geriatricnutritionfinaluploadedversion

GERIATRIC NUTRITION
GUIDED BY:
DR. NILESH BULBULE
PRESENTED BY:
DR. SHALU MONDAL

CONTENTS
 Introduction
 Definitions
 Factors Affecting Nutritional Status
 Nutrients Needs
 Food Pyramid
 Assessing Nutritional Status
 Diet Recommendations
 Diet Instructions for New Denture wearers
 Conclusion
 References
Geriatric Nutrition 2

INTRODUCTION
"Let food be your medicine and medicine be your food." by
Hippocrates.
Aging being a natural process requires special
considerations.
Thus proper nutrition is essential to health and comfort of
oral tissues which , in turn enhance the possibility of
successful Prosthodontic treatment in the elderly.

DEFINITIONS
 In science and human medicine, Nutrition is the science
or practice of consuming and utilizing foods.
 Geriatric nutrition applies the nutrition principles to
delay effects of aging and disease, to aid in the
management of the physical, psychological, psychosocial
changes commonly associated with growing old!

AGING FACTORS AFFECTING THE NUTRITIONAL STATUS OF
THE ELDERLY
Functional:
Impairments affect nutritional
status
e.g. stroke arthritis
Psychological:
Life situational factors increase
nutritional risk in elderly
Pharmacological:
Over counter drugs and several
prescriptions = nutrient deficiency,
weight loss & malnutrition.
Physiological:
Body mass decline= calorie needs
Dehydration= kidney function
Overt deficiency= neurological/
behavioral impairment

ORAL FACTORS AFFECTING THE NUTRITIONAL STATUS
Xerostomia
Associated with difficulty in
chewing & swallowing
Drugs= Hypo salivary side effects
Sense of taste and smell:
Diminished taste and smell
characteristic
Thus limited consumption.
Dentate status:
Impaired masticatory function
leads to inadequate food choice
Thus alteration in nutrition.
Effect of dentures on chewing ability
With age, more strokes and longer
chew.
Masticatory inefficiency is 80%
lower than with dentate patients.

NUTRIENT NEEDS FOR THE ELDERLY
Nutrients are substances in food that your body needs
for energy, proper growth, body maintenance
and functioning.
Classes of nutrients :
1. Carbohydrates
2. Proteins
3. Fats
4. Water
5. Vitamins
6. Minerals Geriatric Nutrition 7

 The requirements decrease with advancing age
 Due to:
Reduced energy expenditure
Decreased basal metabolic rate
 Recommended Dietary Allowances (RDA):
1600 Kcal for women
2400 Kcal for Men
CALORIE INTAKE BY THE ELDERLY

 The requirements decrease with advancing age
 Due to :
Reduced physical activity
 Recommended Dietary Allowances (RDA)
1300 Kcal for women
1800 Kcal for Men
 Deficiency: Causes parotid gland enlargement, muscle
wasting, pale atrophic tongue
ENERGY REQUIREMENT

 Its been consumed largely, possibly at the expense of proteins
due to their low cost, ability to be stored without refrigeration
and ease of preparation.
 RDA
50-60 percent of total calories.
 Fibers:
a special subclass of complex carbo-
hydrates.
 Promotes bowel function
CARBOHYDRATES

 With age the amount of protein required is increased.
 Are a must for the denture wearers
 RDA: {for 51 years and above}0.8g/kg body weight
(i.e. 56gms for male
46gms for female)
OR
9% for males of total calorie intake
10% for total calorie intake for females.
PROTEINS

 Transport and absorb vitamins
 3 types : saturated fatty acids, trans fatty acids, unsaturated fatty
acids.
 Excess energy is stored in form of fats
Excess lead to unhealthy weight gain &
obesity
Type 2 Diabetes.
 RDA :
25-35% of the total calorie intake daily
FATS

 Water is an essential nutrient because it is
required in amounts that exceed the body's ability
to produce it.
WATER
 RDA :
More than 1700ml daily at least.

 Helps control the body process & also release energy to
do work.
 They don’t contain calories
 Neither provide body with energy
 2 types:
Fat soluble (A,D,E,K)
Water soluble (C and B complex)
VITAMINS

 FAT SOLUBLE: carried by fat present in food and stored in the body
VITAMIN D:
 The sunshine vitamin crucially important to the body
 RDA:
10µg in males and females.
 Deficiency: Osteomalacia, Osteoporosis, Poor immune Function.
VITAMIN A:
 RDA:
900µg for males and 700µg for females
 Deficiency: Decreased salivary flow, desquamation of
oral mucosa, Keratosis, decreased taste acuity,
metaplasia of salivary gland epithelium.

VITAMIN E:
 The total plasma vitamin E levels increase with age.
 RDA:
15mg for males and females.
 Deficiency: Doesn’t seem to be much of a problem orally per se.
VITAMIN K:
 The coagulation vitamin is very crucial in relation to
blood clotting process.
 RDA:
1µg in males and females.
 Deficiency: Coagulopathy, Petechiae, Ecchymosis, Low
Bone Density, Increased risk of gingival bleeding.

