chapter 15 nutritional requirements for older adults and eating habits affecting oral health...
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CHAPTER 15CHAPTER 15
NUTRITIONAL REQUIREMENTS NUTRITIONAL REQUIREMENTS FOR OLDER ADULTS AND FOR OLDER ADULTS AND
EATING HABITS AFFECTING EATING HABITS AFFECTING ORAL HEALTHORAL HEALTH
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2
Older Adults: General Health StatusObesity is most
common nutritional disorderContributes to common
chronic diseases: diabetes, cardiovascular disease
Exacerbates age-related decline in physical function; leads to frailty
Malnutrition risk in those with:Less education and
incomeHousebound, especially
those living alonePhysical disabilitiesDepression and other
mental health issuesDrastic changes, such as
death of spouse
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3
Older Adults: Physiological Factors Affect Nutritional Status
Oral cavityOral health issues including chewing,
swallowing, and mouth pain are indicators of risk for malnutrition
Changes in taste and smell may increase cariogenic food choices
Xerostomia may lead to avoidance of crunchy, dry, and sticky foods May choose hard candies to stimulate saliva,
increasing caries riskFrom Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Anatomy & Physiology, ed 6. St.
Louis: Mosby, 2007.Louis: Mosby, 2007.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4
Older Adults: Physiological Factors Affect Nutritional Status
Oral cavity Periodontal disease increases likelihood of weight lossQuality nutrient intake decreases as number of teeth
decreases Studies have found that people with fewer than 28 teeth had
significantly lower intakes of fruits and vegetable and lower serum levels for beta-carotene, folate, and vitamin C
Japanese study found total protein,
animal protein, sodium, vitamins D, B1, B6,
niacin, and pantothenic acid were
associated with number of teethFrom Perry DA, Beemsterboer PL: From Perry DA, Beemsterboer PL:
Periodontology for the Dental Hygienist, Periodontology for the Dental Hygienist, ed 4. St. Louis: Saunders, 2014.ed 4. St. Louis: Saunders, 2014.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5
Older Adults: Physiological Factors Affect Nutritional Status
Gastrointestinal tractChanges in esophageal motility and
deterioration of nerve function maycause dysphagia Those with dysphagia eat slowly and may
not be able to consume adequate amountsDiminished hydrochloric acid secretion may affect
absorption of calcium, iron, and vitamin B12
Constipation may result from altered GI motility and benefits from fiber-containing foods, adequate fluid intake, and physical activity
From Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 8. St. Anatomy & Physiology, ed 8. St.
Louis: Mosby, 2013.Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6
Older Adults: Physiological Factors Affect Nutritional Status
Hydration statusDecreased thirst associated with aging may
predispose to dehydrationCertain chronic illnesses (heart and kidney disease)
lead to impairment of homeostatic mechanisms controlling fluid balance
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7
Older Adults: Physiological Factors Affect Nutritional Status
Musculoskeletal systemBone resorption progresses rapidly in the older patientAfter age 45, lean body mass declines up to 0.4%
every year and adipose tissue increases Inactivity responsible for loss of muscle strength and balance
and may predispose to falls Sarcopenia is the reduction of skeletal muscle mass and
replacement by fat that occurs in older adults Maintaining muscle is essential in reducing the risk of falls
Decline in lean body mass results in decreased basal metabolic rate
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8
Older Adults: Socioeconomic and Psychological Factors
Socioeconomic factorsInflation, failing health, medical bills, and cost of
medications can have a devastating effect on fixed incomes
Title III Nutrition Programs for Elderly (congregate dining and Meals on Wheels) are available
Psychological factors predispose to decreased appetite and interest in foodApathyDepression
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9
Older Adults: Nutrient Requirements—Fluids
Requirements for most micronutrients increased due to effects of aging on absorption, utilization, and excretion
Fluids = minimum 8 glasses of water/daySome older adults may restrict fluids because of:
Nocturia (excessive urination at night) Incontinence (inability to control urinary excretion) Pain associated with movement due to arthritis Having to request assistance to be toileted
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10
Older Adults: Nutrient Requirements—Vitamins
Vitamin D intake is higher for olderadultsAges 51 to 70: 10 µg daily Ages 71+: 15 µg daily30% of persons ages 60 years and older in lower latitudes
have vitamin D insufficiency in the winter
10% to 30% have absorption of vitamin B12
Requirements for folic acid, vitamins B6, and B12 increased to prevent decline in cognitive function and reduce risk for coronary artery disease
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11
Older Adults: Nutrient Requirements—Minerals
CalciumAI = 1200 mg higher than for younger
adults to maintain bone mass and reduce risk of osteoporosis
Decreased physical activity contributes to loss of bone density
SodiumIntake may need to be adjusted based
on physiological condition (e.g., hypertension, congestive heart failure)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12
Older Adults: Eating PatternsMany older adults have a poor dietDeficiencies
1 in 4 older adults consumes less than recommended servings of meat
Dairy products, fruits, and vegetablesfrequently lacking in the diet, especially for those living alone Routine consumption of milk is difficult because of its expense
and frequent trips to purchase it
Choice of soft foods usually results in a decrease in protein and intake of more simple carbohydrates
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13
Older Adults: Eating Patterns
Snacking and nutritional supplementsSnacking may ensure older adults consume adequate
amounts of kilocalories and proteinHealthy snacks such as cheese, hardboiled eggs, low-
fat milk products, bananas, and canned fruit can be recommended
Milk-based food supplements, such as an instant breakfast mix, are economical and can help prevent nutrient deficiencies
Commercial liquid nutrition supplements, such as Ensure or Sustacal, may be more convenient
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14
Older Adults: Eating Patterns
Food safetyMore susceptible to food-borne illness because of:
Compromised immune system Decreased hydrochloric acid in the stomach Lessened senses of smell and taste
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15
MyPyramid for Older AdultsEmphasizes nutrient-dense foodsIncludes packaged, frozen, or
canned fruits, in addition to fresh vegetables that may be more readily available and have a longer shelf life
Stresses the importance of consuming fluids
Foundation: activities characteristic of older adults Copyright 2007 Tufts University. Reprinted with permission Copyright 2007 Tufts University. Reprinted with permission
from Lichtenstein AH et al: Modified MyPyramid for Older from Lichtenstein AH et al: Modified MyPyramid for Older Adults. J Nutr 2008; 138:78-82.Adults. J Nutr 2008; 138:78-82.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16
MyPyramid for Older AdultsVitamins/mineral supplements
Flag at the top of MyPyramid for Older Adults reminder about increased need for calcium, vitamins D and B12 Calcium—1200 mg Vitamin D—600 IU for adults ages 51 to 70 and 600 IU for those
older than 70 years Vitamin B12—2.4 µg
Dietary Guidelines for Americans recommends eating fish twice a week for omega-3 fatty acids
NIH panel advises seniors with early-stage macular degeneration to take antioxidants (vitamins C, E, and beta-carotene and zinc)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
HEALTH APPLICATIONGenomics
Consider nutrigenomics in relation to determining genetic susceptibility to diet-related chronic diseases
Discuss how this research may change the future of healthcare
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