Chapter 13

CHAPTER 13
Nutrition for Adults:
Early, Middle, and Later Years

Eleanor D. Schlenker

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Adulthood: Continuing Growth
and Development

Aging Across the Life Cycle
 Aging begins at the moment of conception and
continues until death
 All periods of life have their unique potential and
fulfillment

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2

and Development – Cont’d

Aging Across the Life Cycle – cont’d
 Two important considerations govern the
physiologic, psychosocial, and nutritional needs
across the adult years:
 1. The individual
 2. The total life



Aging in America
 Changes in population and available technology
are affecting the personal and working lives of
adults in the United States and around the world
 This generation must cope with the costs of
educating their children while caring for their
aging parents



 Many factors shape the path of adult
development
 Physical
 Socioeconomic
 Psychosocial
 Nutritional



Physical Characteristics
 Cell replication: forming new cells to replace old
ones and maintain body structure and function
 At older ages physical growth gradually declines
as cells are lost more rapidly than they can be
replaced



Socioeconomic Status
 Many adults experience changes in resources
as they move through early, middle, and later
adulthood
 Financial pressures at any life stage influence
food security and the availability of healthcare



Psychosocial Development
 Three developmental tasks of psychosocial
growth characterize the adult years:
 1. Young adults develop intimacy and expand
relationships outside of their parents and siblings
 2. Middle adults pursue creative expression or
explore new career direction
 3. Older adults seek fulfillment and strength of
purpose



Nutritional Needs
 Nutrient needs remain important even after
maturation and physical growth are complete
 Nutrient requirements remain dynamic
throughout life according to age, physical activity,
lifestyle, illness, chronic disease, or pregnancy
and lactation


Adult Stages

Young Adult: 19 to 45 Years
 Physical characteristics
 Body functions are fully developed with sexual
maturation and reproductive capacity


Adult Stages – Cont’d

Young Adult: 19 to 45 Years – cont’d
 Socioeconomic status
 Households are established, and individuals may
take on the parenting role
 The changing work environment can bring
difficulty in meeting the life tasks of education,
work, and family



 Psychosocial development
 If positive development is achieved, the individual
can build on personal relationships leading to self-
fulfillment



 Nutritional needs: Energy
 Needs tend to continue to decrease with age
 Recommended Dietary Allowance (RDA) for
active men ages 19 to 30 is about 3000 kcal/day
 RDA for active women ages 19 to 30 is 2400
kcal/day



 Nutritional needs: Energy – cont’d
 RDA for active men ages 31 to 50 is about 2900
kcal/day
 RDA for active women ages 31 to 50 is about
2300 kcal/day



 Nutritional needs: Protein
 RDA is 56 g/day for young men
 RDA is 46 g/day for young women
 An additional 25 g/day is required during
pregnancy and lactation



 Nutritional needs: Minerals
 Young adults need 1000 mg of calcium
 RDA for iron is 18 mg/day for women of child-
bearing age and 8 mg/day for young men
 The iron requirement in pregnancy is 27 mg/day



 Nutritional needs: Vitamins
 Intakes of certain vitamins are less than optimal in
many young adults



Middle Adult: 45 to 65 Years
 Decline in skeletal muscle mass and muscle
strength, a condition called sarcopenia, meaning
“vanishing flesh”
 Most persons increase in body fat



Middle Adult: 45 to 65 Years – cont’d
 Focus is on family, grandchildren, community
 Some experience the “empty nest”
 More opportunities to expand personal horizons



 Shifts in the nature of employment can bring job
loss for workers at all levels of responsibility
 Displaced workers may seek out new educational
opportunities or workforce training for new careers



 Nutritional needs
 Energy needs decline
 Waist circumference can increase
 Calcium intake assumes special importance



 Food habits
 In current surveys fat provides 33% of total
kilocalories (kcalories or kcal), and saturated fat
more than 11%
 Salty snacks and desserts add up to almost 13%
of total kcalories



 Chronic diseases
 Cardiovascular disease, diabetes, and cancer
often develop in this stage of life
 The prevalence of overweight and obesity has
helped to fuel the rise in diabetes



Nutritional needs
 Energy needs continue to decline

 Protein needs remain the same
 56 g/day for men
 46 g/day for women



 Calcium needs rise to 1200 mg/day for adults over
age 50
 Iron needs drop to 8 mg/day for women after
menopause



 Vitamin D needs rise to 10 µg/day (400 IU) for
adults ages 51 to 70
 Vitamin B6 needs increase for both men and
women



Older Adult: 65 to 85 Years
 Chronic diseases such as osteoarthritis, heart
disease, pulmonary disease, and diabetes may
limit physical activity



Older Adult: 65 to 85 Years – cont’d
 Physiologic changes influence nutritional
status:
 Body composition
 Cardiovascular system
 Renal system
 Respiratory system
 Gastrointestinal system



