Nutrition for Older Adults

Learning outcome
 At the end of this chapter, you should be able to:
 Explain the terms life expectancy v/s life span
 Discuss the Hypothesis of Aging
 Understand how the modifiable and non-
modifiable physiological changes of aging affect
nutritional status in old age
 Identify causes of under-nutrition in older adults
and tools to assess the same
 Understand dietary and lifestyle modifications
based on organ function / physiological changes.
 NUTRITION FOR THE ELDERLY
 Gerontology is the study of aging, including
biological, sociological and psychological changes.
 “The important focus is on living healthier and not
necessarily living longer”.
 Life expectancy has gone up in the last few decades,
although the span of healthy years is not as high.
 Geriatrics refers to medical care for the elderly, an age
group that is not easy to define precisely
 The World Health Organization classifies people aged
between 45 and 59 as 'middle aged', 60 to 74 as
'elderly' and over 75 as 'old'.
 65 years and over: 5.5% (male 30,831,190/female
33,998,613) (India 2011 census)
What is Aging ?
 Aging can be defined as a progressive
functional decline, or a gradual deterioration
of physiological function with age
 Aging is a gradual but continuous process
that begins early in life.
 Process of slow cell death. Begins soon after
fertilization. Not apparent in young age as
major metabolic activities are geared towards
growth and maturation.
 Reserve Capacity – The extent to which an
organ can preserve essentially normal
function despite decreasing cell number or
cell activity. Both genetic and environmental
factors (eg. nutrition) affect the rate of
aging.
 Changes occur in all stages of adulthood.
 In early adulthood (20-39yrs)– physical growth
ceases.
 During middle adulthood (40-65yrs) and old age
(>65 years):
- Nutrients are mainly used for repair and maintenance
- Body composition changes like- decreased lean mass,
increased body fat and decreased bone density.
- BMR decreases : means a decrease in body functions,
capacity to do physical work is diminished, so calorie
intake is reduced.
 Striving to have the greatest number of healthy years and fewest years of illness
is often referred to as “Compression of Morbidity” – i.e. delaying the onset of
disabilities caused by chronic diseases.
 Life Span – The potential oldest age an individual person can reach.
 Life Expectancy is the ‘Average’ length of life for a defined group or
population.
 Life Expectancy in India has also seen an upward trend.
 I970: 49 1990: 59 2006: 64 2011: 66.8 2014: 68.4?
 Male: 65.77 years and Female: 67.95 years (2011)

February 5th, 2012 . by economistmom

http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html
http://www.worldlifeexpectancy.com/your-life-expectancy-by-age
http://www.worldlifeexpectancy.com/world-life-expectancy-map
http://apps.who.int/gho/data/view.wrapper.MGHEHALEv?lang=en&menu=hide
http://www.who.int/mediacentre
/factsheets/fs310/en/index1.html
 Theories of Aging
 Gerontologists study aging and have diverse theories
about why the body ages. No single theory can fully
explain the complex processes of aging.
 Broadly, theories can be grouped into two categories:
predetermined and accumulated damage.
 A loss of efficiency comes about as some cells wear out,
die, or are not replaced. This is sometimes referred to as
the one percent rule; most organ systems lose
approximately 1% of their functioning each year, starting
at age 30.
 A recent theory is that the cause of age-related health
decline is malfunctioning telomeres. So far the studies are
in mice (Sahin et aI., 2011).
 Theories of Aging
CATEGORY THEORY DESCRIPTION

Predetermination: Pacemaker "Biologic clock" is set at birth, runs for

A built-in theory a specified time, winds down with
mechanism aging, and ends at death.
determines when Genetic theory Life span is determined by heredity.
aging begins and
time of death Rate of living Each living creature has a finite
Theory amount of a "vital substance,“ and,
when it is exhausted, the result is aging
and death.
Oxygen Animals with the highest metabolisms
metabolism are likely to have the shortest life spans.
theory
Immune system Cells undergo a finite number of cell
theory divisions that eventually
cause deregulation of immune
function, excessive inflammation,
aging, and death.
 Theories of Aging
CATEGORY THEORY DESCRIPTION

