Technical Assistance Forum and

1. Technical Assistance Forum and 30th Anniversary Celebration of the Title VI Program April 28 to May 1, 2008 Minneapolis, Minnesota 2400 Mystic Lake Blvd. Prior Lake, MN

2. Meeting the Nutritional Needs of Tribal Elders Floristene Johnson, MS, RD\LD Desoto, Texas April 30,2008

3. Objectives • Learn about the nutritional needs of older adults and how to meet those needs. • Know how to identify and address some special nutritional needs of older adults. Weight control (+ or -) Sensory Changes in Older Adults

4. What are the nutritional needs of Tribal Elders? Dietary Reference Intakes Age 51-70 Male Vitamin A Thiamin Vitamin B 12 Vitamin D Riboflavin Potassium Vitamin E Calcium Sodium Vitamin K Folate Magnesium Vitamin C Vitamin B6 Protein Fat Carbohydrates Zinc

5. What Happens as We Age • Basal Metabolism (+ or -_ • Height • Weight • Hair • Skin • Eyes • Nose • Teeth • Ears

6. Title III and VI of the Older Americans Act, as Amended (OAA) states…a nutrition program • which, 5 or more days a week provides at least one hot or other appropriate meal per day • which shall be provided in congregate setting • which may include nutrition education and other appropriate nutrition services

7. ...a nutrition project shall____ • provide meals that • Comply with the Dietary Guidelines for Americans, published by the Secretary and the Secretary of Agriculture. • ...a nutrition project provides meals thatprovide to each participating older individual • a minimum of 33 1/3 percent of the Dietary Reference Intakes…, if the project provides one meal per day.

8. a minimum of 66 2/3 percent of the daily recommended dietary allowances … if the project provides two meals per day, and • 100 percent of the allowances if the project provides three meals per day, and • to the maximum extent practicable, are adjusted to meet any special dietary needs of program participants,

9. Using the Dietary Guidelines (2005)To Meet the Nutritional Needs Developed by the • United States Department of Health and Human Services (HHS) • United States Department of Agriculture (USDA)

10. Dietary Guidelines For Americans 41 Total Key Recommendations 23-General Population 18- Specific Populations

11. DG Basics • Meet nutrient needs by consuming foods • Use fortified foods and dietary supplements only in certain cases • Dietary supplements cannot replace a healthful diet. • The DGAs are for Americans 2 years and above.

12. DGA- Nine Focus Areas • Adequate Nutrients Within calorie Needs • Weight Management • Physical Activity • Food Groups To Encourage • Fats • Carbohydrates • Sodium and Potassium • Alcoholic Beverages • Food Safety

13. ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS • Consume a variety of nutrient-dense foods and beverages • Choose foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. • Meet recommended intakes within energy needs • * Over 50 – Consume Vitamin B12 in its crystalline form. • * Older Adults, people with dark skin should consume extra Vitamin D

14. WEIGHT MANAGEMENT • To maintain body weight in a healthy range, • To prevent gradual weight gain over time, make small decreases in calories and increase physical activity.

15. Weight Management For Special Populations • Those Who Need to Lose Weight –Aim for a slow and steady weight loss • Overweight with chronic diseases/medication – Consult doctor • Older adults. Participate in regular physical activity to reduce functional declines associated with aging and to achieve the other benefits of physical activity identified for all adults.

16. Risks Associate with Excess Weight Excess body fat leads to a higher risk for • premature death • type 2 diabetes, • high blood pressure • high blood cholesterol and triglycerides • heart disease, • Stroke • gall bladder disease • respiratory dysfunction, • gout, arthritis, and certain kinds of cancers.

17. Body Mass Index (BMI) Locate your height in the left-most column and read across the row for your height to your weight. Follow the column of the weight up to the top row that lists the BMI. • A BMI under 19 is underweight, • 19 through 24 is the healthy weight range, • 25 through 29 is in the overweight range, • and a BMI of 30 and above is the obese range.

18. PHYSICAL ACTIVITY • Engage in regular physical activity and reduce sedentary activities Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. • Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

19. FOOD GROUPS TO ENCOURAGE • Consume a sufficient amount of fruits and vegetables while staying within energy needs. • Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.

20. FOOD GROUPS TO ENCOURAGE

21. FOOD GROUPS TO ENCOURAGE Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.

23. FOOD GROUPS TO ENCOURAGE Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

24. FATS • Plan meals with less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible. • Plan for the total fat intake to be between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids • When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. • Choose products low in fats and oils.

25. CARBOHYDRATES • Choosefiber-rich fruits, vegetables, and whole grains often. • Choose and prepare foods and beverageswithlittle added sugars or caloric sweeteners • Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.

26. SODIUM AND POTASSIUM • Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. • Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables • Individuals with hypertension, … older adults. Aim to consume • no more than 1,500 mg of sodium per day, and meet the potassium recommendation • (4,700 mg/day) with food.

27. older adults, and those who are immunocompromised. • Do not eat or drink raw (unpasteurized) milk or any products made from unpasteurized milk, • raw or partially cooked eggs or • foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish,

28. ALCOHOLIC BEVERAGES • Those who choose to drink alcoholic beverages should do so sensibly and in moderation • Alcoholic beverages should not be consumed by some individuals, including individuals taking medications that can interact with alcohol, and those with specific medical conditions. • Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.

29. Thanks for your particpation.