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Mapping nutrition for older adults is a forthcoming challenge.

Adequate nutrition is essential, especially to the elderly in many ways.

Everyone requires food to survive. Food builds our body’s cells and holds it in good shape and proper functioning.

Proper nutrition reduces the infection and increases the healing period after surgery or an injury in the elderly.

Many mental symptoms that have been associated with aging and senility could be traced to poor nutrition for older adults.

     Since the turn of the century, the average life expectancy of man has been steadily rising. This is due to an improvement in dietary practices and better overall health in the seniors.

NEED FOR NUTRITION FOR OLDER ADULTS

1. To delay and minimize degenerative changes happening in the old age and associated health problems such as diabetes, hypertension, and heart problems as well as dental problems.

2. Complete denture prosthesis depends, ultimately, upon the health and integrity of the oral tissues for successful function and your comfort.

PROPER NUTRITION FOR OLDER ADULTS

PROTEIN

A protein is believed to be biologically perfect if it contains all the essential amino acids (EAA), an amount matching to human needs. When one or more of EAA is lacking, protein is said to be biologically incomplete.

The nature of dietary protein is closely related to its pattern of amino acids.

Why should you eat meat?

Animal proteins are considered better to vegetable proteins because they are biologically complete.

Of the total calorie need, a protein intake of 12.14% is sufficient for normal body metabolism. Seniors may be advised either high protein or low protein nutrition diets.

A low protein diet is indicated in adults with weakened kidney function.

A high protein diet is prescribed in situations like surgery, trauma, or illness.

VITAMINS

Vitamin does not provide energy but allows the body to use other nutrients.  

Since the body is generally powerless to manufacture them (at least an adequate amount), they must be provided by food in the diet.

VITAMIN A

Vit. A is needed for good vision, youthful skin, and growth and development.

Recent studies also suggest anticancer properties to vitamin A.

Sources – Fish liver oil, butter, ghee, milk, carrots green leafy veg, pulses 

VITAMIN B – COMPLEX

Sources – milk, egg and liver, whole wheat pulses, green leafy veg, nuts, oilseeds, etc.

     Malnourished older people can be seen to be lacking in the blood cells forming nutrients like iron, folic acid, and Vit B12.

 Anemia can result from malabsorption, alcoholism, and poor nutrition for older adults.

CARBOHYDRATE

The carbohydrate reserve rapidly consumes when a man is fasting.

If the dietary carbohydrate does not reach the energy demands of the body, protein, and glycerol from dietary and endogenous roots are used by the body to maintain homeostasis.

Carbohydrates stored in the liver and muscles as glycogen can be rapidly broken down into glucose to produce energy in an emergency.

Over half the energy demand of the body is received from carbohydrates.

     The amount of carbohydrate intake in the diet increases as the income of the family declines as they are more economical than fish and meat or fats and oil.

Why developing countries like India have a nutrition crisis?

In fact, an Indian diet matches ill-balanced due to extreme carbohydrate content.

     Carbohydrates are an energy-yielding source.

Poor nutrition with a sense of taste and smell is less sharp among the older adults, which hinders the craving for many foods.

During old age, loss of teeth makes it hard to chew the food.

Older people tend to eat more carbs with poor nutrition value such as foods that require less chewing, need least cooking time and supreme storage.

FATS AND OILS

Fats and oil make food enjoyable and help in the absorption of fat-soluble vitamin-like A, D, E, and carotene.

The fat intake for the elderly in a nutrition diet must be less than that of young adults.

Excessive consumption of animal fat increases the blood cholesterol, which may be a contributory factor for the developing heart disease, but an increase of blood b-lipoproteins in serum is considered a more critical factor nowadays for the causation of illness.

FIBERS

A low intake of fiber is usually seen in older adults, particularly denture wearers, as fiber-rich food may be tough to eat.

Why do people with dentures have constipation and diabetes?

