1. Importance Of Nutrition In Old Age

2. DIET FOR ELDERLY? Aging is Inevitable, Irreversible and Progressive
Advancing age is accompanied by
Changes in functions of most organs
Health status of elderly depends on many factors
Nutrition is a major determinants of successful aging

3. Health Problem in elderly
One or more of these chronic health problems are present in elderly population
Hypertension
Cardiovascular disease
Osteoporosis
Diabetes
Dementias
This further compromise the quality of life in old age

4. 2) Physical/ Functional Status
“There could be A decrease in food intake by an older adult Causes can be
1) Medical/Health Status
3) Cognition
2) Physical/ Functional Status
Nutritional Status
Aging Process
4)Environmental
Genetics
Age
Gender

5. What are the nutrient requirement for elderly?
Energy
Protein
Carbohydrate
Vitamins
Minerals
Or we can say needs can be explained as:
Energy giving foods
Body building foods
Protective foods

6. Changes in Nutrient Needs with Age
Energy
Energy needs are different for elderly
Why?
Activity levels decrease and the body's metabolism slows down. So energy needs to go down.
So what are energy giving foods?
A reduction in intake of these foods is advised
Protein
Requirements in old age are similar to young adults.
Protein can be provided by the inclusion of milk and milk
products, eggs, meat, fish and chicken
as well as pulses and nuts in the diet.
cereals
Fats
Sugar
Metabolism: the set of chemical reactions which burn body calories in order to maintain life’s basic functions.  With Age changes occur in metabolism because of following reasons:
Changes in body composition such as loss of muscle mass with age.
Reduction of physical activity with age, which further reduces the number of calories needed to maintain weight. Less activity also means less use of the body's muscles, which contributes to the general decline in muscle mass and subsequent changes in body composition.

7. Consume low fat foods in these category like toned milk, lean meat, egg white, whole pulses.
Can you tell me why?
Some of the protein rich food such as red meat, full cream milk, egg yolk, cheese are high in saturated fat and cholesterol. Which raises blood cholesterol, in. A high level of bad cholesterol in the blood is a major risk factor for heart disease, which can lead to heart attack.
Carbohydrates
The following should be avoided or consumed only occasionally:
White bread 
Cookies (or any baked goods made with white flour or refined wheat flour) 
White pasta 
White rice 
Instead Include
Simple CHO lie in sugar and refined CHO should be consume in less amount.
Fiber rich fruits and Vegetables
Pulses

8. like combination of oils -mustard and rice bran oil
Fats
What are fats?
They are oil, ghee, butter and invisible fats like the ones present in milk and flesh foods.
Avoid Saturated fats:
fats that are semisolid or hard at room temp. They are not good for our heart
Cut down on:
Consume healthy fats:
like combination of oils
-mustard and rice bran oil
-Sunflower oil and mustard oil
Fat from fish is also good for health.
Even though the elderly need less energy, but need for vitamis and minerals remain same. Some of these like vitamin E and C are known to have ant ageing benefits as well as protect us from diseases like cancer, heart disease and cataract. A liberal use of vegetables and fruits will help to provide these nutrients.

9. Calcium and vitamin D
Why is it important?
Help to maintain good bone health.
Therefore include:
calcium rich foods like milk and milk products like paneer and curd, green leafy vegetables and sesame seeds (til).
If elderly are confined indoors and are not exposed to sunshine, they should be given supplements of vitamin D.
Iron
Anaemia is another common nutritional problem in old age.
Therefore Include:
Iron rich green leafy vegetables, flesh foods, jaggery, rice flakes etc. in the diets of elderly.
Even though the elderly need less energy, but need for vitamins and minerals remain same. Some of these like vitamin E and C are known to have ant ageing benefits as well as protect us from diseases like cancer, heart disease and cataract. A liberal use of vegetables and fruits will help to provide these nutrients.

11. - Avoid fried, fatty, spicy and very sweet foods.
During old age, digestion and absorption power decreases
Problem: Heaviness, fullness in the stomach, even gas formation and acidity
Solution:
- Avoid fried, fatty, spicy and very sweet foods.
- Very large meals may not be tolerated, so 3-4 small meals may be preferred
- Small nutritious snacks in between meals may help to alleviate acidity and heart burn, diet should therefore be carefully selected
Contd….
Changes in digestive system occur necessitating certain modifications in the kind and amount of food we can eat and number of meals to be taken

12. Problem : the pleasure of eating diminishes
Solution:
- The ability to perceive tastes like sweet and salty diminishes. The taste of food appears bland
- Meals should be made more attractive and appealing by including a variety of foods
- Use a variety of seasonings but do not eat very spicy
Problem : Loss of teeth with advancing age leads to several dental problems. Chewing becomes extremely difficult
- Soft, well-cooked foods like vegetable dalia, khichri etc. can be eaten.
- Hard foods like raw vegetables and fruits can be included in the grated, boiled or stewed form.

13. Problem: Capacity to eat is less
Solution:
-Select nutrient-dense foods such as fish, lean meat, liver, eggs, soy products and low-fat dairy products, fruits and vegetables, herbs and spices, whole-grain cereals, nuts and seeds
Problem: constipation.
-Eat fiber rich foods like whole cereals and pulses, vegetables and fruits
-Consume Soluble fibers in fruits, dals that are better tolerated
Drink at least 6-8 glasses of fluids like water, milk, juice, tea, soup etc. daily.
Try to Include whole fruits instead of juices.