Accumulated Crosslink With time, proteins, DNA and other

damage: theory structural molecules in the body make
Systemic inappropriate attachments, or crosslinks
breakdown to each other, leading to decreased mobility,
over time elasticity, and cell permeability.
Wear-and-tear Years of damage to cells, tissues, and organs
theory eventually take their toll, wearing them out
and ultimately causing death.
Free radical Accumulated, random damage caused by
theory oxygen radicals slowly cause cells, tissues,
and organs to stop functioning.
Somatic Genetic mutations caused by oxidizing
mutation radiations and other factors accumulate
Theory with age, causing cells to deteriorate
and malfunction.
 Physiological Changes in Old Age
 Aging is a normal biological process. However, it involves some
decline in physiological function. Organs change with age. The rates
of change differ among individuals and within organ systems.
 It is important to distinguish between normal changes of aging and
changes caused by chronic disease such as atherosclerosis.
 The human growth period draws to a close at approximately age 30,
when senescence begins. Senescence is the organic process of
growing older and displaying the effects of increased age.
 Disease and impaired function are not inevitable parts of aging.
Nevertheless, there are certain systemic changes that occur as part of
growing older. These changes result in varying degrees of efficiency
and functional decline.
 Factors such as genetics, illnesses, socioeconomics, and lifestyle all
determine how aging progresses for each person. Indeed, one's
outward expression of age may or may not reflect one's chronologic
age.
 Definitions of common terms in old age
• Sarcopenia – loss of lean muscle mass (normal aging change)‫‏‬
• Dysgeusia – altered/impaired taste perception
• Parageusia – abnormal/unpleasant sense of taste
• Hyposmia – reduced ability to smell and to detect odors
• Xerostomia – insufficient saliva producing dry mouth
• Satiety- feeling of having had enough or too much
• Dysphagia – difficulty swallowing
• Achlorhydria –insufficient production of stomach acid
• Edentulism – toothless (no teeth)‫‏‬
Age-associated physiological system changes that affect
nutritional health

 Cardiovascular System
 Reduced blood vessel elasticity, blood volume, stroke, volume
output
 Increased arterial stiffening, blood pressure
 Endocrine System
 Reduced levels of estrogen, testosterone
 Decreased secretion of growth hormone
 Increase in cortisol (stress)
 Reduced glucose tolerance
 Reduced levels of thyroid gland secretions
 Gastrointestinal System
 Reduced secretion of saliva and of mucus
 Missing or poorly fitting teeth
 Dysphagia or difficulty in swallowing
 Damaged, less-efficient mitochondria produce less ATP, less
energy
 Reduced secretion of hydrochloric acid and digestive enzymes
 Slower peristalsis
 Reduced vitamin B12 absorption
 Musculoskeletal System
 Reduced lean body mass (bone mass, muscle, water)
 Increased fat mass
 Decreased resting metabolic rate
 Reduced work capacity (strength)
 Nervous System
 Blunted appetite regulation
 Blunted thirst regulation
 Reduced nerve conduction velocity, affecting sense of smell,
taste, touch, cognition
 Changed sleep as the wake cycle becomes shorter
 Renal System
 Reduced number of nephrons
 Less blood flow
 Slowed glomerular filtration rate
 Respiratory System
 Reduced breathing capacity
 Reduced work capacity (endurance)

Nutrition through the Lifecycle: Judith E Brown

Declines in physiological function seen with aging. The decline in many
body functions is especially evident in sedentary people.

