NUTRITION AND DIETETICS IN GERIATRIC PATIENTS (1).pptx

NUTRITION AND DIETETICS IN GERIATRIC
PATIENTS
PRESENTED BY:
DR. RENUKA DANGE
1ST YEAR RESIDENT
DEPT OF PROSTHODONTICS AND CROWN & BRIDGE
GOVT DENTAL COLLEGE & HOSPITAL, JAMNAGAR.
GUIDED BY:
DR. SANJAY LAGDIVE
HEAD AND PROFESSOR,
DEPT OF PROSTHODONTICS AND CROWN & BRIDGE
GOVT DENTAL COLLEGE & HOSPITAL, JAMNAGAR.

CONTENTS
• Introduction
• Need for discussion
• Definitions
• Factors Contributing To Nutritional Problems In The Elderly
• Changes In The Oral Status Of The Elderly
• Geriatric Nutrition
• Assessing Nutritional Status
• Prosthodontic Considerations Of Nutrition
• Dietary Counseling Of Prosthodontic patients
• Dietary Suggestions For Denture Wearers
• Diet After Denture Insertion
• Conclusion

A geriatric patient is not specifically
age-defined but rather characterized
by a high degree of frailty and
multiple active diseases which
become more common in the age
group above 80 years.
It is the main aim of geriatric medicine
to optimize functional status of the
older person and to ensure best
possible quality of life.

With age, physical changes bring about loss in function
thus, appropriate diet and nutrition will be needed to
support geriatric patients in order to slow down the
development of chronic disease preventing disability.
Eleanor D. Schlenker, Joyce Gilbert. William’s Essentials of Nutrition and Diet Therapy, 11th edition.
Elsevier Inc.; 2015.

The number of people older than 65 years in India is 8
percent i.e. over 80 million and expected to reach 12
percent by 2025.
Pendyala G., Joshi S., & Choudhary, S. The ageing nation. Indian journal of community medicine : official
publication of Indian Association of Preventive & Social Medicine, 2014. 39(1), 3–7.

United Nations. 2019. World Population Aging Report. Available from:
https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Report
(Accessed 18th November 2021)

Definitions
Nutrition
Nutrition can be defined as the sum of the processes by which an individual
takes in and utilizes food.
(FDI)
Nutritional status
Nutritional status is defined as the “health condition of an individual as
influenced by his intake and utilization of nutrients determined from the
correlation of information from physical, biochemical, clinical and dietary
studies.
(Nizel AE, Papas AS. Nutrition in clinical dentistry)
Abraham E Nizel, Athena. S. Papas. Nutrition in clinical dentistry. 3rd ed. USA: W. B. Saunders Company;1989

Diet
Diet can be defined as the type and amount of food eaten daily by an individual.
(FDI)
BMR (Basal metabolic rate)
BMR is defined as the number of kilocalories expended by the organism per
square meter of body surface area per hour. (K cal / msq./ hour).
(Nizel AE, Papas AS. Nutrition in clinical dentistry)

Geriatrics
The branch of medicine that treats all problems peculiar to the aging patients, including
the clinical problems of senescence and senility.
GPT-9
Gerodontics /Geriodontics
The treatment of dental problem in aged or aging person.
GPT-9
Gerodontology
The study of the dentition and dental problems in aged or aging person.
GPT-9

Factors contributing to nutritional problems in the elderly:
1. Physiologic changes associated with aging.
2. Psychosocial aspects
3. Pharmacological factors
4. Economic factors
Hickson M. Malnutrition and ageing. Postgraduate medical journal. 2006 Jan 1;82(963):2-8.

Causes of malnutrition in the elderly:
I] Primary causes
1. Ignorance of balanced diet.
2. Inadequate income
3. Social isolation
4. Physical disability
5. Mental disorders
II] Secondary causes
1. Alcoholism
2. Increased use of drugs
3. Edentulism

PHYSIOLOGICAL
CHANGES
• Body Composition
• Dehydration and kidney function
• Changes in Gastrointestinal tract

Changes in body system of elderly
Eleanor D. Schlenker, Joyce Gilbert. William’s Essentials of Nutrition and Diet Therapy, 11th edition. Elsevier
Inc. ; 2015.

