This document discusses nutrition needs and recommendations for adults and elderly individuals. Key points include: no single age defines "elderly" but recommendations separate adults into 51-70 and those over 70; common health issues in aging include heart disease, cancer, and diabetes; physiological changes with aging like declining testosterone and bone loss affect nutrition needs; risk factors for malnutrition in elderly include loss of senses, lean mass, and mobility as well as depression and financial barriers; nutrition recommendations focus on meeting calcium, vitamin D, protein, fiber and hydration needs through diet and supplements while limiting sodium, saturated fat, and alcohol. Regular exercise, social engagement and medical care can help promote healthy aging.

1. NUTRITION DURING THE ADULT
YEARS
-ALVIC S. RODA, RN, MN, MBA, MPA, LPT

2. Learning Outcomes
 Discuss the factors that affect the rate of aging
 Describe how physical and physiological changes
that occur during adulthood affect nutrition
needs
 Know the current nutrition recommendations for
elderly adults
 Describe community nutrition services for older
persons

3. Learning Outcomes
 Identify nutrition-related health issues of the
adult years and describe the prevention and
treatment of these health problems
 Lists the potential benefits and risks associated
with the use of complementary and alternative
medicine practices

4. What age is considered elderly?
 42
62
50
71
89

5. What age is considered elderly?
 No single, chronological timetable of human aging
exists.
 Genetics, lifestyle, and disease processes affect
the rate of aging
 Assessment of nutritional risk depends on a
variety of factors
 Separate nutrition recommendations for 51-70 and
70
 Assess overall health, quality of life


6. Leading causes of death
 Heart disease 616,067
 Cancer 562,875
 Stroke (cerebrovascular diseases) 135,952
 Chronic lower respiratory diseases 127,924
 Accidents (unintentional injuries) 123,706
 Alzheimer's disease 74,632
 Diabetes 71,382
 Influenza and Pneumonia 52,717
 Nephritis, nephrotic syndrome, and nephrosis
46,448
 Septicemia 34,828

7. As we age
 Around age 2530 the average maximum attainable
heart rate declines by about one beat per minute,
per year
 Hearts peak capacity to pump blood drifts down
by 510 per decade.
 This diminished aerobic capacity can produce
fatigue and breathlessness with modest activity.

8. As we age
 Starting in middle age blood vessels begin to
stiffen and blood pressure often creeps up.
 Blood becomes more viscous and harder to pump
through the body, even though the number of
oxygen-carrying red blood cells declines.
 Nutrition recommendations low sodium diet
(1500-2000 mg/day) with potassium rich foods
(DASH), omega 3s found in fish help thin blood


9. As we age
 Blood sugar levels rise by about 6 points per
decade, making type 2 diabetes distressingly
common in elderly.
 Nutrition recommendations avoid excess weight
gain, encourage activity

10. As we age
 In men, testosterone declines by about 1 per
year after the age of 40 leading to a drop in
muscle mass and bone density.
 In women bone loss mainly occurs after menopause
(estrogen loss)
 Nutrition recommendations
 Calcium requirements increase (from 1000mg to
1200 mg after age 50 in women, 1200 mg after age
70 in men)
 Vitamin D requirements increase (from 15 ug/d to
20 ug/d after age 70)

11. As we age
 Slowing of the digestive tract, decreased
digestive secretions
 Dietary changes, activity changes, and
medications can also play causal role
 Nutrition recommendations
 Increased fiber needs, 21 g for women and 30 g
for men
 Diet that includes nuts, fruits, veg, and whole
grains should provide fiber needs
 Fluid, exercise can also help constipation


12. Why are the elderly at risk for
malnutrition?
 Sensory Changes
 Change in taste, smell
 Nutrition recommendations
 Ensure adequate intake of zinc
 Try and variety of new flavors, experiment with
different types of low sodium seasonings
 Dont over cook food

13. Why are the elderly at risk for
malnutrition
 Structural changes
 Loss of lean mass
 Decreased RMR
 Too many calories for decreased RMR results in
increased fat
 This extra fat contributes to a rise in LDL
cholesterol and a fall in HDL cholesterol
 Nutrition recommendations
 Protein needs 0.8g/kg depending on disease state
 Activity
 Heart healthy diet low in saturated fat and trans
fat and with nutrient dense foods to prevent
weight gain

14. Why are the elderly at risk for
malnutrition
 Loss of body water
 72 of total body water is in lean muscle
 Can lose sense of thirst, forgetting to drink,
frequent urination due to meds
 Recommend 5-8 cups fluid daily