     Low consumption of fiber is correlated with conditions like constipation and diabetes. Such situations in the elderly may be released by promoting nutrition foods high in fiber such as raw vegetables and fruits.

If these foods are hard to eat because of denture problem then bran cereals, cooked prunes or figs may be suggested. 25-30 gm, the nutrition value of fibers is suggested for the elderly.

Sources – Green leaves, fruits, cereals, pulses, and legumes.

WATER

About 60% of body weight is water. Water deficiency and dehydration are more common in elders. This may be somewhat due to a drop in extracellular water, which has been determined to exist from the eighth decade of life.

A consumption of six to eight cups of water one day is a must.

MINERALS

More than 50 chemical elements are found in our human body, which is required for growth repair and regulation of vital body function.

IMPORTANCE OF NUTRITION FOR ELDERLY

The happiness of food is considered as a crucial determinant of an adult’s quality of life.

Loose teeth, lack of teeth, or ill-fitting dentures may obstruct us from having our pet food as well as limit the consumption of necessary nutrients.

Decreased chewing ability, fear of choking, and irritation of the oral mucosa while chewing also may influence the food choices of the denture wearer.

Conversely, the nutrition status of a denture patient affects the health of the oral tissues and how well an elderly adapts to a new denture.

If you find difficulty eating with your new denture, we have a solution to all your problems.        

In fact, well designed and constructed dentures or may prove to be dissatisfying for few people due to poor tolerance by the underlying tissues and bone; hence, denture failure can be not only due to imperfect design but also due to poorly nourished tissues.

     Clinical symptoms of malnutrition are observed first in the mouth.

Active cell turnover in the mouth demands a properly balanced consumption of vital nutrients for the livelihood of oral tissues.

Poor long term nourishment may end in angular cheilitis, glossitis, and delayed tissue healing in the elders.

The degree of bone loss following tooth extraction may be amplified by low calcium and Vit D intake.

     Nutritional risk increases with advancing age.

Persons over 70 years of age are more likely to have a poor diet. Because the majority of edentulous ( lack of teeth ) adults are of advanced age, a large number of denture patients can be explained to have nutritional deficits.

The nutrition for older adults also is influenced by economic leadership, social detachment, degenerative diseases, medication requirements, and dietary supplementation particles.

        Dietary guidance based on an assessment of the elderly nutrition history and diet should be an integral part of a comprehensive prosthodontic treatment.

Nutrition support will improve the tolerance of the oral mucosa to the new denture and prevents the rejection of dentures in the elderly. Because denture fabrication requires a series of appointments, dietary analysis and counseling can be easily incorporated into a treatment plan.

IMPACT OF DENTAL STATUS ON HEALTHY NUTRITION FOR OLDER ADULTS

Nutrient intake in old individuals closely relates to dental status and masticatory efficiency. Although a sound dentition is not an obligation for sustaining nutritional health.

The loss of teeth oftentimes affects adults to pick a diet that is lower in nutrient density.

Investigation in the United States and Sweden have reported that adults with compromised dentition are over-represented in groups with a poor diet.

Poor nutrition quality diets were reported by the elderly who had low educational attainments or low family income or who were partial or complete dentures.

Male denture wearers have poor nutritional intake than females. Specifically mean intake of calories protein vitamin A, ascorbic acid, Vit B6, and folic acid were lower in male denture wearer than in dentate men (having teeth).

     Calcium and protein intake of female denture wearer’s are inferior to those of dentate women (having teeth).

     In a subset of the USDA subjects (united states department of agriculture-human nutrition research center on aging in Boston), the nutrition intake of those who had one or two complete dentures was about 20% lower than that of the dentate (having teeth) individuals.

     Our masticatory ability is mainly determined by age and the number of natural teeth in the mouth.

There is general agreement that the masticatory function of the elderly wearing dentures is greatly inferior to the people having teeth.

