NUTRITION IN GERIATRIC COMPLETELY EDENTULOUS PATIENTS

1. NUTRITION IN GERIATRIC COMPLETELYEDENTULOUS PATIENTS - DR. UnniPympallil

2. CONTENTS .INTRODUCTION .DEFINITIONS .BALANCED DIET .IMPACT OF DENTAL STATUS ON FOOD INTAKE .GASTROINTESTINAL FUNCTIONING .FACTORS THAT AFFECT NUTRITIONAL STATUS IN AGED INDIVIDUALS .PHYSIOLOGICAL FACTORS. .PSYCHOLOGICAL FACTORS. .ECONOMIC FACTORS. .PHARMACOLOGICAL FACTORS.

3. .ORAL FACTORS – xerostomia, . Sense of taste and smell, .Effect of dentures chewing ability, . Effect of dentures on food, diet quality & general health. .NUTRITIONAL NEEDS OF THE ELDERLY. .ASSESESSING NUTRITIONAL STATUS .CALCIUM AND BONE HEALTH .VITAMIN AND HERBAL SUPPLEMENTATION .DIETARY COUNSELING OF PROSTHETIC PATIENTS

4.  .DIET SUGESSIONS FOR A NEW DENTURE WEARER  .SPECIAL DIET IN SPECIFIC DISEASES.  .REVIEW OF LITERATURE.  .SUMMARY.  .CONCLUSION.  .REFERENCES.

5. INTRODUCTION • As we all are basically a part of life, we are amenable to all natural laws. So it is that growth change and age changes form an unbroken continuity, they are our heritage of being mortal. • Aging is a normal, genetically dictated physiological process. It is a state of interplay between the physiologically contractile and pathologically destructive metabolic process. It is a process of morphological and functional involution that affects most organs of the body. It leads to gradual impairment in performance of various systems, hence of the individual as a whole.   Nutrition in oral health and disease. Robert L. Pollack, Edward Kravitz 1985

6. To enjoy food is regarded as an important determinant of an adult’s quality of life. Loose teeth, edentulism, or ill-fitting dentures may preclude eating favorite foods, as well as limit the intake of essential nutrients. Nutrition in oral health and disease. Robert L. Pollack, Edward Kravitz 1985

7. Nearly half of older individuals have clinically identifiable nutritional problems, under nutrition increases with advancing age. Persons older than 70 years of age are more likely to have nutritionally poor diets. Nutrition in oral health and disease. Robert L. Pollack, Edward Kravitz 1985

8. Nutrition in oral health and disease. Robert L. Pollack, Edward Kravitz 1985 Decreased chewing ability, fear of choking while eating, and irritation of the oral mucosa when food gets under the dentures may influence food choices of the denture wearer. The nutritional status of the elderly are affected by a lot of reasons like loneliness, poor cooking facilities, low income, dental and medical problems that interfere with chewing, digestion. Even metabolism can contribute to a poor nutritional status.

9. Proper nutrition is essential for the health & comfort of oral tissues and these healthy tissues enhance the possibility of successful prosthodontic treatment of the elderly. Nutrition in oral health and disease. Robert L. Pollack, Edward Kravitz 1985

10. DEFINITIONS • Nutrition: The taking in and use of food and other nourishing material by the body. The nutrients contained in this food are extracted, absorbed, and then used as "fuel" for growth, repair, movement, thinking, and for many other bodily functions. That is, these nutrients are used to maintain and sustain life. • Nutrient: Food that supplies body with its necessary elements, nutrients used for body fuel are fat, proteins and carbohydrates.

11. 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.”

12. Food: Food can be defined as an edible substance made up of a variety of nutrients that nourish the body. Food :may be defined as any liquid or solid substance which when ingested serves one or more of the following functions .Provide energy,

13. .Supplies material for growth, maintenance of the body functions and substances of life and metabolic processes, reproduction, or for repair and replacement of worn out tissues. Diet: food substance, liquid and solid regularly consumed in the course of normal living.

14. Balanced Diet: a balance diet can be defined as one, which contains the various groups of food stuffs such as energy yielding foods (Carbohydrates, fats), body building foods (proteins, minerals), and protective foods (vitamins) in correct propositions. So that an individual is assured of obtaining the minimum requirements of all the nutrients.

15. Recommended Dietary Allowance (RDA): It is the intake of nutrients derived from the diet which keeps nearly all people in good health. RDA is given for different age groups. RDA takes into account individual variations in nutrient needs and also the availability of nutrients which may vary from diet to diet.

