The Aging Gastrointestinal Tract

GROUP 10
 Objectives
• Understand the components of the
gastrointestinal (GI) tract
• Understand how aging effects the GI
• Understand problems associated with the aging
GI
• Understand dietary interventions to maintain
adequate GI function throughout the lifespan
 Gastrointestinal System
– Oral cavity
– Throat (oropharynx)
– Esophagus
– Stomach
– Duodenum and small intestine
– Gallbladder
– Pancreas
– Liver
– Large intestine
– Rectum
– Anus
Age-Related Changes in the GI Tract

• Aging affects absorption and metabolism of

foods, vitamins and medications
• Aging results in increased susceptibility to
foodborne infections and other infections due
to decreased immune function.
• Table 7-1 pg. 103 – Age-Related Changes in
the GI Tract
GI Tract Problems in Older Adults
• The Oral Cavity
– Gum disease
• Teeth
– Dental caries and periodontal disease
• Oral and Throat Cancers
– Major cause is tobacco and alcohol
Gum Disease vs. Health Teeth
 Oral Health Problems & Food
Avoidance/Food Modification
• Oral health issues in older adults have been
associated with comprised dietary quality, likely
due to decreased fruit, vegetable, and nut intake.
• Older adults adapt their diet (through food
modification or avoidance) to address these
health problems.
• A report showed that having difficulty fixing meals
was associated with a greater risk of mortality,
even more than a lack of financial resources.
Savoca, M.R., Arcury, T.A., Leng, X., Chen, H., Bell, R.A., Anderson, M.A., Kohrman, T., Gilbert, G. H., and Quandt, S.A. (2010). Association between dietary quality of
rural older adults and self-reported food avoidance and food modification due to oral health problems. Journal of the America Geriatric Society. 58: 201. 1225-1232.
Rural Nutrition and Oral Health Study
(RUN-OH)
• A population-based, cross sectional survey of
the dietary intake with 635 adults aged 60 and
older.
– Food frequency questionnaire (HEI-500, based on
the amount of food per 1000kcal of intake)
– Food avoidance and food modification were
measured.
– Finally, oral health exams were completed for
those with at least one natural tooth
Savoca, M.R., Arcury, T.A., Leng, X., Chen, H., Bell, R.A., Anderson, M.A., Kohrman, T., Gilbert, G. H., and Quandt, S.A. (2010). Association between dietary quality of
rural older adults and self-reported food avoidance and food modification due to oral health problems. Journal of the America Geriatric Society. 58: 201. 1225-1232.
Rural Nutrition and Oral Health Study
(RUN-OH) - RESULTS
• Modifying foods in response to oral health
problems is associated with improved dietary
intake, even for those with severe oral health
issues.
• Strategies to minimize food avoidance and
promote food modification may help
personals with eating difficulties due to oral
health issues.

Savoca, M.R., Arcury, T.A., Leng, X., Chen, H., Bell, R.A., Anderson, M.A., Kohrman, T., Gilbert, G. H., and Quandt, S.A. (2010). Association between dietary quality of
rural older adults and self-reported food avoidance and food modification due to oral health problems. Journal of the America Geriatric Society. 58: 201. 1225-1232.
Methods to Prevent Dental Caries &
Periodontal Disease
1. Drink fluoridated water
2. Use fluoride toothpaste
3. Brush teeth carefully with a soft brush after meals
4. Professional oral care (even if no teeth are present)
5. Avoid tobacco (all forms)
6. Limit alcohol
7. Watch for changes in taste and smell (notify health
professional)
 High Fiber Foods and Periodontal
Disease Progression
• Research from the Dental Longitudinal Study found
that each serving of good to excellent sources of
total fiber was associated with a lower risk of
periodontal disease progression and tooth loss.
• Fruit consumption was also associated with a
lower risk of periodontal disease progression.
• Results: higher intake of high-fiber foods,
especially fruits, slow progress on periodontal
disease for men aged 65 and older.
Schwartz, N., Kaye, E.K., Nunn, M.E., Spiro, A., and Garcia, R.I. (2012). High-Fiber Foods Reduce Periodontal Disease Progression in Men
Aged 65 and Older: The Veterans Affairs Normative Aging Study/Dental Longitudinal Study. Journal of the American Geriatric Society.
60:676–683.
 Dysphagia & Odonophagia
• Dysphagia – difficulty with swallowing
– Signs: Pocketing of food in cheeks, speech
abnormalities with slurring of words, orofacial
changes, facial weakness, abnormal tongue
movement and foods becoming stuck if swallowed
• Odonophagia – pain upon swallowing
– Both may be caused by GERD (gastroesophageal
reflux disease)
 Swallowing
• A short video from Nestle Healthcare
discussing the swallowing process,
complications associated with dysphagia and
the importance of proper dysphagia
management.

