Nutrition and Exercise in the Older Person - ACCP

1 PSAP-VII Geriatrics157 Nutrition and Exercise in the Older PersonLearning Objectives 1. Analyze an Older adult s Nutrition status in order to recommend dietary Assess the potential risk factors for and conse-quences of weight loss or obesity in an Older Evaluate the overall risks and benefits of Design the basic components of an Exercise reg-imen for the Older adult with underlying health Evaluate the appropriateness of a diet and Exercise program to meet an Older adult s health promotion Characteristics of Proper Nutrition Proper Nutrition plays a critical role in the preven-tion of many diseases and conditions associated with aging. Adequate Nutrition and maintenance of a normal weight also help maintain optimal physical and mental function as a Person ages.

2 The adverse effects of excess weight are different in people Older than 65 years than in younger individuals. In the healthy aging adult, body weight tends to peak in the 60s and remains somewhat stable into the 70s. A fter 70 years, weight tends to decrease slowly. For the Older adult, obesity is not associated with an increase in mortality. For instance, in one large cohort of men and women ages 70 to 75 years that used body mass index (BMI) cutoffs of less than kg/m2 as under-weight, kg/m2 as normal weight, 25 k g /m2 as overweight, and 30 kg/m2 or greater as obese, individuals who were overweight had a risk of death that was 13% lower than individuals of normal weight.

3 The death rate for obese individuals was about the same as for those of normal weight. Data from several studies show a U-shaped mortality curve with minimal mortal-ity risk in patients with a BMI range of 25 34 kg/m2. Some literature suggests that body fat distribution is as important a risk factor as being overweight. But, once again, individuals Older than 65 years have a mortality risk different from that of younger people when assess-ing fat distribution. The Third National Health and Nutrition Survey examined the relationship between weight and anthropometric measurements and mortal-ity in 34,000 individuals. Abdominal obesity, assessed by waist-to-hip ratios, was associated with an increased mortality in people younger than 65 years but was unre-lated to mortality in people Older than 65 years.

4 For Nutrition and Exercise in the Older PersonBy Erica L. Estus, Phar , CGP; and Nor ma J. Owens, Phar , FCCP, BCPSR eviewed by Carol Fox, , CGP; Katherine H. Chessman, , FCCP, BCPS, BCNSP; and Anita Patel Rahman, , BCPSB aseline R eview R esources The goal of PSAP is to provide only the most recent (past 3 5 years) information or topics. Chapters do not pro-vide an overall review. Suggested resources for background information on this topic include: Department of Health and Human Services and Department of Agriculture. Dietary Guidelines for Americans, 6th ed. Washington, DC: Government Printing Office, January 2005. Available at Accessed May 8, 2011. Department of Agriculture and Department of Health and Human Services.

5 Dietary Guidelines for Americans, 7th ed. Washington, DC: Government Printing Office, December 2010. Available at Accessed May 6, 2011. Department of Health and Human Services, 2008 physical activity Guidelines for Americans, October 2008. Available at Accessed May 6, 2 Geriatrics158 Nutrition and Exercise in the Older Personinstance, in women with waist-to-hip ratios greater than , mortality was markedly higher for women in the 18 65 group but did not rise for women in the Older age groups (65 75 years or 75 years and Older ). As adults age, there is about a ( lb) loss of lean body mass each year, beginning in the fourth decade of life. W hen an Older Person loses metabolically active muscle tissue, adiposity increases such that total body weight is maintained.

6 Because adipose tissue is less metabolically active than muscle, caloric (energy) requirements decrease with age. Sarcopenia is the term for this loss of skeletal muscle mass, which is responsible for a reduction in strength and function that can lead to physical disability. Factors that contribute to the devel-opment of sarcopenia include muscle disuse, age-related decreases in several hormones, activation of inflamma-tory cytokines, and anorexia. Sarcopenia with anorexia, activation of the immune system, and anemia usually lead to the loss of physical mobility and further weight loss, referred to as the frailty syndrome. One possible approach to combat this cycle of decline is adequate Nutrition and Exercise .

7 A lthough obesity (measured by BMI) is not corre-lated with mortality in Older adults, it is related to loss of physical function. Obesity (BMI greater than 30 kg/m2) in the Older adult is a serious health care concern because of its relationship to physical disability. In a prospective longitudinal study conducted over 20 years, Older adults who were obese at study inception had higher rates of upper and lower body disability. Adults who began the study with a normal BMI but became obese over time also had high disability rates; however, adults who were obese at study inception and who lost weight continued to exhibit high upper and lower body disability.

8 In Older obese adults with physical disability, both losing weight and developing a physical Exercise program may be needed to restore function. Weight loss is recommended as a therapeutic inter-vention in overweight and obese adults with certain dis-eases such as type 2 diabetes mellitus, coronary artery disease, and obstructive sleep apnea. In one random-ized, controlled trial of weight reduction for obese indi-viduals with osteoarthritis (average age 69 years), those randomized to weight loss were half as likely to die at 18 months. Weight loss in young and middle-aged over-weight and obese adults is associated with improve-ments in a variety of health risks.

9 However, weight loss to achieve improved patient outcomes in the elderly remains controversial. The important variable to assess in weight loss in Older peo-ple may be whether the loss is intentional. In one pro-spective cohort of more than 900 community-dwelling people (average age 75 years), factors that were corre-lated with an increase in mortality at 3 years included being underweight (BMI less than kg/m2) or unintentional weight loss. Individuals with intentional weight loss had the same mortality rate as those who did not lose weight. Distinguishing the etiology of weight loss may be the critical factor in evaluating the mortal-ity impact of weight loss in Older people.

10 In an Older adult, unintentional weight loss in 1 month that exceeds 5% of usual body weight requires evalu-ation. Appetite may decline because of the loss of the sense of smell. In addition, Older adults may experience a decrease in taste sensitivity, often developing a prefer-ence for sweet and salty flavors. Changes in the gastroin-testinal tract can contribute to appetite changes. Aging leads to a loss of compliance of the fundus of the stom-ach, which causes more rapid antral filling. Distension of the antrum signals the central nervous system to indi-cate satiety. Cholecystokinin, a satiating agent released in response to fat in the gastrointestinal tract, is released in higher concentrations in Older adults.