nutrition in aging-npa

8/9/2019 Nutrition in Aging-NPA

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Nutrition in Aging

Nurpudji A. TaslimNutrition Department

School of MedicineHasanuddin University

@ 2 !


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Older population- 55 years older population- 65 years elderly population

Median Age (In 2000)

- developed countries = 37 ! years- developing countries = 2! 3 years

"i#e $%pectancy (&' 2000)- average #or t e population = 76 years- = 7 5 years♀- = 7! * years♂


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Aging influences by:

gender

race+et nic co,position econo,ic status

presence o# disease

ealt e avior


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Theories of Aging

*) Aging as a result o# rando, events

2) Aging as a result o# progra,,edevents


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Major theories in random events

.ross-lin/ear and tear

1ree radicalate o# living

'o,atic ,utations


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"#$SS%&'N(

. e,ical conversion o# t e solu le #or,s o#collagen into insolu le collagenI,pact to decreased in elasticity and cellper,ea ility

ear and tearears o# da,age to cells tissues and organ

destroy t e,

1ree radical4or,al ,eta olic processes or e%posure to#ree radical da,age cells and cause aging


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#AT) $* &'+'N,

A #inite a,ount o# vial su stance t aten depleted result in aging and deat

S$MAT'" MUTAT'$N'pontaneous c anges in t e structure o#our genes cannot e corrected oreli,inated accu,ulate cause cells to,al#unction die


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MAJOR THEORIESIN PROGRAMMED EVENTS

enetic t eory8ace,a/er t eory


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enetic t eory

9eter,ines y in erited genes- :elp#ul pro,oting longevity- :ar,#ul s ortening li#e span$%ternal condition a##ected y;

1ree radicalsiological cloc/paced y neuroendocrine i,,une syste, regulate t e rate o# aging


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Physiologic changes

ro t ana olic

Aging cata olic

8 ysiologic age - re#lects ealt status- ,ay or ,ay notre#lect c ronologic age

"i#estyle #actor- ade?uacy regularity o# sleep- #re?uency o# consu,ption ell alanced ,eal- p ysical activity- s,o/ing status- alco ol consu,ption- ody eig t


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…..Cont. de .

-ody composition chan es- aging ,ar/ed 2-3@ loss o# lean ody ,ass(">M)+decade- sarcopenia-loss o# s/eletal ,uscle decreased ,uscle

streng t increased ris/ #or c ronic disease- resting ,eta olic rate decreased *5-20@

- reduce energy needs less ">M 1at

Sensory losses- s,ell taste sig t earing touc di,inis ed

- nu, er o# papilla (tongue) ol#actory nerve↓ ending reduce appetite pleasure o# #ood #ood orne illness

- earing loss i,paired vision loss o# #unctionalstatus lo er #ood inta/e


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$ral health status

- %erosto,ia (dry ,out ) di##iculty in c e ing ands allo ing

- dental caries periodontitis toot one loss - eat less e##iciently #ood inta/e

,astrointestinal function. anges in nutrient inta/e a sorption ,eta olis,(McIntos 200*)Mucosal i,,une response (>e ar/a 200*)9ysp agia

astritis atrop y a##ect ioavaila ility o# nutrientsnutritional status ris/ developing c ronic diseaseAc lor ydria > *2 de#iciency (Biesel 2000)


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.onstipation

Most co,,on digestive co,plaints caused yprolonged recto-sig,oid transit ti,e"i,itation o# ,o ility or activity8syc ology #actorMedicationManage

dietary #i er #luid and /ilocalories p ysical activity


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"ardiovascular function- lood vessel less elastic total perip eral resistance ris/ #or ypertension- inade?uate lood #lo to t e eart . disease (&'A)- correction o# ypertension and yperlipide,ia cost

e##ective in ,or idity and ,ortality

#enal function- ,al#unction 1 60@- a ility o# t e /idney to concentrate urine less a le to

respond c anges in #luid status (acid- ase alance)- o# protein aste product electrolytes di##icult to

,eta oliCed need dietary ,odi#ication- co,plication related to /idney #unction de ydratione,orr age cardiac #ailure i,proper use o#

diuretics+to%ic anti iotics


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Neurolo y function- cere ral #unction - synt esis o# neurotrans,itter

- less e##icient nerve conduction - less sleep

- c anges in central nervous syste, di,inis ed coordinationalance c anges in ,ental e?uity sensory interpretation

les de%terity ,ood alteration di##iculties it in#or,ationretrieval

- need ti,e to identi#y depression de,entia alC ei,erDs par/insonDs disease

'mmuno%competence- a##ected u,oral cell ,ediated i,,unities especially


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M)D'"AT'$NS

-*+3 ,edication prescri ed in &'A are unnecessary(Morrison and :ar/ * )- poly-p ar,acy ris/ o# adverse drug reactions drug-nutrient interactions- .oncern pat ologic #actor (. "iver renalE I,al-a sorption)- co,plete drug istory reduce ris/ lead to sa#er,edication usage

- appropriate nutrition assess,ent intervention andcounseling s ould e i,ple,ented to prevent orcorrect drug-nutrient interactions and i,provenutritional status (4el,s Anderson 2002)


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Age-Adjusted Prevalence of Overweightand Obese .!. Adults "Ages #$-%& 'r(

Over ig t or O ese(>MI F25) !7 56 6*

Over eig t(>MI 25-2 ) 32 33 3!