Physiological changes
Body Composition:
• Steady decrease in lean body mass (muscle mass) of about 6.3 per cent for
each decade of life.
• Increase in body fat and decrease in total body water.

Buch A, Carmeli E, Boker LK, Marcus Y, Shefer G, Kis O, Berner Y, Stern N. Muscle function and fat content in relation to sarcopenia,
obesity and frailty of old age—An overview. Experimental gerontology. 2016 Apr 1;76:25-32.
Fat distribution in human body:

AGING
Bone loss
(osteopenia/osteoporosis)
Muscle loss
(Sarcopenia)
Fat gain
(adiposity)
osteopenic obesity sarcopenic obesity
Osteosarcopenic obesity
Risk of fractures
Functionality
Morbidity
Ormsbee MJ, Prado CM, Ilich JZ, Purcell S, Siervo M, Folsom A, Panton L. Osteosarcopenic obesity: the role of bone, muscle, and fat on
health. Journal of cachexia, sarcopenia and muscle. 2014 Sep 1;5(3):183-92.

Decline in kidney function and total body water metabolism, is a major
concern in the older population.
Dehydration
Sheldon Winkler. Essentials of complete denture prosthodontics. 2nd ed. USA: Ishiyaku Euro America Inc.
Publishers; 2000

Britton E, McLaughlin JT. (2013) Ageing and the gut. The Proceedings of the Nutrition Society; 72: 1, 173-177.
Changes in Gastrointestinal tract

 Mental disorders like confusion, forgetfulness, irritability, depression
or dementia.
 Loneliness
 Loss of companion
PSYCHOSOCIAL FACTORS

 A relationship between income and nutritional adequacy.
 Transportation, housing and facilities for food storage and
preparation.
Goodwin JS. Social, psychological and physical factors affecting the nutritional status of elderly subjects:
separating cause and effect. The American journal of clinical nutrition. 1989 Nov 1;50(5):1201-9.

•Use of multiple medications, known as polypharmacy.
•Many of these drugs interfere with digestion, absorption, utilization or excretion
of essential nutrients.
•Additionally, some drugs profoundly affect appetite, decrease salivary flow and
affect taste and smell acuity.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clinical Pharmacology & Therapeutics. 2009
Jan;85(1):86-8.

CHANGES IN THE ORAL
STATUS OF ELDERLY
1. Alteration in gustation.
2. Changes in Salivary function.
3. Oral mucosal changes
4. Changes in muscle function
5. Changes in TMJ
6. Edentualism
7. Alveolar bone loss

a) Alteration in gustation: Decreases with age.
Boyce JM, Shone GR. Effects of ageing on smell and taste. Postgraduate medical journal. 2006 Apr
1;82(966):239-41.

Lose our sense of smell, and ability to discriminate between smells.
Decrease in the sensory aspect of the food Decrease in food consumption
because tasteless, odorless food most likely will not be eaten.
2. Alteration in olfaction
More than 75% of people over the age of 80 years have evidence of
major olfactory impairment, and that olfaction declines considerably
after the seventh decade.
1;82(966):239-41.

• Factors contributing to taste alteration in elderly –
1. Health disorders
2. Medications
3. Oral hygiene
4. Denture use
5. Smoking
1;82(966):239-41.

b) Decreased Salivary function
• Water in the form of saliva is essential for mastication.
The elderly patients are tired and restless.
The skin , eyes and oral mucosa are dry and easily irritated.
Publishers; 2000

Commonly prescribed groups of drugs that produce xerostomia are
antihypertensives, anticonvulsants, tranquilizers antidepressants, and anti-
Parkinson's drugs.
Tan EC, Lexomboon D, Sandborgh‐Englund G, Haasum Y, Johnell K. Medications that cause dry mouth as
an adverse effect in older people: A systematic review and metaanalysis. Journal of the American Geriatrics
Society. 2018 Jan;66(1):76-84.
MEDICATIONS AND SALIVARY FLOW

