Life Cycle Nutrition: Adulthood and the Later Years

Transcription

1 Life Cycle Nutrition: Adulthood and the Later Years Chapter 17

2 Introduction Two motivating goals Promote health Slow aging The ratio of old people to young is increasing Growing old happens day by day Fastest-growing age group Factors influencing life expectancy

3 The Aging of the U.S. Population

4 Nutrition and Longevity Diversity of older adults Nutritional influence on aging process Aging is inevitable Process can be slowed by adopting a healthy lifestyle Physiological age versus chronological age

5 Healthy Habits Eating well-balanced meals Engaging in physical activity daily Not smoking Not using alcohol, or using it in moderation Maintaining a healthy body weight Sleeping regularly and adequately Relieving stress; focus on a sense of purpose Having a community of family and friends

6 Physical Activity Benefits of physical activity in older adults Additional benefits from specific activity types Aerobic activities Moderate endurance activities Strength training Resistance training Most powerful predictor of mobility in later years

7 Exercise Guidelines for Older Adults Examples Aerobic Strength Balance Flexibility Start easy and progress gradually Frequency Intensity a Duration Cautions and comments Be active 5 minutes on most or all days At least 5 days per week of moderate activity or at least 4 days per week of vigorous activity Moderate, vigorous, or combination At least 30 minutes of moderate activity in bouts of at least 10 minutes each or at least 20 minutes of continuous vigorous activity Stop if you are breathing so hard you can't talk or if you feel dizziness or chest pain Using 0- to 2-pound weights, do 1 set of 8-12 repetitions twice a week At least 2 (nonconsecutive) days per week. Moderate to high; 10 to 15 repetitions per exercise; gradually increase weights 8 to 10 exercises involving the major muscle groups Breathe out as you contract and in as you relax (do not hold breath), use smooth, steady movements Hold onto table or chair with one hand, then with one finger, Hold stretch for 10 seconds; do each stretch 3 times 2 to 3 days each week At least 2 days per week, preferably on all days that aerobic or strength activities are performed EMPTY CELL Moderate At least 20 to 30 minutes Stretch major muscle groups for seconds, repeating each stretch 3 to 4 times Incorporate balance techniques with strength exercises as you progress Stretch after strength and endurance exercises for 20 minutes, 3 times a week; use slow, steady movements; bend joints slightly a On a 10-point scale, where sitting =0 and maximum effort=10, moderate intensity =5 to 6 and vigorous intensity = 7 to 8 NOTE: Activity recommendations are in addition to routine activities of daily living(such as getting dressed, cooking, grocery shopping) and moderate activities lasting less than 10 minutes. SOURCE: Centers for Disease Control and Prevention. Division of Nutrition Physical Activity and Obesity, National Center for Chronic Disease prevention and Health Promotion C. E. Garber and coauthors. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine & Science in Sports & Exercise 43 (2011):

8 Manipulation of Diet Energy restriction in animals Animals live longer and have fewer age-related diseases Slows aging process Food intake Prevent malnutrition 70 percent of normal energy intake Increases antioxidant activity and DNA repair Age of starting energy restriction

9 Energy Restriction in Human Beings Difficulty defining energy restriction Time of energy restriction needed to realize health benefit Moderate restriction 10 to 20 percent reduction in energy intake Benefits Nutritional adequacy essential to a long and healthy life

10 Stress Psychological and physical stressors Body s stress response Nervous and hormonal systems Prolonged or severe stress effects Difference between men and women Fight-or-flight response Tend-or-befriend response

11 Physiological Changes Body weight Being moderately overweight may not be harmful Lowest mortality correlates with a BMI of 23.5 to 27.5 Obesity complications Risks associated with low body weight

12 Body Composition Changes Sarcopenia Optimal nutrition, sufficient protein, and regular physical activity

13 Immunity and Inflammation Immune system loses function with age Inflammaging Inflammation critical in supporting health Compromised by nutrient deficiencies Improving immune system response Regular physical activity Diet rich in fruits and vegetables

14 GI Tract Intestinal walls lose strength and elasticity with age GI hormone secretions change Motility slows Diminished appetite Constipation Atrophic gastritis Dysphagia

15 Tooth Loss Difficult and painful chewing Limited food selections Less dietary variety Lower intakes of fiber and vitamins Sensory losses and other physical problems Vision, mobility, hearing, taste, and smell

16 Psychological Changes Depression Lose appetite and motivation to cook Support and companionship of family and friends Economic changes Living arrangements and income Social changes Malnutrition most likely to affect those living alone Especially men, those with low income and/or education

