Introduction
Nutritional needs changes throughout a person’s life that if not properly assessed may lead to malnutrition. Malnutrition is the state of the body lacking important nutrients or having excess or imbalance of energy. According to studies, 16% of people over 65 years and 2% of people over 85 years are malnourished. Studies also show that approximately two-thirds of people occupying hospital beds are above the age of 65 years (Ahmed & Haboubi, 2010). Malnutrition is associated with a number of health outcomes such as poor wound healing, slow recovery from surgery, higher hospital readmissions, and deaths. Malnutrition is high among the elderly because of the multiple changes that occur in their bodies and other factors in their lives. Meeting nutritional needs of the elderly requires an understanding of these changes and factors because meeting those requirements goes beyond just diet (Caroline Walker Trust, 2007).
Dentition and Oral Problems
Dentition problems are a common issue among elderly people with most of them having less than enough or no natural teeth. This affects their nutrition because the ability to chew food is highly dependent on the number of teeth one has. Difficulties in chewing may result in the adults not enjoying the food limiting their food consumption.
A dry mouth condition known as xerostomia also affects approximately 20% of elderly people. Xerostomia affects food taste, and may also interfere with chewing and swallowing of food (Cook & Carter, 2013). As such, people suffering from this condition can have problems eating certain types of food. Elderly people suffering from dementia, head or neck cancers, or have just suffered a stroke can also experience swallowing difficulties. Swallowing problems make eating and drinking difficult and may result in choking.
Biological Changes of Digestive System
These are changes that occur in the gastrointestinal tract of old people because of their age. Selective neurodegeneration is associated with an aging nervous system and could result in various gastrointestinal problems such as constipation, gastrointestinal reflux, and dysphagia. Research shows that nutrition may also influence an aging gut. Aging impairs gastric motility and influences colonic motility through the cellular mechanism controlling smooth muscle contraction and may lead to constipation.
Reduced gastric acid secretion has a high prevalence among the elderly and could lead to the development of hypochlorhydia that is associated with chronic gastritis. This reduction in acid secretion makes the gut vulnerable to bacterial overgrowth that affects micronutrients intake and reduces body weight.
Biological changes of the digestive system are also linked to pathological factors such as pancreatitis and liver disease. Aging leads to structural changes of the pancreas resulting in reduced concentrations of chymotrypsin, bicarbonate, and lipase of the pancreatic juice. The liver also decreases in size and blood flow as one grows older but no significant microscopic changes are observed.
Physiological Changes of Digestive System
As people age, their appetites reduce consequently leading to reduced food consumptions. Studies show that the average daily consumption of food between 20 and 80 years reduces by up to 30% (Ahmed & Haboubi, 2010). The main cause of the age-related decrease in food intake is related to the decline in energy expenditure that comes with age. However, in most elderly people the decrease in energy intake exceeds the decrease in energy expenditure resulting in body weight loss.
Research shows that body mass index and body weight increase until the ages of between 50 and 60 years after which they start to decline. Body fat also increases and fat-free mass reduces as one becomes older. This fat gain is caused by multiple factors including lack or reduced physical exercise, a reduction in growth hormone secretion, reduced resting metabolic rate, and diminished sex returns. Weight loss in elderly people occurs in three distinct mechanisms; wasting, cachexia, and sarcopenia (Culross, 2009). Wasting is an involuntary weight loss because of poor nutrition caused by physiological factors or disease. Cachexia is an involuntary loss of body cell mass caused by catabolism and leads to body consumption changes. Sarcopenia is the major age-related change in elderly people and results in reduced skeletal muscle mass. The main cause of sarcopenia is the lack of physical activity. Other causes include increased cytokine activity that breaks down muscles, and strokes and neural disease that cause neurone cell death leading to muscle atrophy.
Physiological anorexia is thought to be caused by a diminished sense of taste and smell, delayed gastric emptying, altered gastric distension, and hormone secretion. A study showed that up to 60% of the subjects between the ages of 65 and 80 years and 80% of subjects had reduced sense of smell and taste (Ahmed & Haboubi, 2010). The reduced sense of taste is attributed to the reduced number of taste buds. This reduction in smell and taste senses significantly affects food consumption as taste and smell are associated with interest in eating. Elderly people tend to be satiated faster during meals something that is related to gastrointestinal sensory function. Reduction in sensitivity of gastrointestinal tract distension that causes impaired reception of the gastric fundus and rapid antral filling is caused by old age. Elderly people also do not seem to respond to acute undernutrition a fact that is associated with impaired homeostasis. Cholecystokinin that is the satiety hormone is released in the bowel in response to the lipids and proteins in the antrum. Studies show that cholecystokinin is the increased in older people and is related to low hunger levels and high satiety.
Elderly Nutritional Requirements
The recommended dietary analysis for proteins among elderly people is 1.5g of proteins per kg of body weight. This amount of protein consumption will help improve muscle mass, build immune response, and reduce blood pressure. There is no evidence concerning increased intake of protein on cardiovascular, renal, or neurological functions or bone mass among elderly people.
Reduced food intake and unbalanced diet make elderly people susceptible to vitamin and mineral deficiencies. Drugs such as nicotine interfere with the absorption of folic acid and vitamin C, affect hepatic metabolism and cause delayed elimination of vitamins. As such, elderly people should avoid smoking. Elderly people should also have lots of vitamin D supplementation to because of their thinning skin, reduced skin production and reduced exposure to sunlight. Vitamin D increases bone density, reduces chances of developing type 1 diabetes, rheumatoid arthritis, and cardiovascular disease. Calcium supplementation is also necessary to increase bone density. Elderly people should also consume a lot of folate that is deficient is deficient in about 50% of old people. Insufficient diet, excessive alcohol consumption, and drugs such as methotrexate are known to cause folate deficiencies that lead to anemia and increased homocystine levels.
Conclusion
The overall goal of elderly nutrition is to increase food consumption. As such, food should be made as tasty as possible since most of the old people suffer from a diminished sense of taste. Patients with chewing and swallowing difficulties should mostly eat mushy food. Improved food consumption is seen to provide the necessary nutrients to prevent arthritis, loss of weight, diabetes, cardiovascular diseases, anemia and other diseases common in elderly people. Quality protein, vitamin, and calcium supplements should also be provided to ill patients to increase energy, reduce injuries and improve clinical outcomes.
References
Ahmed, T., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clinical Interventions in Aging, 5, 207–216. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920201/
Caroline Walker Trust (2007). Eating well for older people: Practical and nutritional guidelines for food in residential and nursing homes and for community meals (2nd ed.). United Kingdom: The Caroline Walker Trust.
Cook, S., & Carter, M.-A. (2013). Food and nutrition guidelines for healthy older people: A background paper. Wellington, New Zealand: Ministry of Health.
Culross, B. (2009). Nutrition: Meeting the Needs of the Elderly. Gerontology Update. Retrieved from http://www.rehabnurse.org/pdf/GeriatricsNutrition.pdf
