NUTRITION in AGING

Vocabulary Xerostomia: Atrophic Gastritis:

Sensory Losses • Reduced senses of taste and smell are common in the elderly and may result from a variety of factors – normal aging, Alzheimer’s disease, medications, etc. • May not only reduce pleasure and comfort associated with food, but may pose as a risk factor for food poisoning • Also, since taste and smell stimulate metabolic processes, salivary, gastric, and pancreatic secretions may be impaired Gastrointestinal Changes Salivary Flow • Aging is associated with decreased salivary flow • Xerostomia is particularly prevalent and tends to cause: • Decreased ability to taste • Food sticking to tongue and inside of mouth • Difficulty swallowing • Gum disease (increased susceptibility to bacteria) and tooth loss

Esophagus • Often in older adults, normal peristaltic waves do not always occur, and can cause accumulation of food in the esophagus – painful swallowing and acid reflux • Also, heartburn may be caused by loss of normal control of the esophageal sphincter

Stomach and Small Intestine • Decrease in gastric motility • General decrease in secretory ability of digestive glands • Decreased levels of digestive enzymes especially amylase, pepsin, trypsin, and pancreatic lipase • Atrophic Gastritis – chronic inflammation of the stomach, combined with lack of HCl (affects protein, calcium, iron, B12, B6, zinc, and folate digestion)

Malnutrition • Malnutrition is often the most prevalent nutrition-related problem of the elderly • As many as 50% of nursing home residents may be malnourished and underweight • It often remains unrecognized because the result of malnutrition – excessive loss of lean body mass – resembles the signs and symptoms of the aging process

Risk Factors for Malnutrition • Difficulties in chewing or swallowing • Difficulties in procuring or preparing food • Recent loss of a spouse • Oral health problems • Poverty • Multiple drug use • Confusion or depression

1 • Neurological disorders • Altered taste or smell Consequences of Malnutrition • Consequences are far-reaching and complex, depending on specific nutrients that are deficient • Common adverse effects are poor wound healing and defense against infection, depression, and cognitive effects

Dehydration • Elderly people are at risk for dehydration because of: • They may not feel thirst, or notice mouth dryness • Loss of bladder control may lead to limiting water intake • Those with ambulation difficulties may have trouble obtaining water • Those taking diuretic medications

Health Consequences of Dehydration • Common cause of confusion and dementia • Symptoms of dehydration can rapidly progress from thirst, to weakness, to exhaustion, to delirium. If not corrected, death will occur

Vitamin and Mineral Deficiencies • Elderly people are at risk for vitamin and minerals deficiencies due to: • Decreased food intake • Reduced absorptive function of the GI • Reduced secretion of gastric HCl • Drug-nutrient interactions • Increased use of laxatives • Fewer functioning enzymes

Vitamin and Mineral Deficiencies Vitamin D • Due to decreased exposure to sunlight, age-related decreased in synthesis and activation, and low dietary intakes, elderly people may be at risk for deficiency • Too little Vitamin D can lead to brittle bones that are susceptible to fracture

B Vitamins • At least 15% of elderly people have a B12 deficiency (decreased HCL, intrinsic factor, H.pylori) – may lead to anemia, neuropathy, fatigue • Large scale NHANES indicates that elderly people may be deficient in B6 – may lead to homocysteinemia, fatigue, anemia, impaired immune function • Severe dietary deficiencies of B vitamins impair mental ability, including memory

BRAIN FUNCTION DEPENDS on ADEQUATE: Short-Term Memory B12, vitamin C and E Performance in Problem-solving tests Riboflavin, folate, B12, vitamin C Mental Health Thiamin, zinc, niacin, folate Cognition Folate, B6, B12, iron, vitamin E

2 Vision EFAs, vitamin A

Iron • Iron deficiency is a concern for elderly people • May develop from decreased HCl, chronic blood losses, antacids (decrease absorption) • May lead to fatigue and weakness (anemia), decreased immune function, intellectual impairment Calcium • Maintaining adequate calcium reduces the rate of bone loss and the incidence of fractures • Deficiency may arise from decreased Vitamin D, decreased HCl, fiber supplements, lactose intolerance, diuretics (antacids?)

Zinc • Older adults frequently have marginal zinc intakes • A deficiency may develop from stress, decreased HCl, fiber supplements, diuretics • May affect taste perception and appetite regulation, suppress immune function, cause poor wound healing, mental disturbances