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Home My WebLink Aboutzernicke-art-of-healthy-eatingTHE ART OF EATING WELL: OLDER ADULTS MARY LOUISE ZERNICKE MS MPH RDN CSG ALAMEDA COUNTY AREA AGENCY ON AGING TRUE OR FALSE??? •Zip code is as important to health as genetic code. TRUE OR FALSE??? •Heart Disease is the number one killer of older adults. TRUE OR FALSE??? •Vitamin D is needed to improve muscle strength. KEY SOCIAL DETERMINANTS OF HEALTH FOR OLDER ADULTS •Income •Food insecurity •Transportation •Social support •Health Access •Safety •Stress White Paper Better Medicare Alliance Nov 2018 HEALTH OUTCOMES •Physical Environment =10% •Social and Economic Factors = 40% •Health Behaviors = 30% •Clinical Care = 20% POPULATION BY AGE: US CENSUS THE FUTURE OF AGING THE FUTURE OF AGING AGING AND DISABILITY AGING AND INCOME OLDER ADULT SOCIOECONOMIC STATUS 16%20%12%10%9% 18%19% 14%12%18% 66%60%74%78%73% 0% 20% 40% 60% 80% 100% <12 12-24 25-44 45-64 65+ Age Group <100% of FPL 100%-199% of FPL 200%+ of FPL •About 1 in 10 older adults live in poverty •Over 1 in 4 older adults earn <200% of FPLSource: American Community Survey, 2011-2013 Poverty Levels by Age Group SENIOR HUNGER 8.8 million seniors –or nearly 1 in 6 –faced the threat of hunger in 2016 in CA. California data indicates higher numbers of seniors are food insecure –up to 1/3. Alameda County20% of food bank users are older adults Source: Gunderson, Craig and Ziliak, James. "The State of Senior Hunger in America 2011: An Annual Report." National Foundation to End Senior Hunger, September, 2013. MALNUTRITION AND POVERTY AND HEALTH IMPACTS 14 •33% of older adults admitted to hospital may be malnourished •Up to 50% of community dwelling seniors malnourished •Malnutrition increases health care costs by 300%. •Food insecure seniors are 50% more likely to have DM, 3X more likely to be depressed, 60% more likely to have CHF or heart attack, 30% more ADLs, 2X more gum disease and asthma OTHER ISSUES AFFECTING NUTRITIONAL STATUS OF OLDER ADULTS •Dentition •Cognition •Food access •Ability to shop •Ability to cook •Depression •Food-medication interactions EATING ALONE CAN BE HAZARDOUS TO YOUR HEALTH •Proper nutrition vs social engagement •Eating alone associated with eating less (or eating more!) •Eating alone associated with higher rates of malnutrition Depression Lack of motivationSenior Center Without Walls 17 THE IMPACT OF STRESS: LACK OF CONTROL, SAFETY, INDEPENDENCE Physiology of Stress –Cortisol •Increases blood glucose –Abdominal Weight Gain High Cortisol Levels –High Blood Pressure –Reduced Cognition HOW TO LOWER CORTISOL LEVELS •Magnesium •Omega 3’s •Adequate Sleep •Massage •Laughing •Dancing •Music (some studies show an impact) CAN WE CHANGE THE HEALTH HABITS OF OUR CLIENTS? PHYSIOLOGICAL CHANGES WITH AGING THAT AFFECT NUTRITIONAL STATUS •Basal Metabolic Rate •Taste Acuity •Thirst Reflex •Gastric Acid Secretion •Nephron Function and Kidney Clearance •Thinning of the dermis KEY NUTRIENTS OF CONCERN FOR OLDER ADULTS: AVOIDING MALNUTRITION •Fluids •Calories •Protein •Fiber •Antioxidants •Vitamin B-12 •Vitamin D •Calcium H²O…..FLUIDS –Hydration •How much is enough? •Symptoms of dehydration •Hydration and falls •Incontinence/ UTIs CAFFEINE 24 RISKS OF OVERWEIGHT AND OBESITY •Chronic Disease –Diabetes –Cancer –Heart disease –Etc. •Osteopathic problems –Mobility –Attendant care CAN BEING UNDERWEIGHT BE A PROBLEM? •Risk of osteoporosis •Strength and endurance •Rapid weight loss associated with mortality ROLE OF GUT BACTERIA MANAGING OUR MICROBIOME Insoluble fiber:grains, beans Bulking effect to move food through the colon Soluble fiber:fruits and vegetables Aides digestion by increasing bacteria in the gut Adds water to feces We need both types!!! TYPE 2 DIABETES AND DEMENTIA •Dementia called “Type 3”, or Brain Diabetes •Due to visceral fat deposits so more dangerous during middle age •Does insulin repair or destroy? –Insulin appears to protect synapses –Competes with enzymes that break down beta-amyloid plaques? –Really due to C/V risk? 29 PROTEIN NEEDS FOR SENIORS •Need muscle strength to stop falls •How much? 1.0-1.2 gms/kg •About 6 ounces of meat or equivalent per day •Where found? –Meats –Eggs –Fish –Dairy –Legumes –Nuts CALCIUM •Sources •How much is needed? •Should older adults take supplements? DISEASE PREVENTION AND VITAMIN D •Osteoporosis •Muscle Weakness •Cancers •Autoimmune disease •Hypertension •Fall prevention? HOW MUCH VITAMIN D? VITAMIN B -12 CAUSES OF B -12 DEFICIENCY •Pernicious anemia/ Autoimmune disease •Food-bound vitamin B-12 malabsorption •Atrophic gastritis •History of ulcers 35 RECOMMENDATIONS FOR OLDER ADULTS: B -12 •Food and Nutrition Board recommends that all adults over 50 years of age get most of their RDA (2.4 mcg) from fortified foods or supplements •Many experts recommend 100-400 mcg daily for adults over 65 ANTIOXIDANTS AND PHYTOCHEMICALS •Vitamins A, C, E •Selenium, Zinc •Carotenoids •Polyphenols •Lycopene •Co-Enzyme Q EAT •ALA YOUR •Lipoic Acid COLORS!!! 37 ANTIOXIDANT RESEARCH •Stabilize “free radicals” •Free radical damage implicated in… Cancer CV Disease General cognitive decline Alzheimers Macular Degeneration and Cataracts 38 ROLE OF OMEGA -3 FATTY ACIDS ROLE OF SODIUM •Increased sodium can result in increased loss of calcium in the urine •Increased blood pressure in sensitive individuals •Are their other concerns? Controversy surrounds sodium recommendations MAJOR NUTRITION -RELATED RISK FACTORS FOR FALLS •Alcohol intake •Dehydration •Protein ?? •Vitamin D?? •Calcium?? SHOULD OLDER ADULTS TAKE SUPPLEMENTS? •Vitamin D •Vitamin B-12 •Calcium ? •Omega 3’s ? •Antioxidants ? 42 FOOD SAFETY AND OLDER ADULTS •Lower Immune Function •Different Agricultural Practices CAL FRESH EXPANSION: ELIMINATING CASH -OUT PHYSICAL ACTIVITY •Aerobic 3X a week PHYSICAL ACTIVITY, CONT Balance 3X week PHYSICAL ACTIVITY, CONT. •Strength 2X week 1 -800 -222-2225 50