NUTRITION IN
GERIATRICS
DR. MOHAMMED SUBHAN I
LECTURER
DEPARTMENT OF PROSTHODONTICS
COLLEGE OF DENTAL SCIENCES
DAVANGERE.
Contents
• Introduction
• Definitions
• Factors affecting nutritional uptake in geriatrics
• Oral factors affecting the nutritional status
• Nutrition in elderly
• Assessing Nutritional Status
• Food recommended for elderly
• Diet instructions for new denture wearers
INTRODUCTION
Life expectancy has increased from the age of 45 in 1900 to the age of
72 for men and 77 for women in the 1980s.
Nutritional risk increases with advancing age. Therefore a large
number of denture patients can be expected to have nutritional deficits.
Lack of knowledge and interest in desirable food choices also contributes to
the poor nutritional status of elderly.
Proper nutrition is essential to the health and comfort of oral tissues, and
healthy tissues enhance the possibility of successful prosthodontic treatment of
the elderly.
A proper nutritional assessment and suitable dietary advice is often a more
appropriate way to cope with malnutrition than merely instituting prosthetic
therapy.
DEFINITION
• Nutrition may be defined as the sum total of the process by which the living
organism receives and utilizes the food materials necessary for growth,
maintenance of life, enhancing metabolic process, repair and replacement
of worn out tissues and energy supply. (Z.S.C Okoye)
• Balanced diet is defined as that which supplies all the essential nutrients in
adequate amounts and in biologically available forms. (Z.S.C Okoye)
DEFINITION
Geriatrics
The branch of medicine that treats all problems peculiar to the aging patients,
including the clinical problems of senescence and senility.
Dental geriatrics
The branch of dental care involving problems peculiar to advanced age and aging
or Dentistry for the aged patient.
Gerodontics
The treatment of dental problem in aged or aging persons, also spelled
Geriodontics.
Gerodontology
The study of the dentition and dental problems in aged or aging persons.
GERIATRIC NUTRITION applies principles to delay effects of aging and disease ,to
aid in the management of the physical psychological , psychosocial changes
commonly associated with growing old.
Factors affecting nutritional uptake in geriatrics
i. Physio-Congnitive factors
ii. Pharmacologic Factors
iii. Functional factors
iv. Psychosocial factors
v. Economical factors.
ORAL FACTORS AFFECTING THE NURITIONAL
STATUS
• Xerostomia
• Effect of denture on chewing
• Sense of taste and smell
• Dentate status
• Xerostomia
Xerostomia is a condition of dry mouth as a result of diminished salivary flow
commonly found in the elderly. It is not a direct consequence of the aging
process but may result from one or more factors affecting salivary secretion
Emotions (especially fear or anxiety), neuroses, organic brain disorders, and
drug therapy all can cause xerostomia.
lack of saliva can affect the nutritional status in a number of ways;
1. It hinders the chewing of food because it prevents the formation of a bolus.
2. It makes the mouth sore and chewing painful.
3. It makes swallowing difficult due to the loss of saliva’s lubricating effect.
4. It can cause changes in taste perception that decreases adequate food
intake.
Effect of Dentures on taste and swallowing
• A full upper denture can have an impact on taste and
swallowing ability.
• The hard palate contains taste buds, so taste sensitivity may
be reduced when an upper denture covers the hard palate.
• As a result, swallowing can be poorly coordinated
Effects of denture on chewing
• As adults age, they tend to use more strokes and chew
longer, to prepare food for swallowing.
• Masticatory efficiency in complete denture wearers is
approximately 80% lower than in people with intact natural
dentition.
• The effect of dentures on nutritional status varies greatly among
individuals.
1. Some people compensate for decline in masticatory ability by
choosing processed or cooked foods rather than fresh food and by
chewing longer before swallowing.
2. Others may eliminate entire food groups from their diets.
• Dentate adults tend to eat more fruits and vegetables than full-
denture wearers.
• Replacing ill-fitting dentures with new ones does not necessarily
result in significant improvements in dietary intake.
