Diet in elderly people

1. ZERA INTERNATIONAL COLLEGE OF
HEALTH SCIENCES
DEPARTMENT OF CLINICAL MEDICINE
MEDICAL BIOCHEMISTRY & MEDICAL NUTRITION (MBC 120)
LECTURE 14
UNIT 3:NUTRITION & LIFE CYCLE
- GERIATRICS
Mrs Natasha N Ng’andwe
BSc, BMS

2. INTRODUCTION
• Aging is part of living.
• Every human has the choice of aging healthfully or living with sickness and
poor quality of life.
• Nutrition has a major role in protecting health and slowing disease
progression.
• We need to improve on health promotion and disease prevention (better
than cure).
• While it is widely agreed upon that micronutrients play a large role in
promoting health and preventing disease, meeting the nutritional needs of
elderly persons is a great challenge.

3. INTRODUCTION
• There are no nutrient intake standards at present for the elderly
demographic by WHO
• Micronutrient deficiencies are common in elderly people due to a number
of factors such as
 reduced food intake,
 lack of variety in the foods they eat,
 medications that deplete nutrients and create side effects, the price of
foods rich in micronutrients, and the deplorable food choices available in
the institutional setting.

4. INTRODUCTION
• Additionally, the elderly often suffer from “anorexia of aging,” because
the hormones leptin and ghrelin increase as you age, leading to
prolonged satiety and suppressed hunger, which can lead to calorie
deficit and malnutrition.
• Signs of declining nutritional status are:
 Notable changes in weight and Hydration status,
 Loss of muscle mass, performance of activities of daily living, and poor
oral health status.

5. NUTRITION IN THE ELDERLY
• Medications should be closely monitored and for the potential of creating
nutrient deficiency.
• If laboratory measures can be performed at regular intervals (i.e., monthly), a CBC
and Chem Screen are the most reliable measurements for micronutrient
deficiencies and for macronutrient deficiency (i.e., measured by blood protein
and serum albumin).
• There is an epidemic of vitamin D deficiency among older people that simply
cannot be met by food or synthesis in the skin produced by ultraviolet light.
• For this reason, testing for low serum 25-hydroxyvitamin D concentration may be
warranted due to an association with a greater risk of osteoporosis.

6. PREVENTION OF MALNUTRITION
• It is necessary to eat foods that are nutrient dense.
• Maintaining nutritional homeostasis may be challenging, in elderly people.
• Immobility, either in bed or in a chair, contributes to negative nitrogen
balance.
• Increased protein demands are associated with the requirements for healing
surgical wounds, pressure ulcers, or bone fractures and for producing
immune bodies when fighting infections.
• It is also important to provide enough dietary protein to maintain tissue
integrity, muscle mass, and immune function.
• There is an erroneous assumption by many health care practitioners that
elderly people cannot tolerate large amounts of dietary protein because of
their renal function.

7. PREVENTION OF MALNUTRITION
• In the absence of renal disease, most elderly people can tolerate high
levels of dietary protein if they are adequately hydrated.

8. FOODS THAT CAN HELP THE ELDERLY
• •Cruciferous Vegetables
•Pomegranates or Pomegranate Juice Concentrate
•Dried Beans & Peas
•Avocados
•Onion (allium family)
•Wild Pacific Salmon
•Nuts & Seeds (or nut butters if chewing is difficult)
•Tea
•Sea Vegetables

9. FLUID INTAKE
• Achieving adequate fluid consumption in older adults is sometimes
difficult, because with advancing age, thirst sensitivity decreases and
voluntary fluid intake is impaired.
• It is important to maintain adequate hydration((35ml/kg body weight)
because water serves several purposes, including the maintenance of
body temperature, a diluent for medications, and as a solvent for
nutrients, waste products, and electrolytes.

