Geriatric nutrition

A complete brief information about the nutrition required for the elderly.

1. GERIATRIC NUTRITION GUIDED BY: DR. NILESH BULBULE PRESENTED BY: DR. SHALU MONDAL

2. CONTENTS Introduction Definitions Factors Affecting Nutritional Status Nutrients Needs Food Pyramid Assessing Nutritional Status Diet Recommendations Diet Instructions for New Denture wearers Conclusion References Geriatric Nutrition 2

3. INTRODUCTION "Let food be your medicine and medicine be your food." by Hippocrates. Aging being a natural process requires special considerations. Thus proper nutrition is essential to health and comfort of oral tissues which , in turn enhance the possibility of successful Prosthodontic treatment in the elderly. Geriatric Nutrition 3

4. DEFINITIONS In science and human medicine, Nutrition is the science or practice of consuming and utilizing foods . Geriatric nutrition applies the nutrition principles to delay effects of aging and disease, to aid in the management of the physical, psychological, psychosocial changes commonly associated with growing old! Geriatric Nutrition 4

5. AGING FACTORS AFFECTING THE NUTRITIONAL STATUS OF THE ELDERLY Functional: Impairments affect nutritional status e.g. stroke arthritis Psychological: Life situational factors increase nutritional risk in elderly Pharmacological: Over counter drugs and several prescriptions = nutrient deficiency, weight loss & malnutrition. Physiological: Body mass decline= calorie needs Dehydration= kidney function Overt deficiency= neurological/ behavioral impairment Geriatric Nutrition 5

6. ORAL FACTORS AFFECTING THE NUTRITIONAL STATUS Xerostomia Associated with difficulty in chewing & swallowing Drugs= Hypo salivary side effects Sense of taste and smell: Diminished taste and smell characteristic Thus limited consumption. Dentate status: Impaired masticatory function leads to inadequate food choice Thus alteration in nutrition. E ffect of dentures on chewing ability With age, more strokes and longer chew. M asticatory inefficiency is 80% lower than with dentate patients. Geriatric Nutrition 6

7. NUTRIENT NEEDS FOR THE ELDERLY Nutrients are substances in food that your body needs for energy, proper growth, body maintenance and functioning. Classes of nutrients : Carbohydrates Proteins Fats Water Vitamins Minerals Geriatric Nutrition 7

8. The requirements decrease with advancing age Due to: Reduced energy expenditure Decreased basal metabolic rate Recommended Dietary Allowances (RDA): 1600 Kcal for women 2400 Kcal for Men CALORIE INTAKE BY THE ELDERLY Geriatric Nutrition 8

9. The requirements decrease with advancing age Due to : Reduced physical activity Recommended Dietary Allowances (RDA) 1300 Kcal for women 1800 Kcal for Men Deficiency: C auses parotid gland enlargement, muscle wasting, pale atrophic tongue ENERGY REQUIREMENT Geriatric Nutrition 9

10. Its been consumed largely, possibly at the expense of proteins due to their low cost, ability to be stored without refrigeration and ease of preparation. RDA 50-60 percent of total calories. Fibers : a special subclass of complex carbo- hydrates. Promotes bowel function CARBOHYDRATES Geriatric Nutrition 10

11. With age the amount of protein required is increased. Are a must for the denture wearers RDA: {for 51 years and above}0.8g/kg body weight (i.e. 56gms for male 46gms for female) OR 9% for males of total calorie intake 10% for total calorie intake for females. PROTEINS Geriatric Nutrition 11

12. Transport and absorb vitamins 3 types : saturated fatty acids, trans fatty acids, unsaturated fatty acids. Excess energy is stored in form of fats Excess lead to unhealthy weight gain & obesity Type 2 Diabetes . RDA : 25-35 % of the total calorie intake daily FATS Geriatric Nutrition 12

13. Water  is an essential nutrient because it is required in amounts that exceed the body's ability to produce it. WATER RDA : More than 1700ml daily at least. Geriatric Nutrition 13

14. Helps control the body process & also release energy to do work. They don’t contain calories Neither provide body with energy 2 types : Fat soluble (A,D,E,K) Water soluble (C and B complex) VITAMINS Geriatric Nutrition 14

15. FAT SOLUBLE : carried by fat present in food and stored in the body VITAMIN D: The sunshine vitamin crucially important to the body RDA : 10µg in males and females. Deficiency: Osteomalacia, Osteoporosis, Poor immune Function. VITAMIN A : RDA : 900µg for males and 700µg for females Deficiency : Decreased salivary flow, desquamation of oral mucosa, Keratosis, decreased taste acuity, metaplasia of salivary gland epithelium. Geriatric Nutrition 15

16. VITAMIN E: The total plasma vitamin E levels increase with age. RDA: 15mg for males and females. Deficiency: Doesn’t seem to be much of a problem orally per se . VITAMIN K: The coagulation vitamin is very crucial in relation to blood clotting process. RDA : 1µg in males and females. Deficiency: Coagulopathy, Petechiae, Ecchymosis, Low Bone Density, Increased risk of gingival bleeding. Geriatric Nutrition 16

17. WATER SOLUBLE: carried to the body tissues B1 (THIAMINE): Helps cell convert carbohydrates into energy RDA: 1.2mg for males and 1.1mg for females Deficiency: Beriberi B6 (Pyridoxine): It helps metabolize carbs, proteins & fat & also help to keep the immune system healthy. RDA: 1.7mg in males and 1.5mg in females. Deficiency: Nasolabial Seborrhea Glossitis. B-COMPLEX Geriatric Nutrition 17

