NUTRITION, IMMUNITY AND INFECTIONSIN THE ELDERLY

Prepared By:Bhavya Dhir L-2013-HSC-04-BNDGarima Goyal L-2013-HSC-09-BNDKritika Gupta L-2013-HSC-20-BND

HIGHLIGHTS The proportion of elderly individuals is increasing in both

developed and developing countries.Major Consequence –

• Significant increase in age related illness and disease• Increase in health related expenditure

Factors affecting ageing process –• Genetic• Environmental

i. Nutritional factorsii. Exposure to antigens throughout life

Immunological and Nutritional

Status of the elderly

Physiological Changes

Social Factors

Economic Factors

Psychological Changes

PRIMARY AGEING IMMUNE DEFICIENCY

The immune function changes seen in very

healthy elderly individuals with no other underlying

causes are referred as Primary Ageing Immune

Deficiency.

MAIN CHANGES

CHANGES IN

CYTOKINES

CHANGES IN CELL MEDIATED IMMUNITY AND

T LYMPHOCYTES

CHANGES IN B

LYMPHOCYTES

CHANGES IN MACROPHAGE

S AND NK CELLS

>Immature T cells>Memory T cells

>Thymic function>Mature T lymphocytes>Native T & Cytotoxic T cells>Lyphocyte proliferation in response to stimulation>Functional ability of T cells>Effectiveness of CD4+ Th cells & CD8+ T suppressor cells>Cell mediated immunity & DCH responses

INCR

EASE

DDECREASED

Changes in cell-mediated immunity & T lymphocytes

>Plasma levels of IgA & IgG>Production of autoantibodies>B-lymphocytes responses unaltered

>IgM production>Antibody response to vaccines

INCR

EASE

D

DECREASED

Changes in B lymphocytes

Function well preserved

Phagocytosis & lysosomal activity maintained

Macrocytes produce more prostaglandins & free radicles

Changes in macrophages & NK cells

>Th2 cytokine secretions>Production of interleukins (IL-3. IL-4) >During infections IL-1, IL-6 & TNF-α secretions increases

IL-2 secretion as young adults

INCR

EASE

D COM

PARABLE

Changes in cytokines

Diabetes

ALS

COPDDysphagia

Cancer

Palliative CareCeliac Disease

Constipation

SuperbugsCongestive

HeartFailure

PressureUlcers

MultipleSclerosis

Parkinson’sDisease

MalabsorptionSyndromes

Osteoporsis

GERD

Pneumonia

Falls

AlcoholAbuseStroke

Osteoarthritis

Anemia

Family RelatedIssues

Renal Disease

Nutrition Issues For Elderly

System Issues

Dementia

Mental Illness

Obesity

Malnutrition

Nutrition and Quality of Life

Healthy food choices positively influence quality of life of older adults.

Older adults are at risk for inadequate dietary intakes which may lead to:

Poor nutritional statusDecreased quality of lifeFunctional disabilityIncreased health care costsGreater risk for morbidity and

mortality

Factors Affecting Nutrition Status OF ELDERLY

• Declining digestion and absorption• Reduced sensory perception• visual, olfactory, taste acuity, thirst• Anorexia of Aging

(1)Physiological

• Chewing and swallowing difficulty• Affects on body systems : Integumentary (skin),

renal, musculoskeletal, cardiovascular(2)Physical

• Depression• Loneliness• Dementia• Food likes/dislikes

(3)Psychological

• Poverty• Lack of knowledge of nutrition• Inadequate cooking knowledge (men)• Decreased Social support

(4)Social and Economical

• Provision of culturally appropriate food and setting are both important(5)Cultural

beliefs

PHYSIOLOGICAL CHANGES ASSOSCIATED WITH AGEING

System Affected Physiological Change

Body Structure A decline in bone density can cause fractures and result in a period of decreased physical activity and social interaction.

GI tract Older adults have an increased risk of GERD, which can affect swallowing and foods consumed. It might impair digestion and absorption.

Mouth Missing teeth and deterioration of gums can affect chewing and swallowing and can reduce food intake.

Neurologic Decline in cognition, steadiness, reactions, and coordination can decline, potentially affecting food and beverage intake.

Sensory changes Taste perception (dysgeusia) or smell perception (hyposmia) may be altered with aging and/or chronic disease.

Nutritional deficiencies in elderly

Nutritional deficiency in

elderly is multi-

nutrient deficiency.

Inadequate intakes of

macro nutrients such as energy and

protein as well as of

micro nutrients.

Both intakes &

plasma levels of a wide range of vitamins

and minerals

are lower.

Micro nutrients such as

vitamin E, C,B6 ,Se and

Zn were reported to

be below two-thirds of

recomme-nded levels.

EFFECT OF AGEING ON NUTRITION

Submitted to – Dr Harpreet Kaur