صفحه 1:
00
صفحه 2:
صفحه 3:
اهميت تغذيه و سلامت سالمندان
ere a Cel
eee OTe prea
eR eve Rea
#افزایش جمعیت سالمند
صفحه 4:
مصماه۳۵۲ظ
1 1 1
1in 10
1 1 5
1in3
Year
1900
2000
2050
2150
صفحه 5:
اهميت تغذيه و سلامت سالمندان: جنبه هاي
اجتماعي -اقتصادي
كتير جيقاد اجسافي
*کاهش در امد
*نقش جامعه و دولتها
صفحه 6:
جنبه هاي بيولوژيك سالمندی
#فرضیه هاي پيري
و
در ۸( سازی
eB Ros. Sebel
Ce cence nese al
Eee Semel oreo peer tial
# دستگاه گوارش
اد تشر
* دستگاه قلبي-عروقي
و ۱
# دستگاه دفع ادرار
صفحه 7:
Changes with Aging
=" Body composition - less muscle, more fat
=" Decreased metabolism - decline of 5% per
(90506
=" Decreased insulin sensitivity
= Decline in the immune system
=" Chronic disease
= Malabsorption
=" Heart disease
= Decline in kidney function
صفحه 8:
Changes with Aging
= Dementia: forget to eat
= Disability: arthritis, stroke, impaired vision
and hearing
= Depression: death of family members and
friends
ا ا
= Living alone, disconnected socially,
Loneliness,
™ Socioeconomic changes
صفحه 9:
Effect of Aging
Lack of thirst and decreased total body water make dehydration
likely.
Need decreases as muscle mass decreases (sarcopenia).
Likelihood of constipation increases with low intakes and
changes in the Gi tract.
Needs may stay the same or increase slightly.
‘Atrophic gastritis Is common.
Increased likelihood of inadequate intake; skin synthesis
declines.
Intakes may be low; osteoporosis is common,
In women, status Improves after menopause; deficiencies are
linked to chronic blood losses and low stomach acid output.
Nutrient
iron
صفحه 10:
1 Te implications ae consuming
high-protein low-carbohydrate diets in lean
physically active individuals with a family
history of breast, prostate or colon cancer?
High concentrations of IGF-1 and essential
amino acids stimulatethe PI3K/AKT/mTOR
pathway, which promotes cell proliferation
and inhibits apoptosis of mutated cells
(Pollak, 2004).
صفحه 11:
رابطه بين طول عمر سلامت و دريافت انرزى و
پروتئین و میزان 0
Poor health Good health Poor health
Decreased survival Increased survival Decreased survival
Fatand muscle wasting | Optimal tssue & organ | Excess adipose tissue
Melabolic dysfunction: | function | Metabolic dysfunction:
Insulin resistance | Decreased risk of chronic | Insulin resistance
‘Amenorrhea | disease | Amenorthea
انماما ۱ + Infertility
Irmmune dysfunction | | Immune dysfunction
Cardiac dysfunction * Cardiac dystunction
Potential lifespan/
je expectancy
et >
Activation of PISK/AKT/mTOR pathway
صفحه 12:
Protein intake
Exercise
Training
Smoking
Pollution
Fig. 2. The longevity puzzle: determinants of healthy longevity.