Figure 18_02
 EFFECTS OF AGING ON NUTRITIONAL HEALTH
 Decreased appetite and food intake – Decreased BMR and Physical Activity.
This means an increased risk of nutrient deficiencies.
 Reduced sensitivity to taste and smell – Dysgeusia and/or hyposmia affect
food intake. Because taste and smell stimulate metabolic changes such as
salivary, gastric acid, and pancreatic secretions and increases in plasma levels of
insulin. Decreased sensory stimulation may impair these metabolic processes as
well.
 Dental health – about 50-60% of the elderly have lost all their teeth.
Replacement dentures need more time for chewing. Food consistency needs to
be modified.
 Thirst – Fluid intake reduces with age. Perception of thirst diminishes.
Dehydration is common – leads to confusion. 6-8 cups of fluids per day is a
good recommendation.
 Changes in gastro-intestinal tract: Movement of food in the G.I.T. slows down.
 So, constipation is a common complaint. Increase in fibre and fluids will
increase peristalsis.
 Lactase production also decreases with age.
 Synthesis of ‘intrinsic factor’ reduces, affecting vitamin B12 absorption
 Indigestion and heartburn are common in old age.
 Decrease in functioning of liver, gall bladder, pancreas:
- Liver cannot detoxify many substances.
- Gall stones are common – block the passage of bile.
- Sign of failing pancreas is high blood glucose.
 Incontinence: Inability to control the muscles responsible for
retaining urine. Due to this, aged people avoid fluids – can cause
dehydration and constipation.
 Kidney function: With aging, kidneys filter waste more slowly as they
lose nephrons.
 Immune Function: Now operates less smoothly and efficiently.
Consuming enough proteins; Vitamins E, C, B6, zinc, etc. helps to
maximize the health of the immune system. Recurrent sickness and
poor wound healing is associated with a weak immune system.
 Lung Function: Lung efficiency declines somewhat. More so in those
elderly people who have smoked and continue to smoke/consume
tobacco products.
 Reduced lung function limits physical activity.
 Hearing and vision:
- Hearing impairment mainly occurs in people exposed to noise
pollution. Reduced hearing leads to social isolation / withdrawal.
- Retinal degeneration – degenerating eyesight affects independence
and quality of life.
 Neuro muscular system:
- Neuro muscular co-ordination decreases with age
- Conditions such as arthritis hamper life.
- Muscles in lower GIT become weaker.
- Some muscle cells shrink and others are lost, some others lose their
ability to contract
- Loss of muscle mass leads to a lowered BMR, reduced muscle strength
and decreased energy needs.
- The answer is to maintain an active lifestyle always.
 Cardio–vascular Health:
- Heart pumps blood less efficiently in older people due to reduced
physical activity. ‘Cardiac Output’ does not decline in active older
adults.
- Reduced physical activity may also increase the risk of low HDL, high
LDL  Atherosclerosis  C.H.D.
- Hypertension can be lowered by salt restriction.
 Effect of Aging on Weight Gain
(BMR = Base Metabolic Rate; BMI = Body Mass Index)
 Changes in hormone functions:
 Eg : Decreased ‘growth hormone’ concentration – decreased lean
mass. Decreased ‘Testosterone’ concentration – causes decline in
muscle strength. Decreased production of ‘Melatonin’ by the
‘pineal gland’ (in brain) – best known for its ability to induce
sleep.
 Medications: Medication and old age often go together.
- Can improve health and quality of life but some may affect
nutritional needs.
 Bone Health: Bone density decreases with aging. In women, it is
mostly after menopause; For Men – starts in middle years
- Increase calcium, fluoride and vitamin ‘D’ intakes
- Falling down in older years is dangerous.
 Cognitive functioning: by mind exercises, it can be retained.
 Socio – economic factors: Direct effect on nutritional status.
CHANGES WITH AGE WE PROBABLY CHANGES WITH AGE WE
CAN SLOW OR PREVENT PROBABLY MUST ACCEPT
By exercising, eating an adequate diet, These changes are probably
reducing stress, and planning ahead, you may beyond your control:
be able to slow or prevent:  Graying of hair
 Wrinkling of skin due to sun damage  Balding
 Some forms of mental confusion  Some drying and wrinkling
 Elevated blood pressure of skin
 Accelerated resting heart rate  Impairment of near vision
 Reduced lung capacity and oxygen uptake  Some loss of hearing
 Increased body fat  Reduced taste and smell
 Elevated blood cholesterol sensitivity
 Slowed energy metabolism  Slowed reactions (reflexes)
 Decreased maximum work rate  Slowed mental functioning
 Loss of sexual functioning  Diminished visual memory
 Loss of joint flexibility  Menopause (women)
 Diminished oral health: Loss of teeth, gum  Loss of fertility (men)
disease  Loss of joint elasticity
 Bone Loss
 Digestive problems, constipation
 EFFECTS OF AGING ON NUTRITION
CHANGE EFFECT
Sensory impairment
• Decreased sense of taste • Reduced appetite
• Decreased sense of smell • Reduce appetite
• Loss of vision and hearing • Decreased ability to purchase and prepare food
• Oral health/ dental • Difficulty in chewing, inflammation, poor
problems quality diet
Altered energy need Diet lacking in essential nutrients
Decreased physical activity Progressive depletion of LBM and loss of appetite
Muscle Loss (sarcopenia) Decreased functional ability, assistance needed
with ADLs
Psychosocial (isolation) Decreased appetite
Environment (financial) Limited access to food; poor quality diet
Cumulative Effect Progressive under-nutrition
• "I have trouble chewing." "Milk makes me feel bloated and
gassy" "I am not hungry." "Food doesn’t taste and smell the
way it used to."
• These phrases must sound familiar to people around the
elderly. These are also few of the many causes of
