Nutrition and Older Adults: Issues Among Community and Long-Term Care Residents

Nutrition and Older Adults:
Issues among Community and

Long-Term Care Residents
Jean Helps, RD1 and Christina Lengyel PhD, RD2
1Clinical
Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Services
2AssistantProfessor, Human Nutritional Sciences, Faculty of Human Ecology,
University of Manitoba
Outline
 Canadian Demographics
 Factors affecting Nutritional Intake
 Long–Term Care Setting
 Rural and Urban Communities
 Nutritional Guidelines and
Recommendations
 Take Home Messages
Demographics……..Now
Demographics……..Future
Osteoporsis Diabetes Celiac Disease Malabsorption Palliative Care
Syndromes
Pressure Congestive
Superbugs
Ulcers Heart GERD
Failure ALS
Obesity
Renal Disease
Nutrition Falls
Malnutrition Issues Anemia
Parkinson’s For Older Constipation
Disease
Adults Alcohol
Pneumonia Stroke Abuse
Dementia
Multiple
System Issues
COPD Sclerosis
Dysphagia
Family Related
Mental Illness Cancer Osteoarthritis Issues
Nutrition and Quality of Life
 Healthy food choices positively influence the

quality of life of older adults.
 Older adults are at risk for inadequate
dietary intakes which may lead to:
– Poor nutritional status
– Decreased quality of life
– Functional disability
– Increased health care costs
– Greater risk for morbidity and mortality
Factors Affecting
Nutrition Status
 Physiological
– Declining digestion and absorption
– Reduced sensory perception
 visual, olfactory, taste acuity, thirst
– Anorexia of Aging
 Physical
– Chewing and swallowing difficulty
– Affects on body systems
 Integumentary (skin), renal,
musculoskeletal, cardiovascular
Factors Affecting
Nutrition Status (cont’d)
 Psychological
– Depression
– Loneliness
– Dementia
– Food likes/dislikes
 Social and Economical
– Poverty
– Transportation availability
– Lack of knowledge of nutrition
– Inadequate cooking knowledge (men)
– ↓ Social support
Factors Affecting
Nutrition Status (cont’d)
 Cultural beliefs
– Provision of culturally appropriate food
and setting are both important
(Wu and Barker, 2008)
 Others
– Medical conditions
– Prescribed diets
– Medication side effects
The Continuum of Care
Long-Term Care Setting
Malnutrition
 Inappropriate amount of, or quality of

nutrients comprising a healthy diet are not
consumed for an extended period of time
Undernutrition:
 Often thought to be a problem of third world
countries
 Inadequate consumption, poor absorption, or
excessive loss of nutrients
Overnutrition:
 Excessive intake of specific nutrients
Prevalence of
Malnutrition in the Elderly
Hospitalized Patients:
 32% to 50%
Long Term Care:

 5% to 85% (Average= 30%)
Causes of Malnutrition-
Organizational
 Failure to help residents eat or recognize
malnutrition
 Importance of nutrition not realized
 Absence of Dietitian
 Lack of staff, lack of communication,
inadequate training and education
 Monotonous diet, inappropriate diet or
mealtime environment
 Inappropriate medication prescribing
(Cowan et al., 2004)
Liberalization of the
Diet Prescription
Therapeutic diets may contribute to malnutrition
through restriction of:
 preferred food & beverages
 components in food which promote intake

(e.g., salt)
 Culturally significant foods
* A balanced approach is needed in assessment

Combating Malnutrition –
Dining Room Set-up for
Residents with Dementia
 Simplify the environment
 Simplify the food – Provision of too
many foods at one time leads to over-
stimulation, agitation and reduced
intake
 Communicate
 Provide flexible care
– Self-feeding if possible (i.e., finger foods)
Nutrition Based
Interventions
 Oral Nutritional Supplements
 Changes to the meal pattern:
– Protein, energy enriched foods
– Small, frequent meals (i.e., between meal
snacks)
– Individualizing the meal pattern to
accommodate social and cultural
preferences
Nutritional Issues in Rural
and Urban Communities
Prevalence of Malnutrition
Undernutrition:
 5% to 20% prevalence of malnutrition
 ~40% are at risk of malnutrition
Overnutrition:
 Increasing in all age groups
 25% obesity among adults 65+ and older