صفحه 13:
۱ nC CSS Ibe
ارزيابي تن سنجي
"وزن و قد
"نمایه توده بدن (131۷11)
"ترکیب بدن (محیط میانه ماهیچه بازو نسبت دور کمر به دور باسن)
ارزيابي باليني
ا ا ا ا
ا لك
"امعاينه دهان و دندان: زخم در دهان» خونريزى لثهء لقى دندانهاء اندازه نبودن
دندان مصنوعی, نیاز به دندان مصنوعی
۱ Te] Eye)
صفحه 14:
اجزاي ارزبابي تغذيه اي در سالمندان
resol اززكي
اررتابی مصرف عذابی
ا 00
ا ل 0
صفحه 15:
اجزاي ارزبابي تغذيه اي در سالمندان
ارزيابي عملكردي
" ميزان تغيير از وضعيت مستقل به وابسته در انجام
فعالیتهای روزانه برای امور زندگی یا فعالیت های
مرتبط با تغذيه
ارزيابي دا(وبي
"" بيشتر داروى با نسخهء مصرف روزانه داروهاى بدون
نسخه (مانند آسپرین, آنتی اسیدها)؛ باورهای غلط
تغذيه اى
صفحه 16:
NUTRITION SCREENING
com tare) هکس
Special diet for illness/disease (2)
Fewer than 2 meals per day (3)
Few fruits, vegetables, milk prods (2)
3 or more alcoholic drinks daily (2)
Tooth/mouth problems make eating difficult (2)
Not enough money to buy food (4)
Eat alone most of the time (1)
3 or more prescriptions or OTC drugs daily (1)
Unintentional 10 lb wt. loss/gain, past 6 mo (2)
Not always able to shop, cook, feed self (2)
صفحه 17:
مشكلات رايج مرتبط با تغذيه
در سالمندان
صفحه 18:
بی اشتهایی
کل ۱
علل احتمالي:
ean ee Soe OTD Ee OD ad
حسها: کاهش چشايي و بويايي
دريافت غذا: مشكلات جويدن و زخمهاي دهان
دستكاه كوارش: تاخير در تخليه معده(سيري زودرسء اختلالات بلع)» يبوست
رواني-اجتماعي: فقر» افسردگي» فراموشيء انزواي اجتماعي
داروها: ديكوكسين؛ داروهاي روان كردان» داروهاي ضد التهاب
وضعيت جسمي و بيماري: ناتواني» سرطان
صفحه 19:
|
عوامل مرتبط
a دريافت نامناسب
۳ a
۴ انزوای اجتماعی
۴ ناتوانی در فعالیت جسمی
ل لك
صفحه 20:
سوء تغذبه
۴ ۱۰-۶ شیوع
Paro SDR eCaE 0
۴ کمبود انرژی
٩ در مراک سالمدان خطر مکی است سس بان
صفحه 21:
RB tls ot Be ere
lok Was Ret م
" سرطان
بیماری ریوی
بیماری قلبی- عروقی
بیماری احتقان قلبی
فراموشی
د
كم وزنى
فشارخون بالا
پوکی استخوان
مت
ore
افسردكى
صفحه 22:
Re eh a ere
* مشکلات سلامت دهان (نداشتن دندان» پوسیدگی دندان؛
ne 6
۴ اختلالات حسی
0
و9۹
صفحه 23:
Poe Re OP De ee ee
mae Key hes
More common than you
۱2 علسقطة
= 2 - 10% free-living elderly
populations !
= 30 - 60% institutionalized elderly !
= 40 - 85% nursing home residents 2
= 20 - 60 % home care patients ?
(1) Vellas, B. et al, NNWS, 1999, Volume 1; (2) Nutr Screening Initiative
صفحه 24:
Why the concern?