17 Energy and Nutrient Needs of Older Adults Dietary Reference Intakes (DRI) Two age categories 51 to 70 years 71 and older Challenges with setting standards Individual differences are more pronounced with age Different chronic diseases Different medications

18 Water Thirst response and dry mouth Dehydration Total body water decreases with age Risks associated with dehydration Prevention At least six glasses of water daily

19 Energy and Energy Nutrients Energy needs decline estimated five percent per decade Reasons Nutrient needs remain high USDA Food Patterns Protein Especially important Low-calorie sources Liquid nutritional formulas

20 Carbohydrate, Fiber, and Fat Carbohydrate and fiber Abundant carbohydrate needed Eating high fiber foods can alleviate constipation Fat Moderate intake Disease risk

21 Vitamins and Minerals Vitamin B 12 People with atrophic gastritis especially vulnerable Fortified foods and supplements Vitamin D Folate Calcium Iron Zinc

22 Dietary Supplements More than half of older adults use supplements Vitamin D and calcium may be helpful When recommended by a physician Food is best source of nutrients

23 Nutrient Concerns of Aging Nutrient Effect of Aging Comments Water Lack of thirst and decreased total body water make dehydration likely. Mild dehydration is a common cause ofconfusion. Difficulty obtaining water or getting to the bathroom may compound the problem Physical activity moderatesthe decline. Energy Need decreases as muscle mass decreases (sarcopenia) Fiber Likelihood of constipation increases with low Inadequate water intakes and lack ofphysical activity, intakes and changes in the Gl tract. alongwith some medications, compound the problem. Protein Needs maystay the same or increase slightly. Low-fat, high-fiber legumes and gramsmeetboth protein and other nutrientneeds. Vitamin Atrophic gastritis is common. Deficiency causes neurological damages; supplements B12 may be needed. Vitamin D Increased likelihood ofinadequate intake; skin Daily sunlight exposure in moderationor supplements synthesis declines. may be beneficial. Calcium Intakes may be low;osteoporosis is common. Stomach discomfort commonly limits milk intake; calcium substitutes or supplements maybe needed. Iron In women, status improves after menopause; Adequate stomach acid isrequired for absorption; antacid deficiencies are linked to chronic blood losses and or other medicine use may aggravate iron deficiency; low stomach acid output. vitamin C and meat increase absorption. Zinc Intakes are often inadequate and absorption may be poor, butneedsmayalso increase. Medications interfere with absorption; deficiency may depress appetite and sense oftaste.

24 Vision Cataracts Age-related clouding of the lenses of the eyes Lead to blindness if not surgically removed Risk factors Oxidative stress and antioxidants Macular degeneration Leading cause of vision loss

25 Healthy Lens and Cataract Lens Compared

26 Arthritis Osteoarthritis Deterioration of cartilage in the joints Connection with being overweight Benefits of aerobic activity and strength training Rheumatoid arthritis Immune system destroys bone and cartilage Gout Deposits of uric acid in joints Purines in foods

27 The Aging Brain Dementia Affects 15 percent of adults over 70 Brain changes due to genetic and environmental factors Characteristic changes with age Loss of neurons Decreased blood supply Nutrient deficiency May be a factor in loss of memory and cognition

28 Alzheimer s Disease Prevalence in U.S. Characteristic symptoms Possible causes Senile plaques and neurofibrillary tangles Cardiovascular disease risk factors Treatment Alcohol use and binge drinking Affects older adults

29 Alzheimer s and Healthy Brains Compared

30 Food Choices and Eating Habits of Older Adults Older people an incredibly diverse group Quality of life has improved Chronic disabilities have declined Strategies for growing old healthfully Older adults spend more money on foods to eat at home Less on foods eaten away from home Influential factors in food choices

31 Strategies for Growing Old Healthfully Choose nutrient-dense foods. Be physically active. Walk, run. dance, swim, bike, or row for aerobic activity. Lift weights, do calisthenics, or pursue some other activity to tone, firm, and strengthen muscles. Practice balancing on one foot or doing simple movements with your eyes dosed. Modify activities to suit changing abilities and preferences. Maintain appropriate body weight. Reduce stress cultivate self-esteem, maintain a positive attitude, manage time wisely, know your limits, practice assertiveness. release tension, and take action. For women, discuss with a physician the risks and benefits of estrogen replacement therapy. For people who smoke, discuss with a physician strategies and programs to help you quit. Expect to enjoy sex, and learn new ways of enhancing it. Use alcohol only moderately, if at all; use drugs only as prescribed. Take care to prevent accidents. Expect good vision and hearing throughout life; obtain glasses and hearing aids if necessary. Take care of your teeth; obtain dentures if necessary. Be alert to confusion as a disease symptom, and seek diagnosis. Take medications as prescribed; see a physician before self-prescribing medicines or herbal remedies and a registered dietitian before selfprescribing supplements. Control depression through activities and friendships; seek professional help if necessary. Drink six to eight glasses of water every day. Practice mental skills. Keep on solving math problems and crossword puzzles, playing cards or other games, reading, writing, imagining, and creating. Make financial plans early to ensure security. Accept change. Work at recovering from losses; make new friends. Cultivate spiritual health. Cherish personal values. Make life meaningful. Go outside for sunshine and fresh air as often as possible. Be socially active play bridge, join an exercise or dance group, take a class, teach a class, eat with friends, volunteer time to help others. Stay interested in life pursue a hobby, spend time with grandchildren, take a trip, read, grow a garden, or go to the movies. Enjoy life.

