NUTRITION IN THE ELDERLY

Older adults require care, affection and special attention. When an older adult does not
eat properly, they can increase the chances of suffering from diseases such as an
increase in blood pressure or a decrease in glucose tolerance. In addition, the
metabolism slows down and there are difficulties in digestion.
"In the nutritional field the effects of aging are evident in the changes of the muscular
and skeletal system, since with age there is a decrease in lean mass (bone, muscle and
water) and an increase in fat mass. Due to these changes, it is necessary that the elderly
have adequate nutrition to ensure a better quality of life, "explained nutritionist Melania
Cevo.

On the other hand, during this stage people have special nutritional needs, need protein,
fiber and vitamin D. Poor nutrition can cause fatigue and a reduced immune response,
inactivity, irregular body temperature, difficulty to heal wounds, dehydration and fluid
retention.
Cevo mentions some tips for proper nutrition in adulthood. Water plays an important
role to avoid dehydration and weakness, so it is recommended to consume between 6 to
8 glasses a day. In turn, this can be replaced by natural juices without sugar, milk and
defatted broths. The consumption of diets high in fat and the low consumption of
vegetables, fruits, water and whole grains increase the probability of developing
diseases.
"The elderly should eat yogurt and low-fat cheeses, in addition to drinking milk. This
prevents osteoporosis and helps strengthen the bones. You should also increase the
intake of vegetables, fruits, legumes and whole-grain products, as they improve
digestion and prevent constipation, "says Cevo.
Avoid the consumption of red meats, fried foods, sausages, products with a high content
of salt and sugar, pastries, carbonated drinks and sweets to reduce the possibility of
obesity, diabetes, high blood pressure, colon cancer, among others.
Soft foods, easy to chew and in small portions will improve the consumption of food in
the unappetizing people, that is to say that they always feel full and suffer from
problems in their teeth, will avoid stomach heaviness, improves digestion and
absorption of nutrients. We show you a suitable menu for veteran members of the
household.

GERIATRIC DENTISTRY
Diets, vitamins and digestive drugs are prescribed daily to the elderly, but the dental
examination is not routine. Generally, do not keep in mind that the digestion of food
begins in the mouth.
A minimal observation of the teeth of the elderly can modify a whole care behavior.
The dentist is undoubtedly a fundamental pillar in the interdisciplinary gerontological
team of health, although paradoxically, the interconsultations between doctors and
dentists are exceptional.
to. Odontological characteristics of aging
1. Teeth:
Increased fragility due to dehydration.
Decrease in the frequency of caries.
Loss of the relief of the cusps.
Tendency to the exposure of the roots by gingival atrophy.
2. Chewing device:
Loss of teeth.
Frequent malocclusion
Decrease in the strength to crush food.
3. Temporomandibular modifications:
Decreased muscle tone and strength.
Profusion of the lower jaw.
Increase of the temporomandibular angle.