10. GUT BACTERIA
• People over the age of 60 have much less of the “friendly” bacteria in
their gut, making them more susceptible to gastrointestinal infections
and bowel conditions such as irritable bowel syndrome.
• Supplementing with products (e.g. yoghurt, sour milk) that contain
healthy bacteria such as lactobacillus acidophilus and bifidobacterium
are helpful.

11. IMPROVED AGING AND OUTCOMES FOR
ELDERLY BY REDUCING INFLAMMATION
• Aging is associated with chronic, low-grade inflammatory activity.
• Systemic chronic inflammation has found to be related to mortality risk from all causes
in older persons.
• Age-related diseases such as Alzheimer disease, atherosclerosis, diabetes,
sarcopenia (loss of skeletal muscle mass), and osteoporosis are initiated or worsened
by systemic inflammation, which suggests the critical importance of “putting out the
fire.”
• The best laboratory determinants of chronic inflammation are C-reactive protein (CRP)
and WBC (white blood cell count).
• Genetic determinants for predisposition or specific chronic inflammatory pathways are
interleukin (IL) cytokines and tumor necrosis factor (TNF- ).

12. IMPROVED AGING AND OUTCOMES FOR
ELDERLY BY REDUCING INFLAMMATION
• One of the major causes of systemic inflammation is the diet.
• To reduce degenerative disease and chronic pain, specific food triggers
must be eliminated, such as conventional red meat, saturated fat from
lard and meat fats, fried foods, trans fats, soft drinks, artificial sugar
substitutes, and most importantly, sugar (both from heavily processed
sources, such as candy, and from naturally occurring sources such as
fruit juice).
• Sugar is one of the most serious causes of inflammation, rapid aging,
and weight gain.

13. IMPROVED AGING AND OUTCOMES FOR
ELDERLY BY REDUCING INFLAMMATION
• When sugar and foods that quickly convert to sugar are consumed, blood
sugar rises, creating an insulin release and free radicals that oxidize fats.
• When oxidized, the fats form plaque deposits in our your arteries, leading to
disease.
• Insulin release also increases stored body fat and release of pro-
inflammatory chemicals causing cell damage and accelerated aging.
• For a short-term, two-week elimination, we use an Action Plan called The
Pain Relief Diet that removes all food triggers and infuses antiinflammatory
foods complete with a menu and recipes. For the long-term, an
antiinflammatory diet with a 60/40 alkaline to acid ratio is suggested.

14. COMMON CHRONIC DISEASES CAUSED
BY INFLAMMATION
OSTEOPOROSIS
• Osteoporosis and associated fractures are a major cause of illness, disability
and death, and are a huge medical expense. Osteoporosis is an
inflammatory disease with a primary cause of excess acid. To keep
homeostasis, our bodies will pull alkaline calcium out of our bones to
neutralize the acid, creating bone loss.
• Current pharmacologic approaches focus on inhibiting bone resorption in
those with osteoporosis but do little to improve bone mass. To ease the
future burden of osteoporosis, focusing on prevention will be key, and this
includes antiinflammatory dietary interventions to stimulate bone formation.

15. KEY NUTRIENTS FOR MAINTAINING
HEALTHY BONE
 calcium (optimally absorbed)
 magnesium (non-laxative source)
 boron
 vitamin D (deficiency is common in older persons)
 Flavanoids
 adequate protein

16. BE AWARE OF THE “BONE ROBBERS”:
 medications (especially long-term use of steroids, thyroid meds, and
proton pump inhibitors)
 smoking/excess alcohol consumption
 malabsorption (especially low levels of B-12)
 sedentary lifestyle
 inflammatory food triggers

17. DIABETES
• It is key to balance every meal with 50% of calories from complex
carbohydrates, 30% from lean protein, and 20% from healthy fats.
• Ingestion of protein with carbohydrates increases muscle protein synthesis in
elderly men.
• Fruits and vegetables are ideal complex carbohydrates because they turn
into sugar very slowly and because they have more water, are less dense in
carbohydrates.
• Grains have virtually no water and are dense in carbohydrates.
• Soluble fibers delay glucose absorption when eaten in sufficient quantities.
• Consuming 20-35 grams daily is suggested.

