Weight Problems of Older Adults: Weight Loss and Obesity

Chapter 14

Introduction

• Malnutrition– Undernutrition– Overnutrition– Specific nutrient deficiencies– Protein-energy malnutrition

• Assessing nutrition status– Combination of laboratory measures, assessment

of nutrition intake, and anthropometric measurements

Introduction

• Anthropometric methods– Body Mass Index (BMI)

• Biochemical indicators– Serum albumin– Prealbumin– Serum cholesterol– Total lymphocyte count

Introduction

• Signs and symptoms– Weight– Skin– Hair

Importance of Undernutritionand Weight Loss

• Unintentional weight loss• Skilled nursing facility patients– Weight loss is a predictor of early

institutionalization– Malnutrition or high risk of undernutrition

• Hospitalized older patients– Weight loss and hypoalbuminemia often follow

hospitalization

Factors Contributing to Poor Nutrition

• Physiological Changes of Aging– Reduction in Height and Weight Distribution• BMI• Height decreases with age• Reduction in muscle mass• Increase in adipose tissue in trunk and

abdomen• Subcutaneous fat decreases, especially in limbs• Calorie requirements decrease• Required nutrients do not diminish

Factors Contributing to Poor Nutrition

• Physiological Changes of Aging– Reduction in Taste and Smell• Taste sensory threshold increases• Sense of smell decreases

Factors Contributing to Poor Nutrition

• Physiological Changes of Aging– Decrease in Appetite and Anorexia• Contributes to weight loss• Anorexia of aging• Medication side effects• Decoupling of hunger and nutrient ingestion• May be associated with illness, drugs,

dementia, or mood disorders• Polypharmacy may indicate malnutrition

Factors Contributing to Poor Nutrition

• Mechanical Barriers Contributing to Poor Nutrition– Poor oral health– Physical activity may become more difficult– Declined mobility– Pain from arthritis– Restrictive diets– Unrecognized feeding problems

Factors Contributing to Poor Nutrition

• Medical Conditions Contributing to Poor Nutrition– Increased metabolic requirements– Healing increases need for nutrients– Multiple medical conditions with unique nutrition-

related issues– Chronic disease can result in difficulties

Factors Contributing to Poor Nutrition

• Psychological Factors Contributing to Poor Nutritional Status– Depression– Dementia– Malnutrition is prevalent in older adults with mild

cognitive impairments

Social Factors Associated With Undernutrition

• Older adults living in poverty– Insufficient funds to purchase food– Inadequate consumption of fruits and vegetables– Low intake of multiple vitamins/minerals– Social isolation– Loneliness– Rural older adults are vulnerable to nutritional

inadequacies– Culture

Consequences of Weight Lossin Older Adult

• Often leads to death• Suggests a loss of lean body mass• May follow the development of disease• Can predispose older adults to increased risk

for community-acquired pneumonia• Associated with bone loss and hip fractures• Medication side effects decrease food intake

Consequences of Weight Lossin Older Adult

• Interventions– Multiple possible interventions that increase

caloric intake– Nutritional education and healthy hints for

healthy eating

Obesity

• Defined as BMI of 30 kg/m2 or greater• BMI between 25 and 30 – Protective for mortality

• Physiological Changes– Prevalence of obesity peaks– Loss of lean tissue– Intra abdominal and intramuscular fat increase

with age– Visceral body fat increases with age

Obesity

• Physiological Changes– Factors that contribute to obesity• Inactivity• Reduced hormone levels• Poor nutrition

Obesity

• Problems Associated with Obesity– Association between obesity and disability– High body fat is predictive of mobility loss– More likely to experience functional impairment

Obesity

• Other Consequences of Obesity– Associated with numerous diseases and problems– Metabolic syndrome– Increase likelihood of osteoarthritis in knees– Depression– Favorable aspects• Protective for falls and mortality• Increased muscle strength• Decreased risk of pressure ulcers• May be protective against dementia in women

To Lose or Not to Lose Weight

• Effective weight loss interventions include– Nutrition education– Diet– Exercise counseling– Behavioral strategies

To Lose or Not to Lose Weight

• Losing Weight– Nutrition guidelines for older adults

To Lose or Not to Lose Weight

• Losing Weight– Popular diets (trends)– Mediterranean diet– Counseling by a dietitian– Pharmaceutical agents

Conclusion

• Exercise should be an integral part of any research about diet therapy in those with undernutrition as well for obese individuals.