Elderly Assignment Due Tuesday, November 29, 2011 25 points + 15 points for educational material Older Adult Assignment I. Interview an older adult (70 years or older) regarding changes in food habits over the years. · What foods did they eat as a youngster? Why? · What foods are they eating now? Why? · Were there any ethnic, cultural, or regional influences in their diet? · Do they have any nutritional related chronic disease(s)? · What, if anything, are they doing to help the problem? II. Take a diet history/24 hour recall (do during interview). a. Analyze diet; identify key nutrient deficiencies in diet. b. Include the 24 hour recall & Analysis as Appendix A of your paper. III. Take anthropometric data & figure requirements a. Get height & weight b. Figure kcal & protein requirements i. Determine if they are meeting needs using data from II. IV. Give them an educational piece of material on the key nutrient deficiencies of elder adults. THIS IS DUE BY NOVEMBER 17th and worth 15 points a. Language they understand b. Large font c. Easy to read d. Include what the nutrient is, why it’s important, & where to find it in foods. Turn in a ~3 pages essay in response to the questions from I. Discuss what you found out regarding the adequacy of their diet in II & III in your paper as well. The cover of this assignment should be a brief demographic description of the person you select (gender, age, where they live, health disparities, etc). Pictures are welcome and encouraged. Conditions and interventions Angie stiegemeyer, MA,rD,LD, BSN,RN Southeast Missouri State University Nutrition and the Older Adult Health-sense of well-being Quality of Life-measure of life satisfaction Medical Nutrition Therapy-treatment of nutritional aspects of disease Topics Covered Cardiovascular Disease (CVD)/Heart Disease Stroke Hypertention Diabetes/DM Osteoporosis Constipation Osteoarthritis Alzheimer’s Disease Underweight Elder Abuse End of Life Care Nutrition for CVD Decrease amount of fat Reduce cholesterol intake Increase fiber, F & V Limit Sodium Exercise Maintain Healthy Weight Reduce Stress Smoking Cessation Stroke Reduced blood flow to brain Etiology Blocked arteries Easily clotting blood cells Effects Deprive brain of oxygen-nerve cells die Differing levels of paralysis Stroke Risk Factors Hypertension, high chol., DM, smoking, family hx, obesity S/S: FAST F-Facial weakness A-Arm & Leg Problems S-Speech Problems T-Time to call 911 Nutrition Normalize blood pressure Hypertension Systolic 140mm Hg or higher AND/OR Diastolic 90 mm Hg or higher Effects- excess tension on vessels & organs Wears them out before normal aging process Kidney damage Risk Factors Excess alcohol intake, high sat. fat intake, overweight & obesity, low calcium intake, smoking Nutrition for Hypertension DASH Diet Weight management Moderate alcohol intake Limit sodium Adequate calcium, po ...

1. Elderly Assignment Due Tuesday, November 29, 2011
25 points + 15 points for educational material
Older Adult Assignment
I. Interview an older adult (70 years or older) regarding changes
in food habits over the years.
· What foods did they eat as a youngster? Why?
· What foods are they eating now? Why?
· Were there any ethnic, cultural, or regional influences in their
diet?
· Do they have any nutritional related chronic disease(s)?
· What, if anything, are they doing to help the problem?
II. Take a diet history/24 hour recall (do during interview).
a. Analyze diet; identify key nutrient deficiencies in diet.
b. Include the 24 hour recall & Analysis as Appendix A of your
paper.
III. Take anthropometric data & figure requirements
a. Get height & weight
b. Figure kcal & protein requirements
i. Determine if they are meeting needs using data from II.
IV. Give them an educational piece of material on the key
nutrient deficiencies of elder adults. THIS IS DUE BY
NOVEMBER 17th and worth 15 points
a. Language they understand
b. Large font
c. Easy to read
d. Include what the nutrient is, why it’s important, & where to
find it in foods.
Turn in a ~3 pages essay in response to the questions from I.
Discuss what you found out regarding the adequacy of their diet
in II & III in your paper as well. The cover of this assignment
should be a brief demographic description of the person you
select (gender, age, where they live, health disparities, etc).