NUTRIENT NEEDS FOR THE ELDERLY
• Nutirents are substances in food that your body needs
for energy ,proper growth ,body maintainence and
functioning
Class of nutrients
1. carbohydrates
2. proteins
3. fats
4. water
5. vitamins
6. minerals
CALORIE INTAKE BY THE ELDERLY
• The requirements decrease with advancing age due to,
- reduced energy expenditure
- decreased basal metabolic rate
RECOMMENDED DIETARY ALLOWANCES (RDA)
1600Kcal for women
2400Kcal for men
Energy
• Energy needs decline with age due to a decrease in basal
metabolism and decreased physical activity.
• RECOMMENDED DIETARY ALLOWANCES (RDA)
1300 kilocalories (Kcal) for women
1800 Kcal for men
• Deficiency causes dull, dry, sparse easily plucked hair, parotid
gland enlargement, muscle wasting, pallor, pale atrophic
tongue, spoon nails and pale conjunctiva.
Proteins
• As the patients become older, the amount of protein
required increases.
• Protein depletion of body stores in the elderly, is seen
primarily as a decrease of the skeletal muscle mass.
• Proteins is a must for denture wearers.
• The RDA for proteins, for persons aged 51 and over, is
0.8-g protein/kg body weight per day. (56 gms for males
and 46 gms for females, or 9 and 10% respectively, of the
recommended calorie intake).
• The best sources of proteins for the elderly diet = dairy
products, poultry, meats and fish in the boiled and not dried
form
Nuts, grains, legumes and vegetables contain protein, which
if eaten in the proper combination, is of the same quality as
animal sources of protein.
Carbohydrate
• The elderly consume a large proportion of their calories as
carbohydrates, possibly at the expense of protein, because of
their low cost, ability to be stored without refrigeration and
ease of preparation.
• RDA- 50 to 60 per cent of total calories.
• Food sources include grains and cereals, vegetables, fruits
and dairy products
• Reduced glucose tolerance in the elderly can make them
susceptible to hyperglycaemia and non-insulin-dependent
diabetes mellitus
Fats
• Transport and absorb vitamins
• RDA: 25-35 % of the total calorie intake daily
• Intake of saturated fat and cholesterol should be restricted.
Excess intake of these would result in obesity, diabetes,
cardiovascular disease.
• Use palm oil, sesame, rice bran, or cottonseed oils as they
have higher thermal stability.
• For bakery items use coconut oil, palm oil, palm kernel oil, or
their blends/solid fractions
vitamins
• Helps control the body process and also release
energy to do work
• They dont contain calories
• Neither provide body with energy
2 TYPES
Fat soluble (A,D,E,K)
water soluble (C and B complex)
vitamin A
RDA : vitamin A is 800-1000 micrograms .
sources
• Vitamin A in food occurs in two forms: retinal, or active Vitamin A in animal foods
(liver, milk and milk products) and beta-carotene or provitamin A, found in deep
green and yellow fruits and vegetables (apricots, carrots, spinach).
Deficiency
• decreased salivary flow, dryness and keratosis of oral mucosa and decreased taste
acuity.
• Long standing deficiency may cause hyperplasia of the gums, as well as
generalized gingivitis.
Vitamin D
The elderly are frequently deficient in Vitamin D because of lack of sun exposure and an
inability to synthesize Vitamin D in skin and convert it in the kidney.
sources :Vitamin D is found in fish liver oils.
RDA : 5 microgram.
Deficiency: osteomalcia, osteoporosis , poor immune function
Vitamin E
• Total plasma Vitamin E levels increase with age.
• RDA: 8-10 mg
Vitamin K
• The coagulation vitamin is very crucial in relation to blood
clotting process
• RDA: 1microgram
• Deficiency:coagulopathy , petechiae, Ecchymosis .
B COMPLEX
B1(Thiamine )
- helps to convert carbohydrates into energy
RDA: 1.2 mg for males
1.1 mg for females
Deficiency: beri beri
B6 ( PYRIDOXINE)
- Helps to metabolize carbs, proteins and fat and also helps to keep the
immune system healthy
RDA: 1.7 mg for males
1.5 mg for females
Deficiency: Nasolabial Seborrhea Glossitis
B9 (folic acid)
- it act as a coenzyme with vitamin B12 and vitamin C to produce cell in the
body
RDA : 400 micrograms for males and females
Deficiency: mouth uclers , glossodynia , glossitis , stomatitis
B12 (riboflavin)
- it is the largest and most structurally complicated vitamin involved in the
metabolism of every cell of the human body
RDA : 2.4 micrograms for males and females
Deficiency: Fiery or Beefy red tongue , candidiasis , aphthous stomatitis
Vitamin C
RDA: 60 mg for both men and women
sources : citrus fruits, tomatoes, potatoes and leafy vegetables.
