Nutrition and Quality of Life in the Elderly Presenter : John Orta, Professor of Nutritional Sciences, California State University, Los Angeles, CA August 7, 2007 Oxford Roundtable: Successful Aging: Enhancing the Quality of Life

Successful Aging: Enhancing the Quality of Life An interdisciplinary perspective Harris Manchester College Oxford, England Tuesday, August 7, 2007 Nutrition and Quality of Life in the Elderly Presenter : Dr. John Orta, R.D. FADA Professor of Nutritional Sciences, California State University, Los Angeles, CA, USA

Nutrition & Quality of Life In general, subjective estimates of the individual’s health status do not correlate closely with objective assessment of health status as measured by laboratory tests and physical assessments.

Indicators of Well-Being

Diet of Centenarians Characteristic Dietary Habits : The intake of most nutrients were similar among 60-, 80-, and 100-year old community-dwelling groups with few exceptions . Centenarians Consumed about 20 – 30% more carotenoids and vitamin A from foods. Consumed breakfast more regularly than most people. Avoided weight loss diets and large fluctuations in body weight. Lastly, centenarians tended to consume more whole milk, less 2% milk and yogurt, and were less likely to avoid dietary cholesterol. (Fischer et al., 1995; Williams, Johnson, Poon, & Martin, 1995; Johnson, Brown, Poon, Martin, & Clayton, 1992).

Characteristic Dietary Habits :

The intake of most nutrients were similar among 60-, 80-, and 100-year

old community-dwelling groups with few exceptions .

Centenarians

Consumed about 20 – 30% more carotenoids and vitamin A

from foods.

Consumed breakfast more regularly than most people.

Avoided weight loss diets and large fluctuations in body weight.

Lastly, centenarians tended to consume more whole milk, less 2% milk and

yogurt, and were less likely to avoid dietary cholesterol.

(Fischer et al., 1995; Williams, Johnson, Poon, & Martin, 1995; Johnson, Brown, Poon, Martin, & Clayton, 1992).

What are indicators of nutritional risk among the elderly?

Top 10 Risks of Malnutrition in the Elderly The food I eat doesn't taste as good to me as it did. Most of the time I eat by myself. I eat fewer than two meals a day. It is hard for me to prepare meals. I have tooth pain or mouth pain that makes it difficult for me to eat. No teeth or ill-fitting dentures. I take more than three prescribed or over-the-counter drugs daily. Without trying, I have lost ten pounds or more in the last six months. I don't have enough money to buy food throughout the month. I usually “drink my meals.” I have a health-related illness or disease that makes it hard for me to eat properly.

The food I eat doesn't taste as good to me as it did.

Most of the time I eat by myself.

I eat fewer than two meals a day.

It is hard for me to prepare meals.

I have tooth pain or mouth pain that makes it difficult for me to eat.

No teeth or ill-fitting dentures.

I take more than three prescribed or over-the-counter drugs daily.

Without trying, I have lost ten pounds or more in the last six

months.

I don't have enough money to buy food throughout the month.

I usually “drink my meals.”

I have a health-related illness or disease that makes it hard for me to eat properly.

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Disease

Disease

Alzheimer’s Disease Can make it difficult to remember what you eat potentially affecting nutritional status.

Elderly Depression Can Cause changes in appetite, digestion, weight and well-being.

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Eating Poorly

Eating Poorly Compromises Nutritional Health

Eating Poorly & Sentariness Compromises Nutritional Health

Alcohol Displaces Nutritious Meals & Disposes of Income

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Healthy Mouth,Teeth, & Gums, are Needed To Eat Properly

Health Care Reform?

Tooth Loss--Edentulousness A healthy mouth, teeth and gums are needed to eat properly.

Dentures Missing, loose or rotten teeth or dentures which don’t fit well or cause mouth sores make it hard to eat.

Mouth Pain Chronic mouth pain makes it hard to eat.

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Economic Hardship

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Reduced Social Contact

Reduced Social Contact Vienna has the largest elderly population of any metropolis in the world – fully 36 per cent of its 1.6 million inhabitants are over age 60.

Reduced Social Contact? Not in Vienna The Aged In Vienna: A Gerontocracy When asked what is important in his life now, the retiree typically replies unhesitatingly, "Health and good appetite." www.aliciapatterson.org/.../Skerly05.html

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Multiple Medications: Polypharmacy Polypharmacy Polypharmacy, or the concurrent use of many drugs, has been associated with increased rates of potentially inappropriate medication (PIM) use and dangerous drug interactions. Polypharmacy Warning! Increases the potential for adverse drug-nutrient interactions.

Multiple Medications: Polypharmacy

Multiple Medications: Polypharmacy Polypharmacy and Potentially Inappropriate Medication in the Elderly. US Pharm . 2006;10:112-116.