2. Pictures are welcome and encouraged.
Conditions and interventions
Angie stiegemeyer, MA,rD,LD, BSN,RN
Southeast Missouri State University
Nutrition and the Older Adult
Health-sense of well-being
Quality of Life-measure of life satisfaction
Medical Nutrition Therapy-treatment of nutritional aspects of
disease

3. Topics Covered
Cardiovascular Disease (CVD)/Heart Disease
Stroke
Hypertention
Diabetes/DM
Osteoporosis
Constipation
Osteoarthritis
Alzheimer’s Disease
Underweight
Elder Abuse
End of Life Care
Nutrition for CVD

4. Decrease amount of fat
Reduce cholesterol intake
Increase fiber, F & V
Limit Sodium
Exercise
Maintain Healthy Weight
Reduce Stress
Smoking Cessation
Stroke
Reduced blood flow to brain
Etiology
Blocked arteries
Easily clotting blood cells
Effects
Deprive brain of oxygen-nerve cells die
Differing levels of paralysis

5. Stroke
Risk Factors
Hypertension, high chol., DM, smoking, family hx, obesity
S/S: FAST
F-Facial weakness
A-Arm & Leg Problems
S-Speech Problems
T-Time to call 911
Nutrition
Normalize blood pressure
Hypertension
Systolic 140mm Hg or higher AND/OR Diastolic 90 mm Hg or
higher
Effects- excess tension on vessels & organs
Wears them out before normal aging process
Kidney damage
Risk Factors
Excess alcohol intake, high sat. fat intake, overweight &

6. obesity, low calcium intake, smoking
Nutrition for Hypertension
DASH Diet
Weight management
Moderate alcohol intake
Limit sodium
Adequate calcium, potassium, magnesium
DM
1/5 over 65
Greater risk for CVD
Effects
Amputations
Macular degeneration
Vision loss

7. Neuropathies
Increased platelet aggregation
Increased infection
Decreased healing
Nutrition for DM
Diagnosis and criteria for mgmt same as younger adult
If kidney disease, limit protein (0.8-1.0 g/kg)
MVI
Assess cognitive function and create appropriate care plan
Asses Hemoglobin A1C
Below 7% is goal
1
135---------6%
170---------7%

8. 205--------8%
240--------9%
275--------10%
310--------11%
345-------12%
Osteoporosis
Porous bones
80% women
Bone density greatly declines after menopause
Effects-falls & fractures
Wrist, spine, hips
Kyphosis

9. Osteoporosis
Nutrition
Calcium
Vitamin D
Exercise
Limit caffeine
F & V
Limit sodium
Limit SSRIs
Chronic Constipation
2 or less BM Q Week
Etiology
Medications
Diseases-Parkinson’s, cancer, DM,IBS
Risk Factors
Dehydration
Medications
Mineral supplements

10. Chronic Constipation
Treatment
Exercise
Fluid
Fiber
Foods
psyllium
Avoid laxatives if possible
Bowel Retraining
Osteoarthritis
Etiology-cartilage loss, hardening of soft tissue, inflammation,
changes in synovial membrane
Pain in joints-most common in knees & hips

11. Osteoarthritis
Treatment
Control pain
Weight loss
Antioxidants
Flavanoids
Vitamin D
Chondrotin & Glucosamine-cartilage repair
Fatty acids & Oils
Alzheimer's Disease
Dementia-memory impairment
Plaques & Tangles in brain
Effects
Confusion
anxiety
agitation
loss of oral muscular control
impairment of hunger & thirst mechanisms
chewing & swallowing difficulties

12. Alzheimer's Disease
Treatment
Safety
Maintain nutrient dense diet
Plenty of time
Focus on eating
Serve finger foods
Encourage drinks
Nutrition for
Underweight & Unintentional Weight Loss
Adequate kcals
1-1.5 g/kg protein
1 mL/kcal fluid

13. Nutrient dense foods
Added fats
Added kcals
Boost, Ensure
Elder Abuse
Abuse, neglect, exploitation
1-800-392-0210 (For suspected elder mistreatment in the home
and in long-term care facilities)
End of Life Care
Respect patient & family’s wishes
Collaborate & Refer
Palliative care, Hospice

14. Compassion & Empathy
Chapter 18
Nutrition and Older Adults
“Nutrition is one of the major determinates of successful
aging.”
*
Generalizations relative to health status changes with aging are
unwise because “older adults” are a heterogeneous population
Diseases and disabilities are not inevitable consequences of
aging
Functional status is more indicative of health in older adults
than chronological age

