Nutritional Considerations for Elderly Patients

NUTRITIONAL
CONSIDERATIONS IN
ELDERLY PATIENTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INTRODUCTION
Since the turn of the century, there is considerable
increase in the number of elderly patients. 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.
This shift is due in part to improved dietary practices
and better over all health.
But it is observed that nearly half of older
individuals have clinically identifiable nutritional
problems. Nutritional risk increases with advancing age.
Therefore a large number of denture patients can be
expected to have nutritional deficits.

The nutritional status of the elderly are adversely affected
by low income, loneliness, poor cooking facilities. Lack of
knowledge and interest in desirable food choices also
contributes to the poor nutritional status of elderly.
Dental and medical infirmities that interfere with
chewing, digestion, or metabolism can also contribute to a
poor nutritional status.

Certain nutrition related maladies for example
diabetes, obesity, cardiovascular disease, osteoporosis
and cancer – require special dietary regimens.
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.

DEFINITIONS
Nutrition
Nutrition can be defined as the sum of the
processes by which an individual takes in and utilizes
food. (FDI working group – Dr. M. Midda, Prof. K.G.
Konig).
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) www.indiandentalacademy.com

Nutritional status
Nutritional status is defined by Christakis as the
“health condition of an individual as influenced by his
intake and utilization of nutrients determined from the
correlation of information from physical, biochemical,
clinical and dietary studies (Nizel, Papas).

Food
Food can be defined as an edible substance made up
of a variety of nutrients that nourish the body. (Nizel and
Papas).
Food may be defined as any liquid or solid substance
which when ingested serves one or more of the following
functions
1. Provides energy.
2. Supplies materials for growth, maintenance of body
functions and sustenance of life and metabolic processes,
reproduction, or for repair and replacement of worn out
tissues.

3. Supplies materials necessary for the regulation
of energy production or the processes of growth
maintenance, reproduction, or repair. (Z.S.C Okoye)

Diet
Diet can be defined as the types and amounts
of food eaten daily by an individual (FDI).
The some total of the foods or mixtures of
foods which an individual consumes each day is
referred to as his diet. (Z.S.C Okoye)

Malnutrition
Malnutrition is a generic term given to the
patho-physiological consequences of ingestion of
inadequate, excessive or unbalanced amounts of
essential nutrients (Primary malnutrition), as well
as the impaired utilization of these nutrients
brought about by factors such as disease (Secondary
malnutrition). (FDI).

Balanced diet
A balanced diet is that which supplies all the
essential nutrients in adequate amounts and in
biologically available forms. (Z.S.C Okoye)
Basal metabolism
Basal metabolism is the minimum amount of
energy needed to regulate and maintain the
involuntary essential life processes, such as breathing,
beating of the heart, circulation of the blood, cellular
activity, keeping muscles in good tone and maintaining
body temperature. (Nizel, Papas)

BMR (Basal metabolic rate) :
BMR is defined as the number of kilocalories
expended by the organism per square meter of body
surface per hour. (K cal / m2
/ hour). (Nizel, Papas)
Nutrient:
A Nutrient is the active principle or the ultimate
nourishing chemical substance in food. (Z.S.C
Okoye)

As stated by GPT – 7
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.

Metabolism
The sum of all the physical and chemical
processes by which living organized substance is
produced and maintained (anabolism) and also the
transformation by which energy is made available for
the uses of the organism (catabolism).

According to Heartwell
Gerontology
Is the scientific study of the process and
phenomenon of aging.
Senility
Is old age accompanied by infirmity.
Gerontology
As defined by the Gerontological society in
1959 is the branch of knowledge, which is concerned
with situations and changes inherent in increments
of time, with particular reference to post-
maturational stages.www.indiandentalacademy.com

Factors contributing to nutritional problems
in the elderly
1. Physiologic changes associated with aging.
2. Psychosocial aspects
3. Drugs
4. Economic factors
5. Changes in oral conditions

