Nutrition for the Adults and the Elderly

INTRODUCTION
Aging is a normal process that begins at conception and ends at death. O
nce the body reaches physiologic maturity, the rate of catabolic rate or degene
rative change becomes greater that the rate of anabolic cell regeneration. The r
esultant loss of cells leads to varying degrees of decreased efficiency and impa
ired organ function.
ADULTHOOD
It is the period of life when one has attained full growth and maturity.
The onset of this stage varies among the individuals and there are no clear cut
boundaries. However, as related to dietary needs, adulthood pertains to the yea
rs between ages 21 and 50 without stresses such as pregnancy, lactationand conva
lescence. Proper nutrition needs emphasis in adulthood, since it is the longest
period of the life cycle and possibly the peak of productive yeears.
Ideally one should reach adulthood with established sound eating habits.
In general,men are more likely to have better food practices than women. Mother
s are proneto neglect their own meals, partially because of their attention to t
he food needsof their families, or because they, too, have become figure conscio
us without understanding weight control. If changes are to be instituted in the
adult's dietary practices, resistance would be most likely encounterd; hence, th
e importance of proper training in food selection and regularity of eating as ea
rly in life as possible.
Nutritional management of the adult should include maintenance of the de
sirable body weight. Statistics show that by age 60, the average adult has accum
ulated about extra 7 kilograms. Overweight and obesity increase tha chances of d
eveloping chronic disorders associated with aging like: high blood pressure, inc
reased levels of blood cholesterol and triglycerides, hyperuricemia, and diabete
s. All of these in turn, are linked with more risks of heart attacks and strokes
. It is recommended that the daily caloric allowance be reduced with increasing
age. A decrease of 3% is suggested by FAO for each decade of 30-39 years and 40-
49 years, because the resting metabolic rate declines brought by loss of lean bo
dy mass compensated for by accumulation of fat. However, the reduction in energy
needs is likely to result in diminishing intake of nurtients. This may lead to
low resistance to infection and disease.
Physical activity may be curtailed, also. Estimating the degree of reduc
tion in physical activity that is assocoiated with advancing age is difficult. M
en engaged in light activity are found to have fairly constant activity pattern
between ages 20 and 45. Ith advancing age, the differences in energy expenditure
among individuals become marked.
The Philippine RDA makes use of the concept of a Reference Man and a Ref
erence Woman in estimating nutritional allowances. The reference man is between
ages 20 and 39 and weighs 56 kg. He is healthy, i.e., free from disease and phys
ically fit for active work. On each working day, he is employed for 8 hours in a
n occupation, which usually involves moderate activity. When not at activity, he
spends 8 hours in bed, 4-6 hours sitting or moving around in light activity and
2 hours walking, active recreation or in household duties. The reference man is
adequately clothed and housed so that air immediately surrounding his body is c
omfortably warm during work and rest. His body weight is not necessarily ideal b
ut he consumes an adequate diet and is neither gaining nor losing wieght. Studie
s on energy expenditure and food intake of active healthy 40 year old males with
an average weight of 56kg showed that 2440 Kcal/day (44Kcal/kg) adequately cove
r their average energy expenditure.
The characteristics of reference woman are the same as those of the refe
rence man excepts that she weighs 49 kg and needs 1800Kcal or 37Kcal/kg to maint
ain her body weight. Moreover she stands 151.7 cm (5'1") as against the 162.5cm
(5'4") of the reference of man.
Comparing the nutritional allowances between the 20-39 years reference m
an/woman and the 40-49 age group, there is not much difference except for the en
ergy values which implicate thiamin and riboflavin allowances.
SENESCENCE
It is the process of growing oldor the period of old age. The study of t
he phenomena of old age is GERONTOLOGY and the treatment of accompanying disease
s is GERIATRICS. A person belonging to this period is referred to as an elderly
or a senior citizen. A SENILE is often clinically associated with an old man wit
h mental and physical weakness, a meaning shoud not be attached to a nowmal aged
person.
the period of senescence is characterized by disturbed regulatory and fu
nctional mechanisms in the body. The effects are observed in the following sytem
s:
1. GASTROINTESTINAL- decreased taste thresholds, decreased motility, diminished
secretion of digestive enzymes, increase in gastric pH, decreased number of abso
rbing cells all result in constipation and poor nutrient absorption.
2. CIRCULATORY- decreased myocardial ability to use oxygen, loss of elasticity o
f blood vessels, slow rate of blood through coronary arteries, kidneys, GI tract
and brain result in reduced cardiac output , increased pressure and systolic bl
ood pressure.
3. EXCRETORY- diminished amount of functioning nephrons and slow excretion of wa
stes result in reduction of glomerular filtration rate and increased blood urine
nitrogen.
4. ENDOCRINE- reduced sensitivity to insulin release, decreased production of es
trogen and testosterone, thyroxin and pituitary hormones result in decreased cel
lular metabolism amd ability to withstand stress.
5. NERVOUS- diminished conductance of the nerve impulse and decreased sensory se
nsitivity result in slow reflex reaction.
6. RESPIRATORY- loss of pulmonary functional tissues and weakeningof respiratory
muscles result in reduced respiratory reserve, for major illnesses and decrease
d maximum breathing capacity.
7. MUSDCULO-SKELETAL- decrease in number and bulk of muscle fibers, increased pr
oportion of lime to water result in brittle bone. decrease in muscular strength,
stooped posture and stiffened joints.