15. *
IntroductionIn “normal” aging, inevitable & irreversible
physical changes occur over timeWe will look atnutrient
requirementsdietary recommendationsfood & nutrition programs
designed to support healthy aging
*
What Counts as Old?
There is no one age that defines “old” 50—Eligibility for AARP
60—Many businesses offer “senior discounts” & age used by
the Elderly Nutrition Program65—Eligibility for full Social
Security U.S. Census Bureau uses:65 to 74—“young old”75 to
84—“aged”85 & older—“oldest old”
*
Food Matters: Nutrition Contributes to a Long and Healthy
LifeCumulative effects of lifelong dietary habits determine
nutritional status in old ageCDC suggest that longevity depends
on:10% access to health care19% genetics20% environment
(pollution, etc.)**51% lifestyle factors (besides not smoking, a
healthy diet & ample exercise contribute most to longevity)

16. *
A Picture of the Aging
Population: Vital StatisticsMore Americans are living
longerCurrently, ~12.4% are >65 yrsBy 2050, ~20% will be >65
yrs
Persons ≥85 are the fastest growing population group
*
Global Population Trends: Life Expectancy and Life Span
Life expectancy
Average number of yrs of life remaining for persons in a
population cohort or group; most commonly reported as life
expectancy from birth
Life span
Maximum number of yrs someone might live; human life
span is projected to range from 110 to 120 yrs
*

17. Range of Life Expectancy for 15 of 37 Countries Reported in
Health, United States 2005, for 2001, According to Gender
*
Three Groups of Aging Theories
1) Programmed agingHayflick’s theory of limited cell
replicationModular clock theory
2) Wear and tear theories of agingOxidative stress theoryRate of
living theory
3) Calorie restriction & longevity
*
Physiological ChangesBody composition changesLean body
mass (LBM) & fatMuscles: use it or lose itWeight gainChanging
sensual awarenessTaste & smellOral health: chewing &
swallowingAppetite & thirst
*
Body Composition ChangesLean body mass (LBM) Sum of fat-
free tissues, mineral as bone, & waterSarcopeniaTerm used for
loss of LBM associated with aging

18. Fat-free mass decreases ~15% from age 20 to 70Older people
have lower mineral, muscle, & water reserves
*
Muscles: Use It or Lose ItIn older adults, weight-bearing &
resistance exercise increase lean muscle mass & bone
densityRegular physical activity helps maintain functional
status
*
Weight GainWeight gain accompanies aging, but is not
inevitableMean body weight gradually increases with aging,
peaking between 50 & 59 yrsPhysical activity moderates weight
gain & increases in body fatLack of estrogen promotes fat
accumulation
*
Changing Sensual Awareness:
Taste and SmellTaste & smell senses decline with ageDecline in
ability to identify smells varies by genderIn men, decline begins

19. ~age 55 In women, decline is >age 60Disease & medications
affect taste & smell more than aging
*
Changing Sensual Awareness:
Oral Health—Chew and SwallowOral health depends on:GI
secretionsSkeletal systems Mucus membrane Muscles Taste
budsOlfactory nerves (smell & taste)Healthy People 2010
Objective:Reduce % of people aged 65-74 who have lost all
their teeth from 26% to 20%
*
Changing Sensual Awareness:
Appetite and Thirst
AppetiteHunger & satiety cues weaken with ageOlder
adults may need to be more conscious of food intake levels
since appetite-regulating mechanisms may be blunted
ThirstThirst-regulating mechanisms decrease with
ageStudies support that dehydration occurs more quickly after
fluid deprivation & rehydration is less effective with advancing
age
*

20. Nutritional Risk Factors
Risk factors for older adults are:Hunger, poverty, low food &
nutrient intakeFunctional disabilitySocial isolation or living
aloneUrban & rural demographic areasDepression, dementia,
dependencyPoor dentition & oral healthDiet-related acute or
chronic diseasesPolypharmacyMinority, advanced age
*
*
Tufts University’s Modified Food Pyramid for 70+ Adults
Note supplements at the top & water at the base
*
Illustration 18.2 Tufts University modified food pyramid for
70+ adults.

