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Dietary recommendations- What 3 adaptations did groups like University of Florida and Tufts developed for older adults?
-addition of fluids/water
-addition of vitamin-mineral supplements
-advice on physical activity
Nutrient recommendations: when do nutrient recommendation change?
As scientists learn more about effects of foods on human functions
Nutrient recommendations: Which formula predicts energy needs in healthy adults up to 80 yrs old?
Mifflin- St. Jeor formula
AMDR: total fat percent of calories
20-35 percent of calories
AMDR: percent of CHO from calories
AMDR: percent of protein from calories
Protein needs: how much g/kg body weight do several researcher report that older adults should take in?
- 1 to 1.3 g/kg body weight
- *might be due to more protein is trapped in liver and its inefficient process of protein synthesis
Protein needs: what are inactive, older adults living alone be susceptible to?
Having low protein intakes
Protein needs: when is nitrogen balance easier to achieve (3)
-protein is high quality
-adequate calories are consumed
-individuals participate in resistance training
Protein needs: how many grams per meal should be spread through out the day to maximize muscle protein synthesis?
~20 grams per meal
What's take home message on slide 9?
When older adults consumed slightly higher than RDA .8 grams, they lost less LBM or gain more LBM
recommendation for fluid: what happens to the total amount of water as one ages?
- Total amount of water in body decreases with age
- *more prone to dehydration
How many glasses of fluid per day will prevent dehydration in most adults?
More or equal to 6 glasses
recommendation for fluid: what rule of thumb should one follow when trying to individualize fluid recommendations?
1 mL of fluid/kcal
*minimum of 1500 mL
Which 6 nutrients do old people have trouble with?
Nutrients of concern) what happens to plasma levels & liver stores with age? And what is this linked to?
They both increase which may be linked to decrease clearance from the blood
Nutrients of concern) vit. A: Older adults are more vulnerable to...
Toxicity & possible liver damage than deficiency
Nutrients of concern) what is the UL for vitamin A?
Nutrients of concern) vita. A: will beta-carotene damage the liver?
Nutrients of concern) vita D.: 3 factors that put older adults at risk for deficiency
-limited exposure to sunlight
-institutionalization or homebound
Nutrients of concern) which 2 medications affect vita D?
What do vita. e and vita. k do?
They interact with each other
Nutrients of concern) what does vita e. provide?
Nutrients of concern) what does vita. k do? (2)
Nutrients of concern) need adequate intake of magnesium for... (3)
Nutrients of concern) which 2 drugs may lead to overdose in magnesium?
Nutrients of concern) what does adequate intakes of potassium offset?
Excessive NA intakes
Nutrients of concern) what is potassium?
electrolyte that controls water balance with sodium
Nutrients of concern) b12: despite adequate intake, what do 30% of older adults have?
Decrease b12 levels
Nutrients of concern) b12: what is decreased levels of b12 linked to?
Decrease levels of HCL & Pepsin resulting in inability to split B12 from protein carriers
Nutrients of concern) b12: which 2 types of b12 are better absorbed and why?
Synthetic or purified b12 because it is not protein bound
Age associated changes in metabolism) Folate/Folic acid AND Absorption
Can be impaired
Age associated changes in metabolism) which 3 medications affect folate metabolism ?
Age associated changes in metabolism) what can folate in excess result in?
- Masks b12 deficiency
- *more common in elderly
Age associated changes in metabolism) what is calcium needed for?
Age associated changes in metabolism) which 3 nutrients does calcium interfere with?
Age associated changes in metabolism) why was the UL for calcium lowered?
bc of toxic effects
When considering supplements, it may be useful with those who...(5)
-lack appetite resulting from illness, loss of taste/smell, or depression
-diseases in GI tract
-poor diet due to food insecurity, loss of function, or disinterest
-avoids specific food groups
-takes medication or other substances that affect absorption or metabolism
What should one ensure when taking supplements? (4)(
-labels like US pharmacopoeia or NSF code
-safety of product
2 exercise guidelines who should follow
-strength training activities
What is fitness after 50 screening tool?
Screening tool to identify potential contraindications or problem areas
What is a risk factor?
Characteristic that increases likelihood of becoming malnourished
What are some nutritional risk factors? (9)
-hunger, poverty, low food & nutrient intake
-social isolation or living alone
-urban & rural demographic areas
-depression, dementia, dependency
-poor dentition & oral health
-diet related acute or chronic diseases
-minority, advanced age
What is an indicator?
- Observable and recordable
- *specific sign or symptom
Major indicator of poor nutritional status in older Americans (9)
-weight loss over time
-low of high ideal BW
-reduction in serum proteins
-change in functional status
-inappropriate food intake
-reduction in mid arm muscle circumference
-increase or decrease in triceps skin fold
What does screening do? (2)
- identify individuals at high nutritional risk
-determine whether extensive nutrition assessment should be performed
What does assessment do> (3)
-identifies risk factors for malnutrition in individuals which can be treated with MNT
-determine the nutritional status of individuals and identifies at risk and malnourished patients
-establishes nutritional diagnosis
4 special concerns for screening and assessment in the older adults
-poor short term memory
-multiple health conditions
What 3 groups created nutrition screening initiative ?
-American academy of family physicians
-academy of nutrition and dietetics
-national council on aging
What does the nutrition screening initiative do?
Integrates a list of warning signs of poor nutritional health in older adults
What does the nutrition screening initiative promote?
Public awareness of nutrition concerns of older adults
When should nutrition screening intiatitive be used?
In community settings
Mini- nutritional assessment (MNA): how many items does it use?
6 screening items
Mini- nutritional assessment (MNA): what 3 things does it include?
*more extensive than the NSI
4 methods of assessment
-biochemical and lab tests
What does anthopometric data measure? (4)
-height, weight, BMI
Biochemical and lab tests (6)
Biochemical and lab tests: protein status (3)
Biochemical and lab tests: hematological status (4)
Biochemical and lab tests: liver (3)
Biochemical and lab tests: renal (2)
Biochemical and lab tests: diabetes (3)
Biochemical and lab tests: lipids (4)
clinical signs, symptoms, observations: (6)
-current medical diagnosis
-medical and surgery history
Dietary evaluation: 2 ways to measure actual intakes
- -diet history
- *24 hr recall, food freq food records
Dietary evaluation: 3 ways to determine adequacy and needs
7 considerations for educational materials for older adults
-larger type size
-avoid blue, green, & violet color
-reading level of 5th to 8th grade
3 nutritional programs serving older adults
- -USDAs supplemental nutrition assistance program
-seniors farmers market nutrition programs
- -the older American act programs
- *administered by US department of health and human services
2 examples of older American act programs
-meals on wheels home delivered meal programs
-nutrition services for tribal & native older American groups
Senior nutrition program: why was it created? (2)
-To alleviate poor nutritional intake
-reduce social isolation among older adults
Senior nutrition program: why do older adults do not eat adequately? (4)
-lack of income
-lack of skills
-feelings of isolation & loneliness
Senior nutrition program: comparing to non participants, participants had
31% higher intake of recommended nutrients