= Malnourished elderly are:
= 2 times more likely to visit the doctor
= 3 times more likely to be hospitalized
= Infection is the most common disorder
= 2 - 10 times more likely to die if malnourished
= Diminished muscle strength
= Poor healing
= Malnutrition is a greater threat than
obesity
صفحه 25:
Complications and mortality
22:235-9 2003 عخسلة سنا0 .له أعء مأءحدم0ن
infectious wd woiuevtivus P<OG; worultiy PSO
Quell-wursked
Bwoluvuished
2%
90
196
۵
2
worality كص سم جوا اوه
جوا ساموت vowplicutivas
صفحه 26:
00 4 اف
Malnutrition 1.60*
Age = 60 years ۱
Presence of 1
infection
*P<0.05
صفحه 27:
Risk factors for death
۱ rey COM tT Taye
Correia et al. Clin Nutr 2003; 22:235-239
934
WP eyes
Dobe
207
0.16*
IN 4
Malnutrition
Age = 60 years
Presence of cancer
Surgical treatment
Suk}
صفحه 28:
“21111111111011 ع
Pressure Ulcers
aN At risk |Malnouris
00 0
n (%) 4 (17%) 7 (29%) |13 (54%)
ICR Ar se eo) 8143 |79+2
Albumin 3.5 + 0.4 3.0 any 0:2 9.1 (OIL
(g/dl)
11 ES Ce keen:
(kg/m?) 18
1] هه رز مهو INET
صفحه 29:
Malnutrition : A vicious
circle
= زوا el ee
Reduced feeding ره
capabilities ele) g ی
Reduced mobility Poor Appetite
9598 Loss of en م
strength
صفحه 30:
Malnutrition increases
costs
= £7.3 million per yr spent per 100,000
malnourished in the community (BAPEN
report 1999)
= Estimated cost savings in hospitals of £266
million/year if nutritional support provided
(Kings Fund report)
صفحه 31:
Aging & Malnutrition
Why is this an issue?
Changes with aging:
= Physical
= diminishing eye sight
= poor dentition
= taste changes
= poor swallowing
= Physiological
= Metabolic
= Psychosocial changes
صفحه 32:
۱7
A condition in which at least 3 of the following 5
symptoms are present:
« ۲۷۷۵۵155
= Slow walking speed
= Low level of physical activity
= Unintentional Wt loss
= Exhaustion
Malnutrition has been identified
as one of the 4 causes of frailty
صفحه 33:
Components of Frailty
=" Sarcopenia.
=" Osteoporosis
=" Muscle weakness
صفحه 34:
body composition in the
20011
blood calls, bone calls, etc.
1%
صفحه 35:
بيماريهاي شايع دوران سالمندي
لك
))5 ل ره ا 406
renee eS a eens eT Ne eld
from the Greek meaning Bahia) و9
("flesh
* عامل خطر عدم تعادل و زمین خوردن
۱9 a Rae a eS on oO 1
ab,|, Pro, E, Mg, Zn, Ca, vitD cab."
دارد.
صفحه 36:
Consequences of
Sarcopenia
™ Decreased resting energy expenditure
™ Decreased insulin sensitivity
= Diminished muscle strength
= Increased risk of physical disability
= greater reliance on canes & walkers
= several-fold increased risk of serious falls
= inability to conduct activities of independent
living, eg: shopping, dressing, meal
preparation
= Increased risk of mortality
صفحه 37:
Treatment of Sarcopenia
٠ Hormonal therapy
* Testosterone
» DHEA
» Estrogen
» Growth hormone
- Exercise interventions
- Nutritional supplementation
صفحه 38:
بوکی استخوان (051]60۳00۲0515)
"the bone mineral density (BMD) is reduced,
"bone microarchitecture is disrupted, and
"the amount and variety of proteins in bone is altered.
"Diagnosis (WHO): a women bone mineral density 2.5
standard deviations below peak bone mass (20-year-
old healthy female average) as measured by DXA;
۱۹
0 ل ا ل
مهره ها و كمر
ا ل ا ا 0 ل ال ل liad
CS ee Dead
Ca. vit D. vit C. vit KF. Pro 3,2."
صفحه 39:
osteoporosis
= most common in women after menopause:
postmenopausal osteoporosis,
™ May also develop in men,
= and may occur in anyone, in the presence of :
™ particular hormonal disorders
™ chronic diseases
"as a result of medications, specifically glucocorticoids,
when the disease is called steroid- or glucocorticoid-
induced osteoporosis (SIOP or GIOP). Given its
influence in the risk of fragility fracture,
= may significantly affect life expectancy and quality
(9
صفحه 40:
Vitamin D and calcium
availability in the elderly
+ 20% of post-menopausal white women
have osteoporosis
٠ 1 of 2 white women will experience an
osteoporotic fx in their lifetime
* Only 40% of pts experiencing a femoral
neck fx regain their pre-fx degree
of independence
+ Management of 1 hip fx costs $40,000 (in
2001 $$); est. annual cost to U.S.
