chapter 15 nutritional requirements for older adults and eating habits affecting oral health...

CHAPTER 15CHAPTER 15

NUTRITIONAL REQUIREMENTS NUTRITIONAL REQUIREMENTS FOR OLDER ADULTS AND FOR OLDER ADULTS AND

EATING HABITS AFFECTING EATING HABITS AFFECTING ORAL HEALTHORAL HEALTH

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2

Older Adults: General Health StatusObesity is most

common nutritional disorderContributes to common

chronic diseases: diabetes, cardiovascular disease

Exacerbates age-related decline in physical function; leads to frailty

Malnutrition risk in those with:Less education and

incomeHousebound, especially

those living alonePhysical disabilitiesDepression and other

mental health issuesDrastic changes, such as

death of spouse


Older Adults: Physiological Factors Affect Nutritional Status

Oral cavityOral health issues including chewing,

swallowing, and mouth pain are indicators of risk for malnutrition

Changes in taste and smell may increase cariogenic food choices

Xerostomia may lead to avoidance of crunchy, dry, and sticky foods May choose hard candies to stimulate saliva,

increasing caries riskFrom Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Anatomy & Physiology, ed 6. St.

Louis: Mosby, 2007.Louis: Mosby, 2007.



Oral cavity Periodontal disease increases likelihood of weight lossQuality nutrient intake decreases as number of teeth

decreases Studies have found that people with fewer than 28 teeth had

significantly lower intakes of fruits and vegetable and lower serum levels for beta-carotene, folate, and vitamin C

Japanese study found total protein,

animal protein, sodium, vitamins D, B1, B6,

niacin, and pantothenic acid were

associated with number of teethFrom Perry DA, Beemsterboer PL: From Perry DA, Beemsterboer PL:

Periodontology for the Dental Hygienist, Periodontology for the Dental Hygienist, ed 4. St. Louis: Saunders, 2014.ed 4. St. Louis: Saunders, 2014.



Gastrointestinal tractChanges in esophageal motility and

deterioration of nerve function maycause dysphagia Those with dysphagia eat slowly and may

not be able to consume adequate amountsDiminished hydrochloric acid secretion may affect

absorption of calcium, iron, and vitamin B12

Constipation may result from altered GI motility and benefits from fiber-containing foods, adequate fluid intake, and physical activity

From Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 8. St. Anatomy & Physiology, ed 8. St.

Louis: Mosby, 2013.Louis: Mosby, 2013.



Hydration statusDecreased thirst associated with aging may

predispose to dehydrationCertain chronic illnesses (heart and kidney disease)

lead to impairment of homeostatic mechanisms controlling fluid balance



Musculoskeletal systemBone resorption progresses rapidly in the older patientAfter age 45, lean body mass declines up to 0.4%

every year and adipose tissue increases Inactivity responsible for loss of muscle strength and balance

and may predispose to falls Sarcopenia is the reduction of skeletal muscle mass and

replacement by fat that occurs in older adults Maintaining muscle is essential in reducing the risk of falls

Decline in lean body mass results in decreased basal metabolic rate


Older Adults: Socioeconomic and Psychological Factors

Socioeconomic factorsInflation, failing health, medical bills, and cost of

medications can have a devastating effect on fixed incomes

Title III Nutrition Programs for Elderly (congregate dining and Meals on Wheels) are available

Psychological factors predispose to decreased appetite and interest in foodApathyDepression


Older Adults: Nutrient Requirements—Fluids

Requirements for most micronutrients increased due to effects of aging on absorption, utilization, and excretion

Fluids = minimum 8 glasses of water/daySome older adults may restrict fluids because of:

Nocturia (excessive urination at night) Incontinence (inability to control urinary excretion) Pain associated with movement due to arthritis Having to request assistance to be toileted


Older Adults: Nutrient Requirements—Vitamins

Vitamin D intake is higher for olderadultsAges 51 to 70: 10 µg daily Ages 71+: 15 µg daily30% of persons ages 60 years and older in lower latitudes

have vitamin D insufficiency in the winter

10% to 30% have absorption of vitamin B12

Requirements for folic acid, vitamins B6, and B12 increased to prevent decline in cognitive function and reduce risk for coronary artery disease


Older Adults: Nutrient Requirements—Minerals

CalciumAI = 1200 mg higher than for younger

adults to maintain bone mass and reduce risk of osteoporosis

Decreased physical activity contributes to loss of bone density

SodiumIntake may need to be adjusted based

on physiological condition (e.g., hypertension, congestive heart failure)


Older Adults: Eating PatternsMany older adults have a poor dietDeficiencies

1 in 4 older adults consumes less than recommended servings of meat

Dairy products, fruits, and vegetablesfrequently lacking in the diet, especially for those living alone Routine consumption of milk is difficult because of its expense

and frequent trips to purchase it

Choice of soft foods usually results in a decrease in protein and intake of more simple carbohydrates


Older Adults: Eating Patterns

Snacking and nutritional supplementsSnacking may ensure older adults consume adequate

amounts of kilocalories and proteinHealthy snacks such as cheese, hardboiled eggs, low-

fat milk products, bananas, and canned fruit can be recommended

Milk-based food supplements, such as an instant breakfast mix, are economical and can help prevent nutrient deficiencies

Commercial liquid nutrition supplements, such as Ensure or Sustacal, may be more convenient


Older Adults: Eating Patterns

Food safetyMore susceptible to food-borne illness because of:

Compromised immune system Decreased hydrochloric acid in the stomach Lessened senses of smell and taste


MyPyramid for Older AdultsEmphasizes nutrient-dense foodsIncludes packaged, frozen, or

canned fruits, in addition to fresh vegetables that may be more readily available and have a longer shelf life

Stresses the importance of consuming fluids

Foundation: activities characteristic of older adults Copyright 2007 Tufts University. Reprinted with permission Copyright 2007 Tufts University. Reprinted with permission

from Lichtenstein AH et al: Modified MyPyramid for Older from Lichtenstein AH et al: Modified MyPyramid for Older Adults. J Nutr 2008; 138:78-82.Adults. J Nutr 2008; 138:78-82.


MyPyramid for Older AdultsVitamins/mineral supplements

Flag at the top of MyPyramid for Older Adults reminder about increased need for calcium, vitamins D and B12 Calcium—1200 mg Vitamin D—600 IU for adults ages 51 to 70 and 600 IU for those

older than 70 years Vitamin B12—2.4 µg

Dietary Guidelines for Americans recommends eating fish twice a week for omega-3 fatty acids

NIH panel advises seniors with early-stage macular degeneration to take antioxidants (vitamins C, E, and beta-carotene and zinc)

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

HEALTH APPLICATIONGenomics

Consider nutrigenomics in relation to determining genetic susceptibility to diet-related chronic diseases

Discuss how this research may change the future of healthcare

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chapter 15 nutritional requirements for older adults and eating habits affecting oral health...

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