21. Caloric Intake Comparison of Younger and Older Adults by
Gender
*
Eating Occasions
Eating OutOlder adults eat out less than younger persons
SnackingOlder adults snack less than other groups
*
Nutrient RecommendationsNutrient recommendations change as
scientists learn more about effects of foods on human
functionsSpecific DRI for those >51 yrs were 1st established in
1997
Estimating Energy NeedsDecrease in physical activity &
BMR from early to late adulthood results in ~20% fewer
calories needed
*
ProteinInactive, older adults living alone may have low protein
intakesSeveral researchers report protein needs for older adults

22. are 1 to 1.25 g/kg body wt (higher than the DRI of 0.8 g)
Nitrogen balance is easier to achieve when: Protein is a high
qualityAdequate calories are consumed Elders participate in
resistance training
*
Considerations for Protein Adequacy of Older AdultsBased on
ht & wt, how much protein will meet individual’s needs?Are
enough calories eaten so that protein does not have to be used
for energy?If marginal amounts of protein are eaten, is the
protein of high quality?Are there additional needs: wound
healing, tissue repair, surgery, fracture, infection?Is the
individual exercising? (Nitrogen balance is harder to achieve
while sedentary.)
*
Fats and CholesterolMinimize saturated fat & keep total fat
between 20 to 35% of calories----same as young & middle-aged
adult
Even though eggs are high in cholesterol, they are a nutrient-
dense, convenient, & safe food for older adults that do not have
lipid disorders
*

23. Recommendations for FluidThe total amount of water decreases
with age, resulting in a smaller margin of safety for staying
hydrated≥6 glasses of fluid/day will prevent dehydration in
most older adultsTo individualize fluid recommendations, 1 mL
of fluid/kcal consumed, with a minimum of 1500 mL
*
Age-associated Changes in Metabolism: Vitamin D, Calciferol
Factors that put older adults at risk for deficiency:
1. Limited exposure to sunlight
2. Institutionalization or homebound
3. Certain medications (barbiturates, cholestyramine, Dylantin,
laxatives)
*
Age-associated
menopauseMost older adults consume more iron than
neededExcess iron contributes to oxidative stress Reasons that
some older adults may have iron deficiency include Iron loss
*

24. Low Dietary Intake:
Nutrients of Concern
Vitamin E
Folate, folic acid
Calcium
Magnesium
Zinc
*
Nutrient Supplements: When ?May be useful with those
who:Lack appetite resulting from illness, loss of taste or smell,
or depressionHave diseases in GI tractHave a poor diet due to
food insecurity, loss of function, or disinterestAvoid specific
food groupsTake medication or other substances that affect
absorption or metabolism
*
Dietary Supplements Potentially Used by Older Adults for
Health Conditions

25. *
Nutrient Recommendations: Using the Food LabelIn nutrition
labeling & dietary guidance, “one size does not fit all”Nutrient
amounts for older adults are slightly different than those for
youngerMain differences:Need more calcium & vitamins D &
CNeed less iron & zinc
*
Food Safety RecommendationsOlder adults are vulnerable to
foodborne illness because they have compromised immune
systemsLeading hazardous practices:Improper holding
temperaturesPoor personal hygieneContaminated food
preparation equipmentInadequate cooking time
*
Physical Activity RecommendationsExercise: the “true fountain
of youth”Exercise guidelinesKeep Moving—Fitness after 50
screening toolResistance or weight-bearing activitiesAerobic
exercise
*

26. Nutrition Policy and Intervention for Risk Reduction
Nutrition Education
4 C’s:
-Commitment
-Cognitive processing
-Capability
-Confidence
*
Considerations for Educational Materials for Older
AdultsLarger type sizeSerif lettering (such as Times
Roman)Bold TypeHigh contrasts (black on white)Non-glossy
paperAvoid blue, green & violentReading level of 5th to 8th
grade
*
Community Food and Nutrition Programs
Elderly Nutrition Programs
Government programs include:USDA’s food stamp & extension
programsAdult Day Services Food ProgramsNutrition
Assistance Programs for SeniorsMeals-on-WheelsSenior
Nutrition Program of the Older Americans Act

27. *
The Promise of Prevention: Health PromotionGood nutrition
habits make a greater impact when started early in lifeMany not
motivated to make changes until later in life or when health
problems occurThe belief that an 80 y/o is too old to learn and
practice health promotion strategies is an outdated myth
*