1. Physiologic changes associated with aging
The elderly are often at high risk for developing
a nutritional deficiency due to the physiologic changes
accompanying aging. Knowledge of the effects of the
aging processes on nutritional status, nutrient
requirements of the elderly, and the factors affecting
dietary intake will help the prosthodontist provide
meaningful guidance to the elderly patient in
achieving improved oral health. There is gradual loss
of function associated with aging in most organs and
tissues of the body. These changes occur slowly and
are influenced by genetics, socioeconomic status,
illness, life events, accessibility of health care, and the

environment. There is a general loss of cells and
lower energy levels of the remaining cells during
aging. This is associated with a diminished reserve
capacity. That is, in the absence of disease, the organ
will function appropriately, but its ability to respond
to stress will decrease with time. There is a wide
variability in the rates at which these changes take
place, not only between individuals, but within
individuals. Changes might occur more rapidly in
one organ system and more slowly in others; for
example physical changes might occur at a more
rapid rate then mental changes in some individuals.

Body composition
Advancing age, with or without illness, results in
significant changes in body composition. As age
advances, there is a steady decrease in lean body mass
(muscle mass) of about 6.3 per cent for each decade of
life. This loss in lean tissue, however, is accompanied by
an increase in body fat and decrease in total body water.
The rate of decline varies with the specific tissue or organ
being measured. Korenchevsky has reported that by age
70 the kidneys and lungs show a weight loss of
approximately 10% when compared with the values of
young adults, while the liver diminishes by 18% and
skeletal muscles by 40%. This appears to imply that

skeletal muscles are a major contributor to the age
associated loss in lean body mass. Because protein tissue
is the most physiologically active tissue, its decrease
results in a lowered basal metabolic rate. Between the
ages of 20 and 90, BMR declines by 20%. If this is not
accompanied by a reduction in caloric intake or increase
in activity levels, slow weight gain will occur.

Bone density also declines with age. During
growth and development, bone formation exceeds
resorption. After peak bone age is achieved, usually
between 30 and 40 years of age, bone loss begins to
occur, as bone resorption exceeds bone formation.
Progressive bone loss begins in women at about 35 –
45 years of age and in men at about 40 – 45 years of
age. Women tend to have less bone density than do
men.

Metabolic alterations
Varying but progressive decrements occur in
indices of physiologic function such as cellular
enzymes, nerve conduction & velocity, resting
cardiac output, renal blood flow, maximum work
rate, and maximum oxygen uptake. Nutrient
uptake by cells appears to decline with age,
suggesting that older organisms may require higher
plasma levels of nutrients in order to maintain
optimal tissue concentrations.

Along with decline in tissue and cellular function,
metabolic activity is also progressively altered with
aging. Basal metabolic rate (BMR) an estimate of the
body’s energy requirements under basal conditions,
declines by approximately 20% between 30 and 90
years of age. In addition capacity of the elderly to
metabolize glucose is impaired. There is a reduced
ability to synthesize, degrade and excrete lipids, with a
subsequent accumulation of lipids in the blood and
tissues. With respect to hepatic albumin synthesis it has
been observed that aged individuals are less responsive
than younger individuals to increase in dietary protein
intake. This suggests that in the elderly the benefits

derived from improved nutrition may be limited by
the capacity of the individual to respond. Thus,
serum albumin concentrations in the elderly may
normally be maintained at lower levels and the low
values frequently observed may not be due to
malnutrition, as was previously thought.

Gastrointestinal functioning
The physiologic changes in the gastrointestinal
tract that occur with aging include decreased
peristalsis, decreased hydrochloric acid secretion, and
altered oesophageal motility. There is also reduction
in the levels of some digestive enzymes including
salivary amylase, pancreatic amylase, lipase, trypsin,
and pepsin. The overall capacity for absorption, as
determined by xylose absorption, has been shown to
decrease after the age of 70 ; and the intestinal
mucosal surface area available for absorption also
has been shown to be significantly reduced. It is
suggested that the degree of malabsorption differs for

various nutrients with age. For example, the ability to
absorb calcium declines with age. Loss of muscle tone
in the stomach results in reduced gastric motility
causing delayed emptying of stomach as well as a
reduction in hunger contractions. This loss of muscle
tone throughout the digestive tract can contribute to
constipation. In fact, constipation has been shown to
occur five to six times more frequently in the elderly
than in young adults, overall, disorders of the GIT
increase with age. The percent of adults with chronic
digestive disorders under the age of 45 is 4.6%, which
increases to 25% in persons 65 years of age or older.