 Without significant salivary flow, food debris will remain in the mouth, where it is
fermented by dental plaque bacteria to organic acids that initiate the DENTAL
CARIES process.
Dawes C, Pedersen AM, Villa A, Ekström J, Proctor GB, Vissink A, McGowan R, Aliko A, Narayana N. The functions of human saliva: A review
sponsored by the World Workshop on Oral Medicine VI. Archives of oral biology. 2015 Jun 1;60(6):863-74
Salivary function

1. Prevents the formation of a bolus.
2. Makes the mouth sore and chewing painful.
3. Makes swallowing difficult.
4. Cause changes in taste perception that decreases adequate food intake.
Salivary function

c) Oral mucosal changes:
 Burning sensation.
 Pain and dryness of the mouth.
 Cracks in the lips.
 Dry, atrophic, and sometimes inflamed, but more often it is pale and translucent.
 The epithelial membrane is thin, friable and easily injured.
Sheldon Winkler. Essentials of complete denture prosthodontics. 2nd ed. USA: Ishiyaku Euro America Inc. Publishers; 2000

TROPONIN cardiac and skeletal muscles
d) Muscle function and oral movements:
Skeletal muscle contraction Calcium
sTnT
• Several layers of connective tissue, maintain the muscle integrity.
• If this barrier is injured, internal components of muscle, particularly sTnT, leak into
the blood and their measurable presence could indicate sarcopenia.
JafariNasabian P, Inglis JE, Reilly W, Kelly OJ, Ilich JZ. Aging human body: changes in bone, muscle and body fat with consequent changes
in nutrient intake. Journal of Endocrinology. 2017 Jul 1;234(1):R37-51.
contracts

Muscle tone decreases by as much as 20% to 25% in old age,
which probably explains the shorter chewing strokes and
prolonged chewing time.
Machida N, Tohara H, Hara K, Kumakura A, Wakasugi Y, Nakane A, Minakuchi S. Effects of aging and sarcopenia on tongue pressure and
jaw‐opening force. International Journal of Geriatrics & gerontology. 2016 Feb;(2):295-301.

 Age may impair the central processing of nerve impulses,
impede the activity of striated muscle fibers, and retard the
ability to make decisions.
 Also, there is reduction in the number of functional motor
units along with a decrease in the cross sectional area of the
masseter and medial pterygoid muscles.
Muscle function and oral movements
Machida N, Tohara H, Hara K, Kumakura A, Wakasugi Y, Nakane A, Minakuchi S. Effects of aging
and sarcopenia on tongue pressure and jaw‐opening force. Geriatrics & gerontology international.
2017 Feb;17(2):295-301.

e) Temporomandibular joint pain:
Bruxism and Attrition of incisal and occlusal surfaces takes place.
1. Shortened anatomical crowns
2. Exposed dentin
3. Wide, flattened chewing surfaces
4. Overclosure of the jaws
Machida N, Tohara H, Hara K, Kumakura A, Wakasugi Y, Nakane A, Minakuchi S. Effects of aging and
sarcopenia on tongue pressure and jaw‐opening force. Geriatrics & gerontology international. 2017
Feb;17(2):295-301.

 increases with age.
 over the age of 65 are edentulous
 consume soft, easily chewed foods that are low in fiber and have a low
nutrient density.
 Released whole or incompletely indigested from the G.I.T.
f) Edentulism:

 body calcium balance
 Calcium deposited or resorbed
Calcium homeostasis
g) Alveolar bone loss:
Alveolar bone density

 Osteoporosis:
Estrogen ----- bone resorption
Testosterone ------ bone formation
Jonasson G, Rythén M. Alveolar bone loss in osteoporosis: a loaded and cellular affair? . Journal of Clinical,
cosmetic and investigational dentistry. 2016;8:95.