• http://www.youtube.com/watch?v=jK1o3LSQmB0
 Management of Dysphagia
• Management of dysphagia includes:
– Targeting the cause (when possible)
– Consult with a speech therapist
– Beginning appropriate food and liquid consistencies
– Have someone eat with the older adult
– Monitor and control progression symptoms.
– If esophageal spasm are present, calcium channel
blockers may be prescribed.
 Dysphagia Diet
• Foods should be pureed, thickened or homogenous
• No raw foods except bananas
• Cut tender meat to 1cm or less
• Avoid nuts; raw, crispy food, stringy foods
• Liquids – thin, nectarlike (like eggnog, able to drink with a
straw), honeylike (like yogurt - eaten rather than straw) or
pudding-like.
 Aspiration
• Aspiration – a serious risk associated with dyphagia and
dysphasia (difficulty speaking)
– Caused by abnormal entry of food or fluid into the
airway.
– Foreign fluid or substance must be removed by
suction from the airway to promote breathing when
the airway is obstructed.
• Can cause airway obstruction but more commonly
results in pneumonia
– Treatment is antibiotics
 Management of Aspiration
• Older adult must concentrate at meals and avoid social
occasion at mealtime
• Sit upright in a chair (no eating in bed)
• Food should be taken and swallowed from the strongest
side of the mouth (if paralysis or unilateral weakness is
present)
• Sit upright for 30 minutes following a meal
• Choose foods which promote salivation
• Smaller, more frequent meals
Gastroesophageal Reflux Disease
(GERD)
• GERD is a condition in which the gastric contents move
backward (reflux) into the esophagus causing pain and
tissue damage.
– GERD is the most common GI disorder in older adults
– Symptoms include heartburn, water brash, sour taste
in mouth, belching, indigestion, dysphagia and
regurgitation
• 40% of older adults in the US experience these
symptoms
 GERD Management
First Line: Nutritional/Positional
• Avoid symptom-causing foods (fruits, chocolates, caffeine
drinks or alcohol, fried/fatty foods, garlic and onions, mints,
spicy foods, and tomato-based foods
• Stop eating large meals
• Avoid lying down 3 hours after eating
• Avoid tight-fitting clothes
• Lose weight if overweight
• Stop smoking
• Stop drugs that cause reflux (only with a consultation from
a primary caregiver)
 GERD Management
Second & Third Line: Pharmacological
• Second Steps:
– Antacids – Maalox, Mylanta or
Tums
– H2 Antagonists – cimetadine
(Tagamet), famotidine (Pepcid), or
ranitidine hydrochloride (Zantac)
• Third Steps:
– Proton Pump Inhibitors (PPIs) –
Prilosec/Nexium, Prevacid, and
Protonix
 Hiatal Hernia
• Hiatal Hernia – a physical
abnormality that allows the
stomach to protrude through the
diaphragm and up into the chest.
Often caused by weakened
musculature (specifically
esophageal muscles around the
opening of the diaphragm)
– Caused by heavy lifting,
coughing, lying flat in bed or
performing a Valsalva maneuver
 Peptic Ulcer Disease
• Peptic Ulcer Disease (PUD) – a duodenal or stomach
ulceration often caused by the bacterium Helicobacter
pylori.
– 80% of duodenal ulcers and 60% of gastric ulcers caused
by H. pylori
– Treatable with antibiotics.
• Second cause of PUD is NSAIDs (Nonsteroidal anti-
inflammatory drugs)
– Risk of ulcers 3x greater in NSAID users
• Signs of PUD include epigastric pain and coffee-ground
emesis.
 Nausea & Vomiting
• Nausea and Vomiting
– Main concern is dehydration
– If seriously ill, hospitalization and IV rehydration
may be considered
– Medication to stop nausea and vomiting may be
considered
• Caution: These drugs may cause confusion,
sedation and delirium in the older adult.
 Gastroparesis
• Gastroparesis – delayed stomach empting
– Normal stomach emptying – the stomach contracts