O ese (>MIF30) *5 23 27

NHANES

!"#$%!"&'(N ) !!*+'#(

NHANES

!"&&%!"",(N ) !,*,$&(

NHANES

!"""(N ) !,*,,$(


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M-.TIDIS/IP.INAR0 ASSESSMENT

Multidisciplinary approac

Measures and ,o ilityMeasures and #unctional status


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Activities of )ail* +iving and ,nstrumental Activities of )ail* +iving

Activity of Daily &ivin$ating,oving into and out o# eds and c airs

eing ,o ile and outdoorsdressingtoiletting,aintaining continence

'nstrumental Activities of Daily &ivin

using t e telep one

travelings oppingpreparing ,ealsdoing lig t ouse or/ta/ing ,edication,anaging ,oney


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Nutrition !creening

Older adult ris/ #or ,alnutrition8resence o# disease - 8 ysical disa ilities8oor dental and oral ealt - 8oly-p ar,acy8oly-p ar,acy - 'ocial isolation

1inancial li,itation - I,paired ,ental ealt

I,portant #or pri,ary careAdvantage;

.ost e##ective - i,prove t e ?uality o# li#e

8ro,ote ealt - reduce co,plicationeduce ealt care costs - delay ad,ission into nursing

o,eseduce co,plications and ospital lengt o# stay


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Nutritional ealth chec list warning signuse )/T/0M,N/

9 isease$ ating poorly


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N-TRITIONA. NEEDS

)ner y ↓ re?uire,ent (c anges in ody co,position >M ↓p ysical activity)↓

$nergy need > >$$ $$+Average calories inta/e;

♂ 2000 /cal+day ♀ *600 /cal+day

1P1o2ein1Cam2bell34556

- 2rotein inta e 4g 7 g 88- stress-full 2h*sical 9 2s*chological stimuli negative

nitrogen balance-infection altered :, function 9metabolic changes reduce efficienc* of dietar* nitrogen and ; nitrogen

e


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>io,ar/erAl u,in indicator o# protein status8re-al u,in and >8 evaluate response to t erapy

"ar/ohydrate4eeded to protect protein #ro, eing used as energysourceAppro%i,ately !5 -65@ o# total energy.o,ple% car o ydrate legu,es vegeta les ole

grains #ruits to provide p yto-c e,ical essentialvita,ins ,ineral

&ipid25-35@ o# total energy

educed '1Aeduced #at eig t control cancer prevention

H *0@ #at a##ect ?uality o# diet and negatively a##ecttaste satiety inta/eE


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Mineral

8oor ,ineral status inade?uate dietary inta/e p ysiologicc anges a##ect t e need #or a nutrient ,edications"actose intolerance (di,inis ed lactose secretion) causeddiarr ea disco,#ort #ro, cra,ping #latulence need dietary,odi#ication9ecrease .a transport osteoporosis ypoc lor ydriaIron de#iciency unco,,on ,ostly related to lood loss ordecreased a sorption (caused y disease or ,edication)

+itaminsO%idative ,ec anis, play an i,portant role in t e aging processAntio%idant vita,ins ; tocop erols carotenoids vit ..ell da,aged accu,ulate certain disease eEg catarac eartdisease cancer (Aus,an Mayer * )


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ita,in A

1escanic et al 2002; ig losses o# vita,in A ip#racture'ources o# vita,in A dar/ green lea#y yello -orange#ruits and vegeta les provide ade?uate #ood e%cessive

-carotene precursor vita,in A

ita,in .Older adult ave lo er seru, level o# vita,in .

ita,in . re?uire,ent increase ; stress s,o/ing,edication$ncouraging t e consu,ption o# vita,in .-ric #ood ,ost e##ective


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)esirable 8od* Mass ,nde< b* Age

A,) 01)A#S-M' 03)',HT4H)',HT

56 4m27

89%2: 89%2:

2!%;: 2 %2!

;!%:: 28%2<

:!%!: 22%2=

!!%

?


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Protein 0e=uirementsfor 0e2letion of +ow !erum Albumin +evel

"$ND'T'$NA&-UM

'N0 4dl

#$T)'N#) U'#)M)

NT0 46 4day

nor,al nutritionalstatus,ild depletion

,oderate depletionsevere depletion

3E52EG-3E52E*-2E7

H2E*

0EG*E0-*E2*E2-*E5*E5-2E0

nutrition in aging-npa

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