NUTRITION AND OLDER ADULT

Ms.Jonahlyn Gonzales Corpuz,RN,MAN

Outline

CHANGES IN THE BODY COMPOSITION

SENSORY CHANGES Impact of Chronic Disease on Nutritional Status DRIs (Dietary references Intakes) Causes of Unintentional Weight Loss Nutrition Assessment Tools Nursing assessment and Intervention

Nutrition in the Later Years

Should be highly individualized!

CHANGES IN THE BODY COMPOSITION

SARCOPENIA
Decrease lean muscle mass Causes : 1. Decrease physical activities-- Disability or disease or sedentary life style 2. Decrease anabolic hormone production (testosterone,growth hormone) 3.Increase cytokine activity (The Role of Immune System Chemicals in Autoimmune Disease 4. Decreased nutrition

SARCOPENIA
Loss of muscle can lead to

1. Functional decline in strength and endurance affected (loss of type 2 muscle fibers)-2. Physical activity decline-Predisposition to falls 3. Lower total body water (TBW) At age 65, TBW drops to 60% (a decline from 72% as younger adult.)

Bone Mineral Density

Bone mineral density is also lost with aging both man and woman Women risk of osteoporosis following menopause Men- at risk later in life

Oral and Gastrointestinal Changes

At age 65,- 33.1% of adults are EDENTULOUS (EDENTULISM)
Poor dental hygiene Missing or loose teeth Ill fitting dentures -This affects amounts and types of foods consumed and interfere proper nutrition.

Xerostomia - Lack of sufficient saliva production

(Saliva production declines ) Cause: Dehydration, medications, disease Dry mouth affect 1. taste perception 2. Hinder swallowing 3. Insufficient retention of poorly fitting dentures

ACHLORHYDRIA
(lack of hydrochloric acid) In stomach-dec.in size and number of glands and mucous membrane. ATROPHIC GASTRITIS
Absorption of B12 and iron is impaired Because reduced gastric production of intrinsic factor - can also impair B12 absorption(needs acidic environment)

APETITE DYSREGULATION
Cholecystokinin (CCK) production cause by change in emptying and central neurotransmitter ,increases with age and can cause- early satiety . Anorexia of agingthe physiological effect of temporary weight loss that become permanent.

CONSTIPATION
Slowed intestinal peristalsis Contributing factors: Inadequate intake of fluid and fiber Illness or medications Sedentary lifestyle

THIRST DYSREGULATION

Angiotensin production is impaired Increased risk of uncompensated dehydration + decrease TBW -Altered thirst mechanism

Sensory Changes

Changes in vision, hearing, taste, and smell impact the ability to obtain, prepare, and enjoy food.

Altered Nutritional Adequacy

Vision changes (cataract, and macular degeneration and poor vision) Make shopping and food preparation and eating hard Difficulty in reading the labels and cooking instructions, risk in handling hot food or stove Difficult to see food and reduced enjoyment . Poor vision is associated w/ decline in protein/energy

Altered Nutritional Adequacy

CHANGES IN HEARINGMake dining experience more difficult Social isolation (embarrassment)o risk factor for undernutrition in the older person.

Altered Nutritional Adequacy

CHANGES IN HEARINGMake dining experience more difficult Social isolation (embarrassment)o risk factor for undernutrition in the older person.

Nutritional requirements and Aging Unique nutritional requirement due to 1.PHYSICAL AND 2. FUNCTIONAL CHANGES Decline physical activity- lower calorie needs, not decreased in vitamins and minerals . 2 Approaches to provide nutritional recommendations that work with the educational tools. 1. DRIs 2. Food Guide Pyramid

DRIs (Dietary references Intakes)

DRIs(dietary Reference Intakes) Food Guide Pyramid

Provide specific nutrient recommendation Divided into age groups of 51-70/ and 70 and above Recommendations: A) RDA (recommended daily allowance) Meet 97%-98% of healthy people within the specific age groups B) AI (Adequate intake) C) TULs (Tolerable upper limits) Provides guidelines for safe upper limits intake of nutrients D)EERs (Estimated Energy Requirements Based on gender,age,BMI,activity level.

Translates scientific recommendatio n DRI into recommended for daily eating

 Recommended dietary allowance

RDA-Protein

Protein 0.8 gm/kg body weight Needs remain about the same through adult life, but choosing low-fat fiber-rich protein foods may help control other health problems.

DRI
Dietary reference intakes for energy, or estimated energy requirements (EER)
Based on gender, age, body mass index, and activity level 1,600 cal values for all food groups.

EER
The EER (estimated energy requirements )is adjusted for age to account for losses in lean muscle mass Men more than 30 years of age adjust calories downward by 7 calories/decade Women than 30 years of age adjust by 10 calories/decade more
Gerontological Nursing

Carbohydrates & Fiber

6-11 servings of breads, grains and pasta Fiber is necessary to prevent constipation

Fats
Should be limited for the following reasons:
foods lowest in fats are richest source of vitamins, minerals and phytochemicals diets rich in certain fats are associated with many diseases high fat diet correlates with obesity

AI
Adequate intake for vitamin D
Role in maintaining bone mineralization and proper serum level.

