Nutritional Management

of
Geriatric patients

Guided by, Presented by,

1
Dr.B.Sreeramulu Dr.Sowmiya N.M.
Professor & HOD First year PG
2 Introduction

 Mobile teeth ,ill-fitting prosthesis decreased chewing ability - food

choices.

 Health of the denture bearing tissues

Complete denture prosthesis

 Nutritionally deficient denture bearing – Uncomfortable prosthesis.

3
Definitions

As stated by GPT :

 Geriatrics:
The branch of medicine that treats all problems peculiar to
the aging patients, including the clinical problems of senescence and
senility.

 Dental geriatrics:
The branch of dental care involving problems
peculiar to advanced age and aging or Dentistry for the aged patient.
4
Definitions

As stated by GPT :

 Gerodontics:
The treatment of dental problem in aged or
aging persons, also spelled Geriodontics.

 Gerodontology:
The study of the dentition and dental
problems in aged or aging persons.
5 Importance of proper

Medical nutrition…
conditions

Occurrence/
Aging process Nutritional Severity of
problems degenerative
diseases

Medications
6 Objectives of nutrition

 General balanced diet tailored to the patient

 Dietary supportive treatment for specific goals

 To interpret factors which may relate to or

complicate nutritional therapy
7

Aging factors that

affect nutritional
status
8
1)Psychosocial factors:

 Increase nutritional risk - those living alone

 the physically handicapped with insufficient care.

 Elders with chronic disease and/or restrictive diets

 reduced economic status.

9
2)Physiological factors:

 Caloric needs decrease and risk of falling increases.

 Vitamin D deficiency
 Mal-absorption of food-bound vitamin B12.
 Decreased or modified immune responses.
 Dehydration
 Deficiency of vitamins is associated with neurological &
behavioral impairment
10
3)Pharmacological factors:

Prescription drugs are the primary cause of

 Anorexia
 Nausea
 Vomiting
 Gastrointestinal disturbances
 Xerostomia
 Interference with nutrient absorption and utilization.
11
4)Functional factors:

Functional disabilities such as

 Arthritis
 Stroke
 Vision or hearing impairment

can affect nutritional status indirectly.

12

5)Economic Factors:

 Determining the variety and nutritional adequacy of the

diet.

 Vitamin C is shown to be influenced by income.

 Other factors such as transportation, housing and facilities

for food preparation
13 6)Oral Factors:

a)Xerostomia
Causes:
Anticholinergic medications, radiation therapy, Sjogren
Syndrome, diabetes, Alzheimer's disease, dehydration, head
and neck irradiation and chemotherapy
Effects:
 Adversely affect food selection and contribute to poor
nutritional status.
 Deleterious influence on denture bearing tissues.
  Halitosis, stomatodynia and intolerance to acidic and spicy
food
14 Management:

 A low-sugar diet ,topical fluorides and antimicrobial mouthrinses.

 Dysphagia is treated with oral moisturizers and lubricants, artificial

salivas and nighttime use of bedside humidifiers.

 Sugar-free chewing gum, candies and mints can stimulate salivary

output. 

 Two secretagogues, pilocarpine and cevimeline are used for the

treatment of xerostomia
15
b)Sense of taste and smell
 Changes in taste and smell - alter food choice and decrease diet
quality.
 Sense of smell decreases much more rapidly then the sense of
taste.
 Sensory changes may diminish the appeal of some foods limiting
their consumption.
16
Management:

 Make food Appealing

 Use herbs, dressings and sauces to intensify flavors

 Switch between a variety of foods during one meal

 Try combining textures to make foods seem more appetizing.

17
c)Dentate status

 Impaired masticatory function - inadequate food choice - alters

nutrition intake.

 The presence of natural teeth and well fitting dentures - varied

nutrition intakes and greater dietary quality.
18
Management:

 Attend regular dentist appointments

 Make sure dentures fit properly

 Seek medical care for cavities and jaw pain

 Eat finely sliced canned fruit and vegetables

19 d)Oral infectious conditions
 Caries, periodontitis, benign mucosal lesions, and oral cancer.
 Oral candidiasis - acute pseudomembranous candidiasis,
erythematous lesions or angular cheilitis. 
 Periodontal disease

Management:
Regular dental checkups
and appropriate medications
and oral hygiene
20 e)Effects of dentures on taste and
swallowing
 The hard palate contains taste buds, so taste sensitivity may be
reduced.

