Aging is a process that begins with conception and ends at death.  Aging is a continuous process of change throughout the lifespan.

NUTRITION RELATED SYSTEM CHANGES IN THE ELDERLY

1.   Sensory :  With age, the senses of taste, smell, sight, hearing and touch diminish at individualised rates.  Sensitivity to sweet and salty taste declines with age.

2.   Gastrointestinal :  A number of changes that affect appetite and the ability to digest and absorb foods occur in the gastrointestinal system.  Although dental caries are uncommon in the elderly, periodontal diseases or illfitting dentures frequently make eating a painful and embarassing experience and lead to substitution of soft, low-fiber foods for whole grains, fruits, and vegetables.  Diminished salivary secretion decreases the ability to masticate and swallow food.  The incidence of gallbladder disease increases with age, because of decreased motility in the large intestinal and colon, constipation is a common problem.

3.   Metabolic :  A decrease in glucose tolerance associated with the aging process leads to an increase in plasma glucose of 1.5 mg/dl. per decade.  Basal metabolic rate decreases by 20% between the ages of 30 and 90, mainly because of the decrease in lean body mass.

4.   Cardiovascular : Cardiovascular disease is responsible for 70% of all deaths beyond 75 years of age, although the decline in the last 2 decade also includes the elderly.  Blood Pressure continues to increase in women beyond the age of 80 but declines substantially in older men.

5.   Renal :  kidney function can diminish 50% between the ages of 30 and 80 years, and kidney deficiency affects 75% of the population in late adulthood.  Acid-base response to metabolic changes is slowed, and excessive amounts of protein waste products or electrolytes are handled with more diffuculty.

6.   Musculoskeletal :  Progress replacement of lean body mass by fat and connective tissue appears to be an inevitable consequences of aging.  Body protein in the healthy elderly is 30% to 40% less than that of young adults.  This loss includes both muscular and visceral protein, leading to both functional and metabolic changes.

7.   Neurologic :  Confusional states found in some of the elderly have numerous causes of great interest in this area is the experimental use of substances that serve as precursors of brain neurotransmitters involved in abnormalities such as Parkinson’s disease and Alzheimer’s disease.

8.   Immuno Competence :  Immune function declines with age, and both the humoral immunity and to a great degree cell-mediated immunity are affected.  These changes result in diminished ability to fight infections, leading to a prevalence of a variety of infections in the elderly.

9.   Psychosocial :  Some of the elderly fail to obtain an adequate diet because of social isolation.  Depression often accompanies a sense of loss of loved ones, a sense of worth, mobility, income and finally, body image.  If decreased sight & physical function become factors, elderly persons may be trapped by immobility.  In these circumstances, shopping for food and preparing meals may become very difficult.  Elderly persons may become homebound as a result of fear of being victimized.  Retirement income is often inadequate, and elderely individuals may be forced intoa lower socio-economic status.

 

 

 

 

NUTRITIONAL REQUIREMENTS OF THE ELDERLY

1.   Energy :  Energy requirements decrease with age.  In addition to a normal decline in metabolism, a sackening of physical activity lowers energy needs still further.  RDA call for a reduction of average energy allowances after 51 years of age of 600 Kcal / day for men and 300 Kcal for women.

2.   Protein :  Body protein in the healthy elderly is 60 to 70% of that of young adults, which might suggest a decrease need for dietary protein.  Protein intake is related to energy intake, and although the latter tends to decrease with age, protein intake remains considerably higher than the RDA.  Protein needs increase in relation to the severity and duration of disease.  Stressful physical and psychologic stimuli can induce a negative nitrogen balance.

3.   Carbohydrate :  A reduced glucose tolerance renders the elderly more susceptible to temporary hypoglycemia or hyperglycemia.  Insulin sensitivity may be improved by reducing the use of sugar and by increasing the amount of complex carbohydrate and soluble fiber in the diet.

4.   Lipid :  The recommended reduction of dietary fat is to no more than 30% of total Kilocalories also supports principles of weight control and cancer prevention.

5.   Minerals :  The allowances for calcium is the same as for younger adults, while the iron allowance for post menopasual women is the same as that for men i.e. 10mg.  Anemia is of rather common occurrence in women, as is also osteoporosis, and a diet liberal in these mineral element is desirable.

6.   Vitamins :  The allowances for Vitamin A and the ascorbic acid are the same as those for younger adults.  The B-complex vitamins are needed in the same proportion of calorie intake as for younger person.  However, the reduction in the calorie requirement means that the total daily needs for thiamine, riboflavin, and niacin are likewise lower.

7.   Water and Fiber :  About 6 to 8 glasses fluid is as essential for the older person as it is for the younger individual.  The kidneys can function more adequately when there is sufficient fluid with which to eliminate the waste solids.  Water stimulates peristalsis and thus aids in combating constipation.  When nocturia is a problem, the individual should be encouraged to take as much water as possible early in the day.

Many older persons select diets that are smooth in character.  This choice, together with an inadequate fluid intake, can lead to persistent constipation and often to the use of harmful laxatives and mineral oil.  Although rough fiber of tender vegetable, fruits and whole - grain cereals will encourage normal peristalsis.

POSSIBLE CAUSES OF UNDER NUTRITION IN THE ELDERLY

1.   Loss of teeth - Denture

2.   Lack of attention from the other members of the family

3.   If nuclear family, than lonely existence

4.   Not very congenial economic conditions.

5.   Chronic ailments which affect  the appetite, digestion, absorption, resulting in poor nutrition.

6.   Ignorance about good nutrition or food preparation

7.   Alcoholism

8.   Decreased physical ability to buy food or prepare a meal

FOR ENJOYMENT OF MEALS, EASE OF DIGESTION, AND GOOD REST

Give heed to following :-

•    Serve colourful foods attractively on a tray if eating alone.

•    Foods to be eaten leisurly in pleasant surrounding. 

•    Eat four or five light meals instead of three heavy meals

•    Include essential foods first.  Sweets may be taken in moderate amounts as excess may cause discomfort and lead to overweight.

•    Good breakfast should be eaten to start the day right.

•    Fatty meals are hard to digest at thie age, like rich bakery items, fried food, salad dressings, Sauces, Puddings Fatty meals should be avoided

•    Heavy meals should be eaten at Lunch time instead of night to sleep well.

•    Incase insomnia is a problem, use of stimulants like tea, coffee should be avoided later in the day.

•    Drinking hot milk at bed time relaxes lot of people

•    If use of vegetables such as cabbage, cauliflower, cucumber, turnips doesn’t cause any distress.  It can be used any p