Sensory changes
It is assumed that olfaction and taste generally
decrease with age. In addition to smell and possibly
taste, visual and hearing acuity declines with age.
These changes can indirectly affect nutrient intake
through altered food purchasing and preparation
behaviors. Inability to read labels, recipes, prices or
light the gas stove can lead to an inadequate dietary
intake. Loss of hearing can result in a self-imposed
restriction on social activities such as eating out or
asking questions in grocery stores.

Psychosocial factors
Exton Smith has categorized malnutrition in the
elderly according to various primary and secondary
causes.
Primary causes
1. Ignorance of balanced diet.
2. Inadequate income
3. Social isolation
4. Physical disability
5. Mental disorders

Secondary causes
1. Alcoholism
2. Increased use of drugs
3. Edentulism
Because eating is very much a social activity,
loneliness can contribute to malnutrition. Loss of a
spouse or friend can result in the loss of an eating
companion for the elderly individual who might be
eating alone or preparing his own meals for the first
time in his life. Individuals who have family or friends
living in close proximity are more likely to have their
needs met (social, economic or physical) than are thosewww.indiandentalacademy.com

living in relative isolation. It has been observed
that anemia and low leukocyte ascorbic acid levels
are more common in single men living alone, than
their age matched counterparts living with
relatives.
Mental disorders in the older patient can
result in confusion, irritability, acute depression,
or in extreme situations true dementia. These
persons can forget to eat even if food is available
and are particularly at risk for protein or caloric
malnutrition.

Alcoholism undermines the nutritional status
by providing “empty” calories derived from alcohol
and interferes with nutrient absorption.
Drugs
Older people are the chief users of drugs.
Although the elderly account for 11% of the
population, they are taking 25% of the prescribed
and over the counter drugs. Many of these drugs
interfere with digestion, absorption, utilization or
excretion of essential nutrients. Additionally, some
drugs profoundly affect appetite, decrease salivary
flow and affect taste and smell acuity.

Economic factors
Economic factors are a major force in
determining the variety and nutritional adequacy of
the diet. Surveys suggest a relationship between
income and nutritional adequacy. Vitamin C, in
particular, is a nutrient that has been shown to be
influenced by income. Additionally, other factors
that can affect nutritional intake are also influenced
by income, such as transportation, housing and
facilities for food storage and preparation.

Modified diets
It is estimated that 18 – 43% of elderly
individuals are following special diets restricting
their intake of sodium, fat, cholesterol, calories or
carbohydrates because of chronic disease. Although
this could have a positive effect on nutritional status
if foods are selected wisely, but there also could be
adverse effects.

Changes in oral status of the elderly
1. Alteration in gustation and olfaction
Gustation (taste perception) is mediated through
the papillae, taste buds and free nerve endings that are
found primarily in the tongue but also over the hard
and soft palates and in the pharynx. In general, the
number of these structures appears to decrease with
age.
The tongue perceives four modalities of taste –
salt, sweet, sour, and bitter. The tongue is more
sensitive to salt and sweet, where as the palate is more
sensitive to sour and bitter.

Olfaction is the act of perceiving odours. In
contrast with gustation, olfaction can be stimulated by
extremely low chemical concentrations.
In the process of aging, taste perception
diminishes – the perception for salt at an early age,
and for sweet a little later. This is as a result of hyper
keratinization of the epithelium that may occlude the
taste bud ducts. Vitamin A deficiency may be
associated with it. The receptors for the bitter taste in
the circumvallated papillae of the tongue seem to
survive aging process.

