Chapter 13

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

CHAPTER 13

Nutrition for Adults:

Early, Middle, and Later Years

Eleanor D. Schlenker

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 2

Adulthood: Continuing Growth

and Development

Aging Across the Life Cycle

Aging begins at the moment of conception and

continues until death

All periods of life have their unique potential and

fulfillment



and Development – Cont’d

Aging Across the Life Cycle – cont’d

Two important considerations govern the

physiologic, psychosocial, and nutritional needs

across the adult years:

1. The individual

2. The total life




Aging in America

Changes in population and available technology

are affecting the personal and working lives of

adults in the United States and around the world

This generation must cope with the costs of

educating their children while caring for their

aging parents




Many factors shape the path of adult

development

Physical

Socioeconomic

Psychosocial

Nutritional




Physical Characteristics

Cell replication: forming new cells to replace old

ones and maintain body structure and function

At older ages physical growth gradually declines

as cells are lost more rapidly than they can be

replaced




Socioeconomic Status

Many adults experience changes in resources

as they move through early, middle, and later

adulthood

Financial pressures at any life stage influence

food security and the availability of healthcare




Psychosocial Development

Three developmental tasks of psychosocial

growth characterize the adult years:

1. Young adults develop intimacy and expand

relationships outside of their parents and siblings

2. Middle adults pursue creative expression or

explore new career direction

3. Older adults seek fulfillment and strength of

purpose




Nutritional Needs

Nutrient needs remain important even after

maturation and physical growth are complete

Nutrient requirements remain dynamic

throughout life according to age, physical activity,

lifestyle, illness, chronic disease, or pregnancy

and lactation


Adult Stages

Young Adult: 19 to 45 Years

Physical characteristics

Body functions are fully developed with sexual

maturation and reproductive capacity


Adult Stages – Cont’d

Young Adult: 19 to 45 Years – cont’d

Socioeconomic status

Households are established, and individuals may

take on the parenting role

The changing work environment can bring

difficulty in meeting the life tasks of education,

work, and family




Psychosocial development

If positive development is achieved, the individual

can build on personal relationships leading to self-

fulfillment




Nutritional needs: Energy

Needs tend to continue to decrease with age

Recommended Dietary Allowance (RDA) for

active men ages 19 to 30 is about 3000 kcal/day

RDA for active women ages 19 to 30 is 2400

kcal/day




Nutritional needs: Energy – cont’d

RDA for active men ages 31 to 50 is about 2900

kcal/day

RDA for active women ages 31 to 50 is about

2300 kcal/day




Nutritional needs: Protein

RDA is 56 g/day for young men

RDA is 46 g/day for young women

An additional 25 g/day is required during

pregnancy and lactation




Nutritional needs: Minerals

Young adults need 1000 mg of calcium

RDA for iron is 18 mg/day for women of child-

bearing age and 8 mg/day for young men

The iron requirement in pregnancy is 27 mg/day




Nutritional needs: Vitamins

Intakes of certain vitamins are less than optimal in

many young adults



Middle Adult: 45 to 65 Years


Decline in skeletal muscle mass and muscle

strength, a condition called sarcopenia, meaning

“vanishing flesh”

Most persons increase in body fat



Middle Adult: 45 to 65 Years – cont’d


Focus is on family, grandchildren, community

Some experience the “empty nest”

More opportunities to expand personal horizons





Shifts in the nature of employment can bring job

loss for workers at all levels of responsibility

Displaced workers may seek out new educational

opportunities or workforce training for new careers




Nutritional needs

Energy needs decline

Waist circumference can increase

Calcium intake assumes special importance




Food habits

In current surveys fat provides 33% of total

kilocalories (kcalories or kcal), and saturated fat

more than 11%

Salty snacks and desserts add up to almost 13%

of total kcalories




Chronic diseases

Cardiovascular disease, diabetes, and cancer

often develop in this stage of life

The prevalence of overweight and obesity has

helped to fuel the rise in diabetes




Nutritional needs

Energy needs continue to decline

Protein needs remain the same 56 g/day for men

46 g/day for women





Calcium needs rise to 1200 mg/day for adults over

age 50

Iron needs drop to 8 mg/day for women after

menopause





Vitamin D needs rise to 10 µg/day (400 IU) for

adults ages 51 to 70

Vitamin B6 needs increase for both men and

women



Older Adult: 65 to 85 Years


Chronic diseases such as osteoarthritis, heart

disease, pulmonary disease, and diabetes may

limit physical activity



Older Adult: 65 to 85 Years – cont’d

Physiologic changes influence nutritional

status:

