Nutrition

and the
Elderly

dr Putra Hendra SpPD

UNIBA
Weight and Mortality

Potter, et al, 1988

Corrada, et al, 2006
 Usual Weight Trends
Epidemiology

• Gradual Weight Gain – Middle Age

• Peak Weight at 75 years
• Gradual Weight Loss
after age 75
 4 of the 5 most common
causes of death are linked to
obesity
1. Cardiac disease
2. Tumours
3. Cerebrovascular diseases
4. Chronic pulmonary disease
5. Diabetes mellitus

from: National Center for Health Statistics (www.cdc.gov)

4
 Definisi malnutrisi
• Keadaan nutrisi dimana teriadi
kekurangan ataupun kelebihan energi,
protein dan nutrient yang lain, yang dapat
menyebabkan kelainan bentuk, fungsi
tubuh serta kelainan klinis
 Nutritional risks of ageing

1. MALNUTRITION

2. LACK OF SINGLE NUTRITIONAL FACTOR

3. OBESITY

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Geriatric Problems and nutrition
• Weight Loss
• Sarcopenia
• Dehydration
• Swallowing
• Dementia
• Pressure Ulcers
• Constipation
• Depression
Factors affecting dietary intake with aging
• Perubahan rasa dan bau
• Gangguan mulut (poor teeth, chewing difficulties)
• physical activity dan mobility ↓
• Penyakit khronis
• Masalah psychosocial (depression, isolation, dementia)
• Masalah keuangan Not eating enough due
to chewing and teeth
problems
Diet restrictions due to
my high blood pressure, It is difficult to walk, thus
heart disease and hard to shop for food
diabetes make eating
less interesting
I often feel sad and
lose my appetite 9
Formulir MNA

http://www.mna-elderly.com/mna_forms.html

Kaiser MJ et al. J Nutr Health Aging 2009; 13:

782-788.
Recommendations for intervention
Change in body composition by decade

Linear mixed model (LMM) quadratic regression lines for longitudinal change from age 20y.

Body mass % Fat

Fat mass 13.2 %

BMI
Fat-free mass
22.8 kg/m2

Jackson et al. Br J Nutr 2012; 107:1085–1091.

 Malnutrition: a vicious cycle

Reduced mobility Malnutrition

Reduced capacity Apathy, depression,

to feed oneself reduced attention

Loss of muscle
Reduced appetite
mass

14
 Sensory Changes with Aging

• Decreased sense of smell due to

decreased olfactory cells
• Decreased vision
• Hearing loss
• Tactile loss
 Sensory Changes with Aging
• Decreased number of taste buds
– i Loss of sweet
and salty
– Less loss of bitter
and sour
– Dry mouth prevents
adequate tasting
 Identifying Weight Change
• Weight History
• Change in Clothing Fit
• Decrease in Functional Ability
• Dietary Intake Records

These methods are readily

accessible and cost effective
 Strategies: Calories
• Avoid unnecessary dietary
restrictions

• Encourage use of
nutrient dense foods

• Use more frequent meals plus

supplements or snacks
 Obesity Treatment
• Goal: To better manage health and
maintain independence longer
• Minimize loss of muscle mass
– Adequate protein
– Exercise (aerobic and resistance)
• Minimize loss of bone density
– Adequate calcium, Vitamin D
– Exercise (weight bearing)
• Adequate nutrient intake
 Sarcopenia
• Definition: Loss of muscle mass in aging.
• Results: Lower basal metabolic rate
– Weakness -Decreased Functional Status
– Reduced Activity Level
– Decreased Bone Density
• Practical Application
– Progressive Resistance Exercises
– Adequate Protein
 Protein

•1.0-1.25 gm/kg/day
•At least one high protein food
at each of three meals
•Physical activity to maintain
muscle mass
-Exercise against resistance
 Protein Recommendations Protein RDI
Food and Nutrition Board, Institute of Medicine,
National Academies