Denture wearers, do exhibit a significant
decrease in their ability to decipher differences in
sweetness of certain foods, along with hardness and
texture. This decrease in the sensory aspect of the
food can result in a decrease in food consumption
because tasteless, odorless food most likely will not
be eaten.

Salivary function
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. Some of the commonly prescribed
groups of drugs that produce xerostomia are
antihypertensives, anticonvulsants, antidepressants,
tranquilizers and anti Parkinson drugs.

In addition salivary gland function may be
diminished by obstruction of the duct with a salivary
stone, therapeutic radiation for head and neck cancer,
infection such as mumps, sjogrens syndrome, lupus
erythematosus, biliary cirrhosis, polymyositis, or
dermatomyositis or sarcoid and autoimmune hemolytic
anemia.
Since saliva lubricates the oral mucosa, the
lack of saliva creates a dry and often painful mucosa.
Without significant salivary flow, food debris will
remain in the mouth, where it is fermented by dental
plaque bacteria to organic acids that initiate the dental
caries process. A major function of saliva, which

contains calcium phosphates, is to buffer the acids and
to re-mineralize the eroded enamel surface.
In addition, 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.www.indiandentalacademy.com

Oral mucosal changes
The mucous membranes of the lips, the buccal
and palatal tissues and the floor of the mouth change
with age. The patient’s chief complaints are a burning
sensation, pain and dryness of the mouth, as well as
cracks in the lips. Chewing and swallowing become
difficult, and taste is altered. The epithelial membrane
is thin and friable and easily injured. It heals slowly
because of impaired circulation. If the salivary
deficiency is pronounced, the oral mucosa may be dry,
atrophic, and sometimes inflamed, but more often it is
pale and translucent.

When flow of saliva is disturbed, food may have
a metallic or salty taste, and sensitivity to bitter and
sour foods can increase, where as a reduced sensitivity
to sweet tastes can generate an unhealthy craving for
sugar. These changes potentially have an impact on
food choices. In the denture patient it can affect
adaptation of the prosthesis and may lead to the
development of denture related problems.

Muscle function and oral movements
People chew more slowly as they get older. Age
may impair the central processing of nerve impulses,
impede the activity of striated muscle fibers, and
retard the ability to make decisions. In addition there
may be a reduction in the number of functional motor
units along with a decrease in the cross sectional area
of the masseter and medial pterygoid muscles.
Consequently, older people tend to have poor motor
co-ordination and weak muscles.

Muscle tone can decrease by as much as 20% to 25%
in old age, which probably explains the shorter
chewing strokes and prolonged chewing time.
A longitudinal study of the oral health of
veterans found that masticatory ability was
unchanged with age but that older subjects and
individuals with dentures required more time to chew
in preparation of the bolus for swallowing. This could
contribute to the fact that the elderly tend to avoid
hard to chew foods such as meats, raw fruits, and
vegetables.

Temporomandibular joint pain
As a result of masticating very firm foods over
many years or as a result of bruxism, attrition of the
incisal and occlusal surfaces takes place. The
resulting teeth have shortened anatomical crowns,
exposed dentin, and wide, flattened chewing surfaces.
This type of tooth wear can produce overclosure of the
jaws and affect the relations of the mandibular
condyle to the glenoid fossa. With age, the glenoid
fossa can become shallower and the head of the
condyle, flatter. Thus it is possible for the meniscus or
articular

disc between the condyle and fossa, to be perforated
or damaged by this change in temporomandibular
relationships, causing pain and limitation of range of
movements of the jaws.
Another common cause of over closure, or loss
of vertical dimension is partial or complete edentulism
without prosthetic replacement. It is also possible that
degenerative changes, such as osteoarthritis (seen in
other joints of the body), can affect the
temporomandibular joint and can also produce the
articular disc changes that creates the clicking of the
jaw and discomfort in the ear. There may even be
limitation to the opening of the mouth, which may
permit only a small sized bolus of food.www.indiandentalacademy.com

