Chapter 1 Nutrition in Older Adults: An Overview

BOX 1.4 Guidelines for Physical Activity in Older Americans That Are Essential to Healthy Aginga

Older adults need at least ●

●

2 hours and 30 minutes (150 minutes) of moder- ate-intensity aerobic activity (eg, brisk walking) every week and

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

OR ●

1 hour and 15 minutes (75 minutes) of vigorous-in- tensity aerobic activity (eg, jogging or running) every week and

●

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

OR ● ●

an equivalent mix on moderate- and vigorous-in- tensity aerobic activity and

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

Older adults should increase their activity to ●

●

5 hours (300 minutes) of moderate-intensity aerobic activity each week and

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

OR ● ●

2 hours and 30 minutes (150 minutes) of vigor- ous-intensity aerobic activity every week and

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

OR ● ●

an equivalent mix of moderate- and vigorous-in- tensity aerobic activity and

muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms).

aFor those age 65 years and older who are generally fit and have no limiting health conditions.

Source: Adapted from Centers for Disease Control and Preven- tion. Physical activity for everyone. www.cdc.gov/ physicalactivity/everyone/guidelines/olderadults.html. Accessed November 23, 2015.

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older adults and metformin use in people with type 2 diabetes mellitus (40) also make vitamin B-12 sup- plementation advisable (62).

ALTERATIONS IN NUTRIENT REQUIREMENTS DUE TO

USE OF MEDICATIONS Prescription and over-the-counter medications and herbal preparations are widely used by older adults. Prescription drug consumption increases as people age (63). “Having a regular source of health care, health insurance, and health insurance with prescription drug benefits were all associated with increased use of pre- scribed medicines. . . . Among older Americans (aged 60 and over), more than 76% used two or more pre- scription drugs and 37% used five or more, not includ- ing over-the-counter medications” (63). Of those adults older than 65 residing in the community, 50% were shown to use 5 or more prescription and/or over-the- counter medications per week; 12% of this group used more than 10, according to a national survey. When considering prescription drug use by all ages, cholesterol-lowering drugs were the most frequently used drug type for adults aged 60 and over. Diuretics and beta-blockers were also very commonly used (63). Particular care must be taken in determining drug dosages when prescribing for older adults. The risk of creating an adverse drug reaction requiring hospitaliza- tion is about 10.7% for older adults as compared to 5.3% for the overall population (64). “An increased volume of distribution may result from the proportional increase in body fat relative to skeletal muscle with aging. Decreased drug clearance may result from the natural decline in renal function with age, even in the absence of renal disease. Larger drug storage reservoirs and decreased clearance prolong drug half-lives and lead to increased plasma drug concentrations in older people” (65).

Use of herbal or dietary supplements (eg, ginseng, ginkgo biloba extract, and glucosamine) by older adults has also been increasing. In a study of over 3,000 ambulatory adults 75 years of age or older, almost three-quarters used at least one prescription drug and one dietary supplement (65). Often, clinicians do not question the older adult about use of herbal medicines and seniors do not routinely volunteer this information.

“Herbal medicines may interact with prescribed drug therapies and lead to adverse events, underscoring the importance of routinely questioning [older adults] about the use of unconventional therapies. Examples of herbal-drug therapy interactions include ginkgo biloba extract taken with warfarin causing an increased risk of