health care system=$17 billion
صفحه 41:
مرن م۱
نو ایو با مرو لح نو[
ee ا ل ۱۱
0 و
Young #—=
صفحه 42:
توصیه ها
Expert Panel of the National Osteoporosis
Foundation, 2003
= all women over 50 should consume 1200 mgs
elemental calcium/d (median intake of p/m
women in U.S.=600, TUL=2500 mgs)
= all women over 50 should consume at least 600
IU of vitamin D/d; 800 IU for those at risk of
deficiency (elderly, chronically ill, housebound or
institutionalized; TUL=2500 IU/d)
bac np aces a Ee ل روصم
سس
oie ee ct coe ee oe res ee Ned وس
®ouoideare oF tobooee use ood >C ات و
صفحه 43:
7
و
- متلاير بالاق Cig gal راز oe کاهش پیشرفت بیماری موثر
SE ee) ier Te A eee a oa
رژیم مشابه بیماری قلبی (کم چربی کم کلسترول) *
۱
تداخل ۷37 با پراکسیداسیون چربیها *
صفحه 44:
oe 51 653 -(Gout ry)
ae ee Sat el لان
Pee ED Ie TOSS dae os eae TOSS ec a
نسود.
صفحه 45:
بيماربهاي قلبي عروقي
* شایترین علت مرگ و میر در سالمندان
ا 0
ی تردید در مورد متاسب بودن رزيم NCEP براي سنين
ru ere 8
* هيپوليپيدمي و مرگ و میر ناشي از عوامل غیر قلبي-
عروتي
صفحه 46:
صفحه 47:
فشارخون بالا (هيبرتانسيون)
1
|
"" درمان و ييشكيري: تغيير شيوه زندكيء شامل افزايش فعاليت
STO teed rei سر سرت 27 سس
يتاسيم» اسيدهاي جرب كلر و منيزيم)
"" دارو درمانى: داروهاى مدر و بتابلاكرها
صفحه 48:
للا ۲۰۱۳۸۱۱۱۱۸۱۵۹۵
* زوال عقلی بزرگسالان
" از دست دادن بيشرونده حافظه و ساير عملكردهاى ادراكى
" ناشى از از دست دادن نرون هاء قشر كيجكاهى و فرونتال
es
Peer ei] eae On eo re eee ca
oD Ee ROL Lees a6) cee ees iia
" تجمع 41 در مغز بدون لا آن در بدن
B6, Zn, B3, B1, vit B12, vit C 2.5 "
صفحه 49:
Summary of Nutrient
Brain Relationships
Depends on an
Brain Function Adequate Intake of
Short-term mem Vitamin 6
vitamin E
Performance
problem-solvir
Mental health
Cognit
صفحه 50:
کاتاراکت (آب مروارید)
" تغییر در عدسی چشم (عمدتاً بصورت اسکلروز ناحیه
۸۲( )۳ در انر تخریب اکسیداتیو پروتّین های عدسی
* با مصرف کافی ویتامین های ۴6 ,132 6 رو کاروتنوئیدها
نو ور ابطه دارد.
صفحه 51:
3
An eminently age-related but silent
condition
= chronic inflammatory disorder
= associated with Helicobacter pylori
infection
= results in decreased secretion of
hydrochloric acid, pepsin and to a
modest degree, intrinsic factor
صفحه 52:
Prevalence of Atrophic Gastritis by Age
As
درا
00 ا 80+
66
Data from Krasinksi et al. J Am Geriatr Soc. 1986;34:800-6.
صفحه 53:
GREATEST NUTRITION
RISK
= Home Delivered Meal Recipients
=" HIGH risk
= MODERATE risk
= Hospital Inpatients / Outpatients
= HIGH risk
= MODERATE risk
= Average, 83% high or moderate risk
صفحه 54:
0ت
» سالمندان
صفحه 55:
برنامه های غربالگری و پایش تغذیه ای
“By identifying those who are
malnourished or at risk of
malnutrition either in the hospital or
community setting, it may be
possible to provide adequate and
immediate nutritional support to
prevent further deterioration.”
