Old ageSubmitted to:- Submitted by:-

contents Introduction

characteristics.

changes in organ functions

Nutritional requirement.

Problems of old age .

.

Introduction of old ageOld is not a disease but a biological process

that no one can avoid . A little care and caution will prevent or delay disabilities . With proper care every one can enjoy long run , healthy ageing . As age advance , several chronic disease effect our healthy . Many of these like obesity , hypertension and diabetes are diet related and enhance can be controlled and even prevented by modifying our diet .

Characteristics

1) SENSORY LOSSES – the sense of taste , smell , sight ,anorexia, loss teeth , xerostomia . Also decline in neuromuscular coordination are common problems which lead to less food intake as result of decrease appetite , food recognition and self feeding ability

1) CHANGES IN GASTROINTESTINAL TRACT – secretion of digestive enzymes and juices decrease which result in incomplete digestion of food as result absorbtion and utilization of nutrient are affected adversely .

2) CHANGES IN CARDIOVASCULAR SYSTEM – narrowing of lumen , thickening of arterial walls and lowered myocardial contractibility .

3) RENAL FUNCTION – working ability of kidney decreases as a result the elimination of waste products and reabsorption or nutrient are affected

1. REDUCED HARMONES LEVEL

2. IMMUNOCOMPETENCE – immune function decline with age .

3. PSYCHOLOGICAL FACTORS –like depression , anxiety , loneliness , food habits , loss of self esteem can affect apatite digestion , energy level weight , and well being

Changes in organs function with ageing that may influence nutrient requirements

Age (years)Estimated energy

requirementfor males (kcals per day)

Estimated energy requirement

for females (kcals per day)

19-50 2550 1940

51-59 2550 1900

60-64 2380 1900

65-74 2330 1900

75+ 2100 1810

Organ

function

• Taste and smell

• Salivary glands

• Gastric function and emptying

changes

• Decreased taste buds on tongue.

• Decrease in salivary secretion causes feeling of dry mouth, xerostomia.

• Decreased secretion of hydrochloric acid intrinsic factor and pepsin.

• Above 60 years of age rapid rate of emptying of liquids.

• Decreased calcium absorption.

Effects on n

utrition

• Loss of ability to detect salt and sweet.

• Difficulty in chewing and swallowing make them avoid certain food particularly curnchy.

• Decreased bioavailability of minerals, vitamins and proteins.

• Skeletal function

• Opthalmic factor

• Psychological factors

•Changes in bone density•Opacity of eye lens•depression

•Increased requirement of calcium.•Increased requirement•Can affect appetite, digestion, energy level ,weight and well being.

•teeth

•Loss of teeth and wearing dentures.

•Decreased

Nutritional requirements Energy –after the age of 35 the basal

metabolic rate decreases due to reduced muscle mass and other metabolically active tissue mass . Also there is reduction in physical activity which affects the energy needs .

Sarcopenia, an age related loss in skeletal muscle is the result of decline in muscle strenth.

Lean body mass declines approximately 2 to 3% per decade.

Body protein level in the healthy elderly is 30-40% less than that in young adults.

The average body fat % in meals increases from about 15 % when young to 25%.

The calorie intake should be adjusted to maintain the body weight constant. In the case of obese the calorie intake should be adjusted to reduce the body .

Energy requirement decreases with age beyond 30 years.

Although the energy requirements decreases, the decreases the requirements for protein, vitamins and minerals do not diminish.

proteinAs people age there is a decrease in skeletal

tissue mass. This results in decrease in store of protein provided by skeletal muscle and may be inadequate to meet the needs for protein synthesis. Hence the dietary protein intake is more important to meet essential needs.

A protein intake of 1.0g per kg , the normal adult requirement, is safe during old age.

Food should be protein rich compared to adult normal food .

To meet this adequate quantities of protein foods such as milk and curd can be included.

Deficiency of protein result of oedema, anaemia and lowered resistance to infection. The total caloric intake 11-12% should be from protein.

carbohydrate

It is necessary that at least 50% of calories are derived from charbohydrates .

An impaired glucose tolerance in elderly can lead to hypoglycaemia, hyperglycaemia and two type diabetes mellitus .

Insulin sensitvity can be enhanced by balance energy intake, weight management and regular physical activity.

calciumCalcium needs during old age increased.

Women over 50 years of age who are not receiving estrogens require more calcium as there is increased loss resulting in demineralisation of bone .

For women over fatty ,1000mg/ day is recommended for the following reasons:

Calcium is available only from a limited foods.

To compensate age related bone loss and to improve calcium balance.

To decrease the prevalence of fractures and dental decay.