Protein
Age (g/day)
• Recommendation based on requirement Males
– “Adequacy of requirements is defined as the 9–13 years 34
lowest daily intake value for a nutrient that will 14–18 years 52
meet the need…of apparently healthy 19–30 years 56
individuals.” 31–50 years 56
51–70years 56
• Current protein recommendation: > 70 years 56

– 0.8 grams protein / kg BW for all ages Females

9–13 years 34
14–18 years 46
• Requirement determined using short-term nitrogen
19–30 years 46
balance studies in young adults
31–50 years 46
51–70years 46
24 > 70 years 46
 Dehydration: Causes
• Decreased thirst sensation with aging
• More dependent on others to obtain fluid
• Decreased ability to concentrate urine
• Increased incidence of incontinence with
self-imposed fluid restriction
• Increased use of medications contributing
to dehydration
• Increased losses: vomiting, diarrhea, fever
 Dehydration: Symptoms
• Decreased Skin Turgor
• Dry Mouth and Mucosal Membranes
• Decreased Urine Volume
• Darker Urine
• Constipation
• Acute Weight Loss
• CONFUSION
 Fiber Supplementation
•Alleviation of
constipation
•Crude fiber content
increased by 6-8 gm
•60% residents
•JAGS, 1980, 28:410

•Increased stool
frequency
•Fiber increased 3-12 gm
•Decreased laxative use
•JADA, 2003,103:1199
Vitamin/Mineral Supplements
• A daily multivitamin mineral
supplement is recommended
• Geriatric Vitamins
+ Vitamin C,D,E
+ Vitamin B6
+ Vitamin B12
- Iron
 Consequences of Vitamin D
deficiency
- Osteomalacia (rachitis) /osteoporosis
- Fractures
- Myopathia
- Physial disability

30
 Lack of vitamin B12
Causes
- Poor intestinal absorption
- Decreased binding with intrinsic factor eg:
- Gastric resection
- Atrophic gastritis
- Metabolic disorders
- Low consumption
Consequences
- Pernicious anemia
- Memory loss
- Reduced motor coordination
- Myopathia

31
 140
Control
138
Low salt
Change in BP
136
(Pre to Post)
Systolic BP

134
(mmHg)

132
130
Systolic BP
128 Between-diet difference =
126 -6.19 (SEM 2.63) mmHg (ns)
124 95 % CI: -11.4 to -0.94 mmHg
122
84
Diastolic BP

82
Diastolic BP
(mmHg)

80 Between-diet difference =
78 -0.59 (1.22) mmHg (ns)
76 95 % CI: -3.02 to 1.83 mmHg
0 2 4 6 8 10
Intervention (week)
Charlton KE et al. Public Health
Pre = Ave (3 x Run-in visits + Day 1); Nutrition. 2008 11:1397-406.
Post = Ave (Week 4 + Week 8 visits)
 Antioxidant food wheel
OLIVE OIL
NUTS AND
A good diet should contain DRIED
FRUIT
PULSEs
antioxidants: vitamin C, vitamin E,
polyphenols.
FRUIT

Vitamin C and E make your

immune system more efficient
COCOA
(de la Fuente et al. 1998).

“We age because we oxidise (rust)”

and anti-oxidants can mitigate the
signs of ageing
(Miquel et al. 2002). BREAD CEREALS
AND POTATOES

VEGETABLES

S.E.N.E. C.A.
33 2007
Appetite Stimulation: Research
• Megestrol Acetate (MA)
• N= 51 men; Average Age 76
• Weight loss > 5% in 3 months or > 20%
below “ideal” weight
• 800 mg MA/day
• 12 weeks on MA; 13 weeks off MA
• Weighed monthly
• Control – no MA
 Variety and balance: the key to a good diet

At every meal:
protein, carbohydrates, fats,
vitamins, liquids and fibre in
adequate proportions.

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