Malnutrition is closely related to increased mortality and morbidity and increased risk of medical and surgical complications

1. By
Eng. Nashat Dahiyat
Nutrition assessment
in the elderly people

2. Content
1. Introduction
2. objective
2.1. Nutrient Consumption
2.2. Micronutrients of Concern
2.2.1. vitamins
2.2.2. minerals
2.3. Supplementation
3. case study : Dehydration in the Elderly
4. Recommendation
5. Conclusion
6. References

3.  One of the major determinants in maintaining
 Low risk of disease and disease-related disability
 High mental and physical function
 Active engagement of life
 Nutrition, along with physical activity and not
using tobacco, is more influential in avoiding
age-associated deterioration than genetic factors.
( American Dietetic Association 2005 )
Nutrition and Aging

4.  Discuss incidence of malnutrition and dehydration in
the elderly
Discuss specific micronutrients that are of most
concern and why
 Note dehydration signs and symptoms
Provide recommendations for treatment and
prevention of malnutrition and dehydration
Objectives

5. With age, metabolism decreases
Body composition changes
Muscle mass decreases as adipose tissue increases
 Results in 2% deceased metabolic rate per decade
Decreased physical activity – less energy
expenditure
Aging and Energy Needs

6.  30% of elderly consume less kilocalories than
recommended (Lengyel et al 2008)
 Decreased intake due to :
 Loss of appetite – depression, dementia
 Medication-induced anorexia
 Impaired taste perception
 Decreased density of taste buds (Winkler et al 1999)
 Higher thresholds for detection of tastes
 Loss of teeth
 Socioeconomic factors or functional disability effecting
 shopping and meal preparation .
Nutrient Consumption

7. Malnutrition is closely related to increased mortality and
morbidity
 Greater susceptibility to infection and longer hospital
stays
Escott-Stump 2008), increased risk of medical and surgical
complications (Baker and Wellman 2005), increased risk
of pressure ulcers, hip fractures
(Escott-Stump2008)
 Incidence of malnutrition estimates range from 20 – 78 %
(Bouillanne et al 2005)
Incidence of Malnutrition

8.  Those with low lean body mass – about 25%
of elderly population over the age of 65
 Loss of muscle strength,
physical inactivity, slow or unsteady gait,
poor appetite, unintentional loss of weight,
impaired cognition and depression
(Escott- Stump 2008)
 Proper nutrition can help correct, but
physical activity is also necessary
Frail Elderly or FTT

9.  Compared to 20yr olds, 80yr olds need
 1000 to 1500kcals less in men
 600 to 800kcals less in women (Wakimoto et al, 2001)
 Protein needs remain same with age or slightly higher
(Elmadfa and Meyer 2008)
 0.8 to 1gm/kg body weight
 Kilocalorie protein supplement (i.e.Boost, Ensure) may be
helpful in preventing muscle wasting with inadequate total
kcal intake (Evans 2004)
 Fat intake among the elderly is greater than the
recommended 35% or less of total kilocalories
(Meydani 2004)
Macronutrient Needs

10.  Vitamin and mineral needs remain unchanged with
Age
 Decreased food intake often results in deficient intakes of
micronutrients
 50% of older persons have lower than recommended
intakes of micronutrients (Escott-Stump, 2008)
 80% of elderly persons have inadequate intakes of at
least on nutrient (Guigoz et al 2004)
 Digestion, absorption, and synthesis of
micronutrients are decreased (Elmadfa and Meyer, 2008)
Aging and Micronutrient Needs

11. Vitamins
1 . Vitamin E
2 . Vitamin C
3 . Vitamin D
4. Vitamin A
5. Thiamine
Minerals
1 . Selenium
2 . Zinc
3 . Calcium
4 . Iron

12.  High homocysteine levels resulting from B6, B12,
folate deficiencies linked to increased cardiovascular
disease risk and decreased mental agility
 Folate deficiencies linked to increased dementia and
depression (D’Anci et al 2004)
 Excessive folate intake can mask B12 deficiency
 Corrects hematological signs of deficiency but not
neurological signs
 Neurological signs include fatigue, malaise, vertigo,
cognitive impairment (Clarke et al 2003)
Deficiency Risks

13.  Diuretics increases water-soluble vitamins
losses as urinary excretion is increased
 Thiamine is especially at risk of becoming
deficient due to diuretics
 Low dose thiamine supplement in the elderly
on diuretics may be useful in preventing deficiency
(Escott-Stump 2008)
Thiamine and other water soluble vitamins

14.  Commonly deficient – Lengyel et al 2008
found 10%, 84%, 49% of subjects deficient respectively
 Frail elderly are more likely to be deficient vitamin E and
A (Michelon et al 2006)
Centenarians are more likely to have high levels of
Vitamin E and A (American Dietetic Association 2005)
Needed for drug metabolism and detoxification
Vitamins A, E, and C

15.  Vitamin C, E, beta-carotene needed in adequate
supply for decreasing oxidative damage to tissues and
cells including
immune cells
Balanced diet seems to be more effective
than supplementation for improved immune
function but supplementation maybe effective
Antioxidants

16.  Bone mass decreases with age especially in women
resulting in osteoporosis
 Direct health care cost of $12-18 billion each year just
for fractures (USDHHS 2004)
 Absorption of calcium and vitamin D effected by age -
receptor expression in duodenum decreases
 Vitamin D synthesis decreases (MacLaughlin et al 1985)
 Less time spent exposed to sunlight (Escott-Stump 2008)
 Vitamins A and K, and magnesium effect bone health as
well, but more research needed (American Dietetic Association 2005)
Calcium and Vitamin D

17.  Depression in the elderly is associated with low
levels of selenium (Gosney et al 2008)
 Low levels of selenium, zinc, and iron linked to
reduced cell-mediated immune response
(Wintergerst et al 2007)
Low zinc intake associated with increased wounds
and severity (Tobon et al 2008)
Selenium, Zinc, Iron

18.  Age
 Weight (current &usual)
Dentition
Dysphagia
Skin condition
Constipation/Diarrhea
Current medications
I/Os
Changes in appetite
N/V, indigestion
Pain
Infection
Motor coordination
Morbidities

19.  Glucose
 C-reactive protein
(CRP)
 Ca++, Mg++
 N-3, K+
 H&H, serum Fe
Serum folate
Serum homocysteine
Albumin,prealbumin,
or transthyretin
 Cholesterol

20. Increased total number of medications associated
with decreased appetite (Elmadfa and Meyer 2008)
Evaluate for alcohol abuse
 Can cause severe deficiencies of thiamine, folate,
vitamin B12, and zinc
 May not admit to true amount being consumed
Screen for caffeine use
 May promote cognition
 Excessive use can have diuretic effect
(Escott-Stump 2008)

21. American Dietetic Association. Position paper of the
American Dietetic Association: Nutrition across the spectrum of aging.
J Am Diet Assoc .2005:105:616_633.
Elmadfa, I, Meyer AL. Body composition, changing
physiological functions and nutrient requirements of the elderly. Ann
Nutr Metab 2008;52(suppl 1):2_5.
Ferry M. Strategies for ensuring good hydration in
the elderly. Nutr Rev 2005;63(6):S22-S29

22. THANK YOU FOR ATTENDING
Ndhayyat@aseza.jo
nashatdhiat@yahoo.com