NUTRITION IN OLD AGE

Modifying dietary habits in the elderly is extremely difficult, because they are carried
for years. The change must be gradual, so that non-compliance with dietary
requirements is not a constant.
Each case will be considered in particular taking into account:
The elderly usually comply so strictly with the indications of physicians that
definitively remove certain foods from the diet.
Popular beliefs rooted from generation to generation also influence this point. (Ex .: the
meat produces rheumatism, the salt is bad, the egg does bad to the liver, etc.).
Assess the psychic state of each patient, the degree of dependence and the family
support he receives.
Consider if in the environment in which you live you can buy the indicated foods, the
complexity of the preparation and the economic conditions to acquire them.
The nutritional status of the patient in question may be altered by food restrictions that
impose:
Chronic diseases (organic and psychic).
Anorexia or hyporexia (lack or loss of appetite).
Decrease in the sense of taste.
Decreased tone of the chewing muscles.
Inflamed gums, absence of dental pieces or poorly adapted prosthesis.
Decrease in purchasing power.
In the elderly the basal metabolism is diminished and the physical activity is minimal,
which implies a lower caloric requirement than in the young adult. According to Dr.
Pupi, between 80 and 85 years, no more than 1,600 calories are required on average per
day.
Carbohydrates: They can constitute 60% of the diet of the aged. They are cheap, easy to
digest and absorb.
Examples: sugars, pasta, bread, flour.
Proteins: Represent 15-20% of the total caloric value of the diet. In the elderly, protein
synthesis is decreased and muscle mass decreases, therefore adequate protein intake is
essential.
Examples: meat, milk, eggs, soy.
Lipids: Complement 20 or 25% of the total caloric value remaining. They are difficult
to digest but as necessary as proteins and hydrates. Polyunsaturated fatty acids do not
produce arteriosclerosis and are easier to digest, so they are specifically recommended.
Examples: grape or corn oil.
Other components of the diet
Fibers: They are contained in vegetables and fruits. They act by stimulating the
intestinal movement so necessary in the elderly, by their tendency to constipation.
The Orientals, who are large consumers of fibers, have a very low incidence of arterial
hypertension, coronary disease, irritable bowel, hiatal hernia, diverticulosis, gout,
diabetes, arteriosclerosis, appendicitis and varicose veins.
Vitamins and Minerals: A proper diet provides all the vitamins and minerals needed by
the body, however in old age there is a tendency to bone decalcification and vitamin B
deficiency.
Water: Water is very unattractive for the elderly, generating dehydration from mild to
severe. The caregiver will pay particular attention to the total amount of liquids that the
elder incorporates daily (2 liters in winter and 3 liters in summer approximately) and
resort to imagination (smoothies, teas, fruit juices) to be accepted without too many
objections.
It should be noted that the four daily meals (breakfast, lunch, snack and dinner) must be
respected without overloading any of them. It is common for the elderly who do not eat
because of false precepts suffer from insomnia.
Example of a normal regime
Milk and derivatives: alone or with tea, mate or coffee, yogurt, fresh cheese, petit suisse
or ricotta.
Meat: roasted poultry and beef or pan. Of boiled or roasted fish.
Vegetables: raw, boiled or cooked (baked or au gratin).
Eggs: the clear one.
Pasta: noodles, rice, polenta
Bread: white, whole, fresh or toasted, seafood crackers, grilled.
Soups: rice, semolina or vegetables.
Condiments: salt, parsley, garlic, onion, bay leaf, saffron, lemon, vinegar, basil and
oregano.
Oil and butter: corn and olive oils, vegetable margarine.
Fruits: fresh, juices, smoothies, compotes, jams, jellies.
Infusions: tea, mate or coffee.
Drinks: water, juices.
Diabetic diet therapy:
Limitations on employment:
potatoes
yams
choclos
pasta
bread
yolk
grapes and bananas
butter
Disapproved employment:
sugar
sweets
honey
beer
soda
Diet therapy of constipation
A fruit plate can be added to the normal diet before breakfast, mid-morning and after
dinner.
Whole grain or wheat bran bread will be given at lunch and dinner. The foods with the
highest cellulose content are those that stimulate peristalsis. Eg: raw vegetables, fresh
and dried fruits.
Diet therapy of dyslipidemias
Milk: like its derivatives, it must be skimmed.
Meats: beef without fat, hake, pejerrey and poultry without skin.
Egg: only the clear one.
Oil: olive or corn.
Soups: vegetable.
Sweets: its ingestion will be restricted.
Hyperuricemia diet therapy
The normal diet will restrict the use of red meats, achuras, sausages and alcoholic
beverages.
Each time you prescribe a diet, the doctor has to contemplate the real value of it for the
cure or improvement of diseases.
The elder must know that he is medically controlled and not assaulted or punished; In
geriatrics the term "strict diet" should be used little.

