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

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Nutrition assessment of elderly people

  1. 1. ByEng. Nashat DahiyatNutrition assessmentin the elderly people
  2. 2. 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
  3. 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 notusing tobacco, is more influential in avoidingage-associated deterioration than genetic factors.( American Dietetic Association 2005 )Nutrition and Aging
  4. 4.  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
  5. 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 energyexpenditureAging and Energy Needs
  6. 6.  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
  7. 7. 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
  8. 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, butphysical activity is also necessaryFrail Elderly or FTT
  9. 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 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
  10. 10.  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
  11. 11. Vitamins1 . Vitamin E2 . Vitamin C3 . Vitamin D4. Vitamin A5. ThiamineMinerals1 . Selenium2 . Zinc3 . Calcium4 . Iron
  12. 12.  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
  13. 13.  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
  14. 14.  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
  15. 15.  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
  16. 16.  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
  17. 17.  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
  18. 18.  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
  19. 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. 20. 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)
  21. 21. 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
  22. 22. THANK YOU FOR