Involuntary Weight Loss May Have Serious Health Concerns in the Elderly—i.e. Sarcopenia

Involuntary Weight Loss

Involuntary Weight Loss/Gain Body Mass Index

Body Mass Index

Involuntary Weight Loss/Gain Body Mass Index

Body Mass Index

Involuntary Weight Loss/Gain Body Mass Index Optimal body mass index (BMI) values of 21 to 25. The risks increase slightly when BMI values are between 25 and 27. They are significant in BMIs between 27 and 30. They are dramatic over 30.

Body Mass Index

Optimal body mass index (BMI) values of 21 to 25.

The risks increase slightly when BMI values are between 25 and 27.

They are significant in BMIs between 27 and 30.

They are dramatic over 30.

Involuntary Weight Gain May Lead to or Aggravate Serious Health Problems

Involuntary Weight Gain Waist to Hip Ratio

Waist to Hip Ratio

Do Look Fat?

Cartoons often ridicule fat people

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Needing Assistance in Health Care

Needs Assistance in Health Care

D.E.T.E.R.M.I.N.E The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems: D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80 Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living. ____________________________ * Nutrition Screening Initiative

The DETERMINE checklist is the NSI* tool used by physicians, registered dietitians, other health care providers and social service agencies to assess the impact of various dietary, medical, or physical and social problems:

D isease E ating poorly T ooth loss/mouth pain E conomic hardship R educed social contact M ultiple medications I nvoluntary weight loss/gain N eeds assistance in self care E lder years above age 80

Recognizing the risk posed by these factors can result in interventions to improve the quality of life and the ability to perform activities of daily living.

____________________________

* Nutrition Screening Initiative

Elder Years Above 80 Years Old

Nutrition Screening Initiative (NSI) CONTEXT OF USE Instrument for assessing nutritional risk in elderly patients in any setting. STRENGTHS Quick and easy to administer 10 item questionnaire to patient or proxy. The checklist identifies patients who may benefit from nutritional counseling or home delivered meals as well as, evaluation of activities of daily living, depression, poor oral health, polypharmacy or status of underlying chronic conditions LIMITATIONS The instrument is dependent on the patient or proxy having the information and being forthright.

CONTEXT OF USE

Instrument for assessing nutritional risk in elderly patients in any setting.

STRENGTHS

Quick and easy to administer 10 item questionnaire to patient or proxy. The checklist identifies patients who may benefit from nutritional counseling or home delivered meals as well as, evaluation of activities of daily living, depression, poor oral health, polypharmacy or status of underlying chronic conditions

LIMITATIONS

The instrument is dependent on the patient or proxy having the information and being forthright.

Check Up On Your Nutritional Health Circle the number in the "yes" column if the statement applies to you. Total the "yes" numbers to get your nutritional score. TOTAL 2 I am not always physically able to shop, cook and/or feed myself. 2 Without wanting to, I have lost or gained 10 pounds in the last six months. 1 I take three or more different prescribed or over-the counter drugs a day. 1 I eat alone most of the time. 4 I don't always have enough money to buy the food I need. 2 I have tooth or mouth problems that make it hard for me to eat. 2 I have three or more drinks of beer, liquor or wine almost every day. 2 I eat few fruits or vegetables, or milk products. 3 I eat fewer than two meals per day. 2 I have an illness or condition that made me change the kind and/or amount of food I eat. YES

Check Up On Your Nutritional Health Circle the number in the "yes" column if the statement applies to you. Total the "yes" numbers to get your nutritional score. TOTAL 2 I am not always physically able to shop, cook and/or feed myself. 2 Without wanting to, I have lost or gained 10 pounds in the last six months. 1 I take three or more different prescribed or over-the counter drugs a day. 1 I eat alone most of the time. 4 I don't always have enough money to buy the food I need. 2 I have tooth or mouth problems that make it hard for me to eat. 2 I have three or more drinks of beer, liquor or wine almost every day. 2 I eat few fruits or vegetables, or milk products. 3 I eat fewer than two meals per day. 2 I have an illness or condition that made me change the kind and/or amount of food I eat. YES

What Your Nutritional Score Means 3-5 You are at moderate nutritional risk! See what can be done to improve your eating habits and lifestyle. A local office on aging, congregate meal sites, health department or cooperative Extension Office can help. Recheck your nutritional score in three months. 6 or more You are at high nutritional risk! Take this checklist with your the next time you see your doctor, dietitian or other health or social service professional. Talk with them about any problems you may have. Ask for help to improve your nutritional health. These warning signs suggest risk but do not represent a diagnosis of any condition. 0-2 Good! Recheck your nutritional score in six months.

www.ext.vt.edu/.../348-020/348-020.html

Conclusion Optimal Nutrition Is important and necessary for health Quality of Life in the Elderly

Is important and necessary for health Quality of Life in the Elderly

The End