Académique Documents
Professionnel Documents
Culture Documents
GERIATRICS
ARYANTI R. BAMAHRY
The Older Population
The Older Population
Physiologic Changes
Aging is a normal biologic process physiologic function.
Organs change with age.
BASED ON
NUTRITIONAL STATUS
HEALTH STATUS
NUTRITIONAL NEEDS
Energy
Decreased requirement (changes in body composition,
BMR, physical activity)
Calculation Energy need BW, BEE, REE/TEE, actual BW
Average calories intake:
2000 kcal/day
1600 kcal/day
Protein
- Protein intake 1g /kg BB
- Stress-full physical & psychological stimuli negative
nitrogen balance
- Infection altered GI function & metabolic changes
reduce efficiency of dietary nitrogen and nitrogen
excretion
Biomarker
Albumin indicator of protein status
Pre-albumin and RBP evaluate response to
therapy
Carbohydrate
Needed to protect protein from being used as
energy source
Approximately 45 -65% of total energy
Complex carbohydrate legumes, vegetables,
whole grains & fruits to provide phylochemical &
essential vitamins & mineral
Lipid
25-35% of total energy
Reduced SFA
Reduced fat weight control & cancer prevention
Consumption of fat < 10% affect quality of diet
and negatively affect taste, satiety & intake.
Mineral
Poor mineral status inadequate dietary intake, physiologic
changes affect the need for a nutrient & medications
Lactose intolerance (diminished lactose secretion) caused
diarrhea, discomfort from cramping, flatulence need
dietary modification
Decrease Ca transport osteoporosis & hypochlorhydria
Iron deficiency uncommon, mostly related to blood loss or
decreased absorption (caused by disease or medication)
Vitamins
Oxidative mechanism play an important role in the aging
process
Antioxidant vitamins : tocopherols, carotenoids, vit C
Cell damaged accumulate certain disease, e.g cataract,
heart disease, cancer (Ausman & Mayer, 1999)
Vitamin A
Fescanich et al,2002:
High losses of vitamin A hip fracture
Sources of vitamin A dark green, leafy & yellow-
orange fruits and vegetables provide adequate
food excessive -carotene precursor vitamin A
Vitamin C
Older adult have lower serum level of vitamin C
Vitamin C requirement increase : stress, smoking,
medication
Encouraging the consumption of vitamin C-rich food
most effective
Vitamin D
Depend on concentration of calcium and
phosphorus in the diet.
Age, sex, degree of exposure to sunlight
(decreased 60%)
Function heal skin lesionspsoriasis,
hyperproliferative disorder of cancer, actinic
keratoses
Need moderate supplementation of vitamin D and
calciumimprove bone density and prevent bone
fracture
Vitamin E
Vit E reduce the risk of CVD by reducing
the susceptibility of LDL to oxidation
vascular endothelial cell expression of
proinflammary cytokine (Meydani, 2001)
Vit E cancer prevention
Vitamin B6
Many studies older adults do not consume
enough B6
Atrophic gastritis, alcoholism & liver dysfunction
requirement
Severe deficiency homocysteine level
anemia & risk for cardiac disease
Encouraged folate rich food liver, dried
beans, broccoli, avocado, asparagus & spinach
Vitamin B12
Elderly need screening for B12
Prevalence 10-15% in age 60 cause: athropic
gastritis, bacteria overgrowth, anemia
pernicious, crohns disease, ileal resection,
malabsorbtion syndrome.
Supplement vit.B12 or injectable for all older
adults
Water
Daily fluid replacement is essential
Exercise regularly
Consume large amount of protein
Use laxative or diuretics
Live in areas wit high temperatures
Need 30-35 ml/kg BB (actual body weight) or
minimum 1500 cc/d
Increased age total body water decreases
(50%) associated with a corresponding
decrease LBM
Older risk for dehydration
Reduced thirst sensation
Reduced fluid intake
Limited access to fluid
Disminished renal function
Urinary inconvenience
Symptoms of dehydration
Electrolyte disturbance
Altered drug affected
Headache
Constipation
Thirst, Loss of skin elasticity
Weight loss
Cognitive status deterioration
Dizziness
Dry mouth & nose mucous membranous
A swollen or dry tongue
Change blood pressure
Rosessed or sunken eyes
Change in urine color or output
Speech difficulties
An insufficient fluid intake with frequent
diarrhea or vomiting, fever, illness, organ
failure or chronic disease requiring
hospitalization
4 or 5 smaller meals
NUTRITIONAL NEEDS
IN CERTAIN DISEASES
OF GERIATRICS
Nutrition Issues
Older risk of malnutrition
Lack of education
Financial constraints
Decreasing physical & psychological abilities
Social isolation
Treatments for multiple
Concomitant disorder/diseases
Secondary causes of malnutrition
Feeding impairment
Anorexia
Malabsorption (GIT dysfunction)
Increased nutrient needs injury or disease
Drug nutrient interactions
Disease Issues Older Population
Dysphagia
Pressure ulcers
Alzheimers
Parkinsons
Geriatric failure
DM type II
Hypertension & constipation
Dysphagia
Food can chopped, ground or pureed ---
eating regular consistencies
The consistency of liquids can be modified
to thin, nectar, honey or pudding
consistency thickening agent
Appropriate body positioning reduced the
risk of chocking
Pressure ulcers
Most common
Location below the waist, but can develop any
where
Especially: DM, CV (peripheral), chronic illness,
cognitive impairment, mobility problems,
incontinence, neurologic impairments.
Inadequate food; kilocalories, protein, zinc and
vitamin C.
Frequent monitoring of BW, skin integrity, lab.
value for nutritional status
Management of Pressure Ulcers
Based on stage and depth of damage
CHF
TERIMA
KASIH