2. Content
1. Introduction
2. objective
2.1. Nutrient Consumption
2.2. Micronutrients of Concern
2.2.1. vitamins
2.2.2. minerals
2.3. Supplementation
3. case study : Dehydration in the Elderly
4. Recommendation
5. Conclusion
6. References
3. 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
4. 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
5. With age, metabolism decreases
Body composition changes
Muscle mass decreases as adipose tissue increases
Results in 2% deceased metabolic rate per decade
Decreased physical activity – less energy
expenditure
Aging and Energy Needs
6. 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
7. 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
8. 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, but
physical activity is also necessary
Frail Elderly or FTT
9. 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
10. Vitamin and mineral needs remain unchanged with
Age
Decreased food intake often results in deficient intakes of
micronutrients
50% of older persons have lower than recommended
intakes of micronutrients (Escott-Stump, 2008)
80% of elderly persons have inadequate intakes of at
least on nutrient (Guigoz et al 2004)
Digestion, absorption, and synthesis of
micronutrients are decreased (Elmadfa and Meyer, 2008)
Aging and Micronutrient Needs
11. Vitamins
1 . Vitamin E
2 . Vitamin C
3 . Vitamin D
4. Vitamin A
5. Thiamine
Minerals
1 . Selenium
2 . Zinc
3 . Calcium
4 . Iron
12. 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
13. Diuretics increases water-soluble vitamins
losses as urinary excretion is increased
Thiamine is especially at risk of becoming
deficient due to diuretics
Low dose thiamine supplement in the elderly
on diuretics may be useful in preventing deficiency
(Escott-Stump 2008)
Thiamine and other water soluble vitamins
14. Commonly deficient – Lengyel et al 2008
found 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
15. 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
16. 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
17. 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
19. Glucose
C-reactive protein
(CRP)
Ca++, Mg++
N-3, K+
H&H, serum Fe
Serum folate
Serum homocysteine
Albumin,prealbumin,
or transthyretin
Cholesterol
20. 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 consumed
Screen for caffeine use
May promote cognition
Excessive use can have diuretic effect
(Escott-Stump 2008)
21. 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
22. THANK YOU FOR ATTENDING
Ndhayyat@aseza.jo
nashatdhiat@yahoo.com