18. DIABETES
• It is also important to choose your carbohydrates with low glycemic
index and low glycemic load .
• Low Glycemic Index is the amount of sugar in a food (100 is the highest,
0 is the lowest) and Low Glycemic Load is how fast food turns into
glucose.
• The faster food turns into glucose, the worse it is for blood sugar
balance.

19. MICRONUTRIENTS FOR BLOOD SUGAR
BALANCE:
• Alpha Lipoic Acid – improves insulin sensitivity
• Magnesium – most important because, without it, glucose cannot be
efficiently transported into cell membranes; the role of magnesium in
maintaining muscle integrity and function in older persons is significant
as well.
• Chromium – reduces high blood sugar
• EPA/DHA Fish Oil – reduces inflammation (from salmon, cod liver, or a
mixture of herring, anchovy, and sardine)
• Zinc – prevents insulin mediated free radical damage

20. CARDIOVASCULAR DISEASE
• 10 Dietary Tips to Improve Heart Health
 Use olive oil, avocado, and/or grapeseed oil exclusively
 Eat whole, unrefined grains (esp. oatmeal, whole maize meal nshima, and brown rice)
 Eat wild caught fish often (esp. sardines and salmon)
 Eat raw/dry roasted nuts/seeds (esp. peanut seed, pumpkin seed and sunflower seeds)
 Drink tea and coffee in moderation
 Eat more fruits and vegetables (esp. dark greens, and avocado)
 Eat more fiber (esp. oat bran, dried beans, and high fiber veggies)
 Restrict saturated fats (i.e. bacon, lard, sausage, high fat cheese)
 Avoid trans fats (label of all processed foods should read zero trans fats)
 EAT LESS AND SLOWLY!

21. NUTRIENTS FOR HEART HEALTH
• Co-Enzyme Q10 (CoQ10) – a nutritional cofactor for all aspects of heart
health (and suggested if on statin medication)
• EPA/DHA Fish Oil – helps reduce inflammation and prevent excess
coagulation (must discuss with physician if on blood thinning meds)
• Magnesium – important for all aspects of heart health (especially heart
rhythm and prevents heart failure).

22. CANCER
• Try to avoid the following as much as possible:
 Pesticides (eat certified organic)
 Artificial Colors/Flavors
 Nitrates/Nitrites
 Heavy Saturated Fats and Trans Fats
 High sugar foods
 Fried foods
 Grilled foods that have not been marinated
 Bovine Growth Hormone (BGH) in dairy products
 Artificial Sweeteners (sucralose, aspartame, saccharin)

23. CANCER
• Key nutrients
 Vitamin C
 Vitamin E
 CoQ10
 Magnesium
 Vitamin D
 EPA/DHA Fish Oil
 Alpha Lipoic Acid

24. NEUROLOGICAL DISEASE
• The most financially and emotionally devastating of all aging diseases is
memory loss and other neurological disorders.
• Families have trouble coping because the disorders can only be
managed, not cured or reversed.
• Sufficient omega 3 fatty acid and vitamin D intake may slow cognitive
decline, but prevention is paramount.
• High intake of saturated fat, especially from milk products at midlife, is
associated with poorer cognitive function and memory, while high intake
of polyunsaturated fatty acids and fish consumption correlates with
better overall cognitive function.
• High concentrations of homocysteine and low concentrations of B-12
and folic acid are frequently observed in subjects with dementia, and
can predict cognitive decline.

25. BEYOND DIET AND NUTRIENTS
• Of course, men and women do not live by food and nutrients alone, so I conclude with
my…
RECIPE FOR HAPPINESS
-2 heaping cups of patience
-1 heart full of love
-1 head full of understanding.
-A dash of laughter
-Sprinkle generously with kindness.
-Add plenty of faith and mix well.
• Spread over a period of a lifetime, Serve to everyone you meet.