malnourishment and sickness amongst the elderly. Nutrition
has an enormous impact in managing, delaying or preventing
the onset of many chronic medical conditions such as diabetes,
heart disease and blood pressure.
• A wide range of nutritional problems exist amongst the elderly,
ranging from frank nutrient deficiencies to micro-nutrient
imbalances A healthy and balanced diet, appropriate cooking
methods, supplement of certain vitamins and minerals and a
regular exercise routine goes a long way in ensuring a good
quality of life.
HEALTH PROBLEMS/CONCERNS OF THE ELDERLY
 Nutrient deficiencies: Diets are often deficient in protein,
iron, calcium, vitamins A and C. This leads to increased
incidences of Anaemia, infections, etc.
 Alcoholism: Especially if living alone. Alcohol – drug
interactions adversely affect life.
 Obesity: Due to reduced physical activity and reduced
calorie need. High intakes of fat and refined foods. Obesity
reduces mobility. Obesity can complicate any existing
disease and also become a risk factor for others.
 Osteoporosis: Major health problem in elderly.
 In women post menopause and for men in middle years.
 Extra calcium and vitamin D may help, along with
exercise. Fluoride may increase bone density.
 Diabetes: NIDDM is a common problem in middle and
late adulthood. Obesity is a major risk factor. Can be
controlled by diet and weight control.
 Constipation & Diverticulosis: Due to weakening of
intestinal walls and low fibre diets.
 Hypertension: Tends to increase with age. Excess weight
is a more important factor rather than a high intake of
salt.
 Atherosclerosis: A high saturated fat diet is a risk. Can
result in a heart attack /angina.
 Cancer: much research has been done in this area in
relation to pollutants, food additives, smoking and diet
habits. Risk of cancer increases with advancing age due to
various factors, many of which are not well understood.
 Dementia is a condition of progressive cognitive
decline, typically characterized by impaired thinking,
memory, decision making, and linguistic ability.
Dementia is not a disease itself, but rather a set of
symptoms associated with particular degenerative
neurological conditions, like:
 Alzheimer’s disease; Vascular dementia; Parkinson’s
disease; Alcohol-related dementia; AIDS-related
dementia
 Dementia is not a part of normal aging, but rather the
manifestation of various forms of physiological
damage.
 Alzheimer’s Disease (AD) is the most common cause of
dementia and searches for a cause (leading to treatment) are
ongoing.
 Aluminum, copper, carnitine, and choline deficiencies have
been examined as possible causes of AD due to their role in
neurological function, but they have not been
demonstrated to be causative factors
 As the disease advances, individuals with AD will require
more and more assistance with meal preparation and eating.
 In later stages of the disease, wandering and restless
movements expend energy and increase caloric need.
 Behavioral, physical, or neurological problems may impede
adequate food intake. Consequently, individuals with late-
stage AD suffer from unintentional weight loss.
 Parkinson's disease (PD) is a progressive, disabling,
neurodegenerative disease, characterized by slow and
decreased movements, muscular rigidity, resting
tremor, postural instability, etc. Cause is mostly
genetic coupled with environmental / lifestyle factors
 It most commonly occurs between the ages of 40
and 70.
 Vitamin E treatment has been inconclusive
 Vitamin B6 helps to alleviate any nausea
 Under-nutrition in Older Adults
 World-wide, the elderly population is increasing, and with it,
the prevalence of malnutrition. Despite significant medical
advances, undernutrition remains a significant and highly
prevalent global public health problem: the overall
prevalence is 22.6%.
 Malnutrition significantly increases morbidity and mortality
and compromises the outcomes of other underlying
conditions and diseases.
 Malnutrition may delay recovery and prolong
hospitalization, lead to increased susceptibility to infection,
impede an individuals’ independence and quality of life, and
even increase the risk of death in many patients.
 Weight loss in older adults can be divided into three
distinct types
 Wasting, an involuntary loss of weight, which is primarily caused by
inadequate dietary intake. This may be attributable to both disease
and psychosocial factors, and may occur with a background of
cachexia or sarcopenia or both.
 Cachexia, an involuntary loss of fat free mass (FFM - muscle, organ,
tissue, skin and bone) or body cell mass (BCM), which is caused by
catabolism, and results in changes in body composition but in which
weight loss may not be initially present. An acute immune response
occurs. Cytokines are released that have profound effects on
hormone production and metabolism causing increased resting
energy expenditure / metabolic rate.
 Sarcopenia, an involuntary loss of muscle mass, which may be an
intrinsic part of the ageing process rather than the effect of age
associated disease.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563720/
 Causes of Malnutrition in the elderly
Social factors Physiological factors Psychological
factors
Lack of knowledge about Gastrointestinal dysfunction, e.g. Dementia
food and nutrition malabsorption
Isolation/loneliness Poor appetite and poor diet Depression
/Bereavement Oral problems such as teeth loss and
dysphagia; Loss of taste and smell
Poverty Respiratory disorders eg. COPD, Asthma Confusion
Inability to shop Endocrine disorders, e.g. diabetes Anxiety
mellitus type 2; Thyrotoxicosis
Inability to prepare food Cardiovascular disorders Delirium
Alcoholism Neurological disorders, e.g.
Parkinsonism; Stroke
Anxiety Infections, e.g. UTI; Pneumonia
Physical disability to feed self
Drug interactions ; Nausea and vomiting