DIT Cr ee Sou Coe RSTn aR Tee aT
صفحه 56:
Nutrition
= Purpose: to ع5 individuals
nutritionally at-risk or who are
malnourished
Nutrition Assessment
= Purpose: to identify early signs of
malnutrition and prevent it from
becoming a major co-factor in organ
dysfunction and morbidity and mortality
صفحه 57:
What is Screening?
™ Separates those who are healthy from
those at high risk for the condition
= Tests should be non-invasive,
inexpensive, and have rapidly
available results
صفحه 58:
Screening
Tools
= MNA® Short Form
= Nutrition Screening Initiative
™ DETERMINE checklist
= MUST (Malnutrition Universal Screening
Tool)
= Nutrition Risk Screening (NRS) (ESPEN)
صفحه 59:
Developed in 0
Validated for ages 65+
Simple, reliable, non-
invasive,
& quick
Inexpensive
Validated in hospital &
community setting
For screening &
assessment
Nt od ke ML ae
سس زیت مس تا
Oe kN Re RUA aa ale
2000;FO:1900-
1909۶
ل ل ی
صفحه 60:
Tayo
Anthropometrics
Diet questionn
Global assessment
۰ عاتجاوع11]
Subjective
2555222
٠ ممنامعءع7عم لاعه
of health
& nutrition
صفحه 61:
11111111011 5016© 111110
Process
= Level II Screen
™ - same data as
ارت
= - labs and
™ anthropometrics
= - clinical features
= - mental/cognitive
™ status
= - medication use
¢ Level I Screen
- height
تخا وزعت -
- ت7تهاع01 ol
- daily food intake
- living
اصمصصم ده
functional status -
صفحه 62:
111110 ©5001 001111111011 ع
Lae ۱۱۱۱
صفحه 63:
ا هام10 9601۲8 ۷۲۸۲۸۶
۱ cace ON Ncd
سس مر دايا
bk ل 0 حت
تسص مت ۱ ل بي"
۱
صفحه 64:
Predictive ability of MNA
9
™ One-year Mortality
=™<17- 48%
= 17-23.5 - 24%
= > 23.5-0%
= Correlates with functional level
= Good correlation with nutritional
markers
= Dietary intake, vit.D, folate, prealbumin
صفحه 65:
Mini Nutrition Assessment
(MNA®)
Short Form
= Based on the original MNA ®
= Uses only 6 items
= MNA ® determined to be too time consuming to
use as a screening tool
= Was further validated in ambulatory elderly
patients
صفحه 66:
MNA® Screening
Form (MNA-SF)
Screening score it nox. 1¢sor
وی موه لا مهار
۵ 000056:06 مسا ل لدب کرو
صفحه 67:
The Nutrition
Screening Initiative
= ADA, AAFP, NCA
= Designed to increase
community dwelling
رات ارات وت اقا Uh
health & nutrition
= Self-administered
checklist determines
need for referral to a
health care professional
= Not clinically validated
صفحه 68:
Nutrition screening
08 ء ره
DETERMINE Initia ۳۷ high-risk =
population =
™ - disease
™ - eating poorly
= — tooth loss/mouth pain
= - economic hardship
= - reduced social contact
- multiple medicines
= - involuntary weight loss/gain
= - needs assistance in self-care
= - elder years above age 80
صفحه 69:
DETERMINE
YOUR
NUTRITIONAL
The Warning Sigus of poor ustriticnad
vali are nfen vserdocked. Use tis
heck fr مومس سر
‘ow iat wean re
ea same nl Che he pee
0 د سد
صفحه 70:
NRS - Nutrition Risk
Screen
= Developed in 2003 (Kondrup et al - ESPEN)
= Used retrospective analysis of RCT (adults)
= Nutritional criteria or characteristics
= Clinical outcome
Assumption: Indications for nutrition support are :
™ the severity of undernutrition
= the increase in nutritional requirements from the disease
™ Screen includes measures of current
potential undernutrition & disease severity
= Validated vs RCT of NS to determine if it was
able to distinguish those with a positive
clinical outcome vs those with no benefit.