Body composition

Cardiovascular system

Renal system

Respiratory system

Gastrointestinal system





Requires continuing adaptation to new challenges

as physical abilities decline and emotional

supports are lost





Older adults usually enter retirement on a fixed

income

Financial resources influence nutrient intake, and

lower-income older people have poorer diets than

higher-income older people




Nutritional needs: Energy

A physically active 65-year-old man weighing 77

kg needs about 2600 kcal/day

A physically active woman of this age weighing 57

kg needs about 2100 kcal/ day

Beyond age 70 there are further declines in

energy expenditure




Nutritional needs: Protein

RDA is 56 g/day for men and 46 g/day for women

(same as for younger adults)

Health status may change protein needs

Low energy intake may influence utilization of

dietary protein





The Dietary Reference Intake (DRI) for calcium

rises from 1000 mg to 1200 mg for persons over

age 50





Vitamin B6 is used less efficiently by the older

adult, so the RDA is higher

The DRI for Vitamin D is 10 g (400 IU) for those

ages 51 to 70 and 15 g (600 IU) for persons over

age 70




Food intake

Likely problem is unwanted weight loss with

increasing frailty and disability

Energy intake continues to decline




Food intake – cont’d

Increasing fat intake to the upper end of the

Acceptable Macronutrient Distribution Range

(AMDR) may help to stem weight loss

Nonfood calcium rises with over half of this age-

group using either calcium supplements or

calcium-containing antacids




Chronic diseases

Elevated blood pressure increases vulnerability to

heart attack or stroke

Paralysis affecting speech, mobility, movement, or

loss of some degree of cognitive function often

results from a stroke

Deaths from cancer rise in older age-groups




Interest in health improvement

Older adults are an important target audience for

health education



Oldest-Old: 85 Years and Older

Population Projections

U.S. Census Bureau developed the following

three categories:

1. The young-old: ages 65 through 74 years

2. The old-old: ages 75 through 84 years

3. The oldest-old: ages 85 years and older



Oldest-Old: 85 Years and Older – cont’d

Nutritional needs

As persons continue to age, they become less

efficient in nutrient absorption and utilization

Nutrient stores undergo rapid loss in acute

illness or long-term disease

We know very little about the interactions between

the aging process and chronic disease and how they

might influence nutritional needs


The Aging Process

The Study of Gerontology

The field of gerontology includes the biologic,

physiologic, sociologic, and behavioral

aspects of the aging process as they play out

in each individual

Geriatrics: refers to the diseases and medical

conditions common to older people


The Aging Process – Cont’d

Length of Life

Life expectancy of Americans at birth has

increased from 49 years to 77 years

Lowering the infant death rate and the

development of antibiotics and effective

public health practices reduced the early

deaths of young adults, effectively increasing

life expectancy at birth



Length of Life – cont’d

Life expectancy at older ages is influenced by

environmental factors such as pollution and

personal lifestyle including diet, smoking

habits, alcohol use, or activity level



Quality of Life

Average healthcare costs for adults ages 65

to 74 are $8297 per year

These costs increase to $18,353 for those

ages 85 and older



Quality of Life – cont’d

Researchers are studying both the nature

and rate of physiologic aging, looking for

possible means of slowing or preventing

these changes and related diseases


Biologic Changes in Aging

Nature of Biologic Changes

By the age of 70:

The kidneys will have lost about 28% of their weight

The liver will have lost approximately 25% of its

weight

Skeletal muscle will have decreased by almost half,

as compared to a young adult


Biologic Changes in Aging – Cont’d

Individuality of the Aging Process

Lifestyle choices, disease history, and

exposure to environmental hazards or

pollution act on genes to determine the rate

and severity of aging changes


Biologic Changes in Aging – Cont’d

Individuality of the Aging Process – cont’d

Because each person experiences a different set

of these influences over a lifetime, persons age at

different rates; thus older people of the same

chronologic age are very different from each

other, whereas young children of the same age

are biologically very much alike


Adult Health

Food Intake for Optimal Function

The Dietary Guidelines for Americans and

MyPyramid emphasize moderation and

variety and provide an outline for food

selection


Adult Health – Cont’d

Physical Activity for Optimal Function

Two types of physical activity promote fitness

and well-being:

