What Are Physiologic Changes In The Aging Adult That Can Affect Nutritional Status?
Healthcare (Basel). 2015 Sep; 3(3): 648–658.
Crumbling, Nutritional Condition and Health
Samir Samman, Academic Editor and Ian Darnton-Hill, Bookish Editor
Received 2015 Mar 30; Accepted 2015 Jul 23.
Abstract
The older population is increasing worldwide and in many countries older people will outnumber younger people in the nigh hereafter. This projected growth in the older population has the potential to place meaning burdens on healthcare and support services. Meeting the nutrition and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and swallow well those in poorer health may experience difficulties in coming together their nutritional needs. Malnutrition, encompassing both under and over nutrition increases wellness risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, at present justifies weight direction interventions in obese older adults. This growing population group is becoming increasingly various in their nutritional requirements. Micro-food status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can bear on on well-being and quality of life. Crumbling presents a number of challenges for the maintenance of expert nutritional health in older adults.
Keywords: under nutrition, older adults, obesity, nutritional screening and intervention
1. Introduction
Improvements in public health and medical care are well acknowledged factors in the large improvements in infant and childhood mortality observed in the first half of the 20th century. Increased longevity in adults is as well now increasingly mutual in the developed globe. These demographic changes have resulted in increasing numbers and hence proportions of the adult population aged over the age of 60. The time when older people will outnumber younger people is rapidly approaching, information technology is estimated that past the twelvemonth 2025 the number of people worldwide anile 60 and over will exceed ane.2 billion [1]. This projected growth in the older population will create significant boosted demands on healthcare and support services [2].
Nutrition and lifestyle, coupled with maintenance of a healthy torso weight are of import in the maintenance of health for all age groups but are crucial for healthy aging. Maintaining a good nutritional status has significant implications for wellness and wellbeing, delaying and reducing the gamble of developing affliction, maintaining functional independence and thus promoting continued independent living [3].
2. Nutritional Needs and Changes with Advancing Years
Aging is accompanied by many changes that tin brand it more difficult for nutritional needs to be met. These changes have been categorised into broad categories of physical/physiological and psychosocial (Figure i) [iv].
Factors which challenge nutritional status in older adults. Adjusted from [4].
iii. Social Factors
For some, good diet may become less important with historic period. Factors such as bereavement, social isolation tin can influence dietary practices. Cooking a proper meal for one takes time and may feel burdensome and every bit a upshot meals may become express to snacks. Illness and disability may likewise bear on the ability to shop for, and prepare food [5].
4. Chronic Affliction
Aging is accompanied past an increased likelihood of suffering from ane, or more, chronic diseases such every bit respiratory affliction, arthritis, stroke, depression and dementia. These conditions may touch appetite, functional ability or ability to consume, all leading to altered food intake and impairment of nutritional condition.
Medications used in the treatment of chronic illness tin can too accept a detrimental effect on nutritional status through loss of appetite, nausea, diarrhoea, reduced gastrointestinal motility and dry oral cavity [six,7].
five. Physiological Changes
Taste and smell diminish with age and poor dentition may limit nutrient selection to soft foods. Dry oral fissure (xerostomia) is common, making swallowing difficult with subsequent avoidance of foods. Malabsorption of essential nutrient may result as a event of gastrointestinal changes such as atrophic gastritis. Gastric elimination slows with aging with a potential detrimental event on appetite. All of these factors, independently or collectively, can lead to a reduction in food intake [5].
As we age body composition changes—fat mass increases and lean torso mass (musculus) decreases (sarcopenia). Loss of muscle mass begins at effectually age fifty but becomes more accelerated after the age of 60 years of historic period, and fatty mass continues to increase until effectually the age of 75 years [8]. Loss of muscle mass leads to a reduction in basal metabolic rate by approximately fifteen% between the age of 30 and lxxx, and this results in a subsequent reduction in energy requirements, of effectually 150kcal per solar day later on the age of 75 [nine], Table ane.
Table 1
Estimated Boilerplate Requirements (EARs) for Energy. Adapted from [9].
| EARs MJ/d (kcal/d) | ||
|---|---|---|
| Age (Years) | Males | Females |
| 19–50 | ten.60 (2550) | 8.10 (1940) |
| 51–59 | 10.60 (2550) | 8.00 (1900) |
| 60–64 | ix.93 (2380) | 7.99 (1900) |
| 65–74 | nine.71 (2330) | 7.96 (1900) |
| 75+ | viii.77 (2100) | 7.61 (1810) |
Reductions in energy requirements impact on the quantities or volumes of food consumed, people tend to naturally eat less and this in tandem with the physiological changes described, can pb to shortfalls in micronutrients intakes.
