There is also a self-assessment tool for the older adults that enables them to increase their awareness of their nutritional status and helps in promoting routine nutritional screening. This basically a checklist, which is known as DETERMINE checklist and is composed of 10 items, which are [8,9]:    

Disease : any disease, illness, or chronic condition that effects the way you eat, or makes it hard for you to eat, puts the nutritional health at risk. 80% of adults have chronic diseases that are effected by diet. Other factors that can affect the diet are conditions like feeling sad or depression.

Eating poorly : eating too much or too little can also affect the health. Poor nutrition can also result from eating the same food all the time and not eating enough vegetables, fruits, and milk products. Too much     alcohol effects the health status as well.

Tooth loss/Mouth pain : you need healthy teeth, mouth, and gums for eating. Lack of these good lead to difficulty with eating.

Economic hardship : Many older adults have very limited income and that can effect the diet of the individual.

Reduced social contact : Over 30% of all older adults live alone which has a negative effect on wellbeing and eating.

Multiple medications : Almost 50% of older adults take multiple medications. Medications have many side effects that could effect the appetite. Many also take large doses of vitamins and minerals, which if taken too much could act like drugs and cause harm.

Involuntary weight loss/gain : It is important to notice gaining or loosing weight when it happens involuntary. These could be warning signs of serious conditions.

Needs assistance in selfcare : Even though most older adults are able to eat, about 20% have trouble walking, shopping, and cooking food.
Elder years above age 80 : As we get older risks of health problems increase and the importance of a healthy nutrition increases.    

Based on the results of the DETERMINE checklist and nutritional assessment we can apply the appropriate nutritional plan. A balanced diet which contains all the nutrient requirements for the older patients is a key factor in  maintaining the sense of wellness and overall energy level.    

     Vitamins play an important role in the prevention and modulation of chronic diseases. They are basically in two forms, water or fat soluble. The fat soluble vitamins are A, D, E, and K, which are stored in the body’s fat and accumulate at higher concentrations as we age due body composition changes and increase size of fat deposit. Vitamin A is important in maintaining vision and plays a role in the systemic function cell growth, bone development, reproduction, and immunity. Food sources of vitamin A includes egg yolks, butter, milk, liver, and fish liver oils. The recommended daily intake of vitamin A for male and female aged 70+ is 3000 IU. Vitamin D is well known for its function in bone metabolism and calcium homeostasis. Furthermore, vitamin D and parathyroid hormone (PTH) play an important role in healthy bones and prevention of osteoporosis. Vitamin D has also a direct effect on skeletal muscle formation, exerts a protective effect against cancer cells, plays a role in blood glucose levels and insulin secretion and action in DM, and studies have also shown a relationship between myocardial infarction and vitamin D serum levels. The main food source of vitamin D is milk. Current recommended daily intake of vitamin D for both male and female aged 70+ is at least 1000 IU. Vitamin E functions as an antioxidant in preventing lipid oxidation. Food sources of vitamin E are vegetable oils, nuts, seeds, whole grains, and dark green leafy vegetables. Recommended daily intake of vitamin E for male and female aged 70+ is 15 mg. Vitamin K has two main functions which are blood clotting and bone formation. Food sources for vitamin K include spinach, green leafy vegetables, broccoli, brussels sprouts, cabbage, plant oils, and margarine. Recommended daily intake of vitamin K for older males is 120 mcg which is around 350 IU, and for older females is 90 mcg or about 260 IU [7,8,9].

    Calcium and Vitamin D are particularly important in the prevention of osteoporosis. Adequate amount of these vitamins as mentioned above, together with other modifiable risk factors like inadequate weight bearing exercises and excessive consumption of alcohol can reduce the probability and prevent the occurrence of this condition. Furthermore, regular basis of weight bearing exercises and working against gravity can help in the development of a higher peak bone mass and reduce the risk of falls and increase muscle strength and balance [7,8,9].

     Vitamin C is a water soluble vitamin.  It is an antioxidant and plays a role in connective tissue, hormone, and neurotransmitter synthesis. It also has potential preventative agent against cognitive impairment. Good food sources for vitamin C are fruits and vegetables. Recommended daily intake of vitamin C is 75 mg for men and 50 mg for women aged 50 and above [8,9].     

     The B-Complex vitamins (B6, B12, and folate) function as coenzymes involved in one-carbon metabolism and RBC formation. Food sources for vitamin B6 are animal protein, spinach, and bananas. Vitamin B12 is found in animal products and fortified foods. Folate can be found in green leafy vegetables, orange juice, and fortified food. Recommended daily intake of Vitamin B6 is 1.7mg for men and 1.5mg for women aged 70+, vitamin B12 is 2.4mcg/day for both groups, and folate is 400mcg/day for both men and women [8,9].

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