18. B12 (RIBOFLAVIN) It is the largest and most structurally complicated vitamin involved in the  metabolism  of every  cell  of the human body. RDA: 2.4µg in males and females. Deficiency : Fiery or Beefy red tongue, Candidiasis, Aphthous Stomatitis, Intra-oral Burning. B9 (FOLIC ACID) Its acts as a co-enzyme with vitamin b12 and vitamin C to produce cells in the body. RDA: 400µg for males and females Deficiency: Mouth Ulcers, Glossodynia, Glossitis, Stomatitis. Geriatric Nutrition 18

19. B1 B6 B9 B9 W ATER S OLUBLE V ITAMINS Helps cell convert carbohydrates to energy RDA: 1.2mg for males 1.1mg for females . Its acts as co-enzyme to produce cells in body. RDA: 400µg (M&F) It keeps immune system healthy. RDA: 1.7mg in males 1.5mg in females. Metabolism of cell RDA: 2.4µg (M&F) Deficiency : Fiery or Beefy red tongue, Candidiasis, Aphthous Stomatitis, Intra-oral Burning. Geriatric Nutrition 19

20. VITAMIN C (Ascorbic acid): It is an essential nutrient involved in the repair of tissue and the enzymatic production of certain  neurotransmitters. It also functions as an  antioxidant. RDA: 90mg for males and 75mg for females Deficiency: Scurvy, Petechiae, delayed wound healing Geriatric Nutrition 20

21. MINERALS Substances that the body doesn’t manufacture but are essential for healthy bones and teeth. They don’t contain calories Neither provide body with energy Geriatric Nutrition 21

22. CALCIUM A certain amount is required to build & maintain strong bones & healthy communication between the brain & other parts of the body . RDA : 1200mg for males and females Deficiency: Osteoporosis, Muscle loss, Tooth Decay, Ridge Resorption. IRON   Its main purpose is to carry oxygen in the hemoglobin of red blood cells throughout the body so cells can produce energy. RDA: 8mg for males and females. Deficiency: Burning tongue, Dry mouth, Anemia’s, Angular chelitis Geriatric Nutrition 22

23. ZINC: Its utilization reduces with advancing age due to decrease in intestinal absorption. RDA : 15mg for males and females Deficiency: Decreased taste acuity, mental lethargy, slow wound healing. MAGNESIUM:   It helps form bones and teeth and also activates enzymes. RDA: 420mg for males and 320mg for females. Deficiency: Low bone density, muscular weakness, Fatigue. Geriatric Nutrition 23

24. Modified Food Pyramid For Older Adults. R ow of glasses to maintain adequate fluid intakes Various physical activities.  V itamins B  12  or D or calcium supplements. Low-saturated fat  & vegie choices in meat-&-beans group Variety of  fruits and vegetables Whole grains and variety Oils low in saturated fats  & lacking  trans fats Fiber-rich foods in all food groups Low-fat & nonfat dairy foods with reduced lactose Geriatric Nutrition 24

25. Assessing The Nutritional Status The Tri-Phasic analysis Method Phase I Screen all the patients. Present dietary habits are taken into considerations. If Nutritional problems detected then If enough information collected for rationale basis Phase II Phase III Reserved for more complex problems. Biochemical test of blood, urine, tissues along with metabolic and endocrinal functions. (Only under the supervision of a physician.) Assessment terminated. 3 to 5 day period nutrients calculated. Automated blood tests done. Geriatric Nutrition 25

26. Diet Recommendations 4 Serves : 2 serves of Vit C. 1 serve of Vit A. 4 serves of carbs. 4 Serves : Enriched breads, cereals and flour products 2 Serves: Milk and milk based food. 2 Serves: Meat, Fish, Poultry, Eggs , Peas. Serve of : Fats, oil, sugar. Geriatric Nutrition 26

27. Diet Instructions For New Denture Wearers Logical Sequence: Bite, Chew and then Swallow. For New Denture Patients: the Reverse order. Firmer foods along with soft food. Cut into small pieces before eating. 4 th Post Insertion day: Juices and tender cooked veggies. Softened breads, tender meat, cottage cheese. Butter/Margarine and glass of Milk at least once in a day. 2 nd & 3 rd Post Insertion day: Juices of fruits and veggies. Pureed meat or broths. A Glass of Milk at least once in a day. 1 st Post Insertion day: Geriatric Nutrition 27

28. CONCLUSION Considering the high prevalence of poor nutritional status among the elderly, more focus on diet and possible nutritional interventions are required in which practicing Prosthodontist can play a vital role. The nutritional deficiencies are multi-factorial. Where the patients tend to deny the dietary indiscretions. Hence, it’s the prosthodontist who should educate and make sure about the adequate intake of nutrients from regular follow ups. Geriatric Nutrition 28

29. References Essentials of Complete Denture Prosthodontics ; Sheldon Winkler ; 2 nd Edition. Textbook of Geriatrics dentistry ; Poul Holm-Pederson ; 2 nd Edition. Bandodkar K. Aras M, Nutrition for Geriatric Denture patients; Journal of Indian Prosthodontic Society; March 2006; Volume6; Issue 1 Geriatric Nutrition 29

30. THANK YOU Geriatric Nutrition 30