A study of older adults living independently in Eire establish shortfalls in intakes of vitamin C and calcium plus, vitamin D, folate, zinc and magnesium. Lowered intakes were especially evident in those aged 75 years and over [x]. Interestingly the shortfall in micronutrient intakes was accompanied by a high prevalence of overweight and obesity (70%), suggesting free energy dense only micro-nutrient poor food intakes in this grouping. The outcome low micronutrient intakes is highlighted by the example of vitamin D. It is notoriously challenging to provide sufficient from food sources and about of our requirements are met through the effect of ultra violet lite on the skin. UK dietary survey data [11] has shown vitamin D intakes, from food sources, for men and women anile 65 and over, to be deficient, at only 33% of the Reference Nutrient Intake value. In French republic, a study which aimed to characterise a delicate population of free living adults aged over 65 years [12] constitute almost everyone (>95% of participants) had a clinical vitamin D deficiency.
Vitamin D is essential for the maintenance of os health and muscle force and deficiency in older adults may impact on functional chapters and increment the gamble of falls. Vitamin D supplementation of 10 mcg/day [13] is recommended for older adults, peculiarly those who spend little time outside. Even so a meta-assay has reported that supplementation of 700–k IU (17.5–25 ucg) vitamin D daily reduced gamble of falling by 19%, whilst a lower dose of x mcg/400 IU was unlikely to reduce the adventure of falling amid older individuals [fourteen]. Nordic nutritional guidelines advocate vitamin D supplementation for older individuals of xx mcg daily [xv], which may be sufficient to impact on muscle strength [xvi]. Many diverse populations have reflected the tendency for older adults to have low micronutrient status [17].
six. Health Consequences of under and over Nutrition in Older Adults
Older people are vulnerable to malnutrition which is associated with an increased chance of morbidity and mortality [18]. Increased falls, vulnerability to infection, loss of energy and mobility, poor wound healing and confusion are reported consequences of undernutrition [nineteen]. In the Uk the health and social care costs associated with undernutrition are reported at around £13 billion per annum [20]. Malnutrition is common in all types of institutional care settings, however much of the malnutrition present on admission to institutions is thought probable to originate in the community amongst free living older adults. In the UK the prevalence of malnutrition in patients admitted to infirmary from dwelling house is reported to be 23% [twenty]. A small US study which aimed to improve the recognition of undernutrition in customs abode older adults identified iv% with malnutrition and a further 56% at high risk [21]. Social impecuniousness is one of many factors likely to contribute to this. Those with depression incomes are known to have a poorer diet than the more affluent [22] and patients at chance of malnutrition on admission to hospital were establish more than probable to have come from areas of deprivation [23]. In Scotland around 16% of older people (>65 years) currently live in poverty [24].
Whilst undernutrition may be considered a greater risk to wellness in older people, obesity besides increases morbidity and mortality from diabetes, hypertension and cardiovascular illness. The prevalence of overweight and obesity continues to rise amongst the population every bit a whole, and current show indicates that the prevalence in those aged 65+ is increasing. Scottish Health Survey data has shown that betwixt 1998 and 2008, BMI continued to rise betwixt the historic period of 60 and 70, especially in women [25]. European and U.s.a. information show like trends [26]. This is in marked contrast to earlier decades when obesity was less common and prevalence increased with age, peaking around age 60 and then failing [25].
vii. Approaches to Challenge Sub-Optimal Nutritional Status
Recognition of deteriorating or poor nutritional status is key to reversing whatsoever effect. Many screening tools take been validated for utilize in older adults and are bachelor [27]. In the U.k. the most widely used screening tool is the Malnutrition Universal Screening Tool (MUST), a 5 stride screening tool that includes guidelines for the conception of a care programme. Beyond Europe the Mini Nutritional Cess tool (MNA-SF) is more widely used and was developed specifically for use in older adult. The MNA-SF detected undernutrition in frail elderly in greater numbers than MUST [27]. These differences highlight the disparity between screening tools, and may propose that MUST is less useful in this grouping. Both tools collect slightly different information; MUST develops a hazard of malnutrition score based upon current body mass index (BMI), known weight loss and the presence of astute disease/no nutritional intake for 5 days. MNA-SF, includes similar questions to the MUST with additional questions on neuropsychological functional status, physical mobility and nutrient intake.
However nutritional screening policies and practice vary betwixt and within wellness care settings and, despite the availability of screening tools, nutritional screening is often not undertaken and malnutrition continues to be under-recognised and under-treated [21,28]. Screening solitary will accumulate no benefits for people if activeness on findings is not taken. This was highlighted in the study past Wadas-Enright and King [21] who establish that despite screening which identified subjects equally malnourished or at high take a chance; no referrals for nutritional intervention were made.
Meeting the diet and nutrition needs of older people is crucial for the maintenance of health, functional independence and quality of life. For some living at home an approach as simple every bit the provision of meals has been shown to be sufficient to improve nutritional status. Improvements in dietary patterns and food intakes were observed in those in receipt of home delivered meals in comparing to those not receiving meals [29]. A report which looked at the effect of two models of "Meals on Wheels" on the nutritional status of housebound older adults found improvements in both groups over a 6 month period. The greatest improvements were seen in the group who received the enhanced programme of meals which included three meals and 2 snacks per day [xxx]. Notwithstanding provision of meals alone may not ensure that nutritional needs are met. In one study ii thirds of people in receipt of meals at home divided the meals provided for employ on more i occasion, suggesting continued overall bereft nutrient intake [31].
