The science of nutrition 4th edition thompson manore vaughan chapter 19

Chapter 19 Lecture

Chapter 19:
Nutrition Through
the Life Cycle:
The Later Years

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Older Adults

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Age 65 years and older
Age ≥85 years:

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"Very elderly" or "oldest of the old"
Fastest growing U.S. population subgroup

Average U.S. life expectancy = 78.8 years
Life span is the age to which the longest-living member of the species has lived

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Aging Process: Theories

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Aging occurs at the molecular, cellular, and tissue levels
Programmed theories of aging
Error theories of aging

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Cell damage from environmental insults
Linked to nutrient or energy status


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Aging Process: Lifestyle Factors

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Biological age can be influenced by personal choices

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Smoking
Excessive alcohol
Obesity
Sedentary


Sensory Perception

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Senescence: age-related processes that increase risk of disability, disease, and
death

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Systems begin to slow and degenerate
Declined odor, taste, and visual perception

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Dysgeusia: abnormal taste perception

Loss of visual acuity
Support of family and friends helps older adults with food selection and preparation
techniques

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Gastrointestinal Function

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Xerostomia: declined salivary production
Dysphagia: difficulty swallowing foods
Achlorhydria: low gastric HCl production, limits calcium, iron, folate, vitamin B 12
absorption

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Gut microbiota changes ("aging gut"), resulting in

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Increased inflammation

Decreased immune function of GI tract
Impaired functioning of gut mucosal cells

"Anorexia of aging"
Lactose intolerance

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Body Composition

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Increased body fat, sarcopenic obesity
Decreased muscle and lean tissue
Decreased production of hormones: testosterone and growth hormone
Bone mineral density declines
Adequate dietary intake and regular physical activity (strength/resistance training)
help maintain muscle mass and strength

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Organ Function

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Less adaptable to environmental or physiologic stressors
Kidneys: less able to concentrate waste
Liver: less efficient in breaking down drugs
Pancreas: reduced blood glucose control
Bladder control may decline
Connective tissues and blood vessels become increasingly stiff and less pliable
Neurons in the brain decrease: impaired memory, reflexes, coordination, learning
ability

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Factors That Accelerate Aging

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Biologic age is influenced by lifestyle:

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Smoking habits
Alcohol consumption
Sun exposure
Weight status
Level of physical activity


Macronutrients

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Decreased energy needs from loss of muscle mass and lean tissue:

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Lower basal metabolic rate
Reduced activity levels

Recommendations for fat, carbohydrate, proteins: same as for younger adults
Older adults can eat slightly less fiber

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Micronutrients

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Calcium and vitamin D requirements increase: poor calcium absorption and reduced
vitamin D production in the skin

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Iron needs decrease: reduced muscle mass; cessation of menstruation in women
Zinc recommendations stay the same
Vitamins C and E recommendations stay the same
Adequate intake of B-vitamins (B12, B6, and folate) is a special concern
Vitamin A should not be consumed in excess of RDA

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Supplements

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Older adults benefit from multivitamin/multimineral supplement
Single nutrients in some cases

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Vitamin B12
Calcium
Vitamin D

High-potency supplements pose risks

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Fluid

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AI for fluid: same as for younger adults

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Men: 3.7 liters/day
Women: 2.7 liters/day

Impaired thirst mechanism
Hypernatremia (elevated blood sodium levels)

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Overweight and Obesity

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Increases severity and consequences of osteoarthritis
Limits mobility
Causes functional declines in daily activities
Weight loss improves functional status

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Underweight

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Fewer protein reserves
Risk for poor wound healing and a depressed immune response
Geriatric failure-to-thrive: "the dwindles"

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The nine Ds of geriatric weight loss.

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Osteoporosis

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Diagnosed after menopause as estrogen levels sharply decline
Males: linked to declining testosterone levels, steroid therapy, and alcohol abuse
Most serious risk: hip fracture
Osteoporosis treatment: vitamin D and calcium supplementation, resistance
training, medications

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Arthritis

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One of the most prevalent chronic diseases
Osteoarthritis: a disease of "wear and tear"
Rheumatoid arthritis (RA): typically strikes younger adults, not associated with
obesity or overuse syndromes

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Nontraditional treatments (glucosamine)

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Additional Concerns

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Constipation—fluid and insoluble fiber

Dental health issues may cause older adults to avoid healthful foods
Vision disorder studies show beneficial effects of antioxidants
Cognitive impairment (demetia): lower risk with antioxidants, certain unsaturated
fatty acids, folate, vitamin B12, healthy weight

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Medications

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Interactions can be harmful, should be monitored
Polypharmacy: more than five prescription medications at once
Appetite effects
Alters nutrient digestion and absorption
Appropriate use of nutrient supplements can enhance the nutritional status of older
adults

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