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Nutritional Care of Older Adults. Laurie B. Steenwyk M.Ed , RD, LDN. Class Overview. Assessing Nutritional Status Nutritional Needs of the Elderly Nutrition Interventions Eating Lifestyles Meal planning for optimal health. Assessing Nutritional Status.

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nutritional care of older adults

Nutritional Care of Older Adults

Laurie B. Steenwyk M.Ed, RD, LDN

class overview
Class Overview
  • Assessing Nutritional Status
  • Nutritional Needs ofthe Elderly
  • Nutrition Interventions
  • Eating Lifestyles
    • Meal planning for optimal health
assessing weight status
Assessing Weight Status
  • BMI
    • <23 considered underweight >65 yrs
  • Percent Weight Loss (unintended)
    • >5% in 1 month (quadruples risk of death)
    • > 7.5% in 3 months
    • >10% in 6 months
  • Cachexia
    • Severe wasting accompanying diseases such as cancer
mini nutrition assessment
Mini Nutrition Assessment
  • 6 question screening tool
  • Complete in <5 minutes
  • Validated for age >65
  • More sensitive than BMI
  • Available at: http://www.mna-elderly.com/
sarcopenia
Sarcopenia
  • Sarcopenia
    • Loss of skeletal muscle associated with aging
    • Affects 8-40% of adults >60 yrs
    • 50% of adults >75 yrs
  • Sarcopenic Obesity
    • Coexisting loss of skeletal muscle mass and strength with excess body fat
energy
Energy
  • Energy (calorie) needs decrease with age, mostly due to decreased physical activity
  • LBM declines with age and influences energy needs
  • Protein and vitamin/mineral needs remain the same or increase
  • Challenge: adequate micronutrients within caloric requirement
nutrients of concern
Nutrients of Concern
  • Risk for deficiency with age
    • Water
    • Fiber
    • Protein
    • Calcium and Vitamin D
    • Vitamin B12
    • Vitamin C and E – antioxidants
water
Water
  • Dehydration is a form of malnutrition
  • Kidneys’ decreased ability to concentrate urine
  • Adverse effects of medication
  • Mobility disorders
  • Fear of incontinence
  • 25-30 mL/kg actual body wt
fiber
Fiber
  • Fiber Goals for adults over 50:
    • Men: 30 g per day
    • Women: 21 g per day
  • Insoluble: Tough, fibrous plant material that does NOT absorb water
    • Most grains and vegetables
  • Soluble: Plant fibers capable of absorbing water and become gummy or gel-like
    • Oats, fruit, legumes, pectin, inulin, psyllium
sources of fiber
Oats