Nutritionally complete supplements are often a offset line intervention and accept been shown to have a positive effect on nutritional status [32] merely mixed effects on body weight. In i study provision of an boosted 600 kcal per day by supplements over a 12 week catamenia resulted in a hateful weight gain of +3.5 kg in intervention subjects (p < 0.001) [33]. The review by Potter and colleagues, quantified effects on body weight as two.05% (95% CI one.63 to 2.49) [32]. In dissimilarity other studies report significant increases in energy and food intake simply no significant weight gain [34,35,36,37,38,39]. Withal the efficacy of supplements is limited by taste intolerance which precludes their long-term use [34]. Evaluation of their efficacy in customs settings in express [40].
Food enrichment, defined as increasing the free energy density of meals by adding energy rich foods, is an alternative to supplements and may adjust older people, who often accept small appetites. This arroyo may be more economic, avoid taste fatigue and allow continuation, and enjoyment, of usual eating patterns. Results from studies using this approach are however mixed. Two trials, i in hospital inpatients [41], the other in the community in a nursing home [42] increased energy provision by 200 kcal per day for viii and xv weeks respectively. In both trials energy intake increased significantly withal no meaning weight gain was observed in either study. Weight maintenance was achieved in the nursing home subjects receiving the intervention [42].
Another report in complimentary-living adults with chronic obstructive pulmonary illness whose BMI was <20.0 kg/ktwo or had a contempo weight loss of >x%, looked at the effects of tailored dietary advice to increase energy intake along with the add-on of milk powder. At 6 and 12 months body weight had increased significantly (+two.0 kg, SD four.vi; and +three.0 kg, SD 6.2 respectively) and positive improvements in quality of life and activities of daily living were observed [43]. Weight proceeds of (+1.3 (0.53) kg, p = 0.03) was observed in undernourished older people in a residential care home whose nutrient was enriched, in comparison to weight loss in residents who continued with usual meals (−0.ii (ane.5) kg, p = 0.54), between grouping difference were not significant, however the within grouping improvement in body weight suggests a positive event from food enrichment [44].
Improvements in nutritional status and torso weight were seen in complimentary living older adults who were at run a risk of undernutrition later on infirmary access, following 12 weeks of dietary enrichment [45].
Of course not all older people are undernourished and the prevalence of obesity in older people is rise. Anxieties exist regarding weight loss in the older adult. This arises from epidemiological bear witness which suggests an association between lower BMI in older people and increased mortality [25,46]. Even so this is thought likely to be the upshot of unintentional weight loss equally a consequence of atmospheric condition such as cancers, chronic centre and lung disease.
As in younger adults weight management is appropriate in older people and has been shown to reduce disease take a chance and improve quality of life (Table 2). Life style interventions should be the first step and should aim to reach small weight loss of five%–10% (5–10 kg) using a balanced diet with a moderate daily energy deficit of 500–600 kcal daily. Given that the crumbling procedure results in loss of muscle mass, it is essential that weight loss programmes practise non induce further loss resulting in the development of "sarcopenic obesity" where the adult has lowered muscle mass, within a given BMI and impaired functional chapters [47] Preservation of muscle mass can be achieved by the inclusion of an do/physical action component in whatsoever weight management programme. Life style intervention studies in overweight and obese older adults which included both weight loss and physical activeness report improvements in body composition (reduced fat mass and increased full lean mass), metabolic risk factors, functional status, well-being and a reduced degree of frailty [26]. A schematic treatment strategy is shown in Figure 2.
Table ii
Potential benefits and risks related to intentional weight loss in the older adults Adjusted from [fifty].
| Potential benefits | Potential risks |
|---|---|
| |
| |
|
|
|
|
|
|
Schematic treatment strategy for obese older adults. Adapted from [26].
The inclusion of a weight maintenance component in weight management programmes is advocated past all clinical guidelines for weight direction. Nonetheless, it is suggested that weight maintenance in older adults following intentional weight loss may not always exist required. A study in which obese and overweight adults were allocated to either a low intensity dietary counseling maintenance period, to exercise advice or to usual care/control establish no differences in body weight changes between groups. The lack of departure betwixt the groups suggests that older adults who were sufficiently motivated to achieve intentional weight loss were able to commit to weight maintenance without formal direction [48]. A systematic review [49] which examined the effectiveness of weight direction approaches in older adults institute the effect of lifestyle advice and guidance in the older obese or overweight developed on body weight was maintained at around ~2 kg at both i and two years follow-up.
eight. Conclusions
While many older adults remain healthy and eat well, those in poorer wellness may feel difficulties in coming together their nutritional needs. Meeting the nutrition and nutrition needs of older people is crucial for the maintenance of health, functional independence and quality of life.
In the UK, future health policy is aimed at shifting the balance of care towards the community and information technology is essential that nutritional needs of older adults are explored and addressed. Failure to do this is probable to atomic number 82 to a loss of independence with subsequent increased demands on social care provision and increased hospital admissions with the potential for more invasive and expensive healthcare requirements.
Conflicts of Involvement
The authors declare no conflict of involvement.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939559/
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