 Requires continuing adaptation to new challenges
as physical abilities decline and emotional
supports are lost



 Older adults usually enter retirement on a fixed
income
 Financial resources influence nutrient intake, and
lower-income older people have poorer diets than
higher-income older people



 Nutritional needs: Energy
 A physically active 65-year-old man weighing 77
kg needs about 2600 kcal/day
 A physically active woman of this age weighing 57
kg needs about 2100 kcal/ day
 Beyond age 70 there are further declines in
energy expenditure



 Nutritional needs: Protein
 RDA is 56 g/day for men and 46 g/day for women
(same as for younger adults)
 Health status may change protein needs
 Low energy intake may influence utilization of
dietary protein



 The Dietary Reference Intake (DRI) for calcium
rises from 1000 mg to 1200 mg for persons over
age 50



 Vitamin B6 is used less efficiently by the older
adult, so the RDA is higher
 The DRI for Vitamin D is 10 g (400 IU) for those
ages 51 to 70 and 15 g (600 IU) for persons over
age 70



 Food intake
 Likely problem is unwanted weight loss with
increasing frailty and disability
 Energy intake continues to decline



 Food intake – cont’d
 Increasing fat intake to the upper end of the
Acceptable Macronutrient Distribution Range
(AMDR) may help to stem weight loss
 Nonfood calcium rises with over half of this age-
group using either calcium supplements or
calcium-containing antacids



 Chronic diseases
 Elevated blood pressure increases vulnerability to
heart attack or stroke
 Paralysis affecting speech, mobility, movement, or
loss of some degree of cognitive function often
results from a stroke
 Deaths from cancer rise in older age-groups



 Interest in health improvement
 Older adults are an important target audience for
health education



Oldest-Old: 85 Years and Older
Population Projections
 U.S. Census Bureau developed the following

three categories:
 1. The young-old: ages 65 through 74 years
 2. The old-old: ages 75 through 84 years
 3. The oldest-old: ages 85 years and older



Oldest-Old: 85 Years and Older – cont’d
 Nutritional needs
 As persons continue to age, they become less
efficient in nutrient absorption and utilization
 Nutrient stores undergo rapid loss in acute
illness or long-term disease
 We know very little about the interactions between
the aging process and chronic disease and how they
might influence nutritional needs


The Aging Process

The Study of Gerontology
 The field of gerontology includes the biologic,
physiologic, sociologic, and behavioral
aspects of the aging process as they play out
in each individual
 Geriatrics: refers to the diseases and medical
conditions common to older people


The Aging Process – Cont’d

Length of Life
 Life expectancy of Americans at birth has
increased from 49 years to 77 years
 Lowering the infant death rate and the
development of antibiotics and effective
public health practices reduced the early
deaths of young adults, effectively increasing
life expectancy at birth



Length of Life – cont’d
 Life expectancy at older ages is influenced by
environmental factors such as pollution and
personal lifestyle including diet, smoking
habits, alcohol use, or activity level



Quality of Life
 Average healthcare costs for adults ages 65
to 74 are $8297 per year
 These costs increase to $18,353 for those
ages 85 and older



Quality of Life – cont’d
 Researchers are studying both the nature
and rate of physiologic aging, looking for
possible means of slowing or preventing
these changes and related diseases


Biologic Changes in Aging

Nature of Biologic Changes
 By the age of 70:
 The kidneys will have lost about 28% of their weight
 The liver will have lost approximately 25% of its
weight
 Skeletal muscle will have decreased by almost half,
as compared to a young adult


Biologic Changes in Aging – Cont’d

Individuality of the Aging Process
 Lifestyle choices, disease history, and
exposure to environmental hazards or
pollution act on genes to determine the rate
and severity of aging changes


Biologic Changes in Aging – Cont’d

Individuality of the Aging Process – cont’d
 Because each person experiences a different set
of these influences over a lifetime, persons age at
different rates; thus older people of the same
chronologic age are very different from each
other, whereas young children of the same age
are biologically very much alike


Adult Health

Food Intake for Optimal Function
 The Dietary Guidelines for Americans and
MyPyramid emphasize moderation and
variety and provide an outline for food
selection


Adult Health – Cont’d

Physical Activity for Optimal Function
 Two types of physical activity promote fitness
and well-being:
 1. Endurance exercise
 2. Resistance exercise


Nutritional Needs of Older Adults

Maintaining Energy Intake
 Daily energy needs range from 1600 to 2200
kcal for women and 2000 to 2800 kcal for men
 Chronic conditions common in older adults tend
to increase energy needs


Nutritional Needs of Older Adults – Cont’d

Maintaining Energy Intake – cont’d
 For persons above age 59 underweight carries
greater risk than moderate overweight
 Geriatric physicians recommend that older
adults maintain a body mass index (BMI) of 22
or higher