16. Malnutrition: Malnutrition is a generic term given to the patho physiological consequences of ingestion of inadequate, excessive or unbalanced amounts of essential nutrients( primary malnutrition), as well as the impaired utilization of these nutrient brought about by factors such as disease ( secondary malnutrition).

17. Basal Metabolism: Basal metabolism is the minimum amount of energy needed to regulate and maintain the involuntary essential life processes, such as breathing, beating of the heart, circulation of the blood, cellular activity, keeping muscles in good tone and maintaining body temperature.

18. Basal Metabolic Rate (BMR): BMR is defined as the number of kilocalories expended by the organism per square meter of the body surface per hour. (Kcal / m2 / hour).

19. Specific Dynamic Action (SDA): SDA is the term used to describe the expenditure of calories during digestion and absorption of food.

20.     Glossary of Prosthodonticterms According to GPT – 9 .Geriatrics: The branch of medicine that treats all problems peculiar to the aging patients, including the clinical problems of senescence and senility. .Dental geriatrics: The branch of dental care involving problems peculiar to advanced age and aging or dentistry for the aged patient.

21. Geriodontics: The treatment of dental problem in aged or aging persons, also spelled as gerodontics. Glossary of Prosthodontic terms

22. Glossary of Prosthodonticterms, Nutrition in clinical dentistry Ab Gerodontology: The study of the dentition and dental problems in aged or aging persons. Metabolism: The sum of all the physical and chemical processes by which living organized substance is produced and maintained(anabolism) and also the transformation by which energy is made available for the uses of the organism(catabolism).

23. BALANCE DIET • To maintain good health and to function efficiently our body needs proteins, carbohydrates, fats, vitamins and minerals. Our body also needs plenty of water, one must drink 1.5-2 liters of fluids daily to maintain healthy kidneys and prevent urinary infections. The body needs extra fluid when energy expenditure is high and also in hot weather. Water is required in large amounts to regulate body processes such as digestion, excretion and maintenance of the body temperature and the electrolyte balance.   Handbook of food and nutrition – M. Swaminathan

24. Balance diet can be attained by incorporating the following groups of food items into the daily diet • Group 1 – Cereals, Grains and products. .Foods such as rice, wheat, ragi etc are in this group. .These supply energy or calories, proteins, invisible fats. These food also contribute iron, thiamine, riboflavin, folic acid and fiber.

25. Group 2 - Pulses and Legumes . The food stuff in this group are pulses and legumes Such as beans, soya beans, peas, grams etc. . It provides energy, protein, invisible fat ,vitamin B1,Vitamin B2, folic acid, calcium, iron and fibers.

26. Group 3 – Milk, Nuts and Meat products . They include milk, curd, skimmed milk, cheese, almonds, groundnuts, chicken, meat, liver, egg, fish and other flesh foods. . All these foodstuffs supply mainly proteins, fats, Calcium and vitamin B12.

27. Group 4 – Fruits and Vegetables . These include green leafy vegetables, yellow or orange Fruits and vegetables. .Fruits such as amla, lemons, orange are rich in minerals And vitamins, especially vitamin C iron and folic acid.

28. Group 5 – fats and Sugar . Includes butter, ghee, cooking oil,sugar,jaggery. Provides with energy, fat, essential fatty acids. . Does not add appreciably to the protein, mineral or Vitamin adequately. Should be used sparingly in diet.

29.   Handbook of food and nutrition – M. Swaminathan Recommended calorie intake for Indian population Group Particulars k calories Male Sedentary work 2350 Moderate work 2700 Heavy work 3200 Female Sedentary work 1800 Moderate work 2100 Heavy work 2450.

30. Michele J. Saunders. Nutrition and Oral Health in the Elderly. DCNA 1997, 41:4:681-698 IMPACT OF DENTAL STATUS ON FOOD INTAKE

31. The food choices of older adults are closely linked to dental status and masticatory efficiency. Although an intact dentition is not a necessity for maintaining nutritional health, the loss of teeth often leads adults to select diets that are lower in nutrient density.

32. Denture wearers report that foods such as raw carrots, lettuce, corn cob, raw apples with peel, steaks, chops etc. are difficult to chew. When compared to peers with 25 teeth or more, edentulous male health professionals consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat, and calories. Denture wearers had lower serum β-carotene and ascorbic acid than dentate subjects. Papa IbrahimaN’Gom, Alain Woda. Influence of impaired mastication on nutrition. J Prosthet Dent. 2002 Jun;87(6):667-73. Review.

33. Papa IbrahimaN’Gom, Alain Woda. Influence of impaired mastication on nutrition. J Prosthet Dent. 2002 Jun;87(6):667-73. Review. Denture wearers must complete greater number of chewing strokes to prepare food for swallowing. Even with additional chewing, the average denture does not reduce food to as small a particle size as does natural dentition.