14. Neurocognitive disorders in elderly and role of nutrition

15. These include Dementia
It  is a broad category of brain disease that includes any disease that causes loss of cognitive ability (the ability to think and reason clearly)
It is bad enough to affect a person's daily functioning
Alzheimer’s
The most common form of dementia is Alzheimer's 
 Its most common symptoms are short-term memory loss and word-finding difficulties
Dementia must also represent a worsening of functioning compared to how the person was previously.

16. Nutrition related Challenges associated with dementia?
Dementias often lead to changes in eating behavior such as:
Increased or decreased food intake,
Altered food choices
Poor appetite
Disturbances in eating processes.
For example, a person with dementia may forget whether they have eaten, or which meal they should eat. In the early stages of AD, apraxia can affect the person’s ability to prepare food or eat with regular utensils.
As the disease progresses, sensory and perceptive loss may affect vision and smell which can hamper recognition of food items
Increased or decreased food intake- people with dementia may overeat. Reasons for this include forgetting they have recently eaten or being concerned about where the next meal is coming fro or they completely forget to take a meal.
Altered food choices -As a person gets older it is common for the senses of taste and smell to decline, which can lead to food being less palatable. People may have a preference for additional sugar and salt. It is not uncommon for people with dementia to develop a fondness for sweet foods.
Poor Appetite- this could be due to depression, tiredness, medication, constipation etc.

17. Tips to overcome these challenges
If the person appears to have difficulty using cutlery- prompt the person and guide their hand to their mouth to remind them of the process involved
chop up food so it can be eaten with a spoon
When co-ordination becomes difficult- Try finger foods such as sandwiches, Roti rolls, Poha can be made into a cutlet ,slices of fruit, vegetables .
The sensation of thirst changes as people get older, therefore encourage person to drink water
Contd….

18. Some people with dementia will lose the ability to judge
the temperature of food. Make sure food is not too hot,
as it could burn the person’s mouth and result in eating
becoming uncomfortable
Environment should be made more stimulating and
social so that person feel at ease while eating
It is important to keep people involved in preparing food and drink. This is because it can help to maintain certain skills, and keep the person interested in food and drink
Regular snacks or small meals are better than set mealtimes

19. Role of Specific Nutrients in neurocognitive disorders

20. Some foods and nutrients are beneficial and help improve neurocognitive performance A special type of fat : omega-3 fatty acid protect against cognitive decline and dementia. Rich sources of omega-3 fatty acid are:
Flax seeds
Olive oil
Fish
walnut

21. ANTIOXIDANTS
these are protective substances such as vitamin A, C, E which protect our body from free radical damage
Why are they important?
Dietary antioxidant intake is associated with lower prevalence of degenerative diseases and maintenance of physiologic functions in older adults
Greater antioxidant intake may prevent age-related neurologic dysfunction.
Therefore consumption of foods rich in antioxidants should be encouraged
Berries such as raspberry;
strawberry
Nuts such as walnut,
almond, peanut,
sunflower seeds
Beverages such as green tea
and coffee
Vegetable such as carrot and tomato

22. Some B vitamins like B6, B12 and folate
Higher dietary intake of vitamins B6, B12 and folate are related to greater likelihood of neurocognitive protection reducing risk for untoward neurocognitive functioning, including Alzheimer's disease
Deficiency of these nutrients has been linked to neurocognitive disorders such as:
Depression
Dementia
Seizures
Therefore food rich in these nutrients should be made part of daily diet.
Rich Sources of Vitamin B6:
Fish, Meat, Vegetables such as bell peppers, spinach, green peas, yam, broccoli; nuts like peanuts, cashewnuts, hazelnuts; whole grains, bran; legumes such as chickpeas, lentils, soya bean.
Rich Sources of Vitamin B12:
Cheese, yoghurt, egg, liver, fish
Rich Sources of Folate:
 Dark green leafy vegetables, fruits, nuts, peas, dairy products, poultry and meat, eggs, seafood, grains

23. PHYSICAL ACTIVITY FOR ELDELRY
Older adults need at least:
2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and
muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms). or
1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week and
We know 150 minutes each week sounds like a lot of time, but it's not. That's 2 hours and 30 minutes, about the same amount of time you might spend watching a movie. The good news is that you can spread your activity out during the week, so you don't have to do it all at once. You can even break it up into smaller chunks of time during the day. It's about what works best for you, as long as you're doing physical activity at a moderate or vigorous effort for at least 10 minutes at a time.

24. REFERENCES
Nutrition and Brain, Nestlé Nutrition Workshop Series Clinical & Performance Program Volume 5, John D. Fernstrom, Ricardo Uauy,Pedro Arroyo.
Eating and drinking,alzheimers.org.uk.
Nutrition in old age, Help Age India booklet.
B vitamins, homocysteine, and neurocognitive function in the elderly, Jacob Selhub, Laura C Bagley, Joshua Miller, and Irwin H RosenbergAm J Clin Nutr 2000;71(suppl):614S–20S.