Barley

Wheat

Quinoa

Flax

Brown Rice

Bran

Legumes

Seeds

Fruits

Vegetables

Sources of Fiber
protein
Protein
  • Muscle mass (LBM) decreases 15% per decade after age 70
  • Needs increase with illness, injury
    • Surgery, wounds, CHF, COPD, Cancer
  • Optimal intake: 25-30 gm/meal
      • Even distribution most effective in preventing muscle loss during illness
  • 1-1.6 gm/kg IBW may prevent sarcopenia
protein sources
PROTEINSources:
  • Animal Proteins
    • Egg, Turkey, Fish, Beef…
  • Dairy
    • Milk, Cheese, Yogurt, Cottage Cheese…
  • Legumes and Nuts
    • Black Beans, Red Beans, Lentils, Walnuts…
  • Some from grains/breads/plants
    • Quinoa, Greens, Broccoli, Oats, Pasta…
vitamin d
Vitamin D
  • 800 IU >70 years
  • Safe upper limit 4000 IU
  • Supplements are recommended for older adults
  • Sources
    • Fortified milk
    • Fatty fish, fish oil
    • Liver
    • Egg yolk
    • Some enriched beverages
    • Exposure to sunshine during Spring, Summer, early Fall
calcium
Calcium
  • 1000 mg Men <70 years
  • 1200 mg Men >70
  • 1200 mg Women >50
  • Safe upper limit 2000 mg/day
  • A large recent study suggests that calcium supplements don’t prevent hip fractures
calcium1
Calcium
  • Dairy Sources
    • 1 cup milk – 300 mg
    • 4 oz yogurt – 200 mg
    • 1 oz cheese – 200 mg
    • ½ cup cottage cheese – 65 mg
    • ¼ cup ricotta cheese - 200 mg
non dairy calcium sources
Non-Dairy Calcium Sources
  • 1 cup Calcium fortified orange or apple juice (240 mg)
  • Enriched, GF almond, soy or rice milk – 300 mg
  • 3 oz Sardines – 370 mg
  • 3 oz Canned Salmon w/ bones – 180 mg
  • Almonds
  • ½ cup Broccoli (90 mg)
  • 2 oz Tofu (made w/ calcium sulfate
    • Firm Tofu (385 mg)
    • Regular Tofu (200 mg)
  • 1 T Blackstrap Molasses – 135 mg
  • 1 T Tahini – 65 mg
other nutrients in bone health
Other Nutrients in Bone Health
  • Vitamin K
    • Leafy greens, broccoli, soybean oil
  • Manganese
    • Spinach, peanuts, almonds, brown rice, green tea
  • Excesses of sodium, protein and phosphorus decrease calcium availability.
vitamin b 12
Vitamin B-12
  • 6-15% of older adults are deficient
  • Another 20% have marginal status
  • Compromised absorption
    • Pernicious anemia
    • Lack of intrinsic factor
    • Atrophic gastritis
    • Long-term use of PPIs
vitamin b 12 deficiency
Symptoms

Folate Deficiency

Numbness, tingling of arms, legs

Difficulty walking

Memory loss

Disorientation

Dementia

Sore tongue

Poor appetite

Constipation

Possibly depression

Sources

Meat

Poultry

Fish

Dairy Products

Supplement Recs:

Adults 2.4 mcg/day

>50 yrs should take supplement

>65 yrs 100-400 mcg/day

Vitamin B-12 Deficiency
anti oxidants c and e
Anti-Oxidants (C and E)

Vitamin C

Vitamin E

RDI: 15 mg for adults

UL is 1000 mg

Supplements can increase risk of bleeding in patients on anti-coagulant therapy

Sources: oils, nuts, peanuts, avocado

  • RDI 75 mg females and 90 mg males
  • 400 mg may be beneficial to older adults
  • UL is 2,000 mg
  • The role of anti-oxidants in macular degeneration and dementia is unclear
increasing calories
Increasing Calories
  • 5-6 small meals/between meal snacks
  • Calorically dense foods
    • Nut butters, dried fruits, fruit purees, starchy vegetables, legumes, cheese, yogurt
  • Drink calories
    • Milk, juice, smoothies, soups
  • Increase fats
    • butter, sour cream, cream cheese, oils, mayonnaise, avocado
oral nutrition supplements
Oral Nutrition Supplements
  • Use 1.5 -2.0 cal/mL
    • Ensure Plus, Ensure Clinical Strength, TwoCal, Boost Plus, etc
  • Serve 3-4 oz portions several times
  • Use as a “med pass”
  • Dilute with whole milk or serve frozen to reduce sweetness
  • Encourage 1 sip every 5 minutes to reduce early satiety
texture
Texture
  • Meats: chopped, ground, pureed
    • Use puree molds or small colorful dishes
  • Piping soft foods, garnish with sauce
  • Cut hard fruits, vegetables into bite sized pieces
  • Finger foods work well with dementia or severe arthritis
the dining experience
The Dining Experience
  • Buffet service, family style service
  • Encourage selection
  • Avoid social isolation
  • Music
  • Aroma
  • Appearance and presentation
home meals
Home Meals
  • Financial limits
    • Eggs, peanut butter, canned beans, tuna, turkey, frozen veggies, rice
  • Limited cooking ability
    • Weight Watchers, Healthy Choice, Kashi Meals
    • Precut fruits and veggies
    • Prepared soups, crackers, whole grain bread, bagels, quick oatmeal, cheese, yogurt, cottage cheese, frozen veggies, bananas, grapes, hummus
appetite stimulants
Appetite Stimulants
  • Limited evidence of effectiveness in the elderly
  • Megace
  • Remeron
  • Eldertonic
  • Marinol
  • Periactin
  • Oxandrin
eating lifestyles
Eating Lifestyles

