contents Introduction characteristics. changes in organ functions Nutritional requirement. Problems of old age ..
Introduction of old ageOld is not a disease but a biological process that no onecan avoid . A little care and caution will prevent ordelay disabilities . With proper care every one canenjoy long run , healthy ageing . As age advance, several chronic disease effect our healthy . Many ofthese like obesity , hypertension and diabetes are dietrelated and enhance can be controlled and evenprevented by modifying our diet .
Characteristics1) SENSORY LOSSES – the sense of taste , smell , sight,anorexia, loss teeth , xerostomia . Also decline inneuromuscular coordination are common problemswhich lead to less food intake as result of decreaseappetite , food recognition and self feeding ability
1) CHANGES IN GASTROINTESTINAL TRACT – secretionof digestive enzymes and juices decrease which result inincomplete digestion of food as result absorbtion andutilization of nutrient are affected adversely .2) CHANGES IN CARDIOVASCULAR SYSTEM – narrowingof lumen , thickening of arterial walls and loweredmyocardial contractibility .3) RENAL FUNCTION – working ability of kidney decreasesas a result the elimination of waste products andreabsorption or nutrient are affected
1. REDUCED HARMONES LEVEL2. IMMUNOCOMPETENCE – immune functiondecline with age .3. PSYCHOLOGICAL FACTORS –like depression, anxiety , loneliness , food habits , loss of self esteemcan affect apatite digestion , energy level weight , andwell being
Changes in organsfunction with ageing thatmay influence nutrientrequirements
Age (years)Estimated energy requirementfor males (kcals per day)Estimated energy requirementfor females (kcals per day)19-50 2550 194051-59 2550 190060-64 2380 190065-74 2330 190075+ 2100 1810
Organfunction• Taste and smell• Salivary glands• Gastric functionand emptyingchanges• Decreased taste buds ontongue.• Decrease in salivarysecretion causes feelingof drymouth, xerostomia.• Decreased secretion ofhydrochloric acidintrinsic factor andpepsin.• Above 60 years of agerapid rate of emptyingof liquids.• Decreased calciumabsorption.Effectsonnutrition• Loss of ability to detectsalt and sweet.• Difficulty in chewingand swallowing makethem avoid certain foodparticularly curnchy.• Decreasedbioavailability ofminerals, vitamins andproteins.
• Skeletal function• Opthalmicfactor• Psychologicalfactors• Changes in bone density• Opacity of eye lens• depression• Increased requirement ofcalcium.• Increased requirement• Can affectappetite, digestion, energylevel ,weight and wellbeing.
• teeth • Loss ofteeth andwearingdentures.• Decreased
Nutritional requirements Energy –after the age of 35 the basal metabolic ratedecreases due to reduced muscle mass and othermetabolically active tissue mass . Also there isreduction in physical activity which affects the energyneeds . Sarcopenia, an age related loss in skeletal muscle isthe result of decline in muscle strenth.
Lean body mass declines approximately 2 to 3% perdecade.Body protein level in the healthy elderly is 30-40% lessthan that in young adults.The average body fat % in meals increases from about15 % when young to 25%.The calorie intake should be adjusted to maintain thebody weight constant. In the case of obese the calorieintake should be adjusted to reduce the body .
Energy requirement decreases with age beyond 30years. Although the energy requirements decreases, thedecreases the requirements for protein, vitamins andminerals do not diminish.
protein As people age there is a decrease in skeletal tissuemass. This results in decrease in store of proteinprovided by skeletal muscle and may be inadequate tomeet the needs for protein synthesis. Hence thedietary protein intake is more important to meetessential needs. A protein intake of 1.0g per kg , the normal adultrequirement, is safe during old age.
Food should be protein rich compared to adult normalfood . To meet this adequate quantities of protein foods suchas milk and curd can be included. Deficiency of protein result of oedema, anaemia andlowered resistance to infection. The total caloric intake11-12% should be from protein.
carbohydrateIt is necessary that at least 50% of calories are derivedfrom charbohydrates .An impaired glucose tolerance in elderly can lead tohypoglycaemia, hyperglycaemia and two type diabetesmellitus .Insulin sensitvity can be enhanced by balance energyintake, weight management and regular physicalactivity.
calciumCalcium needs during old age increased.Women over 50 years of age who are not receivingestrogens require more calcium as there is increasedloss resulting in demineralisation of bone .For women over fatty ,1000mg/ day is recommendedfor the following reasons:
Calcium is available only from a limited foods. To compensate age related bone loss and to improvecalcium balance. To decrease the prevalence of fractures and dentaldecay.Calcium absorption efficiency decrease, vitamin Dlevels decline and hence men also require morecalcium.