Altered/increased metabolic demands

Other diseases, e.g. cancer
Screening tools for assessment of nutritional status of older adults
 The Malnutrition Universal Screening Tool (MUST) is a five-step screening
tool to identify adults who are malnourished or at risk of malnutrition
 MUST Tool_Full.pdf
 The Mini Assessment (MNA) and Malnutrition Risk Scale (SCALES) were
specifically designed for older patients. The MNA test consists of 18 items
and takes less than 15 minutes to perform.
 MNA_full version.pdf
 The SCALES (S-sadness C-Cholesterol A-Albumin L-Loss of weight E-
Eating problem physical/cognitive S-Shopping problems) test was designed
for outpatient screening.
 The SGA or subjective global assessment relies on physical signs of under
nutrition and patient history and does not use laboratory findings. It is
simple to use, quick (takes a few minutes) and has been shown to be reliable
in elderly outpatients.
 ..\..\Assessment of Nutritional Status and Growth Monitoring\SGA_Scoring
sheet.pdf
 BMI: Good tool for elderly?
 Triceps Skinfold and Mid Upper Arm Circumference:?
Risk

 DETERMINE TOOL_Full.pdf
 Lawton Instrumental Activities of Daily Living Scale*
Activities Evaluated Level of Capability Score†

Preparing meals Without help 2

Doing housework
With some help 1
Doing laundry
Completely unable to do 0
Taking correct doses of the prescribed drugs at the the task
correct time

Getting to places beyond walking distances

Shopping for groceries
Managing money
Using the telephone
Patients are asked questions about the activity; some questions can be made sex-specific and modified by the interviewer.
*

