Nutrition assessment of elderly people
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Nutrition assessment of elderly people

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Malnutrition is closely related to increased mortality and morbidity and increased risk of medical and surgical complications

Malnutrition is closely related to increased mortality and morbidity and increased risk of medical and surgical complications

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    Nutrition assessment of elderly people Nutrition assessment of elderly people Presentation Transcript

    • ByEng. Nashat DahiyatNutrition assessmentin the elderly people
    • Content1. Introduction2. objective2.1. Nutrient Consumption2.2. Micronutrients of Concern2.2.1. vitamins2.2.2. minerals2.3. 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 notusing tobacco, is more influential in avoidingage-associated deterioration than genetic factors.( American Dietetic Association 2005 )Nutrition and Aging
    •  Discuss incidence of malnutrition and dehydration inthe elderlyDiscuss specific micronutrients that are of mostconcern and why Note dehydration signs and symptomsProvide recommendations for treatment andprevention of malnutrition and dehydrationObjectives
    • 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 energyexpenditureAging and Energy Needs
    •  30% of elderly consume less kilocalories thanrecommended (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 andmorbidity Greater susceptibility to infection and longer hospitalstaysEscott-Stump 2008), increased risk of medical and surgicalcomplications (Baker and Wellman 2005), increased riskof 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 necessaryFrail 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 behelpful in preventing muscle wasting with inadequate totalkcal intake (Evans 2004) Fat intake among the elderly is greater than therecommended 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 ofmicronutrients 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
    • Vitamins1 . Vitamin E2 . Vitamin C3 . Vitamin D4. Vitamin A5. ThiamineMinerals1 . Selenium2 . Zinc3 . Calcium4 . Iron
    •  High homocysteine levels resulting from B6, B12,folate deficiencies linked to increased cardiovasculardisease risk and decreased mental agility Folate deficiencies linked to increased dementia anddepression (D’Anci et al 2004) Excessive folate intake can mask B12 deficiency Corrects hematological signs of deficiency but notneurological 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 andA (Michelon et al 2006)Centenarians are more likely to have high levels ofVitamin E and A (American Dietetic Association 2005)Needed for drug metabolism and detoxificationVitamins A, E, and C
    •  Vitamin C, E, beta-carotene needed in adequatesupply for decreasing oxidative damage to tissues andcells includingimmune cellsBalanced diet seems to be more effectivethan supplementation for improved immunefunction but supplementation maybe effectiveAntioxidants
    •  Bone mass decreases with age especially in womenresulting in osteoporosis Direct health care cost of $12-18 billion each year justfor 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 aswell, but more research needed (American Dietetic Association 2005)Calcium and Vitamin D
    •  Depression in the elderly is associated with lowlevels of selenium (Gosney et al 2008) Low levels of selenium, zinc, and iron linked toreduced cell-mediated immune response(Wintergerst et al 2007)Low zinc intake associated with increased woundsand severity (Tobon et al 2008)Selenium, Zinc, Iron
    •  Age Weight (current &usual)DentitionDysphagiaSkin conditionConstipation/DiarrheaCurrent medicationsI/OsChanges in appetiteN/V, indigestionPainInfectionMotor coordinationMorbidities
    •  Glucose C-reactive protein(CRP) Ca++, Mg++ N-3, K+ H&H, serum FeSerum folateSerum homocysteineAlbumin,prealbumin,or transthyretin Cholesterol
    • Increased total number of medications associatedwith 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)
    • American Dietetic Association. Position paper of theAmerican Dietetic Association: Nutrition across the spectrum of aging.J Am Diet Assoc .2005:105:616_633.Elmadfa, I, Meyer AL. Body composition, changingphysiological functions and nutrient requirements of the elderly. AnnNutr Metab 2008;52(suppl 1):2_5.Ferry M. Strategies for ensuring good hydration inthe elderly. Nutr Rev 2005;63(6):S22-S29
    • THANK YOU FOR ATTENDINGNdhayyat@aseza.jonashatdhiat@yahoo.com