People wearing dentures must complete a greater number of chewing strokes to prepare food for swallowing. People with dentures do not reduce the food to a small particle size even with the additional chewing.

     Because of the impaired chewing ability, texture and hardness determine the acceptability of food for many denture wearers rather than the taste and smell.

Generally, the intake of harder food (raw vegetables or fruits, fibrous meat, hard bread, etc.) is lessened, whereas the intake of soft food (ground beef, cereals, pastries) is put up.

Whether these changes in food selection negatively affect the nutritional status depends on the nutrient density of food substituted.

     Wearing of the denture by people without teeth for several years improves the quality of their diet.

Fruits raw vegetables, bread, cheese, and meat are more frequently eaten by these persons after denture placement.

The condition of an individual’s denture also may influence food selection. When new complete dentures replaced old ones that had poor retention, the nutrition and chewing performance of the elderly is improved. They can chew better and chew different foods.

The use of dental implants in the treatment of seniors increases the variety of food eaten. Chewing ability is markedly improved following the insertion of a lower fixed prosthesis on the dental implants.

     The inability to distinguish the taste quality of food reduces an elderly enjoyment of eating and may lead to a low nutrition calorie intake.

Because a decrease in taste and smell acuity frequently accompanies aging, it is difficult to separate the effects of aging and denture wearing on taste acuity.

Nearly all the denture wearers complain about a transient decline in taste acuity when dentures are first inserted. This is usually attributed to denture base coverage of the hard palate.

     The comfort of wearing dentures is dependent on the lubricating ability of saliva in the mouth.

If the oral mucosa is dry, denture retention is compromised, and mucosal soreness or ulceration develops.

Because salivary flow facilitates mastication, the formation of the food bolus, and swallowing, it is a major contributor to the pleasure of eating.

Xerostomia (dry mouth) is a clinical indication of salivary gland dysfunction. There are several causes of dry mouth, the use of medication, therapeutic radiation to head and neck, diabetes, depression, alcoholism, pernicious anemia, menopause Vit A or Vit B complex deficiency and autoimmune disease such as Sjogren’s syndrome.

However, the ability to taste usually improves as an older individual adapts to the dentures when compared with a dentate adult or partial denture wearers.

Denture wearers are significantly less able to detect differences in the texture and sweetness of certain food.

     The management of dry mouth depends on the foundation of the condition.

If a drug is doubted to be the reason for the cause, consulting the patient’s physician may result in an alternative drug being appointed or change of the dose.

Saliva replacements are available but regrettably have not shown to be satisfactory to many people and, moreover, are also costly.

Milk has been recommended as a saliva replacement.

milk improves water in the mouth

Milk not only helps in greasing the tissues and improve the enjoyment of eating but also has a buffering action.

This may be a great benefit when overdenture abutment teeth (implant) are present.

Dry mouth may result in inadequate nutritional intake.

The consumption of milk not only works as a saliva substitute but is an outstanding source of nutrients.

GASTROINTESTINAL FUNCTIONING

        Little research exists on the effect of tooth loss on the incidence of choking on food.

The purpose of mastication is to reduce the food particles in size so they can be swallowed and to increase the surface area exposed to digestive juices and enzymes.

Complete denture wearers may not detect a foreign object in the mouth due to impaired tactile sensitivity. These older adults are at higher risk of having large pieces of food or bone lodge in the air or food passage.

     Inadequate mastication appears to cause gastrointestinal disturbances. For example, the use of laxatives, antacids, anti-reflux drugs, and antidiuretics was significantly higher in elderly edentulous Canadians with poor masticatory performance.

A nutrition diet high in fiber helps to prevent constipation in the elderly.

NUTRITION NEEDS AND STATUS OF ELDERLY

     The nutrition for older adults differs depending on medical condition and level of physical activity. Thus it is hard to generalize about energy, vitamin, and mineral requirement appropriate for all older individuals.

Depending on the level of body functioning, an individual may need more or less of nutrients proposed in the recommended dietary allowances (RDA) for his or her chronological age.