Inadequate poor bone mineralization,rickets,osteomalacia Between 51 and 70 years- 400 IU per day Over age 70- 600 IU per day Tolerable upper limit (TUL) is 2,000 IU per day
Gerontological Nursing

Calcium
Maintenance of bone mineral density and plasma calcium levels-1% Majority reserve are in the bone and teeth Inadequate osteoporosis, periodontal dse AI 1,200 -1,500 mg per day TUL 2,500 mg per day

B12 (cyanocobalamin)
Require in cell division and to maintain the myelin sheaths of the CNS RDA 2.4 mcg per day Inadequate
Risk of decreased absorption and CNS sequelae possible Macrocytic anemia Neurological problems such as peripheral neuropathy, irritability,depression,and poor memory,athropic gastritis Altered gastric pH

Folic Acid

If giving the TUL of folic acid (1 mg), - B12 should be added to prevent masking deficiency.
Vitamin B6 (pyridoxine) Required co enzyme in metabolism of protein, fats, and other biochemicl reactions RDA 1.5 mg/day- women,1.7 mg/day- men

Routine Recommendations
Nutrients with routine recommendations
Vitamin D Calcium B12

Hyperhomocysteinemia or Alcohol Abuse

DRI -B6 1.5 mg for men or 1.7 mg per day for women TUL of B6 is 100 mg
Toxicity can cause reversible neuropathies

Gerontological Nursing Patricia Tabloski

Water
RDA 1 to 1.5 ml/calorie of energy intake Approximately 9 cups/day = women 13 cups/day = men Minimum of 1500 ml per day recommended Alcohol and caffeinated beverages not to be included in fluid calculations

Causes of Unintentional Weight Loss

Insufficient intake Increased losses Hypermetabolism

Gerontological Nursing

Physical and Psychological Causes for Insufficient Intake

Reduced access Fear of incontinence Dependence for toileting or feeding Depression or cognitive impairment Polypharmacy Pain Chronic diseases Dysphagia Sensory changes
i

Physical and Psychological Causes for Insufficient Intake (cont.)

Diet
Preferences Unfamiliarity Medically restricted diets

Finances
Quality and quantity

Hypermetabolism
Chronic illnesses Fever Wounds Infection Fractures

Nutrient Losses
Malabsorption or high output from diseases or treatments

Consequences of Undernutrition
Impact quality and quantity of life, and morbidity and mortality
Poor wound healing Skeletal muscle loss Functional decline Altered immune response Altered pharmacokinetics Increased risk of institutionalization

Nutrition Assessment Tools

Nutritional Screening Initiative (NSI) DETERMINE checklist Mini Nutritional Assessment Subjective Global Assessment

Gerontological Nursing

Patient Being Weighed on a Bed Scale

NUTRITIONAL ASSSSEMENT PARAMETERS A-ANTHROPOMETRICS B- Biochemical Values

C- Clinical assessment
D- Diet history

ANTHROPOMETRICS-scientific measurement of the body A)Height Standing or recumbent pos(lying flat) or arm/leg calculationst Indirect measurement (Demi- arm-fingertip to sternal notch times two Arm-left finger to right finger B)Weight Standing independently or with bed or chair scales Done w/ minimal clothing Take note edema wt. hx of loss of 5%/mos & 10%/6 mos-clinical significance

Anthropometric Measures
C)BMI (body mass Index) BMI: wt(kg)/ht2(m) <22 undernutrition (higher mortality) >25 overweight (risk for morbidity) D) Body fat measurements Calipers-tricep skinfold measurement (done by experience person.)other site subscapular,ileac creast,thigh Bioelectrical impedence Near infrared devices (use for elderly for research) Muscle mass Midarm circumference measure to derived lean body mass.

Laboratory Values
PLASMA PROTEIN(use to assess visceral protein status Albumin < 3 to 3.5 mg/dl mild malnutrition Half-life 21 days Prealbumin Half-life 2 to 3 days Transferrin Affected by anemic states Half-life 8 days MCV(folate and Vit B12 assessment) High indicates possible B12 or folate deficiencies

Laboratory Values (cont.)

Cholesterol
<160 may indicate malnutrition if not caused by pharmacological reduction

Lymphocyte percent
Almost 100% protein content Decreased levels can indicate lowered overall protein status

Clinical findings identified during nursing assessments

Gerontological Nursing

Nutritional History

1.Dietary recalls
24 -hour recall- to determine daily/ weekly consumption of food 2. Food frequency Excellent to use w/ 24 hrs recal 3. Food record Cognitive intact older person Three-day food record-provide view of variable eating pattern

NOTE: Dietary intake is often overestimated by Gerontological Nursing caretakers.

Nursing assessment
Abdomen- firmness and tenderness Bowel movement- last time Swallowing difficulty Positioning problems Pain Food preferences, religious, preference,cultural and ethic traditions Medications (early satiety, alteration in taste, appetite suppressant

Eating or Drinking Assessment

Dysphagia Positioning Need for adaptive equipment

Gerontological Nursing

Dining Environment Assessment

Small frequent meals Avoid distractions and delays Pay attention to smells, sounds, sights Include family members

Gerontological Nursing

Review of Medications
Review of medications potentially causing
Anorexia Depression Early satiety Taste alterations Lethargy Appetite suppression

Gerontological Nursing

Common Offending Medications

Common offending medications include
Digoxin Diuretics Chemotherapy Antibiotics Antidepressants

Gerontological Nursing

Nursing Interventions
Individualized nutritional care plans Feeding assistance Altering the physical environment Liberalizing restrictive diets Collaborating with registered dieticians Making appropriate referrals More aggressive interventions (feeding tubes and appetite stimulants) should be consistent with healthcare wishes and advance directives
Gerontological Nursing

Medical Nutritional Therapy

Weight loss and sodium restriction may benefit
Sleep apnea Osteoarthritis Hypertension

Gerontological Nursing

Remember: Whatever you do ENJOY IT!

We were always told that laughter is the best medicine and now we know it to be true it raises the Serotonin levels in the brain and gives you that feel good factor

Thank you for your kind attention!

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