Edentulism
Edentulism increases with age. It is generally
agreed that one third to one half of elders over the age
of 65 are edentulous in both maxillary and mandibular
arches. Lack of dentition does not necessarily mean
dietary intake will be compromised but considering
that teeth serve as the primary means of mastication as
well as has an impact on socialization and
communication. Loss of teeth will alter selection of
food, often adversely. Frequently, individuals with
poor dentition consume soft, easily chewed foods that
are low in fiber and have a low nutrient density.
When the food is insufficiently masticated, it is
released whole or incompletely digested from thewww.indiandentalacademy.com

G.I.T. Gastritis and ulcers have long been reported
in subjects with impaired masticatory function.
Relatively recent research suggests that the link
between masticatory deficiency and gastrointestinal
disturbances, as expressed by the presence of
symptoms such as diarrhea and constipation, is
mostly seen in the elderly.

Alveolar bone loss
The alveolar bone participates in the
maintenance of body calcium balance just as the rest
of skeletal bone does. Thus calcium is constantly
being deposited or resorbed from the alveolar bone to
maintain calcium homeostasis in the body. Alveolar
bone density, like skeletal mass declines with
advancing age. The rate at which this occurs is
affected by oral hygiene, (intestinal absorption of
calcium) nutrition, genes, hormones, bone density at
maturity, exercise and sunlight exposure. In persons
with osteoporosis the rate of alveolar bone loss is
increased. It has been demonstrated that calcium
supplementation can slow down the rate of bone loss

including alveolar bone. The relationship of systemic
bone loss to jaw bone loss is unclear. Bone loss is
accelerated and bone height is diminished when teeth
are lost. A greater degree is observed in women than
in men. Resorption is much greater in the mandible
than in the maxilla.

Nutritional needs of the elderly
Introduction
Energy Values of Foods and Nutrients
Because energy is of prime importance in the
life processes, the study of nutrition is concerned with
the basic question of how the human body metabolizes
or transforms the elements of food into energy.
The energy from food is made available to the
body in four basic forms: chemical, for synthesis of
new compounds; mechanical for muscle contraction;
electrical, for brain and nerve activity and thermal for
regulation of body temperature.

Because heat is produced by the transformation of
food energy to body energy, calories are used as units
of energy measurement. In nutrition, we measure
energy in kilocalories (kcal, formerly calories, or
large calories), which provide 1000 times the heat of
the gram (g), or small calorie, used in chemistry.
Thus the nutritional kilocalorie is defined as the
amount of heat required to raise the temperature of 1
kilogram (kg) (2.2 lb) of water by 10
C (from 14.5 to
15.50
C).

Energy needs of the Body
The overall energy needs of the body are
calculated to be the sum of three factors
1. Basal metabolism
2. Energy for physical activity,
3. A small amount of additional energy expended
during digestion and absorption of carbohydrates,
proteins, and fats in the gastrointestinal tract, called
the specific dynamic action, or SDA of food.
Thus the energy requirement = basal
metabolism + physical activity + SDA.

Basal metabolism and Basal Metabolic Rate
The basal metabolic rate (BMR) is defined as
the number of kilocalories expended by the organism
per square meter of body surface per hour
(kcal/m2
/hour). It is determined by body size, age,
sex, and secretions of endocrine glands.
Physical activity
Muscular activity affects both energy expenditure
and heat production. Energy expenditure increases
with muscular activity.

Environmental temperature
Environmental temperature is an important factor
in heat production. When the body is exposed to a
low environmental temperature, it automatically
produces more heat to maintain normal body
temperature.
Specific Dynamic Action (SDA) of Food
Specific dynamic action (SDA) is the term used to
describe the expenditure of calories during the
digestion and absorption of food.

Classification of foods
1. By origin
a. Plant food: Cereals, legumes, fruits, vegetables,
sugars, oils.
b. Animal products: Meat, fish, milk, dairy
products,
eggs, poultry products.