†Each of the 8 tasks is assigned a score. The maximum score is 16, although
scores have meaning only for a particular patient (eg, declining scores over time
reveal deterioration).
Based on M Powell Lawton, PhD, Director of Research, Philadelphia Geriatric Center, Philadelphia.
IMPORTANCE OF
DIET DURING
DIFFERENT
STAGES OF LIFE
While inadequate or bad
nutrition is a risk factor in
the development and
progression of many
chronic diseases, good
nutrition is not a
guarantee of prevention or
cure, but can significantly
reduce the likelihood of
developing a number of
common chronic diseases
and/or slow down their
progression (WHO)
 Recommended Nutrient Intakes For Older Persons (WHO)
 Energy: 1.4/1.5 to 1.8 multiples of the basal metabolic rate (BMR) to
maintain body weight at different levels of physical activity.
 Protein: 0.9 - 1.1 g/kg per day
 Fat: 30 en% in sedentary older persons and 35en% for active
older persons. Saturated fats should not exceed 8% of energy.
 Calcium: 800 - 1200mg/day
 Iron: 25 mg/day assuming no excessive iron losses.
 Selenium: 50-70ug/day
 Zinc: Moderate Zn availability (30%) Men 7.0 mg/day, Women 4.9
mg/day
 Riboflavin: 1.3 mg for men and 1.1 mg for women.
 Folate: 400ug/day
 Vitamin B12: 2.5ug/day
 Vitamin C: 60-100 mg/day
 Vitamin A:600-700ug retinol equivalents/day
 Vitamin D: 10-15ug/day (600-1,000 IU)
 Vitamin E:100-400IU/day
“Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys.” By R.J.
Colman, R.M. Anderson, S.C. Johnson, C. Cruzen, H.A. Simmons, J.W. Kemnitz, R.
Weindruch, E.K. Kastman, K.J. Kosmatka, T.M. Beasley, D.B. Allison. Science, Vol.
324 Issue 5937, July 9, 2009.
 Caloric restriction came to scientific attention in the mid-1930s, when Cornell
researchers showed that it extended the lives of mice by about 40 percent. The feat
was subsequently duplicated in many other animals, from roundworms to dogs, but
until now had not been conclusively demonstrated in primates.
 The results of a 20-year-long study on caloric restriction in rhesus monkeys
provides the strongest evidence yet that a low-calorie diet produces life-extending
metabolic changes in primates — even, perhaps, in people.
 Fed a diet that provided adequate nutrition on 30 percent fewer calories than is
considered normal, the monkeys have largely escaped the ravages of heart disease,
cancer and other age-related diseases.
 Caloric restriction appears to trigger energy-saving metabolic changes, activating
metabolic pathways involved in regulating cell growth and repair.
 “This is the first study to show that caloric restriction slows aging in a primate
species. And of course, we’re primates, too. It’s a lot more relevant to humans than
the mouse.”
 Update 8/29/2012: Reports from a parallel study of calorie restriction in rhesus
monkeys found no increase in longevity, and complicate the picture described above.
 Modification of diet during old age
Dietary modification Reason
Foods must be soft, easily chewable. Problems of dentition, fallen teeth or
dentures.
Foods should be easily digestible Decreased production of digestive
enzymes.
Restricted fat in the diet, inclusion of Susceptibility to heart disease.
PUFA and MUFA.
Foods rich in fibre should be given. To prevent constipation and reduce
cholesterol level. Also to prevent colon
cancer
Coffee, tea and cola beverages should May result in insomnia due to over
be restricted. stimulation. Also act as diuretics.
Foods rich in calcium like milk or its To compensate the bone loss and reduce
products should be given. the incidence of osteoporosis.
Green leafy vegetables can be given Source of nutrients like carotene,
liberally. calcium, iron, riboflavin, folic acid and
vitamin C, besides supplying fibre . Rich
in antioxidants.
Dietary modification Reason
Foods of elderly should consist of Unfamiliar foods or changes in the food
familiar foods. New foods are pattern may lead to psychological
difficult to accept. problems
Clear soup at the beginning of Aids digestion…adds to fluid intake too
meal.
Small and frequent meals instead Favour more complete digestion and
of three heavy ones. reduce GI distress.
A glass of hot milk just before May induce sleep and also help in
going to bed. regularizing bowel movements
Heavy meal at noon and light Sleep is less likely to be disturbed.
evening meal.
Too many sweets with lot of fat and Too much sugar may cause fermentation,
sugar be avoided. discomfort due to indigestion and cause
tooth ache. High fat diet may increase
cholesterol level. May lead to obesity.
Plenty of fluid. To prevent constipation and dehydration.
 Advise non – fat or low fat milk and milk products; limit the
no. of eggs / week (2-3); limit intake of dairy fats,
hydrogenated fats (dalda) and other saturated fats.