Milk is an important source of calcium for elderly As caloric requirement decrease, total foodconsumption decreases, hence calcium supplementsare essential. Mild anaemia affects the healthy of old people due toless efficient circulation of blood.
iron Iron prevent intake should be adequate to preventanaemia . Iron requirement can be same as adult man, 30mg. If there is anaemia, supplemental iron can be given.
zinc Such features of old age such as delayed woundhealing , decreased taste sensitivity and anorexia alsofindings associated with zinc deficiency. Older people who avoid flesh foods may be atincreased risk of poor zinc status.
Vitamin D Elderly people are at risk for vitamin D deficiency dueto decreased exposure to sunlight . Prudent dietary supplementation with calcium andvitamin D improves born density and may preventfractures in a healthy elderly population.
Vitamin C Stress, smoking and some medication can increasevitamin C requirement. Vitamin C may be protective against cataract at anintake level of between 150 and 250mg per day which ispossible to achieve from dietary sources alone.
Vitamin E Vitamin E has also been found to be a potent nutrientfor reducing the decline in cellular of immunity thatoccur in the elderly . Change in immune system can be overcome by taking200 mg of vitamin E.
water With aging a progressive decline in the water contenttherefore 1ml of water for each kcal of food consumedfor all people of ages is recommend. Water stimulates peristalsis and thus aids incombating constipation. Dehydration can result in themental confusion, headaches and instability. Elderlyshould be advised to consume some fluids at interval.
fiber Increase consumptions of dietary fiber are corelatedwith decreases rate of heart diseases. Fiber stimulatesperistalsis. It is essential to consume fiber containing food butincrease should be gradual other wise boweldiscomfort ,distension will result. Rough fiber, bran and mature vegetable are notadvised . Fiber also helps in reducing cholesterol which mayreduce the incidence of atherosclerosis.
Fat and essential acids These requirements for the aged have not been dealtwith by ICMR . With advancement of age , since the energyrequirements are reduced, the requirement of energynutrients i.e. carbohydrates and fats also needsreduction.
Other fat soluble vitamins As already mentioned in adulthood, ICMR not givenany recommendations for vitamin D . If the elderly are confined indoors and do not getenough sunshine, they should be given supplements ofthis vitamin. No recommendations have been given for vitamin Eand vitamin K.
Cereals Vegetable ands Pulses ,nuts, milk products, fish and chicken Egg and red meat Oil , ghee , butter
Dietary guidelines Empty calorie foods should be taken minimum and caloriedense foods should be avoided. Foods rich in protein, vitamin and mineral should beincluded. Vegetables and fruits are good sources of antioxidants. Aminimum of five servings should be taken. Fat promotes weight gain. Fat particularly fat should belimited
Soft well cooked foods are preferred. Food should be less salty and spicy . Fried and concentrated foods be avoided High fiber diet including green and whole grains are toincluded in the diet. Easily digestable steamed foods like idlis can be part ofthe diet.
Plenty of fluids and semisolid foods should be taken. 2-3 serving of low fat milk should be included in diet. Tobacco chewing, smoking and betel leaves chewingare the habits which may affects consumption of foodin diet.
PROBLEMS OF OLD AGEThe elderly are at a risk of poor nutrition due toeconomic pressure , reduced mobility depressionloneliness , ageing tissues and inadequate foodconsumption .NUTRITION RELATED PROBLEMS AREOBESITY – it is higher among elderly . Because ofmore consumption of calorie and sedentary life style .Obese are susceptible to diabetes ,cardio vasculardisease , arthritis ,
OSTEOPOROSIS- loss in bone density and bone mass . Itsprimarily found in middle age . Bone demineralizationtakes place at faster rate than bone mineralization . Bonesbecome porous lighter and fragile .DIABETES – it increases with age in booth male and female .The elderly are at a risk of poor nutrition due to economicpressure , reduced mobility , depression loneliness , agingtissues , and inadequate food consumption.CARDIO VASCULAR DISEASE – hypertension , acutemyocardial infection, congestive cardiac failure is highamong elderly
CONSTIPATION – it is infrequent passes of stools whichare more often drier or harder than normal . The stoolsbecomes harder and drier because move to slowlythrough colon . The natural contraction and rhythm ofcolon might be disturbed due to loss of tone , stressmedication , illness , resisting the urge of defecate.ANEMIA- inadequate intake of iron causes fatigue, anxiety , lack of energy and sleeplessness caused bylow dietary intake lack of iron or vitamin c or bloodloss .MALNUTRITION- due to various physiological andsocio psychological changes , food intake of the elderlymay decreases.