2. By chemical composition
a) Macronutrients: Proteins
Fats
Carbohydrates
b) Micronutrients: Vitamins
Minerals

3. By predominant function
- Body building foods (Proteins)
- Energy giving foods (Carbohydrates, fats)
- Protective foods (Minerals, vitamins)

Recommended dietary allowances (RDA, s)
The recommended dietary allowances (RDA, s) are
standards commonly agreed upon for assessing and
planning to meet nutrient needs at various ages.
RDA for the elderly currently are based on
extrapolations from the nutrient and calories needs of
adults up to the age of 50. RDA includes two age
groupings for energy allowances – persons aged 51 to
75 and those aged 76 or older. But the RDA for
vitamins and minerals includes only one age grouping
– those aged 51 and older.

Calories:
Calorie requirements decrease with advancing age
owing to reduced energy expenditures and a decrease
in basal metabolic rate. It has been suggested that
energy allowances for persons between 51 and 75 years
be reduced by 10% of the amount required as a young
adult, and for those over 75 years, by 20-25%.
Cross sectional surveys show that the average energy
consumption of 65 to 74 year old women is about 1300
kilo calories (kcal) and 1800 (kcal) for men of the same
age. This is lower than the RDA for adults 51 to 65
years of age (1900 k. cal for women and 2300 k. cal for
men) when the calorie intake is low, consumption of

foods of high nutrient density (such as legumes,
vegetable, soups, meat, casseroles, fruit, desserts, low
fat diary foods, and whole gram breads and cereals) is
important.

Carbohydrates:
Carbohydrates serve as the primary source of energy
for most individuals. There is no specific dietary
requirement for carbohydrates but the recommended
range of intake is 50-60% of total calories. Food
sources include grains and cereals, vegetables, fruits
and diary products.

An important component is complex carbohydrates,
that is fiber, which promotes normal bowel function,
may reduce serum cholesterol, and is thought to
prevent diverticular disease.
The best means of reducing calorie intake is to replace
foods high in simple sugar and fat with complex
carbohydrates (starchy grains and vegetables). These
should be the mainstay of the elder diet.
Fiber also helps in the prevention of cancer of the
colon, crohn’s disease and gallstones. It lowers
glycemic response so as to positively affect non-insulin
dependent diabetes mellitus.

Protein:
It has been claimed that healthy elderly persons need
no more protein to maintain a positive nitrogen
balance than do younger individuals. Old people who
are healthy and active require a protein intake of
1g/kg of body weight. The 1980 RDA figure, which is
0.8gm/kg wt for those 51 years and over, must be
regarded as absolute minimum.
The protein proportion of energy intake in elderly
individuals should be at least 12-14%
If the older individual is ill, additional protein may be
needed for rehabilitation.

Food sources of protein include animal foods: meat,
fish poultry and diary products. Nuts, grains, legumes
and vegetables contain incomplete protein, which, if
eaten in the proper combination, is of the same quality
as animal sources of protein.
Fats:
Fats contribute about 34% of total calories in the
diet of the normal adult. Because the energy value of
fat is twice that of carbohydrate and protein high fat
intakes are undesirable in any age group especially the
elders.
There is growing epidemiological evidence of the
link between dietary intake of saturated fat,
cholesterol, and occurrence of hyperlipidemias,www.indiandentalacademy.com

cardiovascular problems, non-insulin dependent
diabetes, certain cancers, and obesity.
National cholesterol education program of national
heart blood and lung institute recommends fat intake
to 30% of total calories. They also recommend
calculating fat intake as a percentage of total calories
based on the type of fatty acids found in food as
follows,
Saturated fats – 8 to 10% of total calories
Monounsaturated fats – up to 15% and
Polyunsaturated fats – up to 10%

Highly saturated fats are found in animal fats
and Monounsaturated or polyunsaturated fats are
found in liquid oils of vegetable origin.
Mono unsaturated oils such as olive oil and
canola oil are recommended because they depress
low-density lipoprotein without lowering high-density
lipoprotein as polyunsaturated fats do.
Sources are animal foods, such as diary
products, butter, meats, fish poultry, nuts oils and
margarine.