Classification of food
• By origin:
1. Food of animal origin
2. Food of plant origin
• By chemical composition:
1. Carbohydrates
2. Proteins
3. Fats

REGULATORS
• Vitamins
• Minerals
• Water
•By Function:
1.Body building foods: Milk,meat,eggs,fish
2.Energy giving foods: Cereals,sugars
3.Protective foods: Fruits,vegetables

The sum total of ingesting the diet, the digestive functioning, and absorption of
nutrition by tissues until its complete usage by the cells.
NUTRITIONAL RECOMMENDATION:

GERIATRIC NUTRITION
• ENERGY REQUIREMENT:
- Decreases in older persons by about 100kcals/decade
- RDA for energy: 30kcal/kg/day

CARBOHYDRATES
• The recommended range of intake is 50 % of total calories.
•Fiber rich complex carbohydrates are recommended.
Food sources include grains and cereals, vegetables, fruits and dairy
products.

PROTEINS
• Protein depletion seen primarily as a decrease of the skeletal muscle
mass.
• Proteins is a must for denture wearers.
• The RDA for proteins, for people aged 51 and over, is 0.8-1 g/kg body
weight per day.

FATS
•Dietary fats from either animal or plant sources provide an alternate for
storage form of energy.
• Fat is a more concentrated fuel than carbohydrate, with a fuel factor of 9,
yielding 9kcal/g.
• Contains essential fatty acids required for life and health.

• Promotes bowel function.
• reduce serum cholesterol.
• Fiber in the form of bran is added to dry cereals and breads.
FIBRE

• Excessive water loss through damaged kidney.
• Inadequate fluid intake will lead to rapid dehydration and associated problems such as:
Hypotension, elevated body temperature, dryness of mucosa, decreased urine output and
mental confusion.
• Fluid intake should be atleast 30 ml/kg/day.
WATER

PROTEIN Milk, egg, fish, meat, liver, pulses, nuts and oilseeds.
FAT Butter, ghee, vegetable oils, hydrogenated fats, nuts and
oilseeds.
CARBOHYDRATES Cereals, pulses, sugar and jaggery, roots and tubers.
FIBERS Green leafy vegetables, fruits, unrefined cereals, pulses, and
legumes
CALCIUM Milk and milk products, green leafy vegetables
MAJOR FOOD SOURCES OF NUTRIENTS
Naik N et al., Diet guideline for geriatric patient: A litrature review. International Journal of Dental Health Scienes.
2015; 2(4):826-833

• Deficiency is common in older adults.
- megaloblastic anemia
- causes include –
1. inadequate intake
2. alcoholism
3. medications
4. malabsorption syndrome
• RDA is 500 microgram.(above 50 years)
FOLATE

VITAMIN B12
 Low gastric acid level Reduced absorption of Vit B12
because gastric acid is required for food bound vitamin B12 and make it available for
absorption.
 The RDA is 2.5-3.0 microgram (above 50 yrs)
1 microgram (below 50 years)
Causes of deficiency include
•Reduction in consumption of Vit B12 rich diet.
•Decreased absorption and bioavailability of vitaminB12

VITAMIN C
The RDA is about 60 microgram.
- Protects against stress related and degenerative diseases.
- Essential for synthesis of collagen and thus essential to the healing of wound.
-Causes of deficiency include inadequate intake and high doses of salicylates.

• Required for maintenance of bone health and absorption of calcium
• Institutionalized and home bound people at particular risk.
• The RDA is 15-20 microgram (above 50 years)
5 microgram (below 50 years)
VITAMIN D

Vitamin D
(Calcitriol)
• Vitamin D intake
• Skin production of cholecalciferol
• Activity of both liver and renal hydroxylases

CALCIUM SUPPLEMENTS
• Post menopausal women taking estrogen supplements :1000mg/day
• Post menopausal estrogen deprived women : 1500mg/day
• Supplementation needed for the prevention and treatment of osteoporosis.