34. .Texture and hardness, rather than taste and smell, determine acceptability of a food for many patients with denture. Generally the intake of hard food is avoided and the intake of soft food is increased which in turn is lower in nutrient density and fiber content. .Replacing a complete denture with osseointegrated implants results in significant improvement in masticatory function.

35. GASTROINTESTINAL FUNCTIONING

36. The purpose of mastication is to reduce food particles in size so they can be swallowed and to increase the surface area of food exposed to digestive juices and enzymes. Individuals with poor masticatory ability often swallow large pieces of food.

37. Investigators have proposed that accidental deaths occurring in restaurants have been inaccurately attributed to “café coronary” when the true cause was choking on food. When a denture covers the palate, it is difficult to detect the location of food in the mouth. Adults with such dentures are at a greater risk of having a large piece of food or a bone lodge in the air or food passage. Michele J. Saunders. Nutrition and Oral Health in the Elderly. DCNA 1997, 41:4:681-698

38. Michele J. Saunders. Nutrition and Oral Health in the Elderly. DCNA 1997, 41:4:681-698 Inadequate mastication appears to cause gastrointestinal disturbances. For example the use of laxatives, antacids, antireflux drugs, and antidiuretics are significantly higher in elderly edentulous population, while gastric distress and the use of laxatives was reportedly reduced when ill fitting dentures were replaced with well fitting ones.

39. FACTORS THAT AFFECT NUTRITIONAL STATUS IN AGED INDIVIDUALS 27-45 Bandodkar KA, Aras Meena. Nutrition for geriatric denture patients. J.IPS 2006;6:22-28. Kapur K.K, Soman SD: Masticatory performance and efficiency in denture wearers. J. Prosthet Dent 1964:14: 1054-1064. . Food selection, dietary adequacy, and related dental problems of patients with dental prostheses.J Prosthet Dent. 1974 Jul;32(1):32-40. Nutritional problems of the aged. J Prosthet Dent. 1983 Jan;49(1):16-9.

40. 1.Physiological changes associated with aging

41. The elderly are often at high risk for developing a nutritional deficiency due to the physiological changes accompanying aging. • Knowledge of the effects of aging process on nutritional status, nutrient requirements of the elderly, and the factors affecting dietary intake will help the dentist provide meaningful guidance to the elderly patient in achieving improved oral health.

42. There is gradual loss of function associated with aging in most organs and tissues of the body. These changes occur slowly and are influenced by genetics, socioeconomic status, illness, life events, accessibility of health care, and the environment.

43. There is a general loss of cells and lower energy levels of the remaining cells during aging. This is associated with diminished reserve capacity. In the absence of disease, the organ will function appropriately, but its ability to respond to stress will decrease with time. There is a wide variability in the rates at which these changes takes place, not only between individuals, but within individuals.

44. BODY CHANGES • Advanced age with or without illness, results in significant changes in body composition. As age advances there is a steady decrease in lean body mass (muscle mass) of about 6.3% for each decade of life. This loss in lean tissue, however, is accompanied by an increase in body fat and decrease in total body water.

45. Bone density also declines with age. During growth and development, bone formation exceeds resorption. After peak bone age is achieved, usually between 30 and 40 years of age, bone loss begins to occur, as bone resorption exceeds bone formation.

46. Progressive bone loss begins in women at about 35- 45 years of age and in men at about 40 -45 years of age. Women tend to have less bone density than do men.

47. METABOLIC ALTERATIONS • Varying but progressive decrements occur in indices of physiological functions such as cellular enzymes, nerve conduction & velocity, resting cardiac output, renal blood flow, maximum work rate and maximum oxygen uptake.

48. . Nutrient uptake by cells appears to decline with age, suggesting that older organisms may require higher plasma levels of nutrients in order to maintain optimal tissue concentrations. . Along with decline in tissue and cellular function, metabolic activity is also progressively altered with aging.

49. Basal metabolic rate (BMR) an estimate of the body’s energy requirements under basal conditions. It declines by 20% between 30 and 90 years of age. In addition capacity of the elderly to metabolize glucose is impaired. There is reduced ability to synthesize, degrade and excrete lipids, with a subsequent accumulation of lipids in the blood and tissues. With respect to hepatic albumin synthesis it has been observed that aged individuals are less responsive than younger individuals to increase in dietary protein intake.

50. This suggests that in the elderly the benefits derived from improved nutrition may be limited by the capacity of the individual to respond. Thus, serum albumin concentrations in the elderly may normally be maintained at lower levels and the low values frequently observed may not be due to malnutrition, as was previously thought.