculty of Sumatera Utara
PREFACE
Aging is a continuous process that occurs in the
absence of disease
Aging is a normal biologic process invlove some
decline in physiologic function
Factors that influenced ageing process are
genetics, illness, socioeconomics, and lifestyle
Quality of life reflects the role of nutrition in the
maintenance of health, the management of chronic
conditions , and the treatment of serious illness
TOPICS
Physiologic changes that involved nutrition support
Nutrition screening

Nutrition assesment of the elderly

Medical nutrition therapy

PHYSIOLOGIC CHANGES THAT
INVOLVED NUTRITION SUPPORT
The human growth period draws to a close around
age 30 senescence starts
There are certain systemic changes varying
degrees of efficiency and functional decline
Factors that affecting aging progress:
Genetics
Illnesses
Socioeconomics
Lifestyle
BODY COMPOSITION CHANGES
Fat mass and visceral fat increase, lean muscle
mass decreases
Sarcopenia the age-related loss of muscle mass,
strenght, and function quality of life decrease
physical activity weight bearing exercise can slow
its pace
Sarcopenic obesity the loss of lean muccle mass
with excess adipose tissue
SEDENTARY LIFESTYLE
Defined as a level of inactivity below the threshold
of the beneficial health effects of regular physical
activity burning under 200 calories per day
Greater risk of inactivity are CVD, hypertension,
diabetes, dyslipidemia, obesity, overweight, and
increased rase of age
SENSORY LOSSES
Age-related alterations to the sense of taste, smell,
and touch
Dysgeusia loss of taste
Hyposmia decreased sense of smell

Besides aging process, other caused by

medications, or some conditions such as zinc or
niacin deficiency
Untreated mouth sores, tooth decay, poor dental
and nasal hygiene, and cigarettes smoking
decrease
Impair: salivary, gastric acid, pancreatic secretions
and insulin
ORAL HEALTH
Poor oral health, tooth loss, use of dentures, and
xerostomia (dry mouth) difficult of chewing and
swallowing suggest: soft, easily chewed foods
and avoid dense food (whole grains, fresh
fruits/vegetables and meats)
Polipharmacy: taking five or more precriptions
moisture rich (soups and stews; adding sauces;
pureeing and chopping foods)
GASTROINTESTINAL
Weakened tounge or cheek muscles
dysphagia thickened liquids and texture-modified
foods
Decreased gastric mucosa damage such as
cancer, ulcers, infections
Achlorhydria (prone to B12 deficiency)

Atrophic gastritis

Constipation increasing fluids, activity, and fiber

OTHER DISEASE
Cardiovascular
Renal disease

Neurologic function

Depression providing nutrient- and calorie dense

food, and favorite foods
Hearing and eyesight
Vitamin B12 deficiency chronic tinnitus
Vitamin D hearing loss because involved in calcium
metab, fluid and nerve transmission
Vision loss difficulty shopping for, identifying, and
preparing foods
NUTRITION SCREENING

Tools to evaluate nutrition status in older adults:

The Mini Nutritional Assessment to detect risk for
malnutrition using questions and anthropometric
measurement
Anthropometric assessment (weight, height, and weight
loss)
General assessment (lifesyle, medication, mobility)
Dietary assessment (number of meals, food and fluid
intake, autonomy eating)
Self assessment (self perception and health)
Awareness tool to highlight the warning sign of
malnutrition: Determine Your Nutritonal Health
Checklist
DETERMINE YOUR NUTRITIONAL
HELATH
Yes
I have an illness or condition that made me change the kind 2
and/or amount of food I eat
I eat fewer than two meals per day 3
I eat few fruits or vegetables or milk products 2
I have three or more drinks of beer, liquor, or wine almost 2
everyday
I have toooth or mouth problems that make it hard for me to eat 2
I dont always have enough money to buy food i need 4
I eat alone most of the time 1
I take three or more different prescribed or over-the-counter 1
drugs a day
Without wanting, i have lost gained 10 pounds (4.5 kg) in the 2
last 6 month
I am not physically able to shop, cook, and/or feed myself 2
 Total nutritional score, if it is_
0-2: good recheck your nutritional score in 6 months
3-5: you are at moderate nutritional risk
3-5: you are at high nutritional risk
DETERMINE (as a warning sign)
Diease
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contact
Multiple medicine
Involuntary weight loss
Needs assistance in self-care
Elder years above age 80
NUTRITION ASSESMENT OF THE ELDERLY

Assessment measure: inaccurate or feasible

Clinical assessment
Anthropometric assessment:
for stature using knee height measurements and for weight
can be estimated by using recumbent measurement of arm
and calf circumference, subscapular thickness, and knee
height
Biochemical measurement: protein (albumin level) and
cholesterol
Dietary assessment
MEDICAL NUTRITION THERAPY
ENERGY
Energy need decrease approximately 3 per
decade because of decreasing basal metabolic
rate changing body composition
Needs: nutrient-dense food that provide substantial
amounts of micronutrients for calories supplied
PROTEIN
Protein requirements can vary because of chronic
desease
General declined inkidney function, excess protein
could unnecessarily
The RDA for protein is set at 0.8 g/kg/day, but this
range could vary
Suggested that older sedentary persons consume
at least 1.0 g/kg/day
Older persons who habitually perform high-intensity
exercise consume 1.2 g/kg/day

CARBOHYDRATE
Dietary giudelines recommended 45-65% of the
total calories
Emphasis is on increasing intake of complex CHO
sources (legumes, vegetables, whole grains, and
fruits) fiber and essentials vitamin
Dietary fiber laxation
LIPIDS
About 20-35% of total calories, with most PUFA and
MUFA sources
Less than 7% SFA

Less than 200 mg/ day cholesterol, minimal trans

fat
Not recommended losing fat in diet because of
severe restriction of fats alter the taste, texture, and
enjoyment of food
VITAMINS AND MINERALS
Vitamin B12 low gastric acids could slower releasing
B12 from protein suggest fortified food
Vitamin D supplementation, because the skin does
not synthesize vitamin as efficiently and declineing
kidney function
Vitamin E vitamin E-rich food (antioxidant properties)
Folate homocystein level
Calcium decrease absorption 1200-1500 mg/day
Potassium (4700 mg/day could blunt the effect of
sodium on blood pressure) and sodium (less than 1500
mg/day)
Zinc impaired immune function, anorexia, loss of
sense of taste, delayed wound healing (pressure ulcer)
WATER
Fluid balance is important
Dehydration in older adults can be caused by
decreased fluid intake, decresed kidney function, or
increased losses due to infrease urine output from
medication including laxative or diuretics
Symptom of dehiydration: electrolyte imbalance,
altered drug effect, headache, constipation, blood
pressure change, dizziness, confusion, and dry
mouth
 Older adults are at increased risk of dehydration
because of their impaire sense of thirst, fear of
incontinence, and dependence on others to get
beverages
Dehydration often unrecognized because it can
present as falls, confusion, change in level of
consciousness, weakness or change in functional
status, or fatique
Fluid intake should > 1500 mL/day, ensures proper
hydration
RECOMMENDATIONS FOR CHEWING
DIFFICULTY
Eat slowly and allow enough time for meal
Do not eat or drink when rushed or tired
Take small amounts of food or liquid in mouth; a
teaspoon, not a tablespoon
Concentrate on swallowing; eliminate distractions like
television
Avoid mixing food and liquid in the same mouthful
Place the food on the stronger side if there is unilateral
weakness
Add condiments such as mayonnaise, butter or jelly to
dry food to moisture texture
Enhance taste with orange juice or vinegar and other
seasonings
THANK YOU