 Swallowing can be poorly coordinated.

21 f)Effects of dentures on chewing
ability
 Tend to use more strokes and chew longer.

 Masticatory efficiency in complete denture wearers is

approximately 80% lower.
22 g)Effect of dentures on food
choices and general health
 Choosing processed or cooked foods rather than fresh food

 Replacing ill-fitting dentures with new ones

 Exchanging optimal complete dentures for implant-supported dentures

23

Nutrient
needs
24
How does elderly needs differ from
adults ?
 Calorie needs change

 Meet the same nutrient needs as when they were younger

 Need to choose foods high in nutrients

 Pick whole unprocessed foods

 Healthy fats, whole grains, fresh fruits, vegetables, protein-rich

beans, legumes, meat, and dairy products
25

Energy
 Energy requirement reduces

 BMR decreases (15-20 percent)

 Reduced physical activity

 Increase in fatty tissue Sedentary Moderate

Male 1883 kcal 2216 kcal
Female 1706 kcal 2007 kcal
26

Carbohydrates

 Requirement reduces.

 Impaired glucose tolerance

 Insulin sensitivity can be enhanced by balance energy intake,

weight management and regular physical activity.
(50 percent energy should be derived from carbohydrates)
27

Protein

 Decresed skeletal tissue mass.

 Decrease in store of protein
 Intake of 1.0gm/kg is safe during old age.
 Protein rich food should be included.
 May lead to edema, anemia, and low resistance to infections.
(10%–35% of daily energy intake come from protein)
28

Lipid

 Dementia and CVD - high intake of dietary total fat.

 Reducing the intake of saturated fat

 Choosing mono saturated or poly saturated fat sources.

 Sufficient intake of ω-3 fatty acids

29

Minerals

 Calcium: 800mg/day To compensate age related bone loss, to

improve calcium balance and to decrease prevalence of fracture.
 Iron: 30mg/day Deficiency is seen in elderly due to inadequate
iron intake, blood loss due to chronic disease or reduced non-heam
iron absorption.
 Zinc: Some features like delayed wound healing, decreased taste
sensitivity and anorexia are associated with zinc deficiency.
30

Vitamins

 Elderly are at risk of Vitamin D deficiency

 Stress, smoking, and medication can increase vitamin c

requirement.

 Vitamin E causes decline in cellular immunity.

31

Vitamins

 Requirement of vitamin B6 is increased

 Severe deficiency of folic acid may result anemia and elevated

serum homo-cystiene level

 Causes for vitamin B12 deficiency are atrophic and bacterial

overgrowth, which decreases absorption.
32
Deficiency manifestations of vitamins
and minerals
 Vitamin B12- Anemia, fatigue, nervous system damage, or sore tongue

 Calcium- bone mineral loss and urinary stones

 Vitamin E- Red Blood cell breakage and anemia, weakness,

neurological problems, or muscle cramps

 Folate- Anemia, weakness, fatigue, irritability, shortness of breath, or

swollen tongue

 Zinc- Loss of appetite, impaired taste acuity, skin rash, impaired

immune function, or poor wound healing
33 THE FIVE FOOD GROUPS

All the nutrients necessary for optimal health in the desirable amounts
can be obtained by eating a variety of foods in adequate amounts
from the five food groups. 
34 Vegetable Fruit Group
Four servings of vegetables and fruits, subdivided into three categories

 Two servings of good sources of vitamin C

 One serving of a good source of provitamin A
 One serving of potatoes and other vegetables and fruits
35 Bread – Cereal Group

Four servings of enriched bread, cereals, and flour

products
36 Milk - Cheese group

Two servings of milk and milk based foods, such as cheese

37 Meat, Poultry, Fish and Beans
Group
Two servings of meats, fish poultry, eggs, dried beans and peas,
and nuts
38 Fats and Sugar Group

Fats, oils, sugar - serving recommendation is for about 2 to 4

tablespoons of polyunsaturated fats.
39
40 Modified food pyramid
41

Aging
&
Gastrointestinal
system
42
43
44

Assessing nutritional
status

(Tri-phasic analysis )
45
Phase 1

 Screen all patients and obtaining medical,social history, screening

for clinical signs of deficiency and assessing the adequacy of
dietary intake.