The Mediterranean Diet

The DASH Diet

The New American Plate

MyPlate for Older Adults

2009 version
2009 Version
  • Fruits, Vegetables, grains, olive oil, beans, nuts and seeds are grouped together at the base
  • Herbs and Spices are added at base
  • Fish is promoted over poultry and dairy
benefits
Benefits
  • 9% decrease in overall mortality
  • 9% decrease in death from cardiovascular disease
  • 6% decrease in death from cancer
  • 13% decrease in incidence of Parkinson’s and Alzheimer’s Disease

Safi, F. et al, Adherence to Mediteranean Diet and Health Status: Meta-analysis. British Journal of Medicine, 2008: 337:a1344.

key mediterranean principles
Key Mediterranean Principles
  • Generous amounts of fruits and vegetables
  • Healthy fats: olive oil
  • Small portions of nuts
  • Red wine in moderation, for some
  • Very little red meat
  • Fish on a regular basis
dash benefits
DASH Benefits
  • Reduces blood pressure, especially in older adults.
  • Also protective against
    • Osteoporosis
    • Cancer
    • Heart Disease
    • Heart Failure
    • Stroke
    • Diabetes
key dash principles
Key DASH Principles
  • Limits sodium to <2300 or <1500 mg/day
  • Generous amounts of fruits & vegetables
  • Whole Grains
  • Emphasizes low fat dairy
  • Monounsaturated Fats
    • <27% of calories from fat
  • Legumes, nuts or seeds daily
  • Lean protein: fish, poultry, soy products
  • High in calcium, potassium and magnesium
new american plate proportions
New American Plate Proportions:
  • 2/3 plate should be plant based
    • Whole grain
    • Vegetables
    • Fruit
    • Legumes
  • 1/3 from protein
    • Fish
    • Lean Beef
    • Poultry
    • Dairy

1/3

2007 expert report on cancer prevention
2007 Expert Report on Cancer Prevention
  • Joint effort of AICR and World Cancer Research Fund
  • 7000 global scientific studies reviewed
  • 10 lifestyle recommendations for cancer prevention
diet recommendations
Diet Recommendations
  • Limit sugary drinks and energy dense foods
  • Eat more of a variety of fruits, vegetables, grains, legumes
  • Limit red meat and processed meats
  • Limit salt and foods processed with sodium
myplate for older adults1
MyPlate for Older Adults
  • Bright-colored vegetables such as carrots and broccoli. 
  • Deep-colored fruit such as berries and peaches.
  • Whole, enriched and fortified grains and cereals such as brown rice and 100% whole wheat bread.
  • Low- and non-fat dairy products such as yogurt and low-lactose milk.
  • Dry beans and nuts, fish, poultry, lean meat and eggs.
  • Liquid vegetable oils, soft spreads low in saturated and trans fat, and spices to replace salt.
  • Fluids such as water and fat-free milk.
  • Physical activity such as walking, resistance training and light cleaning.

http://now.tufts.edu/news-releases/tufts-university-nutrition-scientists-unveil-

resources
Resources
  • Food & Nutrition Information Center
    • http://fnic.nal.usda.gov/lifecycle-nutrition/aging
  • Tufts Human Nutrition Research Center on Aging
    • http://hnrca.tufts.edu/
resources1
Resources
  • DASH Eating Plan Booklet, free on the web: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
  • Mayo Clinic http://www.mayoclinic.com
    • Use their search engine and type in “DASH Diet” or “Mediterranean Diet” to view numerous consumer friendly articles.
  • Oldways: Mediterranean diet info http://www.oldwayspt.org/med_pyramid.html
resources2
Resources
  • AICR: The New American Plate
    • Printable brochures, Cookbook, recipes

http://www.aicr.org/site/PageServer?pagename=reduce_diet_new_american_plate

  • Linus Pauling Institute
    • micronutrient information center
    • http://lpi.oregonstate.edu/infocenter/