32 Malnutrition One in six are malnourished Contributing factors Diminished quality of life Nutrition Screening Initiative Screening for malnutrition Food assistance programs OAA Nutrition Program provides group meals in a social setting Meals on Wheels

33 Meals for Singles Challenges for older adults living alone Purchasing, storing, and preparing food Foodborne illness Risk is greater for older adults Spend wisely Wise shoppers Be creative Invite others to share a meal

34 Nutrient-Drug Interactions Highlight 17

35 Introduction Use of over-the-counter and prescription drugs by people over 65 Average prescriptions per year Vitamin and mineral supplements Numerous doctors Physiological changes occur that may impact drug metabolism and excretion

36 The Actions of Drugs Drug Any substance that modifies one or more of the body s functions Consequences Desirable Undesirable Example of aspirin

37 The Interactions between Drugs and Nutrients Interactions can: Lead to nutrient imbalances Interfere with drug effectiveness Factors that increase risk for adverse nutrientdrug interactions Methods of nutrient and medication interactions

38 The Effect of Drugs on Food Intake Eating may be difficult or unpleasant May stimulate appetite and cause weight gain May suppress appetite and promote weight loss

39 The Effect of Drugs on Nutrient Absorption Most likely occurs with medications that damage the intestinal mucosa May bind with nutrients in GI tract, preventing nutrient absorption May reduce stomach acidity May interfere with intestinal metabolism or transport of nutrients into mucosal cells

40 The Effect of Diet on Drug Absorption Most drugs are absorbed in upper small intestine Influences on drug absorption Stomach acidity and emptying rate Direct interactions with dietary components Drug formulation Whether drug is taken on empty or full stomach Binding with nutrients and nonnutrients

41 The Effect of Drugs on Nutrient Metabolism Some drugs enhance or inhibit enzyme activity needed for nutrient metabolism Diet alters drug metabolism Some foods affect the activities of enzymes that metabolize drugs May counteract the drugs effects Some food and drug interactions can cause toxicity and exacerbate side effects

42 Some Grapefruit Juice- Drug Interactions Drug Category Anticoagulants Anti-diabetic drugs Anti-infective drugs Cardiovascular drugs Central nervous system drugs Cholesterol-lowering drugs Immunosuppressants Drugs Affected by Grapefruit Juice Repaglinide Saxagliptin Erythromycin Saquinavir Amiodarone Felodipine Nicardipine Buspirone Carbamazepine Diazepam Atorvastatin Lovastatin Simvastatin Cyclosporine Tacrolimus Drugs Unaffected by Grapefruit Juice Acenocoumarol Warfarin Glyburide Metformin Clarithromycin Indinivir Amlodipine Digoxin Diltiazem Haloperidol Lorazapam Risperidone Fluvastatin Pravastatin Rosuvastatin Prednisone

43 The Effect of Drugs on Nutrient and Drug Excretion Interfere with nutrient reabsorption Greater urinary losses of nutrients Mineral depletion Diets alter drug excretion May lead to toxicity Urine acidity Example: lithium Diet-drug toxicities Example: tyramine

44 Examples of Foods with a High Tyramine Content Aged cheeses (cheddar, Gruyére) Aged or cured meats (sausage, salami) Beer Fermented vegetables (sauerkraut, kimchi) Fish or shrimp sauce Prepared soy foods (miso, tempeh, tofu) Soy sauce Yeast extract (Marmite, Vegemite) NOTE: The tyramine content of foods depends on storage conditions and processing; thus the amounts in similar products can vary substantially.

45 The Inactive Ingredients in Drugs Sugar, sorbitol, and lactose Diabetics Lactose intolerance Sodium Hypertension Antacids Nutrient-drug interactions also happen with over-the-counter drugs Consult a physician