     Energy needs to decline with age due to a decrease in basal metabolism and decreased physical activity. This leads to a decrease in the metabolic rate.

The onset of a chronic disease usually leads to a decline in physical exercise.

     The best means of reducing calorie intake is to replace food high in fat with a complex carbohydrate. These should be the mainstay of the elderly’s food.

     Oral symptoms of poor nutrition in the elderly are usually due to a nutrition lack of the vitamin B complex (Iron or protein) vitamin B12 deficiency.

Lack of intrinsic gastric factors required for the absorption of the vitamin leads to Vit B12 deficiency.

Achlorhydria or deficiency of hydrochloric acid in the gastric secretions common in the elderly also results in decreased B12 absorption.

     There is a wide variation in Vit C intake in adults. In one survey, one-fourth of the elders are associated with low ascorbic acid intake. Heavy smokers, alcohol abusers, or persons with high aspirin intake have a higher daily requirement for ascorbic acid.

The seniors with dentures should be encouraged to consume Vit C rich food such as citrus fruits, peppers, melons, mangoes, etc. daily.

Two minerals of calcium and zinc are of particular concern in older adults.

Tissue healing and immune function are affected by zinc status.

     Alcohol abuse appears to be serious nutrition, health problems among some of the elderly.

Deficiencies of thiamine, niacin, pyridoxine, folate (all B complex Vit), and ascorbic acid are commonly seen in alcoholics.

Osteopenia (reduced bone mass) in males without a history of the bone disease may be due to chronic alcohol intake when efforts to resolve tissue intolerance to a prosthesis are unsuccessful the misuse of alcohol should be considered.

CALCIUM AND BONE HEALTH

     Loss of bone is a natural chain of aging that affects the upper and lower jaw as well as the spine and long bones. Skeletal sites where trabaculae bone (alveolar bone, vertebrae, wrist, and neck of the femur) is more prominent than cortical bone are affected first.

Several factors are thought to contribute to age-related bone loss that leads to osteoporosis(a condition in which bones become brittle and fragile). Also, factors like genetic background, hormonal status, bone density at maturity, a disturbance in the bone remodeling process, a low exercise level and inadequate nutrition in the elderly.

Loss of bone affects women earlier than a man because of estrogen at menopause and a smaller skeleton.

In women, bone loss begins during the fourth decade of life or whenever estrogen secretion declines or ceases. Women with lower bone mineral density tend to have fewer teeth.

    Resorption of the alveolar ridge is a widespread problem among denture wearer and results in unstable dentures. Some remodeling of the bone appears to occur in response to chewing forces.

However, bone resorption is accelerated, and bone height is diminished when teeth are lost.

A greater degree of such residual ridge resorption is observed in women than men. Such bone loss is accelerated in the 1st six months following tooth extraction with resorption much greater in the mandible than the maxilla.

The loss of bone often makes it more challenging to build a stable and retentive mandibular denture than the maxillary one.                   

     It has been proposed that alveolar bone loss may precede loss of mineral from the vertebrae and long bones and that the dentist may, therefore, be the first health care provider to detect the loss of bone mass.

The amount of bone mass in the mandible has been associated with body calcium level and the bone mass in the vertebrae and wrist of the healthy postmenopausal women by researches concern. In the elderly local factors have a great influence on alveolar bone resorption.

        Dietary calcium intake is critical to maintaining the body skeleton. Denture wearer with excessive bone resorption reports lower calcium intake and poorer calcium phosphorous ratios.

     The recommended intake for a man over 64 years and postmenopausal women taking no estrogen and calcium.

Adults must drink 3-4 glasses of low-fat milk per day, eat 5-7 g of hard cheeses or consume very large quantities of non-dairy food.

Adequate intake of Vit D enhances calcium absorption in the intestine. The trace element of fluoride is being used in the treatment of osteoporosis.

