By

Eng. Nashat Dahiyat

Nutrition assessment in the elderly people

Content 1. Introduction2. objective 2.1. Nutrient Consumption 2.2. Micronutrients of Concern 2.2.1. vitamins 2.2.2. minerals 2.3. Supplementation3. case study : Dehydration in the Elderly4. Recommendation5. Conclusion6. References

One of the major determinants in maintaining

Low risk of disease and disease-related

disability

High mental and physical function

Active engagement of life

Nutrition, along with physical activity and not

using tobacco, is more influential in avoiding

age-associated deterioration than genetic

factors.

( American Dietetic Association 2005 )

Nutrition and Aging

Discuss incidence of malnutrition and

dehydration in the elderly

Discuss specific micronutrients that are of

most concern and why

Note dehydration signs and symptoms

Provide recommendations for treatment and

prevention of malnutrition and dehydration

Objectives

With age, metabolism decreasesBody composition changesMuscle mass decreases as adipose tissue

increases Results in 2% deceased metabolic rate

per decadeDecreased physical activity – less energy expenditure

Aging and Energy Needs

30% of elderly consume less kilocalories than recommended (Lengyel et al 2008) Decreased intake due to : Loss of appetite – depression, dementia Medication-induced anorexia Impaired taste perception Decreased density of taste buds (Winkler et al

1999) Higher thresholds for detection of tastes Loss of teeth Socioeconomic factors or functional disability

effecting shopping and meal preparation .

Nutrient Consumption

Malnutrition is closely related to increased mortality

and morbidity Greater susceptibility to infection and longer

hospital stays Escott-Stump 2008), increased risk of medical and

surgical complications (Baker and Wellman 2005),

increased risk of pressure ulcers, hip fractures (Escott-Stump2008)

Incidence of malnutrition estimates range from 20

– 78 % (Bouillanne et al 2005)

Incidence of Malnutrition

Those with low lean body mass – about 25%

of elderly population over the age of 65

Loss of muscle strength, physical inactivity, slow or unsteady gait, poor appetite, unintentional loss of

weight, impaired cognition and depression (Escott- Stump 2008)

Proper nutrition can help correct, butphysical activity is also necessary

Frail Elderly or FTT

Compared to 20yr olds, 80yr olds need 1000 to 1500kcals less in men 600 to 800kcals less in women (Wakimoto et al, 2001)

Protein needs remain same with age or slightly higher (Elmadfa and Meyer 2008) 0.8 to 1gm/kg body weight Kilocalorie protein supplement (i.e.Boost, Ensure) may be helpful in preventing muscle wasting with inadequate total kcal intake (Evans 2004)

Fat intake among the elderly is greater than the recommended 35% or less of total kilocalories (Meydani 2004)

Macronutrient Needs

Vitamin and mineral needs remain unchanged withAge

Decreased food intake often results in deficient intakes of micronutrients

50% of older persons have lower than recommendedintakes of micronutrients (Escott-Stump, 2008)

80% of elderly persons have inadequate intakes of atleast on nutrient (Guigoz et al 2004)

Digestion, absorption, and synthesis ofmicronutrients are decreased (Elmadfa and Meyer, 2008)

Aging and Micronutrient Needs

Vitamins 1 . Vitamin E 2 . Vitamin C3 . Vitamin D4. Vitamin A 5. Thiamine

Minerals 1 . Selenium 2 . Zinc 3 . Calcium 4 . Iron

High homocysteine levels resulting from B6, B12, folate deficiencies linked to increased cardiovascular disease risk and decreased mental agility

Folate deficiencies linked to increased dementia and depression (D’Anci et al 2004) Excessive folate intake can mask B12 deficiency

Corrects hematological signs of deficiency but not neurological signs Neurological signs include fatigue, malaise, vertigo, cognitive impairment (Clarke et al 2003)

Deficiency Risks

Diuretics increases water-soluble vitaminslosses as urinary excretion is increased Thiamine is especially at risk of becomingdeficient due to diuretics Low dose thiamine supplement in the elderlyon diuretics may be useful in preventing

deficiency (Escott-Stump 2008)

Thiamine and other water soluble vitamins

Commonly deficient – Lengyel et al 2008found 10%, 84%, 49% of subjects deficient

respectively

Frail elderly are more likely to be deficient vitamin E and A (Michelon et al 2006)

Centenarians are more likely to have high levels of Vitamin E and A (American Dietetic Association 2005)

Needed for drug metabolism and detoxification

Vitamins A, E, and C

Vitamin C, E, beta-carotene needed in

adequate supply for decreasing oxidative

damage to tissues and cells including

immune cells

Balanced diet seems to be more effective

than supplementation for improved immune

function but supplementation maybe

effective

Antioxidants

Bone mass decreases with age especially in women resulting in osteoporosis Direct health care cost of $12-18 billion each year just for fractures (USDHHS 2004) Absorption of calcium and vitamin D effected by age - receptor expression in duodenum decreases

Vitamin D synthesis decreases (MacLaughlin et al 1985) Less time spent exposed to sunlight (Escott-Stump 2008) Vitamins A and K, and magnesium effect bone health as well, but more research needed (American Dietetic

Association 2005)

Calcium and Vitamin D

Depression in the elderly is associated with low levels of selenium (Gosney et al 2008)

Low levels of selenium, zinc, and iron linked to reduced cell-mediated immune response

(Wintergerst et al 2007)

Low zinc intake associated with increased wounds and severity (Tobon et al 2008)

Selenium, Zinc, Iron

Age Weight (current

&usual)DentitionDysphagiaSkin conditionConstipation/DiarrheaCurrent medications

I/OsChanges in appetiteN/V, indigestionPainInfectionMotor coordinationMorbidities

Glucose C-reactive protein (CRP) Ca++, Mg++ N-3, K+ H&H, serum Fe

Serum folateSerum

homocysteineAlbumin,prealbum

in, or transthyretin Cholesterol

Increased total number of medications associated with decreased appetite (Elmadfa and Meyer 2008)

Evaluate for alcohol abuse Can cause severe deficiencies of thiamine,

folate, vitamin B12, and zinc May not admit to true amount being

consumedScreen for caffeine use May promote cognition Excessive use can have diuretic effect (Escott-Stump 2008)

American Dietetic Association. Position paper of the

American Dietetic Association: Nutrition across the spectrum of aging. J Am Diet Assoc .2005:105:616_633.

Elmadfa, I, Meyer AL. Body composition, changing

physiological functions and nutrient requirements of the elderly. Ann Nutr Metab 2008;52(suppl 1):2_5.

Ferry M. Strategies for ensuring good hydration in

the elderly. Nutr Rev 2005;63(6):S22-S29

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Ndhayyat@aseza.jonashatdhiat@yahoo.com