Deficiency : spongy, bleeding gums, petechiae, delayed healing
tissues, painful joints
Calcium
RDA: 1200 mg/day.
sources: include milk and milk products, dried beans and peas,
canned Salmon, leafy green vegetables.
Deficiency: osteoporosis , muscle loss tooth decay , ridge
resorption.
IRON
- its main purpose is to carry oxygen in the hemoglomin of red blood
cells throughout the body so cells can produce energy.
RDA : 10 mg.
Deficiency causes burning tongue, dry mouth, anaemia's and
angular cheilosis
Zinc
-Its utilization declines with advancing age, because intestinal
absorption decreases after the age of 65 years.
RDA :15 mg.
sources: animal products, whole grains and dried beans.
Deficiency : decreased taste acuity, mental lethargy and slow wound
healing.
Magnesium
it helps form bones and teeth and also activities enzymes
RDA : 420 mg for males
320 mg for females
Deficiency : low bone density , muscular weekness , fatigue.
ASSESSING THE NUTRITIONAL STATUS
Food Guide Pyramid.
In 1992, the U.S. Department of Agriculture developed the Food Guide Pyramid. This replaces the
former basic four model of milk, fruits and vegetables, and grains. The pyramid now contains
six categories:
1. Bread, cereal, rice, and pasta.
2. Vegetables.
3. Fruits.
4. Milk, yogurt, cheese.
5. Meat, poultry, fish, dry beans, eggs, and nuts.
6. Fats, oils and sweets.
DIET INSTRUCTIONS FOR NEW DENTURE WEARERS
• 1st Post Insertion Day
• Vegetable-Fruit group: Juices
• Bread-Cereal group: Gruels cooked in either milk or
water.
• Milk group: Fluid milk may be taken in any form.
• Meat group: Eggs, pureed meats, meat broths, or soups.
• The sample menu should contain a glass of milk at least
once a day.
2nd and 3rd Post insertion day
• Vegetable-Fruit group: Juices; Tender cooked fruits and
vegetables, (seedless and skinless)
• Bread-cereal group: Cooked cereals, softened breads
boiled, rice, noodles and macaroni.
• Milk group: Fluid milk and cottage cheese.
• Meat group: Chopped beef, ground liver, tender
chicken/fish in a cream sauce, scrambled eggs, thick
soups, etc.
• The sample menu must include butter or margarine, a
glass of milk at least once a day.
4th Day and after
• By the fourth day, or as soon as the sore spots have
healed, firmer foods can be eaten in addition to the soft
foods. These should ideally be cut into small pieces
before eating.
• The sample menu must contain butter or margarine and
a glass of milk.
conclusion
Considering the hgh prevalence of the nutritional status among the elderly
more focus on diet and possible nutritional interventions are required in
which practicing prosthodontist can play vital role
The nurtitional deficiences are multi-factorial. where the patients tend to
deny the dietary indiscrtions. Hence ,its the prosthodontist who should
educate and make sure aout the adequate intake of the nutrients from
regular follow ups.
References
1. Zarb –Bolender : Prosthodontic treatment for edentulous
patients, 12th edition
2. Glossary of Prosthodontic terms – 9. J. Prosthet Dent. Feb.
2018
3. Heartwell C.M. Jr. Syllabus of complete dentures. Fourth
edition – 1986
4. Essentials of complete denture prosthodontics. Second
edition, Sheldon Winkler – 2000
5. Nutrition in clinical dentistry Abraham E Nizel, Athena. S.
Papas – 1989
6. Textbook of geriatric dentistry, second edition. Poul Holm -
Pederson and Harald Loe 1996
7. Nutrition in oral health and disease. Robert L. Pollack,
Edward Kravitz 1985