 Advise a diet moderate in sugars – Simple sugars should

supply no more than 10-15% of total energy intake.

 Advise a diet moderate in salt and sodium – Limit sodium

intake to 2.4 – 3gms/ day. This is the amount of sodium found
in 5-6gms of salt (~1tsp).

 Prescribe less salt in cooking; do not keep salt on table;

restrict highly salted, processed, salt preserved and pickled
foods, salted snack food mixtures, canned soups, cheeses,
tomato based processed foods (sauces, purees), pickles etc.

 Explain how to balance the food intake with physical activity.

 What are the benefits of regular physical exercise?
 Slows the aging process
 Helps one look and feel better.
 Increases stamina and energy.
 Strengthens bones to fight osteoporosis.
 Improves muscle tone, strength, and endurance.
 Keeps joints, tendons, and ligaments more flexible, and promotes
easy, unrestricted movement.
 Increases the efficiency of heart and lungs.
 Decreases blood pressure and resting heart rate so the heart does
not have to work as hard.
 Increases the sense of balance and agility, lessening the likelihood
of injuries from falls or accidents.
 Improves digestion and bowel movements.
 Psychological benefits of physical activity:
 Improved self-image, sense of self-reliance, and independence.
 Decreased stress and tension.
 An overall sense of well-being.
 Nutrient-Drug Interactions
 Medicines and Nutrition
 People sometimes think that medical drugs do
only good, not harm
 Both prescription and OTC medicines can have
unintended consequences - causing harm when
they interact with the body’s normal use of
nutrients
 Many drugs interfere with the absorption of
various vitamins and minerals. For example:
 Antacids- Vitamin B12, folate, iron
 Diuretics- Zn, Mg, Vitamin B6, K, Cu
 Laxatives- Ca, Vitamins A, B2, B12, D, E, K
Ways that Foods, Drugs and Herbs can Interact
 Potential Drug-Nutrient Interactions for some commonly
Used Drugs
DRUGS USES NUTRIENTS POTENTIAL
AFFECTED MECHANISM
Antacids Reduce stomach Calcium, vitamin Decreased
acidity B-12, and iron absorption due to
altered
gastrointestinal pH

Anticoagulants Prevent blood Vitamin K Interference with

clots utilization
Aspirin Is an anti- Iron Anemia from blood
inflammatory; loss
reduces pain
Laxatives Induce bowel Calcium and Poor absorption
movement Potassium
Cholestyramine Reduces blood Vitamins A, D, E Poor absorption
cholesterol and K
 DRUGS USES NUTRIENTS POTENTIAL
AFFECTED MECHANISM
Cimetidine Treats ulcers Vitamin B-12 Poor absorption

