The Complex Relationship Between Depression and Nutrition in the Elderly. A presentation for providers of long term and inhome

Transcription

1 The Complex Relationship Between Depression and Nutrition in the Elderly A presentation for providers of long term and inhome care

2 General Indicators of Health Status Nutritional Status! Dietary Intake! Impact of chronic disease! Psychological Status! Memory! Emotional well-being

3 Factors That May Affect Nutrition Status in the Elderly!! Social Factors! Biological Factors! Psychological factors

4 Social Factors Level of food security! German et al report older adults reporting food insufficiency are ten times more likely to be depressed. 1! Eating alone, eating environment: Kimura et al found that among a group of elderly! persons in Japan, those who ate alone experienced significant depressive symptoms 2! Lower socioeconomic status 1! Skipping meals to save money

5 Biological factors 3 Risk of altered dietary intake increases with age related changes

6 Biological Factors 3 Certain medications affect nutritional status! Polypharmacy 4! Side effects! Some medications may alter taste sensation! Some medications may require restriction of certain foods (see next slide)! Example: warfarin! Monitor vitamin K intake! Restrict spinach, kale

7 Food and Drug Interactions Download From: Drug Food Increase Drug Effect Decrease Drug Effect Some statins Grapefruit, pomegranate, and cranberry juices (eg, Lipitor, Zocor, Mevacor, Advicor) Antidepressants Chocolate and other foods containing (MAO inhibitors) tyramine Allergy medications (eg, Allegra) Black pepper Potentially all drugs Black tea metabolized by P450 liver enzymes Cancer drugs Beer (eg, tamoxifen) Anticlotting agents Fatty fish (eg, Plavix) Beta-blockers Meat (hypertension medications) Blood thinners Leafy greens (eg, Coumadin) Beta-blockers Natural licorice (hypertension medications) Antibiotics Milk and calcium-fortified juices (eg, Cipro, tetracycline)

8 Polypharmacy 4 Polypharmacy may be linked to malnutrition in some elderly patients! Use of multiple prescription drugs! May or may not be clinically indicated! Pharmacist should be part of health care team to monitor prescriptions for compatibility and interactions! Drug interactions! Impact of medications on nutrition! Food and drug interactions

9 Psychological Factors! Dementia! Alzheimer s! Depression

10 Psychological Factors! Dementia/ Alzheimer's 5! Patients may forget to eat or eat twice because they forgot that they ate earlier! Patients who wander or pace may have increased caloric needs! Weight loss and malnutrition complications

11 Psychological Factors Depression 3! 1 to 5 % of older adults suffer from depression, 13.5% in long-term care 6! Chronic disease experienced within the context of chronic conditions worsens symptoms of both the chronic disease and the depression 7! Symptoms of depression can be different in the elderly and can often be confused with symptoms of chronic disease 3

12 Symptoms of Depression in the Elderly 3! Lack of interest in usual activities! Depressed mood! Anxiety, agitation, indecisiveness! Vague complaints of pain or lack of sleep! Memory problems! Loss of appetite! Overeating

13 Risk Factors for Depression in the Elderly 3! Family history! Previous diagnosis! Some types of chronic disease! Parkinson s, Alzheimer s, MS! Substance abuse! Certain medications! Single/divorced, loss of spouse

14 Depression and Nutrition! It is unclear whether depression is caused by poor diet, or whether depression leads to poor dietary habits that increase the incidence of malnutrition in the elderly; however, it is clear that the two are inextricably related, especially in the elderly.

15 Nutrition Factors Related to Depression Depression often co-morbid with other chronic diseases such as diabetes or cardiovascular disease 3! Some depression medications can negatively impact nutrition 3! Malnutrition and vitamin/mineral deficiencies are common 3! Vitamin deficiencies related to depression 8! Geriatric failure to thrive 3!!!

