Nutrition in the Older Adult Geriatric Education Center of Michigan

Dale Cortes, MS,RDN, CSG Registered Dietitian/Nutritionist Board Certified in Geriatric Nutrition

Geriatric Education Center of Michigan activities are supported by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Public Health Service Act, Title VII, Section 753(a). The module was developed by Geriatric Education Center of Michigan Michigan State University

Course Objectives At end of this session, participant will be able to: Describe how a persons nutritional needs change with aging and identify warning signs for possible nutritional problems in older adults Discuss interventions that can be used to improve nutritional status of older adults Recognize limited role of therapeutic diets in older adults

Changes in Aging that Affect Nutrition Appetite Feeding Converting Food to Energy Musculoskeletal Elimination

Appetite Change Decreased taste Decreased smell Decreased visual acuity Dry mouth Nutrition Need Social encouragement Increase smells and taste of foods Medical review for drugs that increase dry mouth Good oral hygiene

Feeding Change Decreased dexterity Decreased shopping and cooking abilities Nutrition Need Family and/or community support

Converting Food to Energy Change Decreased basal metabolic rate Decreased GI motility Increased bacteria overgrowth of GI tract Increased body fat Decreased pancreatic enzymes Nutrition Need Regular meals Vitamin B12 level monitoring Regular Physical Activity when possible

Musculoskeletal Change Decreased muscle mass Decreased bone mineralization Decreased vitamin D conversion by skin and kidney Nutrition Need Regular Physical Activity Adequate vitamin D and calcium

Elimination Change Increased likelihood of constipation Nutrition Need Adequate fiber and fluids

Changes in Aging: Nutrients Nutrients of Concern for Older Adults Vitamin B 12 Vitamin D Calcium

Consequences of Inadequate Nutrients Vitamin B12 Megaloblastic anemia (pernicious anemia) Peripheral neuropathy Weigh loss Vitamin D Osteomalacia (soft bones) Muscle weakness and twitching Calcium Osteoporosis Bone loss Tetany

Diet for Older Adults

Healthy Diet for People Over Age 70 Healthy Diets Emphasize High fiber--fortified cereals Whole grains Dark green, orange, or yellow vegetables (fresh, frozen, or canned) Whole fruits (rather than juices) Low-fat dairy products Lean meats and fish Main dishes of beans, grains, and vegetables Remain Physically Active

Summary of Healthy Diet Vary foods in the diet (color, texture, flavor) Drink plenty of fluids Consider supplements Calcium Vitamin D Vitamin B12

Healthy Diet for People Over Age 70 Low to moderate intake Sugar Salt Alcohol Limit foods High in refined sugars High in saturated fats and cholesterol

Assessment of Dietary Habits Food record of the pattern of food and fluid consumption Usual adult weight? Recent changes in weight? Special diet (type, who prescribed, compliance)? Who prepares food? Salt added: While cooking? At the table? Meals and snacks?

Assessment of Dietary Habits Fluids during the day, including Alcohol? Coffee? Soft Drinks? Eats alone? With others? Problems affecting intake? Who does grocery shopping?

Assessment Method DETERMINE warning signs (for possible nutrition problems) Disease Eats Poorly Tooth loss/mouth pain Economic Hardship Reduced social contact Multiple medicines Involuntary weight loss/gain Needs assistance in self care Elder years above age 80

Steps to Managing Nutritional Problems Address and treat early Review risk factors Treat the treatable Prevent further weight loss when possible Address issues that fit the problem Monitor food intake, meal patterns, quality of food Follow preferred meal pattern Use supplements judiciously and medications

Nutrition Intervention Plan Nutrition Intervention Suggestions Physical activity and exercise may enhance appetite and protein intake and increase mobility, strength, and balance Alcohol or drug abuse treatment as necessary

Nutrition Intervention Plan Nutrition Intervention Suggestions Community Resources that improve services and support in home Family members Caregivers Meals on wheels Nutrition sites for older adults Adult day care programs Congregate dining rooms Food commodities/food stamps

LIBERALIZE DIETS New Dining Practice Standards (Resource: Pioneer Network food and dining clinical standards taskforce) Encourage a variety of food choices Encourage low fat low salt food choices Encourage milk three times a day

Interdisciplinary Team Approach Interdisciplinary team approach as necessary, with referrals to: Dentist Speech therapist (swallow evaluation) Dietitian Social services (social, financial services, placement) Food service manager and caregivers (for facilitating food intake) Psychiatrist (anxiety, depression, psychosis, medication management) Occupational therapy (impairment in activities of daily living) Physical therapy (pain, mobility) Ophthalmologist Audiologist Other Medical Specialties

Medication Review Review all medications Eliminate any unnecessary medications No drugs are FDA approved for treatment of weight loss in older adults Treat depression as appropriate

THE INTERVIEW Show respect and concern when approaching Seniors startle easily Speak slowly Vision and hearing deficits Need time to process your question Ask questions that have a yes or no answer Ask questions in a different way Be as clear and specific as possible

RESOURCES Journals Journal of Nutrition for the Elderly Books Beers,MH, Berjow,H. The Merck Manual of Health & Aging, First edition. Whitehouse Station, NJ. Merck Research Laboratories: ISBN: Chapman-Novakofski,K. Geriatirc Nutrition: Guidelines for Working with Older Adults. Fourth Edition. Clarksville, MD: Wolfe Rinke Associates, Inc. 2012

WEB SITES Nutrition for Older Adults (AND site) /aging_network.asp /aging_network.asp AND Position Paper =8374