SWK-597-43W Chapter 11

Chapter 11
Nutrition and
Aging

Objectives (1 of 3)
1. Demonstrate knowledge of current research
on the impact of aging on nutrition status for
healthy individuals and individuals with
chronic diseases.
2. Describe the importance of early screening
and intervention for nutritional risk in older
adults.
3. Identify screening tools for the assessment
of nutritional risk in the older adult.

Objectives (2 of 3)
4. Recognize the multiple factors that affect
nutrition status in older adults
(physiologic, social, psychological,
economic, and environmental).
5. Describe the physiologic impact of aging
on dietary intake and absorption.
6. Use MyPlate to advise the older adult
about the implementation of the 2010
Dietary Guidelines for Americans.

Objectives (3 of 3)
7. Describe the basics of the Mediterranean
diet and the DASH diet for the treatment
of common chronic diseases in the older
adult.
8. Recognize the impact of polypharmacy on
nutritional status and drug–nutrient
interactions in older adults.
9. Describe the appropriate use of nutritional
supplements for the older adult.

Screening (1 of 20)
• The Nutrition Screening Initiative (NSI)
– Encourages early and routine screening and
intervention for nutrition risk in older adults
– Views nutrition status as a vital sign
– Strives to increase older adults’ awareness
about nutrition and health and offers health
care practitioners the tools to do so,
including the DETERMINE questionnaire

Screening (2 of 20)
The National Resource Center on Nutrition & Aging

Screening (3 of 20)
The National Resource Center on Nutrition & Aging

Screening (4 of 20)
• Malnutrition Screening Tool (MST)
– Consists of three questions:
• Have you lost weight recently without trying?
• If yes, how much weight have you lost?
• Have you been eating poorly because of
decreased appetite?

Screening (5 of 20)
• Malnutrition Screening Tool (continued)
– First two questions are scored as 0 (No), 1
(Yes), or 2 (Unsure)
– Third question is scored from 1–4, based on
the amount of weight lost
– Total score of 2 or more indicates that the
older adult is at risk of malnutrition and
further assessment is warranted

Screening (6 of 20)
• Malnutrition Universal Screening Tool
(MUST)
– Malnutrition risk is determined by assessing:
• Body mass index (BMI)
• Unintentional weight loss
• Severity of acute disease

Screening (7 of 20)
• Nutrition assessment tools
– Used for patients identified as “at risk” for
malnutrition
– Useful in:
• Quantifying risk
• Determining severity and duration of malnutrition
• Identifying possible causes for the deficits

Screening (8 of 20)
• Subjective Global Assessment (SGA)
– Classifies patients from well-nourished to
severely malnourished
– Clinician records patient weight history, diet
history, primary diagnosis, stress level, and
changes in functional status
– Clinical judgment needed in analyzing the
information provided

Screening (9 of 20)
• Mini Nutritional Assessment (MNA)
– Includes:
• Anthropometric measurements
• Diet history
• Appetite
• Feeding mode
• Laboratory measures of nutritional status
– Developed especially for use with older
adults

Screening (10 of 20)
• Diagnosis of malnutrition needs to include two
or more of the following characteristics:
– Insufficient energy intake
– Weight loss
– Loss of muscle mass
– Loss of subcutaneous fat
– Localized generalized fluid accumulation that may
mask weight loss
– Diminished functional status as measured by
handgrip strength

• Undernutrition: weight and malnutrition
– Prevalence of malnutrition varies depending
on factors such as age distribution and
living situation
– Decreases in body weight are common in
adults ages 65 to 90
• Considered a warning sign for nutritional risk
– Strong association between undernutrition
and increased morbidity and mortality

• Involuntary weight loss may be caused
by:
– Inadequate dietary intake
– Loss of appetite
– Muscle atrophy
– Inflammatory effects of disease
• Many older adults may experience a
combination of these factors