16 Vitamin Deficiency and Depression 7! Vitamins B 12 and other B vitamins play role in producing chemicals in the brain that regulate mood 8! Deficiencies in B 12,B 6 and folate may be linked to depression 8! Low levels of Vitamin D linked to depression, but evidence is not conclusive 3,9! May be related to behavior of depressed individual rather than the cause of depression, i.e. a depressed individual may spend less time outdoors! Vitamin D may improve serotonin levels

17 Dietary Reference Intakes for B12, B6, Folate and Vitamin D Males > 70 years old:! B 12 : 2.4 "g/d! B 6 : 1.7 mg/d! Folate: 400 "g/d! Vitamin D: 15 "g/d! Females > 70 years old:! B 12 : 2.4 "g/d! B 6 : 1.5 mg/d! Folate: 400 "g/d! Vitamin D: 15 "g/d

18 Geriatric Failure to Thrive! Downward spiral of interrelated conditions 3! Decreased appetite! Weight loss! Malnutrition! Depression! Decreased physical function! Decreased cognitive function

19 Antidepressant Medications that Affect Nutrition 3 Tricyclic and tetracyclic antidepressants are not usually prescribed for older adults! SNRI s! Side effects include: Nausea, dry mouth, and constipation! Atypical! Side effects include: Suppress appetite, increase lipid levels and cholesterol! MAOI s! Side effects include: Diarrhea, nausea, constipation, weight gain! SSRI s! Side effects include: Nausea, vomiting, weight gain or loss, diarrhea, dry mouth

20 Course of Action for Intervention 3! Identify seniors at risk for depression and malnutrition! Appropriate referrals! Team approach: nurses, physician, RD, caregivers 3! Identify and treat the depression, or dementia 3! Psychotherapy! Pharmacotherapy

21 Intervention 3 (continued)! Nutrition related assessments, involve RD! Food diary, 24-hour recall! Identify and treat other problems decreasing desire to eat! Side effects of medications! Mobility, strength issues! Dental problems

22 Intervention 3 (Continued)! Review of medications! OTC! Herbal supplements! Recommend least restrictive diet possible! Cost benefit analysis regarding need for restriction! Assess need for supplementation

23 Intervention 3 (continued)! Eating environment! Pleasant, easy to access, socialization! Availability of food! Address financial concerns! Counsel regarding availability of social services! Cultural considerations! Do preferences modify dietary intake?

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25 Successful education and empowerment involves both the patient/resident and the caregiver " It's interesting how the views of nutrition in the elderly have changed in the last five years. We used to focus on the amount of calories we could get into people. Now we are preaching eating close to home, cutting out [bad] fat and sodium, whole foods etc. My residents know the difference between quinoa and barley (and have eaten both). They want to know where their meat comes from, and appreciate the fact that we make everything from scratch. 10! Kara Emig, RD Holly Creek Assisted Living

26 References 1. German L, et al. Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community dwelling people. The Journal of Nutrition, Health and Aging Jan; 15(1):3-8.! 2. Kimura Y, at al. Eating Alone Among Community Dwelling Japanese Elderly: Association with depression and Food Diversity. The Journal of Nutrition, Health and Aging Aug; 16(8): ! 3. Phillips RM. Nutrition and Depression in the Community Based Oldest Old. Home Health Care Nurse. 2012, vol. 30, number 8, pp ! 4. Jyrkka J, et al. Polypharmacy and nutritional status in elderly people. Current Opinion in Clinical Nutrition, and Metabolic Care Jan;15(1):1-6.! 5. Guerin O, et al. Nutritional Status Assessment During Alzheimer's Disease: Results After One Year. The Journal of Nutrition, Health and Aging. 2005; 9(2):81-4.! 6. Centers for Disease Control and Prevention, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion. (2010). Depression is not a normal part of aging. Retrieved fromhttp:// 7. National Institute of Mental Health. (2011). Depression (NIH Publication No ). Retrieved fromhttp:// 8. Skarupski, K. A., Tangney, C., Li, H., Ouyang, B., Evans, D. A., & Morris, M. C., (2010). Longitudinal association of Vitamin B-6, folate, and Vitamin B-12 with depressive symptoms among older adults over time. American Journal of Clinical Nutrition, 92, ! 9. Bertone-Johnson E. Vitamin D and the occurrence of depression: causal association or circumstantial evidence? Nutrition Reviews. 2009: 67(8) ! 10. Emig K. Interview: 16 June, 2013.! 11. Hetherington, M. M., Anderson, A. S., Norton, G. N., & Newson, L. (2006). Situational effects on meal intake: A comparison of eating alone and eating with others. Physiology & Behavior, 88(4-5), ! 12. Gebretsadik, M., & Grossberg, G. T. (2007). Nutrition and depression. In J. E. Morley & D. R. Thomas (Eds.). Geriatric nutrition (pp ). Boca Raton, FL: CRC Press.