VITAMIN SUPPLEMENTATION

     Based on the nutrient deficiencies reported in the elderly, it may be reasonable to prescribe a low dose multivitamin-mineral supplement for certain people even though clinical signs of nutrient deficiency are lacking.

For an elderly patient, a generic one a day tablet that includes zinc, folacin, and Vit B6 may be recommended. If the intake of dairy food cannot be increased to meet daily needs, a calcium supplement is advised, because it is bulky, calcium must be taken in a separate tablet.

The use of megadose of vitamins or minerals by the elders is a practice of great concern. Thus the denture wearer should be cautioned against indiscriminate use of any nutrient or fiber.

DIETARY NUTRITION COUNSELING FOR ELDERLY

        Goals to be achieved by nutrition for older adults and dietary counseling :

1. A healthy nutrition diet for the elderly population person’s over 70 years of age is more likely to have poor diets. And nutrition risk increases with advancing age seen in the elderly.

2. To lower the rate of bone resorption, usually, it takes place because of low calcium & vitamin intake.

The only expectation of the elderly seeking new dentures is that they will be able to eat a greater variety of food. Such a person often is receptive to suggestions aimed at improving the quality of their diet.

Nutrition screening for the elderly begins at the 1st appointment so that counseling and follow up can occur during the course of treatment with continued guidance and encouragement from the dental team.

Elders are more apt to make permanent changes in their food patterns.

Nutrition care can be provided by dentist and dental hygienist who has a background in basic nutrition.

The main objective of nutrition diet counseling for the elderly is to correct the imbalance in the nutrient intake that interferes with the maintenance of oral tissue health. It is often different to identify patients in need of nutrition for older adults care base on a usual inspection or an interview.

Most elders tell us that they eat a healthy diet. However, certain denture wearer is known to be at greater risk of being malnourished.

Dietary evaluation and counseling should be included in treatment if the elder has any of the following physical or social conditions – Greater than 75 years of age, reduced wages, less social interaction, unintentional weight loss, daily use of various medicines, or need for assistance with daily self-care.

Risk factors for poor nutrition for older adults

– unplanned weight gain or loss of >10 lbs in the last six months.

– Undergoing chemotherapy or radiation therapy.

– Poor dentition or ill-fitting prosthesis.

– Oral lesions like – Glossitis, cheilosis, or burning tongue.

– Severely resorbed jaw.

– Alcohol or drug abuse.

– Eating less than two meals/day.

If an elderly report weight loss or gain greater than 10 pounds during the past six months or untreated or poorly controlled hypertension, a diabetic state or oral tissue changes suggestive of poor nutrition.

An elder who express concern about obesity or low body weight or who report poor adherence to diabetic reduced-sodium or low cholesterol diet can be referred to a consulting registered dietician.

nutrition for older adults guidelines

Providing nutrition care for the elderly entails the following steps :

– Obtaining a nutritional history and accurate record of food intake over a 3-4 or 5 days period.

– Evaluating the diet.

– Teaching about the components of the diet that will support the oral mucosa as well as bone health and total body health.

– Follow up.

Nutrition guideline for the elderly

extooth presents you a guideline of proper nutrition for older adults

· Eat a variety of food

· Build a diet around complex carbohydrates, fruits, vegetables, whole grams, and cereals.

· Take a minimum of 5 servings of fruits and vegetables daily.

· Have fish, poultry, meat, or dried peas and beans on a daily basis.

· Obtain adequate calcium.

· Restrict yourself from bakery products as they are high in fat and simple sugar.

· Limit intake of processed food high in sodium and fat.

· Consume 8 glasses of water daily.

CONCLUSION

        The success of a complete denture prosthesis is mainly influenced by oral conditions.  

So an elder has to be well-nourished and consuming a well-balanced diet. Dietary guidance based on an assessment of the elderly nutrition history and diet should be an integral part of comprehensive prosthodontic treatment by a dentist.