THE TABLE AND THE MEALS

For our seniors, mealtime can be transformed into one of the moments of maximum
pleasure of the day.
Just as it is usual for the elderly to never feel completely satisfied with their bowel
movement, so is the fact that daily meals generate complaints.
Regarding the first point we must consider that when those who today are 85 - 90 years
old, were 20 - 30 or 40 years old, the medicine was very different, the intestinal
movement was considered a priority and the "purges" very common. When we read the
texts of medical clinic or of surgery of those times, it draws our attention that practically
there were no diseases that were not indicated as therapeutic "intestinal cleansing".
From that medicine to the current, much has changed, but the older grew with those
concepts and habits. Anyway, we must reflect on why we go from one extreme to
another. Today, the elderly tend to remain hospitalized or institutionalized and the
professionals who care for them control almost everything, but of the intestinal
movement they do not remember, and as a result of this, the bowel movements are
everyday pathology.
Related to the second point, the satisfaction or not of the food, must be analyzed
considering several aspects. In principle, doctors usually indicate diets that, although
they have a precise prescription and are not questionable in their conception, make some
foods almost "inedible". In addition, the elderly, by the sole effect of the passage of
time, have diminished sense of taste, smell and sight, essential to desire and savor food
When our grandparents got married, they probably did it with delicate sets of
earthenware dishes, special cutlery, embroidered tablecloths, porcelain tea sets, etc., etc.
From that time to the present, much changed. But if we want to get good results with
our meals, all aspects should be considered. Among others:
 At meal times, the caregiver will cleanse himself, fix his hair and place an
appropriate apron or other uniform to serve the table.
 Invite the elder (s) to wash their hands and improve their appearance in general.
 Check that the dining room environment is properly acclimated, deodorized, and
free of insects.
 The tablecloth, the crockery and napkins must be clean. These last ones will be
marked to avoid the change between the diners.
 If feasible, it is always important to add some delicate detail to the table or the
environment in general (seasonal flowers, dried flowers, etc.)
Serve the table
We will detail here only the elements that are used daily to perform this task.
I consider it of interest to clarify that if the elderly under our care are autonomous (they
have the capacity or power of decision for their mental lucidity), it is convenient that the
dishes used, as well as the glasses, be made of materials appropriate to their situation
and cognitive aptitude. The glass is suitable and well accepted, instead plastic jars,
metal cups, high impact plastics plates, etc., are more suitable for use in patients with
significant mental deterioration, thus avoiding frequent breakage of the dishes.
DISORDERS OF DEGLUTION
Dysphagia or swallowing disorder may have a high or low origin.
1 - High or oropharyngeal dysphagia.
2 - Low or esophageal dysphagia.
Unfortunately there are many causes that can cause alterations in swallowing in the
elderly, but the reality is that we see more and more these problems and what is even
worse, its complications: "Aspirative pneumonias." False routes facilitate the passage of
food to the lung, generating these pneumonias that can end the life of the patient.
High dysphagia
Manifestations of high dysphagia:
The signs can be:
Drooling
Dififultad to chew.
Retention of food in the mouth.
Nasal regurgitation.
The old man has a cough, a feeling of suffocation and difficulties in swallowing (he
may become afraid of food).
Most frequent causes
ACV
Parkinson's disease
Senile arteriosclerosis
Dementias
Confusional syndromes
Patient evaluation:
1. The risk of aspiration is evaluated by asking the patient to cough (patient who can not
cough voluntarily or enough to remove secretions from the mouth, runs severe risks of
aspiration)
2. Assess if the swallowing reflex is adequate, observing the rise and fall of the larynx
during swallowing.
3. Take into account: salivary secretions can make the patient choke or have nausea.
Measures to be adopted:
The elder should be seated (on the chair or in the bed) and with the head tilted between
15 and 30 ° forward. This position favors the closing of the trachea and the opening of
the esophagus.
If necessary, pillows will be placed in the area of the head and neck. In addition to the
forward inclination, it may be necessary to ask the patient to tilt the head laterally to the
healthy side (if he has paralysis of the face or half body)
Avoid pasty foods (bread crumbs, bananas, etc.) that adhere to the palate and dairy
products that increase saliva secretions.
Food and drinks
First start with semi-solid foods:
(Always in small quantities)
Gelatins
Yogurts
Flans
If you can swallow move to:
Fruit juice.
Stepped fruits.
Thick soups
Third stage:
Preserved fruits.
Harder foods
Thick liquids
Keep the glasses full of drink so you do not have to take your head back to drink.
The liquids will be separated from the solids. While the old man eats, he will take small
sips of water, but he should not do so while he has solid food in his mouth.
If possible, the elderly can be instructed in this way:
1 Take a bite.
2 - Chew.
3 - Hold your breath.
4 - Swallow.
Experience indicates that both to feed an elderly person who is seated at the table, and
when fed in bed, it is preferable that the caregiver sits on par with a stool or low chair.
The idea is that the spoon came to the old man's mouth always from below (like a
submarine), never like a plane as you once heard saying homologate the game that is
practiced for some children eat.
Enteral Feeding
It is indicated in patients with severe swallowing disorders, in some confusional
conditions, coma, moribund patients, severe anorexics, etc.
The food that is passed to the sick person is based on milks fortified with minerals or of
the maternized type. Foods are also available for the use of this technique. Medications
can be administered. A drip of 56 drops per minute is calculated, which allows
consuming a food container (500cm3) in 3 hours. Afterwards, they rest for 3 hours and
the operation is repeated.
The most economical way to assemble a device for enteral feeding is with the Perfus
tubulators that connect the sache with the probe.
Every time the food passes, the tubulars will be washed to prevent them from clogging.
In this regard, dextrose serum can be passed at 28 drops per minute or simply 100 ml. of
water. This system also helps the patient's hydration. The position of the patient during
the passage of food, the cleaning of tubes and up to 20-30 minutes later, is that of semi-
sitting.

