Factors Contributing to Malnutrition in the Elderly
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BIOLOGICAL FACTORS

Integumentary System
     deficiencies
          -decreased vitamin D production -> decreased calcium absorption by the small intestine
Circulatory System
     deficiencies
          -atherosclerosis reduces blood flow through the digestive system -> reduced digestion and absorption of various nutrients
          -atherosclerosis and high blood pressure -> greatly altered diet (salt, water, lipid restrictions)
Respiratory System
     deficiencies
          -emphysema -> difficulty obtaining, preparing, and eating proper diet
Nervous System
     deficiencies
          -dementias or strokes -> disabilities -> difficulty planning, obtaining, preparing, and eating proper diet
          -decreased sense of smell from aging, Alzheimer's, Parkinson's -> loss of interest in eating
          -age changes in flavor preferences -> altered diet
          -decreased sensory function and coordination -> difficulty obtaining, preparing, and eating proper diet
          -decreased thirst sensation -> water deficiency
Eyes and Ears
     deficiencies
          -decline in vision -> difficulty obtaining, preparing, and eating proper diet including reading labels for instructions and nutrient content
Muscle System and Exercise
     deficiencies
          -weakness and decreased exercise -> decreased eating to prevent weight gain
     excesses
          -weakness and decreased exercise -> excess energy intake for body needs
Skeletal System
     deficiencies
          -disabilities (fractures, arthritis) -> difficulty obtaining, preparing, and eating proper diet, more reliance on prepared foods -> less fresh fruits and vegetables, less activity -> less kcals used -> obesity
     excesses
          -disabilities (fractures, arthritis) -> decreased exercise -> lower energy use -> obesity
Digestive System
     deficiencies
          -mouth region
               -slower healing of oral mucosa -> sores -> discomfort -> less eating
               -tooth disease or loss -> altered or bad tastes, discomfort when eating, trouble eating firm (fruits and vegetables) or drier foods, swallowing large pieces -> less eating, less fiber intake, indigestion and maldigestion
               -decreased saliva from infected salivary ducts, diabetes, medications, radiation therapy -> dry mouth, decreased taste -> less eating
          -esophagus
               -slowed and spastic peristalsis, refluxing from stomach -> discomfort, difficulty swallowing -> less eating
               -esophageal rings and webs -> difficulty swallowing (discomfort) -> limited food selection and less eating
               -sliding hiatal hernia -> refluxing, esophagitis -> less eating
               -diabetes -> slower peristalsis -> difficulty swallowing -> less eating
          -stomach
               -decreased HCl -> altered small intestine bacterial flora -> altered digestion and absorption of many nutrient
               -decreased intrinsic factor production -> decreased vitamin B-12 absorption by small intestine
               -acute gastritis -> discomfort -> less eating
               -atrophic gastritis -> decreased production of HCl, intrinsic factor, and pepsin -> decreased protein digestion -> indigestion -> decreased eating and protein maldigestion -> protein deficiency
               -gastric peptic ulcer -> pain with eating -> less eating, need for altered diet, obstruction, antacid use -> deficiencies, obstruction -> malnutrition, use of certain antacids (containing Mg)
          -small intestine
               -decrease in absorption of vitamins A, D, and K, and zinc
               -decreased lactase -> lactose intolerance -> decreased dairy intake
               -decreased vitamin D production by skin and activation by kidneys -> decreased calcium absorption
          -large intestine
               -constipation -> laxative use (depending on type) -> water, mineral, and vitamin A, D, E, and K deficiencies. -very high fiber diets -> decreased mineral absorption
               -diarrhea -> water and mineral deficiencies
               -fecal incontinence -> less ability to obtain foods (shopping), social isolation -> less or altered eating
               -diseases (diverticulitis, cancer) -> altered diets -> malnutrition
          -liver
               -slight decrease in vitamin C storage -> increased risk of vitamin C deficiency (Note that vitamin C is not stored well in the body.)
               -cirrhosis -> liver malfunction -> poor storage and conversion of nutrients, decreased vitamin D activation and bile production -> poor fat digestion and vitamin A, D, E, and K absorption
          -gall bladder
               -stones -> pain (especially with fats) and decreased fat digestion -> discomfort (less eating), decreased fat and vitamin A, D, E, and K absorption
          -pancreas
               -pancreatitis -> decreased protein and fat digestion, diabetes (slowed peristalsis)
 excesses
              -peptic ulcer -> antacids with magnesium -> magnesium excess
Urinary System
     deficiencies
          -urinary incontinence -> less ability to obtain foods (shopping), social isolation -> less or altered eating
          -kidney disease -> less protein intake to decrease nitrogen wastes in blood (BUN)
Endocrine System
     deficiencies
          -hyperparathyroidism -> decreased appetite -> less eating
          -hyperthyroidism -> increased metabolic rate -> excess energy use -> underweight
     excesses
          -non-insulin dependent diabetes mellitus (NIDDM) -> excess eating -> obesity
Immune System
     deficiencies
          -various autoimmune disorders -> malfunctions in salivary glands, stomach, small intestine, and large intestine functioning) -> altered taste and decreased absorption (e.g., vitamin B-12, vitamin K, Fe, Ca, Zn)
Alcoholism
     deficiencies and excesses
          -alcohol -> less eating, decreased functioning of the liver and other digestive organs, altered the absorption and utilization of several nutrients -> certain deficiencies and excesses (See page 10-51+)
Medications
     deficiencies and excesses
          -from altered appetite, diet, absorption, utilization, and elimination
Cancer
     deficiencies
        -  growth of cancer -> loss of appetite and excess nutrient use (cachexia)
 

SOCIAL FACTORS

Deficiencies
     -cultural limitations on food choices
     -religious factors
     -transportation to food sources
Deficiencies and Excesses
     -loss of companionship (spouse, other family members, friends, retirement) -> altered appetite -> less eating or over eating
     -institutionalization -> imposed diets, foods overcooked or heated for extended periods
     -inadequate educational opportunities
     -inadequate social programs -> inadequate social contact, assistance with food preparation and eating, or exercise

PSYCHOLOGICAL FACTORS

Deficiencies and Excesses
     -depression -> altered appetite -> less eating or over eating, slowed peristalsis -> constipation -> laxative use
     -stress, loneliness, boredom, grief -> less eating or over eating
     -ignorance -> poor diet planning
     -eating habits -> excess eating after activity levels decline

ECONOMIC FACTORS

Deficiencies and Excesses
     -fixed income, limited income, retirement, high medical bills, -> less money -> cannot afford proper diet
     -advertising
     -availability and price of proper and varied foods
     -cost of food storage and preparation facilities

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© Copyright 1999 - Augustine G. DiGiovanna - All rights reserved.
This material MAY be reproduced or distributed in any form or by any means, or stored in any data base or retrieval system ONLY under one of the following two conditions: (1) If no individual, group, organization, institution, company, corporation or other entity is charged for its use and only for use by instructors and students in courses where students are required to purchase the book HUMAN AGING: BIOLOGICAL PERSPECTIVES by Augustine G. DiGiovanna, The McGraw-Hill Companies, New York, 1994 or 2000; (2) If prior written permission is obtained from Augustine G. DiGiovanna.