 WATER SOLUBLE: carried to the body tissues
• B1 (THIAMINE):
Helps cell convert carbohydrates into energy
RDA:
1.2mg for males and 1.1mg for females
Deficiency: Beriberi
• B6 (Pyridoxine):
It helps metabolize carbs, proteins & fat & also help to keep the
immune system healthy.
RDA:
1.7mg in males and 1.5mg in females.
Deficiency: Nasolabial Seborrhea Glossitis.
B-COMPLEX

• B12 (RIBOFLAVIN)
It is the largest and most structurally complicated vitamin
involved in the metabolism of every cell of the human body.
RDA:
2.4µg in males and females.
Deficiency: Fiery or Beefy red tongue, Candidiasis,
Aphthous Stomatitis, Intra-oral Burning.
• B9 (FOLIC ACID)
Its acts as a co-enzyme with vitamin b12 and vitamin C to
produce cells in the body.
RDA:
400µg for males and females
Deficiency: Mouth Ulcers, Glossodynia, Glossitis, Stomatitis.

WATER SOLUBLE VITAMINS
Helps cell convert
carbohydrates to
energy
RDA:
1.2mg for males
1.1mg for females
.
Its acts as co-enzyme
to produce cells in
body.
RDA:
400µg (M&F)
It keeps immune
system healthy.
RDA:
1.7mg in males
1.5mg in females.
Metabolism of cell
RDA:
2.4µg (M&F)
Deficiency: Fiery or
Beefy red tongue,
Candidiasis, Aphthous
Stomatitis, Intra-oral
Burning.

VITAMIN C (Ascorbic acid):
It is an essential nutrient involved in the repair
of tissue and the enzymatic production of
certain neurotransmitters. It also functions as
an antioxidant.
• RDA:
90mg for males and 75mg for females
Deficiency: Scurvy, Petechiae, delayed wound healing

MINERALS
• Substances that the body doesn’t manufacture but are
essential for healthy bones and teeth.
• They don’t contain calories
• Neither provide body with energy

• CALCIUM
A certain amount is required to build & maintain strong bones &
healthy communication between the brain & other parts of the body.
RDA:
1200mg for males and females
Deficiency: Osteoporosis, Muscle loss, Tooth Decay, Ridge
Resorption.
• IRON
Its main purpose is to carry oxygen in the hemoglobin of red blood
cells throughout the body so cells can produce energy.
RDA:
8mg for males and females.
Deficiency: Burning tongue, Dry mouth, Anemia’s, Angular
chelitis Geriatric Nutrition 22

• ZINC:
Its utilization reduces with advancing age due to decrease in
intestinal absorption.
RDA:
15mg for males and females
Deficiency: Decreased taste acuity, mental lethargy, slow wound
healing.
• MAGNESIUM:
It helps form bones and teeth and also activates enzymes.
RDA:
420mg for males and 320mg for females.
Deficiency: Low bone density, muscular weakness, Fatigue.

Modified Food Pyramid For Older Adults.
Row of glasses to
maintain adequate fluid
intakes
Various physical
activities.
Vitamins B 12 or D or calcium supplements.
Low-saturated fat &
vegie choices in meat-&-
beans group
Variety of fruits and vegetables
Whole grains and
variety
Oils low in saturated fats &
lacking trans fats
Fiber-rich foods in all
food groups
Low-fat & nonfat dairy foods with
reduced lactose

Assessing The Nutritional Status
The Tri-Phasic analysis Method
Phase I
 Screen all the patients.
 Present dietary habits
are taken into
considerations.
 If Nutritional problems
detected then
 If enough information
collected for rationale
basis
Phase II
Phase III
 Reserved for more
complex problems.
 Biochemical test of
blood, urine, tissues
along with
metabolic and
endocrinal
functions.
 (Only under the
supervision of a
physician.)
Assessment
terminated.
 3 to 5 day period
nutrients
calculated.
 Automated blood
tests done.

Diet Recommendations
4 Serves :
• 2 serves of Vit C.
• 1 serve of Vit A.
• 4 serves of
carbs.
4 Serves :
Enriched breads,
cereals and flour
products
2 Serves:
Milk and milk
based food.
2 Serves:
Meat, Fish, Poultry,
Eggs , Peas.
Serve of :
Fats, oil, sugar.

Diet Instructions For New Denture Wearers
Logical Sequence: Bite, Chew and then Swallow. For New Denture Patients: the Reverse order.
Firmer foods along with soft food.
Cut into small pieces before eating.
4th Post Insertion day:
Juices and tender cooked veggies.
Softened breads, tender meat, cottage cheese.
Butter/Margarine and glass of Milk at least once in a day.
2nd & 3rd Post Insertion day:
Juices of fruits and veggies.
Pureed meat or broths.
A Glass of Milk at least once
in a day.
1st Post Insertion day:

CONCLUSION
 Considering the high prevalence of poor nutritional status among the
elderly, more focus on diet and possible nutritional interventions are
required in which practicing Prosthodontist can play a vital role.
 The nutritional deficiencies are multi-factorial. Where the patients
tend to deny the dietary indiscretions. Hence, it’s the prosthodontist
who should educate and make sure about the adequate intake of
nutrients from regular follow ups.

References
Essentials of Complete Denture Prosthodontics ; Sheldon Winkler ; 2nd
Edition.
Textbook of Geriatrics dentistry ; Poul Holm-Pederson ; 2nd Edition.
Bandodkar K. Aras M, Nutrition for Geriatric Denture patients; Journal of
Indian Prosthodontic Society; March 2006; Volume6; Issue 1

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