THE CONSTIPATION
The anguish that causes constipation in the elderly is a well-known issue for the people
who assist them.
In many cases it is a reality, in others it is a concern that only exists in your imagination.
A. Etiology:
1. Gastroenterological:
Tumors
Fecalomas
Diverticles
2. Endocrine:
Hypothyroidism
3. Neurological:
Dementias
Confusional syndromes
4. Nutritional:
Deficit of fibers in the diet.
Decrease in liquid intake.
Malnutrition.
5. Dental:
Chewing deficits
6. Medications:
Excesses of laxatives, sedatives, atropine.
7. Other:
Patient in bed.
Lack of exercise.
Lack of privacy.
Disadaptation syndrome (residences).

The evacuation rhythm is variable in each elderly person but a range ranging from three
daily stools to one every three days could be considered normal (as long as the
characteristics of the stool are normal).

B. Elderly caregiver in the face of constipation

In principle we will try to generate a daily defecatory habit explaining to the elderly that
after a meal, or when getting up in the morning, you should sit on the toilet and help
with your abdominal muscles to the bowel movement. At the same time, the diet will be
controlled, which will contain fibers (vegetables, fruits, bran) and the ingestion of
liquids. Exercise (walks) helps the evacuation movement and health in general.

The privacy of the patient will always be respected or their confidence will be generated
so that the caregiver can assist him if necessary, in the act of defecation.

The fecal bolus or fecaloma should be suspected in front of:

1. Prolonged period without defecation.

2. Abdominal distention.
3. Palpable mass in the lower abdomen.

4. Abdominal cramps.

5. Persistent diarrhea.

C. Overview of laxatives:

They can be classified in:

Lubricants: Lubricate the stool and soften it. Eg liquid petrolatum, glycerin
suppositories.

Salines: They produce an increase of the volume of the fecal matter by osmotic effect.
Ex .: Magnesia salts.

Irritants: They stimulate the intestinal muscle directly, producing peristaltic evacuation
movements. Ex .: Aloe, senna, sacred shell.

Emollients: Soften stool by incorporating water. Ex: sodium dioctyl sulfosuccinate.

Mass formers: Increase the volume of stool. Ex .: Psillium.

Laxatives are a valuable "help" for the chronic constipated patient but will be avoided as
a definitive treatment. The choice of laxatives is the responsibility of the doctor as well
as the amount of time that can be administered.

D. Enemas:

The enemas will be prescribed by the doctor who, on the other hand, will indicate the
particular characteristics of its volume and composition.

Enemas should never be administered in patients with undiagnosed abdominal pain.

The volume of enemas performed is preferable to be small (500 cm3) in elderly

patients, although they have to be repeated in two or three occasions.

They can be used:

Microenemas (sold in pharmacies).

Rubber pears
Irrigators

Examples of enemas:

With warm water.

With warm water and salt.

With oil.
With warm water, salt and oil.