1. Endurance exercise

2. Resistance exercise


Nutritional Needs of Older Adults

Maintaining Energy Intake

Daily energy needs range from 1600 to 2200

kcal for women and 2000 to 2800 kcal for men

Chronic conditions common in older adults tend

to increase energy needs


Nutritional Needs of Older Adults – Cont’d

Maintaining Energy Intake – cont’d

For persons above age 59 underweight carries

greater risk than moderate overweight

Geriatric physicians recommend that older

adults maintain a body mass index (BMI) of 22

or higher



Planning an Adequate Diet

Carbohydrates

Persons of all ages should obtain 45% to 65% of

their total energy from carbohydrates



Planning an Adequate Diet – cont’d

Fats

Fat intake is best contained within the range

of 20% to 35% of total kcalories; including fat

at the upper end of the range may help to

prevent weight loss when food intake is low



Planning an Adequate Diet – cont’d

Protein

Current RDA of 0.8 g/kg body weight may not

be sufficient for frail or chronically ill older

adults

Overall, 10% to 35% of total kcalories should

be supplied by good-quality protein



Vitamins

Vitamins of special importance to the aging

adult:

Folate

Vitamin B6

Vitamin B12

Vitamin D



Minerals and Electrolytes

In planning diets for older adults, the following

require particular attention:

Calcium

Potassium

Sodium



Water

Dehydration is a concern for both healthy and

chronically ill older adults

Older adults experience a change in the thirst

center of the brain and do not become thirsty as

they should



Water – cont’d

The general fluid requirement of 1500 ml/day

increases when either the outside or inside

temperature rises

High protein intakes will increase the need for

fluids

Monitoring fluid intake is especially important for

older persons who cannot drink or obtain fluids

without help


Nutrient Supplementation

Older adults with low energy intakes can

benefit from prudent, individually assessed

supplementation

May be needed to replenish losses following

critical or debilitating illness

Should be based on an individual

assessment and advice of a healthcare

professional


Influences on Food Intake

of Older Adults

Physical Changes

Decayed teeth, tooth loss, or poorly fitting

dentures all make chewing and eating both

painful and difficult

Losses in taste, smell, or sight reduce the

enjoyment of eating and lower appetite



of Older Adults – Cont’d

Multiple Medications

Can lower food intake by producing

Anorexia

Nausea

Unpleasant taste




Psychosocial Distress

Emotional loss arising from the death of a

spouse or physical separation from family and

friends causing depression can lead to

disinterest in food

Alcohol sometimes displaces food in the diet




Economic Problems

Lack of resources to purchase the quantity or

quality of food they should have

Chronic Illness and Disability

Food shopping and meal preparation can be

difficult or impossible with some physical

disabilities


Clinical Applications

Medical Nutrition Therapy

Under certain circumstances a medically indicated

diet may be appropriate; however, the greater the

restriction the more likely the rejection of the food

offered and consequent weight loss


Clinical Applications – Cont’d

Medical Nutrition Therapy – cont’d

Older persons with diabetes can often be well

managed on a regular diet if high-sugar items

are restricted

A regular diet—well-balanced nutritionally—

that offers a wide variety of foods with

moderation in fats and sweets has the best

outcomes


Clinical Applications – Cont’d

Support Programs for Self-Care

Expand knowledge about a condition and its

management, build emotional support, and

work with the individual and family to promote

creative decision making


Community Resources

for the Aging

Food Assistance Programs for Older

Americans

Food stamps

Commodities distribution program

Elderly Nutrition Program: national program with

the greatest impact on the nutritional status of

older adults


Food Assistance Programs

Elderly Nutrition Program

Funded under the Older Americans Act and

managed by the Administration on Aging

First authorized in 1972


Food Assistance Programs – Cont’d

Elderly Nutrition Program – cont’d

Intended to meet both the nutritional and

social needs of older adults

Operates in all 50 states and provides various

nutrition services based on local needs and

the funds available


Government Research

and Education Services

Research Centers of the United States

Department of Agriculture

Authorized by Congress to study the role of

nutrition in the aging process and help us learn

more about nutritional requirements at older

ages


Government Research

and Education Services – Cont’d

Extension Services of the United States

Department of Agriculture

Provide nutrition education classes and practical

nutrition materials for older adults and

community workers


Government Research


State Public Health Departments

Provide nutrition education and oversee nutrition

and health screening of older people in the

community


Government Research


State Departments for the Aging

Area agencies on aging manage congregate

and home-delivered meals programs on the

local level under the guidelines of the state unit


Professional Organizations

and Resources

National Council on the Aging

Nonprofit organization that promotes research,

training, technical assistance, advocacy and

public policy, program standards, and

publications relating to all aspects of aging



and Resources – Cont’d

American Geriatrics Society

Made up of physicians who provide medical care

to older patients

The Gerontological Society

Includes a wide range of health and social

service professionals




Volunteer Health Organizations

Organizations such as the American Heart

Association and the American Diabetes

Association

Support health and nutrition programs of interest

to older adults




Community Groups

Medical societies, nursing organizations, and

dietetic associations

Sponsor classes and programs to help meet the

needs of older adults in their communities

Chapter 13

Health & Medicine

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