صفحه 71:
NRS - Nutrition Risk Screen
Nutritional Risk Screening 2002 (ESPEN guideline)
ronic patients, in particular with acute
(1), COPD
| complications: cirrhosi
(12)
Chronic hemodialysis, diabetes,
matignant oncology.
Major abdominal surgery (13-15).
Stroke (16)
Severe pnewmonia, malign
hematology
Head injury (18, 19),
Bone marrow transplantation (20)
Intensive care patients (APACH.
= TOTAL SCORE:
normal | Mild
requirement in preceding week. |
Score 1
Weloss>3% in 2 mths
Or
BMI 18.5 - 20.5 + impaired
eral condition
Moderate
Or
Food intake 25-50% of normal
requirement in preceding week |Score 2
We loss
3 mths (17)
lor
BMI <18.5 ~ impaired general
condition (17)
5% of
requirement in precedin
Moderate
Score 3
صفحه 72:
Nutrition
Assessment
‘A comprehensive evaluation to define
nutrition status
‘Forms the basis for nutritional support in
patients who require specific nutritional or
metabolic evaluation, and perhaps special
feeding techniques.
‘An expert task.
صفحه 73:
Nutrition
۱۵ ۳8
Components
= Medical History
= Dietary History
= Body Composition
= Physical Exam
= Laboratory Analysis
صفحه 74:
1121221111 11212115 10 11171110
Longer
=" Regular balanced meals
=" Weight control
=" Regular exercise
= Abstinence from smoking
= Ability to bounce back
after a loss
=" Challenge the mind
= Stay social with friends
صفحه 75:
MEALS ON WHEELS
= Project outcomes:
= Expansion of service to vulnerable clients
= Delivery & cost efficiencies while
improving dietary intake
= New referrals & improved community
service coordination
= Quicker implementation of breakfast as a
new service
= Identification & measurement of
participant & project outcomes
صفحه 76:
NUTRITION
COUNSELING
an individualized process that can help
manage personal nutrition care effectively.
it is an essential service, particularly for
those at risk.
may be used to obtain more information, to
review & strengthen acquired knowledge
or desirable habits, or to help set personal
goals & make individualized decisions.
.سوسم مطااشت له عمو لمصووصاطت رس
وکا ل
صفحه 77:
THE NUTRITION GAP
Supportive Medical / Health
OLDERADULYT Services اروت
Food & Nutrition: .الها Pisa aloyery
nurturing, emotional, therapeutic tx for
quality of life, social role medical
conditions
2 SEPARATE, PARALLEL SYSTEMS
LITTLE CONTINUITY OF CARE
صفحه 78:
MNT HELPS BRIDGE
THE NUTRITION GAP
OORC1OG LOOE 9
00۶ ۰
Oy تفه و 000000
ی ای 0 OD لكك
2000 4 ۸ ها
eh omnes
00۰0۰
00 000۰
ا 200200
Ferenc ل
0086001006 >
2
صفحه 79:
NUTRITION & AGING INFO
= www.aoa.gov & Wwww.usda.gov
= National Center on Nutrition & Aging
www.fiu.edu/~nutreldr
= IOM Report: Nutrition Services in
Medicare
www.nap.edu/catalog/9741.html
= American Dietetic Association
www.eatright.org
= Nutrition Screening Initiative
www.aafp.org/nsi/manual/index.html
صفحه 80:
Figure 1. Social protection instruments across the lifecycle
Child grants,
education stipends,
family allowances
{conditional cash
transfers, school
feeding
Education/training
stipends, employment
guarantee
schemes/public works
|
و
Childhood
۱/۹۵
Employment ونم
guarantee
schemes/public
works, family
allowances