Planning an Adequate Diet
Carbohydrates
 Persons of all ages should obtain 45% to 65% of
their total energy from carbohydrates



Planning an Adequate Diet – cont’d
Fats
 Fat intake is best contained within the range

of 20% to 35% of total kcalories; including fat
at the upper end of the range may help to
prevent weight loss when food intake is low



Planning an Adequate Diet – cont’d
Protein
 Current RDA of 0.8 g/kg body weight may not

be sufficient for frail or chronically ill older
adults
 Overall, 10% to 35% of total kcalories should
be supplied by good-quality protein



Vitamins
 Vitamins of special importance to the aging
adult:
 Folate
 Vitamin B6
 Vitamin B12
 Vitamin D



Minerals and Electrolytes
 In planning diets for older adults, the following
require particular attention:
 Calcium
 Potassium
 Sodium



Water
 Dehydration is a concern for both healthy and
chronically ill older adults
 Older adults experience a change in the thirst
center of the brain and do not become thirsty as
they should



Water – cont’d
 The general fluid requirement of 1500 ml/day
increases when either the outside or inside
temperature rises
 High protein intakes will increase the need for
fluids
 Monitoring fluid intake is especially important for
older persons who cannot drink or obtain fluids
without help


Nutrient Supplementation

 Older adults with low energy intakes can
benefit from prudent, individually assessed
supplementation
 May be needed to replenish losses following
critical or debilitating illness
 Should be based on an individual
assessment and advice of a healthcare
professional


Influences on Food Intake
of Older Adults

Physical Changes
 Decayed teeth, tooth loss, or poorly fitting
dentures all make chewing and eating both
painful and difficult
 Losses in taste, smell, or sight reduce the
enjoyment of eating and lower appetite


of Older Adults – Cont’d

Multiple Medications
 Can lower food intake by producing
 Anorexia
 Nausea
 Unpleasant taste



Psychosocial Distress
 Emotional loss arising from the death of a
spouse or physical separation from family and
friends causing depression can lead to
disinterest in food
 Alcohol sometimes displaces food in the diet



Economic Problems
 Lack of resources to purchase the quantity or
quality of food they should have

Chronic Illness and Disability
 Food shopping and meal preparation can be
difficult or impossible with some physical
disabilities


Clinical Applications

Medical Nutrition Therapy
 Under certain circumstances a medically indicated
diet may be appropriate; however, the greater the
restriction the more likely the rejection of the food
offered and consequent weight loss


Clinical Applications – Cont’d

Medical Nutrition Therapy – cont’d
 Older persons with diabetes can often be well
managed on a regular diet if high-sugar items
are restricted
 A regular diet—well-balanced nutritionally—
that offers a wide variety of foods with
moderation in fats and sweets has the best
outcomes


Clinical Applications – Cont’d

Support Programs for Self-Care
 Expand knowledge about a condition and its
management, build emotional support, and
work with the individual and family to promote
creative decision making


Community Resources
for the Aging

Food Assistance Programs for Older
Americans
 Food stamps
 Commodities distribution program
 Elderly Nutrition Program: national program with
the greatest impact on the nutritional status of
older adults


Food Assistance Programs

Elderly Nutrition Program
 Funded under the Older Americans Act and
managed by the Administration on Aging
 First authorized in 1972


Food Assistance Programs – Cont’d

Elderly Nutrition Program – cont’d
 Intended to meet both the nutritional and
social needs of older adults
 Operates in all 50 states and provides various
nutrition services based on local needs and
the funds available


Government Research
and Education Services

Research Centers of the United States
Department of Agriculture
 Authorized by Congress to study the role of
nutrition in the aging process and help us learn
more about nutritional requirements at older
ages


Government Research
and Education Services – Cont’d

Extension Services of the United States
Department of Agriculture
 Provide nutrition education classes and practical
nutrition materials for older adults and
community workers


Government Research

State Public Health Departments
 Provide nutrition education and oversee nutrition
and health screening of older people in the
community


Government Research

State Departments for the Aging
 Area agencies on aging manage congregate
and home-delivered meals programs on the
local level under the guidelines of the state unit


Professional Organizations
and Resources

National Council on the Aging
 Nonprofit organization that promotes research,
training, technical assistance, advocacy and
public policy, program standards, and
publications relating to all aspects of aging


and Resources – Cont’d

American Geriatrics Society
 Made up of physicians who provide medical care
to older patients

The Gerontological Society
 Includes a wide range of health and social
service professionals



Volunteer Health Organizations
 Organizations such as the American Heart
Association and the American Diabetes
Association
 Support health and nutrition programs of interest
to older adults



Community Groups
 Medical societies, nursing organizations, and
dietetic associations
 Sponsor classes and programs to help meet the
needs of older adults in their communities


Chapter 13

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Chapter 13