Immunity elderly

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NUTRITION, IMMUNITY AND INFECTIONSIN THE ELDERLYPrepared By:Bhavya DhirL-2013-HSC-04-BNDGarima Goyal L-2013-HSC-09-BNDKritika GuptaL-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 diseaseIncrease in health related expenditureFactors affecting ageing process GeneticEnvironmentalNutritional factorsExposure to antigens throughout life

PRIMARY AGEING IMMUNE DEFICIENCYThe immune function changes seen in very healthy elderly individuals with no other underlying causes are referred as Primary Ageing Immune Deficiency.

Changes in cell-mediated immunity & T lymphocytes

Changes in B lymphocytes

Changes in macrophages & NK cells

Changes in cytokines

DiabetesALSCOPDDysphagiaCancerPalliative CareCeliac DiseaseConstipationSuperbugsCongestiveHeartFailurePressureUlcersMultipleSclerosisParkinsonsDiseaseMalabsorptionSyndromesOsteoporsisGERDPneumoniaFallsAlcoholAbuseStrokeOsteoarthritisAnemiaFamily RelatedIssuesRenal Disease

Nutrition Issues For Elderly System IssuesDementiaMental IllnessObesityMalnutrition

9Conditions including those due to deficits in body systems such as Celiac Disease, DM and Renal disease. To neurological degenerative conditions such as MS, ALS or Parkinsons Disease or Huntingtons Disease. To those that may develop over time or occur more frequently in the elderly population such as osteoporosis, GERD and dementia. To those related to the living in a PCH itself, such as superbugs, family related issues, PCH system issues.While the main focus of our presentation today is going to be on the issue of malnutrition, we will also talk about other issues that influence the likelihood of malnutrition occurring, such as some of the issues listed here.

Nutrition and Quality of LifeHealthy 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

10This slide defines why we care about nutrition in older adults.Not only does good nutrition provide benefits, but poor nutrition increases the likelihood of:Increased dependence: Those with poor nutrition status are more likely to need help with ADLs that is, those activities we do as part of normal functioning such as getting up, getting dressed and washed, preparing our meals and eating them. Therefore, those older adults who have poor nutrition status are more likely to need more help. Those with poor nutrition status also have delayed discharge from hospital and are more susceptible to nutrition related complications like delayed wound healing and increased vulnerability to infection.All of these factors, not only have implications on the health care system, but also result in lower quality of life for the individual.

Factors Affecting Nutrition Status OF ELDERLY

11There is potential for reduced Digestion, absorption and utilization of nutrients in the older adult:reduced HCL secretion and secretion of intrinsic factor and digestive enzymes reduces an elderly persons ability to utilize the nutrition in th e food they are eating. Many older adults, about one in three, are at risk of inadequate Vitamin B12 due to reduced HCl and Pepsin (an enzyme for protein) prevent the release of vitamin B12 from food. Intrinsic factor binds with Vitamin B12 and allows the B12 to be absorbed, therefore reduced intrinsic factor results in reduced absorption of vitamin B12.other nutrients of concern in the older adult, include calcium, vitamin D, magnesium, vitamin A and folate, as well as iron, and zinc.Difficulty with vision affects a persons ability to shop and prepare and eat foods independently.As we age there is a reduction in the neurons in the olfactory bulb, which is responsible for detecting smell. While there is also a reduction in sense of taste (especially for sweet and salty) with reduced taste buds, much of the perceived reduction in sense of taste is related to a reduction in sense of smell. This affects enjoyment at meals, appetite and also increases the likelihood of a person consuming spoiled food.Reduced sense of temperature also exists which increases the likelihood of a person being burned without even knowing about it until its too late.Reduction in sense of thirst is a contributing factor to inadequate fluid intake in the elderly. Other factors which also compound the problem include:Reduced ability of the kideys to concentrate urine, therefore greater loss of fluid with voidingSelf restriction to reduce the need to void (such as in the evening)Difficulty with access, perhaps due to reduced mobilityAs we age there is a decline in intake sometimes referred to as the Anorexia of Aging. Signals which promote intake as reduced, while those that limit intake are enhanced.Older adults exhibit less hunger and earlier satiety (or fullness) than younger individualsImpaired appetite contributes to undernutrition seen in both community and institutionalized settingsIn many cases, difficulty with chewing and swallowing in the older adult is as a result of medical conditions such as stroke or degenerative disease (Parkinsons Disease, for example). However, aging alone can result in difficulty with chewing and swallowingThe older adult is more likely to have reduced dental status, have reduced number of teeth and poor condition of teeth and require dentures.Those with dentures are estimated to have 1/6th the chewing ability of those with natural teeth and there is a correlation between poor dental status and poor diet quality.All body systems are affected in some way with aging. For example, there is reduced ability of the skin to synthesize Vitamin D with sun exposure as we age. Other factors which affect Vitamin D status is limited food supply of Vitamin D (for example to achieve an adequate vitamin D intake from milk source which is our major source in the diet along with fatty fish, a person over the age of 70 would need to drink 6 cups daily, this may not be reasonable for most people over the age of 70), due to our northern location, the sun is not a good source of Vitamin D in the winter, which limits the time frame during which we can replentish our stores of this fat soluble vitamin.

12There is an increased likelihood of depression with aging, considering that poor intake is a symptom of depression it falls to reason that depression affects nutrition status. Treating the underlying condition is key to promoting best intake.Studies have shown that eating in communal type settings promotes not only nutrition, but also improved quality of life, with increased social interaction, support and friendship.Dementia is the most common diagnosis in the LTC setting within the WRHA and has very significant affects on nutrition, which I will discuss a bit later.Many of the issues identified related to social and economic factors are seen, particularly in the community setting, these factors will be discussed in greater detail later

PHYSIOLOGICAL CHANGES ASSOSCIATED WITH AGEINGSystem Affected Physiological ChangeBody StructureA decline in bone density can cause fractures and result in a period of decreased physical activity and social interaction.GI tractOlder 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.NeurologicDecline in cognition, steadiness, reactions, and coordination can decline, potentially affecting food and beverage intake.Sensory changesTaste perception (dysgeusia) or smell perception (hyposmia) may be altered with aging and/or chronic disease.

Nutritional deficiencies in elderly

EFFECT OF AGEING ON NUTRITION

Submitted to Dr Harpreet Kaur