- Essential for the oxygen carrying capacity of hemoglobin of the blood.
Deficiency is associated with:
- Inadequate intake
- Blood loss associated with hemorrhage or chronic disease
- Associated vitamin C deficiency
The RDA for iron is 10 mg.
IRON

VITAMINS SOURCES DEFICIENCY
VITAMIN A
Liver, kidney, eggyolk, milk,
cheese, butter, fish liver oils.
VITAMIN D
Fatty fish, fish liver oils, egg yolk,
milk.
•Bitot’s spots (eyes)
•Conjunctival xerosis
•Xerosis of skin
Cereals, pulse, oil seeds ,nuts,
yeast.
Milk and milk products,cereal,
fruits, vegetables and fish.
Fissuring and redness of eyelid ,
corners and mouth, Magenta
colored tongue.
VITAMIN B1
(THIAMINE)
VITAMIN B2
(RIBOFLAVIN)
•Required for maintenance of bone
health and absorption of calcium
•Osteoporosis.
Mental confusion, Irritability, Beri
Beri, stunted growth.
2015; 2(4):826-833

VITAMIN C Citrus food,Amla, guava, tomatoes, green
vegetables, potatoes etc.
Bleeding in the gums,Delayed
wound healing,Hemorrhage and
decrease immunity.
Meat, milk, fish, egg yolk,
corn, wheat
Liver, egg,fish,chicken,milk,curd
Folic Acid
(Folacin)
Green leafy vegetables, Whole grains,
eggs, cereals ,liver , kidney beans
Depression, Irratibility,
Nervousness, mental confusion,
Decrease in hemoglobin levels.
VITAMIN B6
VITAMIN B12
Megaloblastic anemia, Dementia,
Neuropsychiatric disorders,
Lethargy and Malaise.
Glossitis, Skin hyper-
pigmentation, Megaloblastic
anemia
2015; 2(4):826-833

VITAMIN E
Vegetables oils (sunflower,soyabean
etc) sunflower seeds,green leafy
vegetables.
•Known as anti sterility
vitamin.
•No oral manifestations seen.
VITAMIN K
Fish, liver, eggs , cereals,green
leafy vegetables,brocolli,prues
Spontaneous gingival bleeding
and Gingival haemorrhages.

This is an outline of what to eat each day.
It’s not a rigid prescription, but a general guide that let you choose a healthful diet that’s
right for you.
It emphasizes foods from the five food groups.
Food in one group can’t replace those in another.
FOOD GUIDE PYRAMID
Wardlaw GM, Insel PM, Seyler MF. Contemporary nutrition: issues and insights. Mosby-Year Book, Inc.; 1994.

THE FIVE FOOD GROUPS: By Russel et al.

1. Vegetable and Fruit Group :
Four servings
subdivided into three categories:
• Two servings of good sources of vitamin C
• One serving of good source of Vitamin A
• One serving of potatoes and other vegetables and fruits.

2. Bread – Cereal Group
Four servings of enriched bread, cereals, and flour products.
3. Milk - Cheese group
Two Servings of milk and milk based foods, such as cheese (but not butter).
4. Meat, Poultry, Fish and Beans Group
Two servings of meats, fish poultry, eggs, dried beans and peas, and nuts.

The last item on the pyramid, fats, oils, and sweets, is
not considered as a nutritional category and comes with
the admonition that these substances are to be used
sparingly.

FOODSTUFF MALES FEMALES
CEREALS 320 gms 220 gms
PULSES 70 gms 55 gms
GREEN LEAFY VEGETABLES 100 gms 125 gms
OTHER VEGETABLES 75 gms 75 gms
ROOTS AND TUBERS 75 gms 50 gms
MILK AND MILK PRODUCTS 600ml 600 ml
OILS AND FATS 30 gms 30 gms
FRUITS 75 gms 50 gms
SUGAR AND JAGGERY 30 gms 30 gms
COMPOSITION OF BALANCED DIET FOR GERIATRICS OVER 60 YEARS:
2015; 2(4):826-833

Clinical signs of Nutritional Deficiency
The physical signs of nutrient deficiency are not early indications that a
particular nutrient is lacking.
They develop after period of inadequate intake during which tissue stores
are depleted and metabolism is disturbed.

Assessing nutritional
Status:
• Anthropometric data
• Biochemical tests
• Clinical observations
• Diet evaluation and personal histories
(i.e., medical, social,
medications)
Eleanor D. Schlenker , Joyce Gilbert. William’s Essentials of
Nutrition and Diet Therapy, 11th edition. Elsevier Inc. ; 2015.