Corticosteroids Are anti-inflammatory Zinc, Calcium Poor absorption

Poor utilization
Furosemide Decreases blood Potassium and Increased loss
(anti-hypertensive) pressure; is a potassium- Sodium
wasting diuretic
Hydrochlorothiazide Decreases blood Potassium and Increased loss,
pressure; is a diuretic magnesium decreased
absorption
Tricyclic Are anti-depressants -- Weight gain
antidepressants from appetite
(Elavil) stimulation
Colchicine Treats gout Vitamin B-12, Decreased
Carotenoids and absorption due
Magnesium to damaged
intestinal
mucosa
 References
 https://www.cia.gov/library/publications/the-
world-factbook/
 https://apps.who.int/nut/age.htm
 http://www.senescence.info/aging_definition.ht
ml
 Nutrition through the Lifecycle. Judith E Brown
 Life Span Nutrition. Sharon D Rolfes, Linda K
Debruyne and EN Whitney
 Understanding Nutrition, Rolfes S.R et al.,
Thomson Wadsworth
 Krause’s Food & Nutrition Therapy by L.
Kathleen Mahan & Sylvia Escott-Stump.
 Perspectives in Nutrition: Gordon M.Wardlaw
 Nutrition Concepts and Controversies: Sizer and
Whitney
 Nutrient Requirements and Recommended
Dietary Allowances for Indians: ICMR 2010
 Dietary Guidelines for Indians. NIN. ICMR. 2011
 Nutrient Needs Change with Ageing
Nutrient Changes with ageing Practical Solutions
Energy • Basal metabolic rate decreases • Encourage nutrient-dense foods in
(BMR for age x with age because of changes in amounts appropriate for
PAL) body composition. • caloric needs.
• Energy needs decrease -3% per
decade in adults.
Protein • Minimal change with age but • Protein intake should not be
0.9-1.1 g/kg research is not conclusive. Wear routinely increased
and Tear is more. • excess protein could unnecessarily
• Requirements vary with chronic stress aging kidneys.
disease, decreased absorption,
and synthesis.
Carbohydrates • Constipation may be a serious • Emphasize complex carbohydrates:
(55%-65%) concern for many legumes, vegetables, whole grains,
Fiber 25-35gms fruits to provide fiber, essential
per day vitamins, minerals.
• Increase dietary fiber to improve
laxation especially in older adults.
Lipids 20%-35% • Heart disease is a common • Severe restriction of dietary fats
total calories diagnosis alters taste, texture and enjoyment
SFA:<1/3rd of food; can negatively affect overall
Cholesterol: diet, weight, and quality of life.
200-300mg
Nutrient Changes with ageing Practical Solutions
Vitamins • Understanding regarding vitamin • Encourage nutrient-dense foods in
& Minerals and mineral requirements, amounts appropriate for caloric
absorption needs. Oxidative and
• use and excretion with aging has inflammatory processes affecting
increased but much remains aging reinforce the central role of
unknown. micronutrients, especially
antioxidants.
Vitamins • Risk of deficiency increases because • Those who are 50 and older should
B12 2.4- of low intake of vitamin B12, and eat foods fortified with vitamin
2.5mcg decline in gastric acid, which further B12 or take supplements.
impairs B12 absorption.
Vitamin D • Risk of deficiency increases as • Encourage dairy products and sun
600-1,000 synthesis is less efficient, skin exposure.
IU responsiveness as well as exposure to • Supplementation may be
sunlight decline, kidneys are less necessary. A supplement is
able to convert D3 to active hormone indicated in virtually all
form. As many as 30%-40% of those institutionalized older adults.
with hip fractures are vitamin D
insufficient.
Folate • May lower homocysteine levels; • Fortification of grain products has
400 mcg possible risk marker for athero- improved folate status. When
thrombosis, Alzheimer disease and supplementing with folate, must
Parkinson’s disease. monitor B12 levels.
Nutrient Changes with ageing Practical Solutions
Calcium • Dietary requirements may increase • Recommend through naturally
800-1200 because of decreased absorption; only occurring and fortified foods.
mg 4% of women and 10% of men age 60 • Supplementation may be
and older meet daily RDA. necessary.
Potassium • Potassium-rich diet can blunt the effect • Recommend meeting potassium
4700 mg of sodium on blood pressure. RDA with food, especially fruits
• and vegetables.
Sodium • Risk of hypernatremia caused by dietary • Recommend consuming 1500 to
1500 mg excess, fluid retention and dehydration. 2300 mg/d.

Zinc • Low intake association with impaired • Encourage foods rich in Protein in
Men 7-11mg immune function, anorexia, loss of sense order to meet Zinc RDA
Women of taste and smell, delayed wound
5-8mg healing, and pressure ulcer development.
Water • Hydration status can easily be • Encourage fluid intake of at least
8-10 cups of problematic due to decreased fluid 1500mL/day or one mL per calorie
fluids intake. Dehydration causes decreased consumed.
kidney function. Increased losses caused • Dehydration can manifest as falls,
by increased urine output from confusion, change in levels of
medications (laxatives, diuretics. consciousness, weakness or
• Risk increases because of impaired sense change in functional status, or
of thirst, fear of incontinence, and fatigue.
dependence on others to get beverages. • Decreased fluid intake may also
precipitate constipation.