 A questionnaire has been developed to identify older individuals

with nutritional problems (Vogt et al, 1995)

 If potential nutritional problems are detected, the nutritional

evaluation should progress to Phase II.
46 Questionnaire
47
Phase 2
A semiquantitative dietary analysis and routine blood chemistry
should be undertaken.

PHASE 2

Semi-quantitative Biochemical
dietary analysis assessment
48
Phase 3

The analysis in this phase includes :

 comprehensive nutritional biochemical assays of blood,

urine and tissues
 tests of metabolic and endocrine function
49

Prosthodontics
&
Nutrition
50 Why is nutrition of geriatric
patients important in
Prosthodontics ?

Nutrition Prosthodontics Nutrition

* Healthy oral tissues * Maintain/

enhance the possibility restore
of successful masticatory
prosthodontic function
treatment
51 Risk Factors For Malnutrition in patients
wearing
Complete denture prosthesis

 Unplanned weight gain or loss of >10 lb in the last 6

months
 Undergoing chemotherapy or radiation therapy
 Poor dentition or ill-fitting prosthesis
 Oral lesions – glossitis, cheliosis, or burning tongue
 Severely resorbed mandible
 Alcohol or drug abuse
 Eating less than 2 meals/day 
52
Providing nutrition care for the
denture patient entails the following
steps…

  Obtaining a nutrition history

 Evaluating the diet

 Teaching about the components of a diet

 Guidance in the establishment of goals

 Follow-up
53 Diet recommended for a new
denture wearer

Order of learning of a new denture wearer:

Swallowing Chewing Biting

54 First post-insertion day
 Vegetable-Fruit group: Juices
 Bread-Cereal group: Gruels cooked in either milk
or water.
 Milk group: Fluid milk may be taken in any form.
 Meat group: Pureed meats, meat broths, or soups.

The sample menu should contain a glass of milk at

least once a day.
55 Second & Third post-insertion
day
 Vegetable-Fruit group: Juices; Tender cooked fruits and
vegetables, (seedless and skinless)
 Bread-cereal group: Cooked cereals, softened breads boiled,
rice, noodles and macaroni.
 Milk group: Fluid milk and cottage cheese.
 Meat group: Chopped beef, ground liver, tender chicken/fish
in a cream sauce, scrambled eggs, thick soups, etc.

The sample menu must include butter or margarine, a glass of

milk at least once a day.
56 Fourth day and after

By the fourth day, or as soon as the sore spots have

healed, firmer foods can be eaten in addition to
the soft foods. These should ideally be cut into
small pieces before eating.

The sample menu must contain butter or margarine

and a glass of milk.
57 Dietary guidance

 Dietary analysis and counseling.

 Detailed diagnostic procedures and treatment, when

severe deficiency disease is present.

 Dental advice to be given when there is obvious poor

dietary habits
58 Conclusion

Many denture failures are the result of

nutritional deficiencies.

Good health and nutrition of older

patients are necessary for the
successful wearing of dentures.
59 References
 Ramsey WO. The role of nutrition in conditioning edentulous
patients. J Prosthet Dent 1970;23:130-5.
 Kreher JM, Graser GN, Handelman SL. The relationship of drug
use to denture function and salivary flow rate in geriatric
population. J Prosthet Dent 1987;57:631­7.
 Brodeur JM, Laaurin D. Nutrition intake and gastrointestinal
disorders related to masticatory performance in the edentulous
elderly. J Prosthet Dent 1993;70:468-73.
 N’Gom PI, Woda A. Influence of impaired mastication on
nutrition. J Prosthet Dent 2002;87:667-73.
 Marshall, Warren, Hand, Stumbo. Oral health, nutrition intake
and dietary quality in the very old. JADA 2002;133:1369-79.
60 References
 Krall E Hayes, Gilbert GH, Duncan P. How dentition status and
masticatory function affect nutrition intake. J Am Dent Assoc
1998;129:1261-9.
 Greska L, Parraga IM, Clark CA. The dietary adequacy of
edentulous older adults. J Prosthet Dent 1995;73:142-5
 Palmer CA. Gerodontic nutrition and dietary counseling for
prosthodontic patients. Dent Clin N Am 2003;47:355-71.
 Fisher WT. Prosthetics and geriatric nutrition. J Prosthet Dent
1955;5:481-5.
 Adams CD. Gerodontologic aspects of diet and nutrition. J
Prosthet Dent 1961;11:345-50.
 Detroit, Mich. Nutrition for the denture patient. J Prosthet Dent
1960;10:53-60.
61