Calcium absorption efficiency decrease, vitamin D levels decline and hence men also require more calcium.

Milk is an important source of calcium for elderly

As caloric requirement decrease, total food consumption decreases, hence calcium supplements are essential.

Mild anaemia affects the healthy of old people due to less efficient circulation of blood.

ironIron prevent intake should be adequate to

prevent anaemia .

Iron requirement can be same as adult man, 30mg.

If there is anaemia, supplemental iron can be given.

zincSuch features of old age such as delayed

wound healing , decreased taste sensitivity and anorexia also findings associated with zinc deficiency.

Older people who avoid flesh foods may be at increased risk of poor zinc status.

Vitamin DElderly people are at risk for vitamin D

deficiency due to decreased exposure to sunlight .

Prudent dietary supplementation with calcium and vitamin D improves born density and may prevent fractures in a healthy elderly population.

Vitamin CStress, smoking and some medication can

increase vitamin C requirement.

Vitamin C may be protective against cataract at an intake level of between 150 and 250mg per day which is possible to achieve from dietary sources alone.

Vitamin EVitamin E has also been found to be a potent

nutrient for reducing the decline in cellular of immunity that occur in the elderly .

Change in immune system can be overcome by taking 200 mg of vitamin E.

waterWith aging a progressive decline in the water

content therefore 1ml of water for each kcal of food consumed for all people of ages is recommend.

Water stimulates peristalsis and thus aids in combating constipation. Dehydration can result in the mental confusion, headaches and instability. Elderly should be advised to consume some fluids at interval.

fiberIncrease consumptions of dietary fiber are

corelated with decreases rate of heart diseases. Fiber stimulates peristalsis.

It is essential to consume fiber containing food but increase should be gradual other wise bowel discomfort ,distension will result.

Rough fiber, bran and mature vegetable are not advised .

Fiber also helps in reducing cholesterol which may reduce the incidence of atherosclerosis.

Fat and essential acidsThese requirements for the aged have not

been dealt with by ICMR .

With advancement of age , since the energy requirements are reduced, the requirement of energy nutrients i.e. carbohydrates and fats also needs reduction.

Other fat soluble vitaminsAs already mentioned in adulthood, ICMR

not given any recommendations for vitamin D .

If the elderly are confined indoors and do not get enough sunshine, they should be given supplements of this vitamin.

No recommendations have been given for vitamin E and vitamin K.

Five Steps to Healthy Eating

Cereals

Vegetable ands

Pulses ,nuts, milk products, fish and chicken

Egg and red meat

Oil , ghee , butter

Dietary guidelinesEmpty calorie foods should be taken minimum and

calorie dense foods should be avoided.

Foods rich in protein, vitamin and mineral should be included.

Vegetables and fruits are good sources of antioxidants. A minimum of five servings should be taken.

Fat promotes weight gain. Fat particularly fat should be limited

Soft well cooked foods are preferred.

Food should be less salty and spicy .

Fried and concentrated foods be avoided

High fiber diet including green and whole grains are to included in the diet.

Easily digestable steamed foods like idlis can be part of the diet.

Plenty of fluids and semisolid foods should be taken.

2-3 serving of low fat milk should be included in diet.

Tobacco chewing, smoking and betel leaves chewing are the habits which may affects consumption of food in diet.

PROBLEMS OF OLD AGE The elderly are at a risk of poor nutrition due

to economic pressure , reduced mobility depression loneliness , ageing tissues and inadequate food consumption .

NUTRITION RELATED PROBLEMS ARE OBESITY – it is higher among elderly .

Because of more consumption of calorie and sedentary life style . Obese are susceptible to diabetes ,cardio vascular disease , arthritis ,

OSTEOPOROSIS- loss in bone density and bone mass . Its primarily found in middle age . Bone demineralization takes place at faster rate than bone mineralization . Bones become porous lighter and fragile .

DIABETES – it increases with age in booth male and female . The elderly are at a risk of poor nutrition due to economic pressure , reduced mobility , depression loneliness , aging tissues , and inadequate food consumption.

CARDIO VASCULAR DISEASE – hypertension , acute myocardial infection, congestive cardiac failure is high among elderly

CONSTIPATION – it is infrequent passes of stools which are more often drier or harder than normal . The stools becomes harder and drier because move to slowly through colon . The natural contraction and rhythm of colon might be disturbed due to loss of tone , stress medication , illness , resisting the urge of defecate.

ANEMIA- inadequate intake of iron causes fatigue , anxiety , lack of energy and sleeplessness caused by low dietary intake lack of iron or vitamin c or blood loss .

MALNUTRITION- due to various physiological and socio psychological changes , food intake of the elderly may decreases.