15. Why are the elderly at risk for
malnutrition
 About 30 of older people in N. America have lost
all their teeth
 Nutrition recommendations
 Focus on nutrient dense foods
 May need soft, moist forms of protein (ground
meat, tofu, beans, eggs, tuna, etc)

16. Why are the elderly at risk for
malnutrition
 20 of nursing home residents and 5-10 of older
people outside of nursing homes suffer from
depression
 Other barriers to healthy eating include
financial barriers, difficulty cooking for one,
limited resources for shopping and preparing food
 Adequate social support and possibly
psychological interventions are important

17. Why are the elderly at risk for
malnutrition
 1/3 of alcohol abuse begins later in life
 Due to more free time, loneliness, depression,
more social events with alcohol
 Older adults have less body water to distribute
alcohol and metabolize alcohol slower
 Alcohol can deplete B vitamins
 Nutrition recommendations
 Men and women over 65 should limit alcohol to 1
drink/day (12 oz beer, 1.5 oz shot, 5 oz wine)


18. Why are the elderly at risk for
malnutrition
 Increased risk of food borne illness due to
 Weaker immune systems
 Decreased stomach acid needed to control
bacteria.

19. Prevent food borne illness
 Raw, rare or undercooked meats, poultry, and fish
(rare hamburgers and beef or steak tartare,
sushi)
 Undercooked and raw shellfish (clams, oysters,
mussels and scallops)
 Unpasteurized dairy products, fruit and vegetable
juice (raw milk and cheeses)
 Raw or undercooked eggs (soft-cooked, runny or
poached)
 Washing hands, washing counters where raw meat
was handled, proper thawing, not using expired
products

20. Medication interactions
 ¼ of elderly adults take multiple prescription
medications
 Different medications can affect appetite,
absorption of nutrients
 Some medications cannot be taken with certain
foods and certain foods can interfere with their
action

21. Nutrition needs change
 Iron-too much iron is a pro oxidant, only
supplement if iron deficiency anemia
 DRI for women 51 decreases to 8 mg
 B12 is common deficiency due to decreased gastric
acid (needed to free B12 from food)
 Deficiency associated with pernicious anemia,
nerve damage, cognitive decline
 DRI is 2 ug/d (no change), however supplements or
fortified foods are better absorbed than B12 in
food

22. Nutrition needs change
 Vitamin B6 requirement is increased with
advancing age, although the reasons for this are
uncertain
 Deficiency can lead to irritability, depression,
and confusion additional symptoms include
inflammation of the tongue, sores or ulcers of
the mouth
 Anti-Parkinson drugs form complexes with vitamin
B6 and thus create a functional deficiency.
 DRI increases from 1.1 mg to 1.4 mg in men and
1.3 mg in women after age 50

23. Nutrition needs change
 Calcium and vitamin D insufficiency can lead to
increased risk of osteoporosis.
 A decrease in the intestinal absorption of
calcium
 The kidneys are less able to retain calcium,
leading to increased urinary calcium loss
 Less frequent exposure to sunlight
 A decrease in the capacity of the skin to
synthesize vitamin D
 A decrease in the capacity of the kidneys to
convert vitamin D into the most active form,
1,25-dihydroxyvitamin D
 Calcium requirements increase (1200 mg after age
50 in women, 1200 mg after age 70 in men)
 Vitamin D requirements increase (20 ug/d after
age 70)

24. Recommendations
 If exercise were a pill it would be the most
prescribed medication in the world


25. Recommendations for exercise
 Endurance exercise improves cardiovascular
function, lowers blood pressure, protects against
wt gain, improves insulin sensitivity, improve
cholesterol. Recommendation is 30 min most days
of the week.
 Resistance exercise and flexibility training 20
minutes two or three times a week
 Exercises for balance will help avoid injuries
and prevent the falls


26. How to age well
 Exercise
 Eat properly for heart health and weight
management
 May need supplemental calcium, D, and B12
 Drink plenty of water
 Limit to 1 alcoholic drink a day
 Keep the mind active and stimulated
 Build strong social networks
 Get regular medical care


27. Nutrition products targeted to elderly
 Multivitamins for people over 50
 No iron
 Extra D, B12, and B6
 Added lutein and lycopene
 Vitamins for memory
 Omega-3
 Vitamin B-12 and B-6
 Vitamin D-3
 Meal replacement products
 Protein Drinks
 300-350 kcal, 10-20 grams protein, low saturated
fat