Triphasic Nutritional Analysis:
This is the three phase nutritional evaluation of geriatric population:
1. Phase 1: Qualitative Dietary Assessment
2. Phase 2: Semi-quantitative Dietary Analysis
Biochemical Assessment
3. Phase 3: More complex nutritional problems
Bandodkar KA, Aras M. Nutrition for geriatric denture patients. The Journal of Indian Prosthodontic Society.
2006 Jan 1;6(1):22.

Prosthodontic
Considerations Of
Nutrition

Treatment planning for partially dentate patients with good prognosis:
1. Removable partial dentures (RPDs):
Designed considering hygienic principles, to prevent plaque accumulation.
2. Minimal invasive dentistry (MID):
• effective and acceptable form of dental management for older adults.
• Includes the use of resin-bonded or cement-retained bridges.
• Reduce maintenance burden.
• Economical as compared to conventional bridges and RPDs.
3. Glass fibre-reinforced composite bridgework
Krishnan Y, Jain L, Seth J, Kumar V. Nutritional and prosthodontic care for geriatric patients. International Journal of Oral
Health Dentistry; 2017;3(3):127-132

Treatment planning for partially edentulous with poor prognosis:
1. Immediate Denture:
• Maintains satisfactory appearance and function during the post-extraction phase of
treatment.
2. Overdentures:
• Used especially in the mandible where bone resorption can severely compromise
denture stability and retention.
• Also used in hypodontia cases as well as cleft palate or surgical defect cases.
Krishnan Y, Jain L, Seth J, Kumar V. Nutritional and prosthodontic care for geriatric patients. International Journal of Oral
Health Dentistry; 2017;3(3):127-132

Treatment planning in completely edentulous patients:
1. Complete Dentures:
• Most common and economical
• Successful treatment modality if its retention and stability are taken care of.
2. Implants:
• Can overcome many of the functional, psychological and physiological
consequences of edentulism.
• Helps to preserve alveolar bone and bite force is increased when compared
with conventional complete dentures.
Krishnan Y, Jain L, Seth J, Kumar V. Nutritional and prosthodontic care for geriatric patients. International
Journal of Oral Health Dentistry; 2017;3(3):127-132

Dietary Counseling of
Prosthodontic Patients
• Patients often are receptive to suggestions aimed at
improving the quality of their diets. Nutrition screening
begins at the first appointment itself so that counseling and
follow up can occur during the course of treatment.

Effect of dentures on taste:
• Maxillary denture covers the taste
buds present in the palate.
Effect of dentures on chewing ability:
• Need to use more strokes and chew
longer, to prepare food for swallowing.
• Masticatory efficiency in denture
wearers is approx. 80% lower than in
people with intact dentition.
Publishers; 2000

 Use of herbs and condiments can heighten food flavors for denture
wearers.
 Serving foods that are tolerably hot.
 For maximum taste sensation, the use of sharply contrasting flavors in
combinations (such as sweet and sour)
Dietary Suggestions For Denture Wearers
Modifying food selection and Food Habits:
Ejvind, Budtz-Jorgensen. Prosthodontics for the elderly, diagnosis and treatment. 1sts ed. Quintessence
Publishing Co Inc: Illinois; 1999.

TEACHING THE PATIENT TO MASTICATE WITH THE NEW
PROSTHESIS:
The process of eating actually involves three steps:
• Biting or incising
• Chewing
• Swallowing.

Tearing action by the incisor
dislodgment of the denture by the pulling action of over-tensed
muscle.
Biting or incising

Chewing
 Chewing by molars and bicuspids are less difficult than incising.
 The coordination of many muscles of mastication that produce the hinge
and sliding movement of the mandible during eating requires some
experience.
 Therefore it is said that a denture wearer can start adapting to the new
denture after 6 weeks of wearing.

DIET AFTER DENTURE INSERTION
On the first post-insertion day :
A new denture wearer can choose food which are essentially liquid and are arranged
according to the four basic food groups:
•Vegetable fruit group - juices
•Bread cereal group - gruels cooked in either milk or water
•Milk group - milk may be taken in any form
•Meat group - for the first day or so, eggs will be the first food choice; meat broths or
soups may also be eaten.
2006 Jan 1;6(1):22.