• Inadequate dietary intake
– Associated with:
• Social isolation
• Limited ability to purchase food
• Chronic disease and medications
• Malignancy and depression
• Dysphagia
• Dementia
• Chewing difficulty related to poor dental health

• Physiologic changes of aging that can
result in anorexia or decreased appetite:
– General reduction in gastrointestinal motility
– Declines in senses of taste and smell
– Decreased basal metabolic rate
– Impaired hormonal regulation of food intake
• Certain drugs and medications can also
reduce taste and smell acuity

• Decreased absorption of nutrients
– Lactose intolerance
• Consumption of dairy products causes intestinal
gas, diarrhea, and cramping
• Caused by decreased intestinal lactase
production
• Severe form can:
– Decrease the absorptive capacity of the intestinal cells
– Cause malabsorption of many nutrients
• Risk of inadequate calcium intake

• Celiac disease
– Sensitivity to gliadin, a component of gluten
found in wheat and some other grains
– Consumption of gluten causes:
• Damage to intestinal villi
• Malabsorption of fats, fat-soluble vitamins, and
minerals such as calcium and iron

• Vitamin B12 deficiency
– Vitamin B12 absorption requires the gastric
secretion of acid and intrinsic factor, which
decreases with age
– Absorption can be further compromised by
medications for heartburn,
gastroesophageal reflux, or diabetes
– Deficiency can also contribute to age-
related cognitive decline

• Vitamin D deficiency
– Ability to synthesize vitamin D with
exposure to sunlight decreases with aging
– Many older adults reduce sunlight exposure
– Low vitamin D levels:
• Decrease muscle strength
• Increase the risk of falls
• Contribute to the development of osteoporosis

• Dehydration
– Aging is associated with:
• Decrease in total body water
• Decline in thirst perception
• Decrease in renal water conservation capacity
– Risk factors:
• Cognitive impairment
• Issues with incontinence or mobility

Treatment of Weight Loss and Other
Nutritional Problems Related to Aging
(1 of 23)
• Weight loss
– Healthcare providers need to identify the
cause when an older adult loses:
• 5% or more of body weight in 1month
• 10% or more in 6months
– Treatable causes of weight loss:
• Anorexia
• Dysphagia

(2 of 23)
• Use the MEALS ON WHEELS
mnemonic to identify the general causes
of weight loss in older adults:
– M: medications
– E: emotional (depression)
– A: alcoholism, anorexia nervosa, or abuse
– L: late-life paranoia
– S: swallowing disorders

(3 of 23)
– O: oral factors
– N: no money
– W: wandering and dementia-related behaviors
– H: hyperthyroidism, hypothyroidism,
hyperparathyroidism, hypoadrenalism
– E: enteric problems, malabsorption
– E: eating problems
– L: low-salt, low-cholesterol diet
– S: shopping and meal preparation problems

(4 of 23)
• Treatment of gastrointestinal problems
– Constipation
• Treated by increasing fluid and dietary fiber
intake
• Must increase both dietary fiber and fluid to
avoid the risk of fecal impaction
• Ensuring adequate fiber intake may also reduce
the incidence of diverticulosis and the risk of
certain types of colon cancer

(5 of 23)
• Malabsorption
– Most common causes in older adults are
lactose intolerance and celiac disease
– Eliminating lactose treats lactose
intolerance
– Avoiding gluten treats celiac disease
– There are a number of food products
designed for people with each of these
conditions

(6 of 23)
• Inadequate intake or absorption of vitamins
and minerals
– Little clinical evidence to support routine
multivitamin and mineral supplementation in the
absence of compromised nutritional status
– Older adults can benefit from supplemental B12
– Vitamin D supplements should be considered for
older adults at risk for vitamin D deficiency
– Calcium supplement may also be appropriate

(7 of 23)
• Dehydration
– Signs and symptoms:
• Dry mouth
• Dark urine
• Fatigue and lethargy
– Important to develop prevention strategies
– Older adults should try to:
• Consume at least 6 cups of fluid per day
• Consume fluids with meals and between meals