(controlled by the Vagus nerve) and food moves down
into the small intestine for digestion
– Symptoms include nausea, early satiety, vomiting,
pain and possibly heartburn from reflux
– Common causes: diabetes, idiopathic, and
postsurgical
• Occurs in 30% of those with type 2 diabetes
• Occurs in 27% to 58% of those with type 1
 Management of Gastroparesis
Dietary Recommendations:
– First Diet:
• Liquids to prevent dehydration, salt and mineral losses;
avoid milk products, vegetables, fruits, and meat; eat
saltine crackers and drink Gatorade
– Second Diet:
• Small amount of dietary fat, skim milk and yogurt; low-fat
cheeses; fat-free bouillon and soups made with skim milk
and with pasta; cream of wheat; white rice,; eggs; peanut
butter; vegetable juice; well-cooked vegetables w/o skins;
apple, cranberry, grape, pineapple and prune juices;
canned fruits without skins
– Avoid citrus fruits
Management of Gastroparesis
• Third Diet
– All items in Diet 2 with the addition of poultry, fish,
and lean ground beef; breads and cereals; coffee,
tea and water
– <50 grams of fat/day
– Restrict non-calorie fluids if calorie intake cannot be
maintained
• Enteral and parenteral nutrition if symptoms flare,
weight loss (10% over 6 months), nutrient deficiencies,
or electrolyte imbalances
 Malabsorption
• Some defect that occurs during digestion and
absorption of food nutrients
• Can occur at any of the three phases of digestion:
– (1) Luminal Phases – dietary fats, proteins and
carbohydrates are hydrolyzed and solubilized
– (2) Mucosal Phase – brush-border membrane of intestinal
epithelial cells transport digested nutrients from the
lumen into cells
– (3) Postabsorptive Phase – lipids and other nutrients are
transported from epithelial cells via the lympatic system
and portal circulation to other parts of the body
 Malabsorption
• Causes
– Pancreatic insufficiency (20-30% of older adult
malabsorption cases)
– Anatomic abnormalities (30%) – stasis and predispose
to bacterial overgrowth
– Bacterial Overgrowth Syndrome w/o anatomic
abnormalities (20%)– inadequate gastric acid secretion
• Pernicious anemia and vitamin B12 deficiency are
common
• Treatment will be dependent on the cause.
 Steatorrhea
• Steatorrhea – production of stools containing an
abnormally high amount of fat
– Hallmark of malabsorption
– Stool smells foul, bulky and difficult to flush down
the toilet
– >6% of dietary fat is excreted in feces
– Clinical signs: anemia, deficiencies in iron, folate,
B12, Vit K or a combination, easy bruising
 Steatorrhea
• Diagnosis: 72-Hour Stool Collection
– If fecal fat is >40 g, pancreatic insufficiency or small
intestine mucosal disease indicated
• D-xylose test to differentiate
• Treatment: Correct nutrient deficiencies and treat underlying
causes
– Iron supplement via ferrous sulfate or gluconate tablets
– Monthly B12 injections
– Supplement fat-soluble vitamins and calcium
– High protein/calorie, low-fat diet prescribed
– MCT supplement
 Behavior Assessment
Lack of Irregular
Overeating/
physical Poor diet eating
stress
activity pattern
Indigestion
Constipation Constipation
Indigestion
Nausea

Constipation Gas Bloating

Heartburn Heartburn

Diarrhea Bloating Indigestion

Gas
Constipation
Heartburn Heartburn
Bloating

Used with permission from the “Nourish Your Digestive System” program by Julie Garden-Robinson, NDSU Extension Service
 In Summary
• Basic age-related gastrointestinal changes may
impact absorption and metabolism of food,
vitamins and medication
• Special attention needs to be paid to oral
health issues, including chewing and
swallowing, which may impact nutritional
status
• Prevention is key to many age-related
gastrointestinal issues