Baby Boomer and
Nutrition Study
 10 focus groups conducted in rural
and urban Manitoba communities
 8-12 participants/group recruited by
MAFRI GO Team Representatives in
specified areas
 All participants completed a focus
group questionnaire
 Moderator facilitated the sessions for a
2 hour period
Preliminary Key Findings
 Distrust in nutrition labeling
 Misleading advertising on packaging
 Importance of locally grown foods, their
availability in local markets and supporting
the local economy
 Portion control on packages
 Costs associated with healthier products
 Environmental concerns
 More nutrition education needed
 Importance of flavor, texture, taste and
variety in food products
Nutritional Guidelines
and Recommendations
(www.healthcanada.gc.ca/foodguide)
Reading Food Labels
 Compare the Nutrition

Facts Table on food labels
to choose products that
contain less fat, saturated
fat, trans fat, sugar and
sodium.
 The calories and nutrients
listed are for the specific
amount of food found at
the top of the Nutrition
Facts Table.
(http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/educat/info-nutri-label-etiquet-eng.php)
(Canadian Diabetes Association and Dietitians of Canada, 2007)
Dietary Fibre
 Increase dietary fibre intake to 21 g/day for

women and 30 g/day for men (51+ years)
 Replace refined cereals and flour products
with whole grain foods
 Increase fibre slowly to prevent excessive
bloating, cramping, flatulence and diarrhea
 Drink adequate amount of fluids
 Examples: oat bran, psyllium, legumes,
fruits, vegetables, wheat bran, flax seeds
Fluid Intake
Dietary Reference Intake (DRIs) (51+ years)

 Females: 2.7 L/day total water
(2.2 L = 9 cups total beverages)
 Males: 3.7 L/day total water
(3.0 L = 13 cups total beverages)
 NOTE: these values may be difficult to

achieve for older adults due to reduced food
intake. Aim for 6-8 cups per day.
Vitamins and Minerals
 Vitamin D
– Current DRI’s are:
 Males and Females 51-70 years: 10 ug (400 IU)
 Males and Females 70 +years: 15 ug (600 IU)
– Canada’s Food Guide recommends an

additional daily vitamin D supplement of 10
ug (400 IU) for everyone over the age of 50
– New research is demonstrating a need for
increasing vitamin D requirements for older
adults
Canada’s Physical Activity Guide to Healthy
Active Living for Older Adults
(www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html)
Take Home Messages
 Nutrition is one of the major determinants of
healthy aging
 Individualized care
– Ensuring effects of aging are considered
 High quality diet is important across the lifespan
 Consume a variety of nutrient dense foods from the
four food groups
 Nutrient supplementation with low-dose
multivitamin and mineral supplements can be useful
in achieving recommended intake levels
 Enjoy your meals!
Resources
 Dietitians of Canada
– www.dietitians.ca
 Eating Well with Canada’s Food Guide
– www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
 Canada’s Physical Activity Guide for Older Adults
– www.phac-aspc.gc.ca/pau-uap/fitness/pdf/guide_older_e.pdf
 Nutrition Labelling
– www.healthcanada.gc.ca/nutritionlabelling
 Alzheimer Society of Canada
– www.alzheimer.ca/english/care/dailyliving-mealtime.htm
“If we knew what it
was we were
doing, it would not
be called research,
would it?”
Albert Einstein
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Nutrition and Older Adults:

Issues among Community and

 Healthy food choices positively influence the

 Inappropriate amount of, or quality of

Long Term Care:

 components in food which promote intake

* A balanced approach is needed in assessment

 ~40% are at risk of malnutrition

 25% obesity among adults 65+ and older

 Compare the Nutrition

 Increase dietary fibre intake to 21 g/day for

Dietary Reference Intake (DRIs) (51+ years)

 NOTE: these values may be difficult to

– Canada’s Food Guide recommends an

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