Third post insertion day:
The patient can consume soft foods that require a minimum of chewing.
•Vegetable fruit group: tender cooked fruits and vegetables
•Bread-cereal group: cooked cereals ,boiled rice.
•Milk group: milk.
•Meat group: ground meat, chicken or fish in a cream sauce;eggs may be
scrambled or soft cooked.
2006 Jan 1;6(1):22.

By the fourth day:
•In addition to the soft diet, firm foods can be eaten.
•In most instances, these foods should be cut into small pieces before eating.
•Raw vegetables and fruits are the least preferred by denture wearers.
2006 Jan 1;6(1):22.

Nutrition is one of the factors which determine the success or failure
of prosthetic appliances in the mouth of aging people. Therefore, as a
prosthodontist we should be aware that, a well-balanced diet of
essential nutrients is vital to the general health of the patient and also
to the success of the prosthesis.
Geriatric patients are particularly exposed to compromised nutritional
health so care must be taken to maintain healthy nutritional status.
Conclusion
87

1. Sheldon Winkler. Essentials of complete denture prosthodontics. 2nd ed. USA: Ishiyaku Euro America Inc.
Publishers; 2000
2. Glossary of Prosthodontic terms – 7. J. Prosthet Dent. Jan. 1995: 81:1:39
3. Heartwell C.M. Jr. Syllabus of complete dentures. 4th edition; 1986
4. Zarb –Bolender : Prosthodontic treatment for edentulous patients, 12th edition
5. Abraham E Nizel, Athena. S. Papas. Nutrition in clinical dentistry. 3rd ed. USA: W. B. Saunders Company;1989
6. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Suitland,
MD, USA: United States Census Bureau, Economics and Statistics Administration, US Department of
Commerce; 2014 May 9
7. United Nations. 2019. World Population Aging Report. Available from:
https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing201
9-Report (Accessed 18th November 2021)
8 Strait JB, Lakatta EG. Aging-associated cardiovascular changes and their relationship to heart
failure. Heart failure clinics. 2012 Jan 1;8(1):143-64
References

9. Buch A, Carmeli E, Boker LK, Marcus Y, Shefer G, Kis O, Berner Y, Stern N. Muscle function
and fat content in relation to sarcopenia, obesity and frailty of old age—An overview.
Experimental gerontology. 2016 Apr 1;76:25-32.
10. Goodwin JS. Social, psychological and physical factors affecting the nutritional status of
elderly subjects: separating cause and effect. The American journal of clinical nutrition. 1989 Nov
1;50(5):1201-9.
11. Boyce JM, Shone GR. Effects of ageing on smell and taste. Postgraduate medical journal. 2006 Apr
1;82(966):239-41
12. Tan EC, Lexomboon D, Sandborgh‐Englund G, Haasum Y, Johnell K. Medications that cause
dry mouth as an adverse effect in older people: A systematic review and metaanalysis. Journal of
the American Geriatrics Society. 2018 Jan;66(1):76-84.

13. Dawes C, Pedersen AM, Villa A, Ekström J, Proctor GB, Vissink A, McGowan R, Aliko A,
Narayana N. The functions of human saliva: A review sponsored by the World Workshop on Oral
Medicine VI. Archives of oral biology. 2015 Jun 1;60(6):863-74
14. Bandodkar KA, Aras M. Nutrition for geriatric denture patients. The Journal of Indian
Prosthodontic Society. 2006 Jan 1;6(1):22.
15. Rathee M, Singla S, Bhoria M, Kundu R. Role of Nutrition Assessment and Dietary Counselling in
Geriatric Denture Population-An Overview. J Oral Health Res. 2015 Apr 1;6(2):
16. Eleanor D. Schlenker , Joyce Gilbert. William’s Essentials of Nutrition and Diet Therapy, 11th edition.
Elsevier Inc. ; 2015.

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NUTRITION AND DIETETICS IN GERIATRIC PATIENTS (1).pptx

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