Vitamins
Vitamin deficiencies in the elderly are apt to be
subclinical, but any body stress may result in an
individual developing detectable symptoms.
Individuals who have low calorie intakes, ingest
multiple drugs, or have disease states that cause
malabsorption are at greatest risk of hypovitaminosis.
Among the vitamins that may be particularly low are
vitamins A, D, C, B6,
folic acid and riboflavin.

Vitamin A:
Elderly persons usually ingest foods rich in vitamin A
sparingly. Thus the intake is substantially below the
RDA for Vitamin A. Vitamin A in food occurs in two
forms, retinol or active Vitamin A, in animal foods
(liver, mild and milk products) and beta-carotenes or
provitamin A, found in deep green and yellow fruits
and vegetables (apricots, carrots, spinach).
Half of the beta-carotenes absorbed are converted
to vitamin A. Hypervitaminosis A is more of a
problem than a vitamin A deficiency because of
excessive use of multivitamin tablet supplements by
the elderly. www.indiandentalacademy.com

Vitamin D:
Vitamin D is essential for the regulation and
promotion of the intestinal absorption of calcium and
phosphorus. Requirement of the elderly for vitamin
D is greater than that for young adults.
Vitamin D deficiency may occur in elderly who are
housebound and receive minimal exposure to
sunlight. Because of the important of vitamin D in
calcium metabolism, adequate intake is crucial
The primary diet source of vitamin D is fortified
diary products. If an individual lacks sun exposure,
is lactose intolerant, or dislikes dairy food, a vitamin
D supplement of 400 IV (10µg) is desirablewww.indiandentalacademy.com

Vitamin E:
Vitamin E deficiency in the elderly does not seem to be
a problem. Therefore the use of megavitamin E
preparations is not indicated. Total plasma vitamin E
levels increase with age
Vitamin C (Ascorbic Acid)
Vitamin C intake generally declines with age. An
inverse correlation between age and ascorbate levels in
whole blood, plasma and leukocytes has been reported.
Oral manifestations include edematous oral mucosa
tender red spongy gingiva along with spontaneous
bleeding. Heavy smokers, alcohol abusers, or personswww.indiandentalacademy.com

with high aspirin intake have a higher daily
requirement for ascorbic acid. The denture patient
should be encouraged to consume vitamin C rich food
such as citrus fruits, peppers, melons, kiwi fruit,
mangoes, tomatoes, papaya and strawberries daily.

Vitamin B. Complex:
Oral symptoms of malnutrition usually are due to a
lack of vitamin B complex, iron or protein.
Thiamine:
Evidence of thiamine deficiency occurs most often in
the poor, institutionalized, and alcoholic segment of
the elderly population. R.D.A has been set at 0.5 mg
per 1000 calories or 1 mg daily owing to evidence that
the elderly use thiamine less efficiently. Food sources
include meat (especially, pork and chicken), peas,
whole grains, fortified grains, cereals and yeast.

Riboflavin
Although, a deficiency of riboflavin is rare, it does
occur in the elderly with variable frequency. Angular
cheilosis is a prominent oral manifestation observed
in its deficiency.
Recommended level of intake for riboflavin is 0.6 mg
per 1000 calories or a minimum of 1.2 mg per day in
the elderly. Food sources include milk and milk
products, dried beans, peas and fortified grains and
cereals.

Pyridoxine: (Vitamin B6
)
Pyridoxine along with folic acid plays an important
role in cell division and in red blood cell formation.
Anemia results from long term inadequate intakes of
either. Many drugs and alcohol negatively affect their
absorption and metabolism.
Pyridoxine is found in whole grain breads, and cereals
and in animal products

Thank you
For more details please visit

Nutritional Considerations for Elderly Patients

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a Nutritional Considerations for Elderly Patients

Similar a Nutritional Considerations for Elderly Patients (20)

Más de Indian dental academy

Más de Indian dental academy (20)

Último

Último (20)

Nutritional Considerations for Elderly Patients