(8 of 23)
• Overnutrition
– Excess nutrient and energy intake over time
– Form of malnutrition when it leads to morbid
obesity
– Associated with an increase in:
• All causes of mortality
• Morbidity related to hypertension, dyslipidemia,
type 2 diabetes, and other chronic diseases

(9 of 23)
• Best weight for height in older adults
may be higher than that for younger
adults
• Weight loss recommendations must be
made on an individual basis
– Any weight loss should be pursued
cautiously

(10 of 23)
• Cardiovascular disease
– Evidence suggests dietary changes can help
prevent cardiovascular disease in older adults
– PREDIMED trial
• Found a relative risk reduction for men and women
consuming Mediterranean diet
• Participants had type 2 diabetes or at least three
major risk factors for cardiovascular disease
• Diet was energy unrestricted and participants did not
lose significant amounts of weight

(11 of 23)
• Diabetes
– Necessitates evaluation by a dietician
– Older diabetics may need regular help
adhering to a diet to manage blood glucose
levels
– Plan should emphasize foods low on the
glycemic index
– Obese older people with diabetes may
benefit from modest weight loss

(12 of 23)
• Dietary patterns that support persons
with diabetes:
– Mediterranean diet
– DASN (Dietary Approach to Stop
Hypertension) diet

(13 of 23)
• General nutrition recommendations
– Dietary Guidelines for Americans 2015–
2020 provide food-based guide to help
individuals:
• Improve and maintain overall health
• Reduce their risk of chronic disease
– Overarching focus is on making food
choices to support healthy eating patterns

(14 of 23)
• General guidelines for older adults:
– Follow a healthy eating pattern across the
lifespan
– Focus on variety, nutrient density, and
amount
– Limit calories from added sugars and
saturated fats and reduce sodium intake
– Shift to healthier food and beverage choices
– Support healthy eating patterns for all

(15 of 23)
Reproduced from U.S. Department of Health and Human Services,
Office of Disease Prevention and Health Promotion. 2015-2020
Dietary Guidelines. www.health.gov/dietaryguidelines/2015/

(16 of 23)
• Diet plans consistent with the
recommendations in the Dietary
Guidelines:
– Healthy U.S.-Style Eating Pattern
– DASH dietary pattern
– Health Mediterranean-Style Eating Pattern
– Healthy Vegetarian Eating Pattern

(17 of 23)
• Appropriate caloric level varies based on
the individual’s specific caloric needs
– Recommended Daily Allowance (RDA) for
energy for individuals over the age of 50:
• 1900 kcal for females
• 2300 kcal for males

(18 of 23)

(19 of 23)
• MyPlate
– Part of a communications initiative from the
USDA to encourage healthier eating habits
– Uses a graphic of a dinner plate to illustrate
serving size in the five food groups
– ChooseMyPlate.gov offers a special section
focused on older adults

(20 of 23)
Data from Choose My Plate. U.S. Department of Agriculture. www.choosemyplate.gov/myplate-mywins

(21 of 23)
• Drug and nutrient interactions
– Many drug–drug interactions involve
interactions between medications and dietary
supplements
– Examples:
• Antihyperlipidemic drugs can interact with niacin
• Grapefruit affects the metabolism of statins
• Garlic interacts with warfarin, increasing its effects
• Leafy greens may decrease warfarin’s
effectiveness

(22 of 23)
• Alcohol
– Not patently discouraged unless it:
• Directly inhibits or exacerbates effectiveness of
medications
• Contributes to loss of balance and mobility
• Interferes with health and nutrition due to abuse
– Focus by healthcare professionals should
be on whether drinking has increased and
why

(23 of 23)
• Nutritionally, alcohol abuse compromises
health and can lead to malnutrition by:
– Adding calories to the diet, leading to weight
gain
– Replacing nutrient-rich food in the diet
– Interfering with the normal absorption and
metabolism of vitamins

SWK-597-43W Chapter 11

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SWK-597-43W Chapter 11