NUTRIENT ALLOWANCES
geriatric nutrition is concerned mainly with the conservation of good he
alth and the prevention of chronic degenerative diseases to which an elderly is
prone to, such as: arthritis, rheumatism, gout, coronary heart disease, and diab
etes. Advancements in medical knowledge, improvements in socio-economic conditio
ns, and research in nutrition have considerably prolonged life expectancy of the
aged.
An important factor to consider in viewing geriatric nutrition is that w
hile nutritional requirements remain similar, no matter what one's age is, the c
aloric requirements decrease with the age. However, at the same time, disease an
d ill health in manny elderly may actually increase requirements for some nutrie
nts while reducing the efficiency of nutrient digestion, absorption and metaboli
sm. Selection of nutrients within the dietary requirements needs to be checked c
losely.
ENERGY. The demand for calories is decreased because of the reduced basa
l metabolism and physical activity. FAO recommends a decrease of 7.3% for each d
ecade of 50-59 and 60-69 and 10% for 70 years and above. It is proposed that ene
rgy allowances for persons between 51 and 75 years of age be reduced to about 90
% of the amount required as a young adult, and for persons beyond age 75years, t
o about 75-80% of the amount.
CARBOHYDRATE and FATS. Around 50-60% of the total Kcal should come from
carbohydrates primarily in the form of starches rather than sugars: and about 20
-25% from fat. Studies have shown a link between the kind of carbohydrates and f
ats with the occurence of ccoronary heart disease. Sucrose and saturated fatty a
cids are known to increase triglyceride and cholesterol levels in the blood. How
ever, rich sources of cholesterol and saturated fatty acids are among the "prote
ctive foods"like eggs, milk and organ meats. Hence, severe retsriction of these
foods is not advisable.
Not only the quality but also the quantity of fat should be regulated in
the diet of elderly. Digestion and absorption of fat tends to be slow down in t
he aged. Too much fat in the diet can cause indigestion.
PROTEIN. Its allowance for the aged is maintained at 1.12 gm/kg body wei
ght based on a net protein utilization of 63%. Protein is necessary for the pre
vention of progeressive tissue wasting and susceptibility to disease and infecti
on.
There is no increased requierement for protein under normal circumstance
s because the overall mass of actively metabolizing tissue decreases with age. H
owever, older persons who have had poor dietary habits or illness will benefits
greatly from an increased intake. Studies indicate that a poor protein intake am
ong the aged is due to low intake of calories or a combination of low intake wit
h incomplete digestion and assimilation of nutrients. Since proteins are not sto
red in the body, they must be provided in the daily diet.
VITAMINS and MINERALS. Dietary Vitamin B12, calcium, iron, and zinc have
impaired gastrointestinal bioavailability during aging. Also, calcium, iron, an
d vitamins A and C are commonly found lacking in the diet of aged, because of th
e low intake of meat, milk, green leafy vegetables and fruits. When calcium is
inadequately supplied, bones become thin and fragile due to demineralization of
the bony tissue and this results to osteoporosis, a phenomenon that progress fas
ter in women than in men. When calcium is poorly absorbed and metabolized becaus
e of lack of vitamin D, bones fracture easily and this condition is reffered to
as osteomalacia or adult tickets.
The chronic condition of osteoporosis is often regarded as manifestation
of the aging process associated with demineralization. Review of current litera
ture indicates that osteoporosis is not preventable by increasing calcium intake
. However, there are evidences that calcium supplementation induces calcium rete
ntion and relieves symptoms. Moreover, an ample intake of calcium makes up for t
he reduced absorption with advancing age. The Philippine RDA recommends 500mg ca
lcium daily up to 700mg calcium/day.
A combination of nutritional anemias may coexist among older persons. Th
is is brought about by a multiple deficiency of nutrients which include IRON, wh
ich is an important component of hemoglobin, VITAMIN B6, which catalyzes the syn
thesis of heme portion of the hemoglobin molecule, VITAMIN E, which affects the
stability of the red blood cell membranes, VITAMIN B12 and FOLACIN, which are es
sential for normal blood formation, VITAMIN C, which increases iron absorption,
and COPPER, which facilitates hemoglobin formation. Women's iron allownace at th
e age of 50 and above drops to 11.0 mg/day. At around this time menopause takes
place, marking the permanent cessation of menstruation.
Since impaired taste acuity occurs frequently in elderly, adequate intak
e oof ZINC should be noted. Meat, liver, eggs, seafood especially oysters are go
od sources of zinc which improves not only the taste acuity but also wound heali
ng.
special emphasis may also be placed on VITAMIN C, because it is often de
ficient among aged people. It facilitates absorption of calcium and iron and tog
ether with vitamin E, it is observed to retard cellular aging.
An adequate inttake of THIAMIN is important, because it counteracts the
poor appetitecommonly found among the aged and it also helps regulate the muscle
tone of the gastrointestinal tract and the normal functioning of the nerves.
VITAMIN D is also found to be deficient among elderly people. This is of
ten brought about by liver injury, antibiotic therapy, poor intestinal absorptio
n. and inadequate exposure to sunlight.
WATER. with the slow excretion of waste matter, water becomes more impor
tant as a carries. It helps control constipation that frequently occurs among el
derly people because of reduced gastric motility, diminished bulk or fiber in th
e diet, and decreased physical activity. Approximately 6-8 glasses/day are neede
d. Elderly people confined to bed need water intake as high as four liters a day
to prevent kidney stone formation.