Elderly Nutrition with dentures: Secret of eating with false teeth
Adequate nutrition is important to especially the elderly in many ways.
Everyone needs food to survive. Food builds our body’s cells and keeps it in a good shape and proper functioning. Food is the fuel that makes our human-machine work.
Proper nutrition reduces the infection and increases the healing period after surgery or an injury in the elderly.
Many mental symptoms which have been attributed to age and senility could, in fact, be traced to poor nutrition.
Since the turn of the century, the average life expectancy of man has been steadily increasing. This is due to an improvement in dietary practices and better overall health
NEED FOR NUTRITION DIET FOR ELDERLY
1. To delay and minimize degenerative changes and health problems such as diabetes, hypertension, and heart problems as well as dental problems.
2. Complete denture prosthesis depends, ultimately upon the health and integrity of the oral tissues for successful function and your comfort.
A protein is said to be biologically complete if it contains all the essential amino acids (EAA) an amount corresponding to human needs. When one or more of EAA is lacking protein is said to be biologically incomplete.
The quality of dietary protein is closely related to its pattern of amino acids.
Animal proteins are rated superior to vegetable proteins because they are biologically complete.
Of the total calorie need a protein intake of 12.14% is sufficient for normal body metabolism. Elderly persons may be advised either high protein or low protein nutrition diets.
Low protein diet is indicated in the elderly with declined renal function.
A high protein diet is prescribed in conditions like surgery, trauma, or illness.
Vitamin does not yield energy but enable the body to use other nutrients.
Since the body is generally unable to synthesize them (at least in sufficient amount) they must be provided by food.
Vit. A is necessary for good eyesight, healthy skin and growth and development.
Recent studies also suggest anticancer properties to
Sources – Fish liver oil, butter, ghee, milk, carrots green leafy veg, pulses R.D.A- 1mg
Vitamin B – complex
Sources – milk, egg and liver, whole wheat pulses, green leafy veg, nuts, oil seeds etc.
Malnourished older people can be found to be deficient in the hematinic (blood cells forming) nutrients like iron, folic acid, and Vit B12.
Anemia can result from malabsorption; alcoholism, poor nutrition, and drugs in
The carbohydrate reserve (glycogen) of a human adult as about 500 gm.
The reserve is rapidly exhausted when a man is fasting.
If the dietary carbohydrate does not meet the energy needs of the body protein and glycerol from dietary and endogenous sources are used by the body to maintain homeostasis.
Carbohydrate is stored in the liver and muscles as glycogen which can be rapidly broken down into glucose to produce energy in an emergency.
Over half the energy requirement of the body are obtained from carbohydrates.
Amount of carbohydrate intake in the diet increases as the income of the family diminishes as they are cheaper than fish and meat or fats and oil.
In fact, an Indian diet becomes ill-balanced due to excessive carbohydrate content.
Carbohydrates are an energy-yielding source.
Poor nutrition with a sense of taste and smell are less sharp among the elderly. Which interfere with the appetite for many foods.
During old age loss of teeth make it difficult to chew the food.
Elderly people tend to consume more of carbohydrate with less nutrition value such foods which require minimum chewing, need minimum cooking time and maximum storage.
FATS AND OILS
Fats and oil make food enjoyable and help in the absorption of fat-soluble vitamin-like A, D, E, and carotene.
The fat intake for the elderly in a nutrition diet must be less than that of young adults.
Excessive consumption of animal fat increases the blood cholesterol which may be a contributory factor for the development of heart disease but an increase of blood b-lipoproteins in serum is considered nowadays a more important factor for the causation of disease.
A low intake of fiber is commonly seen in old people especially denture wearers as fiber-rich food may be difficult to eat.
A low intake of fiber is connected with conditions like constipation and diabetes. Such condition in the elderly may be relieved by recommending nutrition foods high in fiber such as raw vegetable and fruits.
If these foods are difficult to eat because of denture problem then bran cereals, cooked prunes or figs may be suggested. 25-30 gm the nutrition value of fibers is recommended for elderly.
Sources – Green leaves, fruits, cereals, pulses and legumes.
About 60% of body weight is water. Water deficiency and dehydration are more common in elderly people. This may be partly due to a decrease in extracellular water which has been shown to exist from the eighth decade of life.
An intake of six to eight cups of water 1 day is must.
More than 50 chemical elements are found in our human body which is required for growth repair and regulation of vital body function.
IMPORTANCE OF NUTRITION FOR ELDERLY
Enjoyment of food is regarded as an important determinant of an adults quality of life.
Decreased chewing ability, fear of choking and irritation of the oral mucosa while chewing also may influence food choices of the denture wearer.
Conversely, the nutrition status of a denture patient affects the health of the oral tissues and how well an elderly adapts to a new
In fact well designed and constructed denture or may prove to be dissatisfying for few people due to poor tolerance by the underlying tissues and bone hence denture failure can be not only due to imperfect design but also to poorly nourished tissues.
Clinical symptoms of malnutrition are observed first in the mouth.
Rapid cell turnover in the mouth requires a regular balanced intake of essential nutrients for the maintenance of oral tissues.
Inadequate long term nutrition may result in angular cheilitis, glossitis, and slow tissue healing in the elderly.
The amount of bone resorption that occurs following tooth extraction may be amplified by low calcium and Vit D intake.
Nutritional risk increases with advancing age.
Persons over 70 years of age are more likely to have a poor diet. Because the majority of edentulous ( lack of teeth ) adults are of advanced age, a large number of denture patient can be explained to have nutritional deficits.
The nutrition in the elderly also is influenced by economic headship, social isolation, degenerative diseases, medication requirements, and dietary supplementation particles.
An understanding of the nutritional requirements, symptoms of malnutrition an environmental factors that influence food choices in the elderly will assist the dentist in identifying denture wearer at risk of malnutrition.
Dietary guidance based on an assessment of the elderly nutrition history and diet should be an integral part of a comprehensive prosthodontic treatment.
Nutrition support will improve the tolerance of the oral mucosa to the new denture and prevents the rejection of dentures in the elderly. Because denture fabrication requires a series of appointments dietary analysis and counseling can be easily incorporated into a treatment plan.
IMPACT OF DENTAL STATUS ON HEALTHY NUTRITION INTAKE IN ELDERLY
Nutrient intake in old individuals closely relates to dental status and masticatory efficiency. Although an intact dentition is not a necessity for maintaining nutritional health.
The loss of teeth often leads adult to select a diet that is lower in nutrient density.
Investigation in the United States and Sweden have reported that adults with compromised dentition are over-represented in groups with poor diet.
Poor nutrition quality diets were reported by the elderly who had low educational attainments or low family income or who were partial or complete dentures.
Male denture wearers have poor nutritional intake than female. Specifically mean intake of calories protein vitamin A, ascorbic acid, Vit B6 and folic acid were lower in male denture wearer than in dentate men (having teeth).
Calcium and protein intake of female denture wearer’s are inferior to those of dentate women (having teeth).
In a subset of the USDA subjects (united states department of agriculture-human nutrition research center on aging in Boston) the nutrition intake of those who had one or two complete dentures was about 20% lower than that of the dentate (having teeth) subjects.
Our masticatory ability is mainly determined by age and the number of natural teeth in the mouth.
There is general agreement that the masticatory function of elderly wearing dentures is greatly inferior to the people having teeth.
People wearing dentures must complete a greater number of chewing strokes to prepare food for swallowing. People with dentures does not reduce the food to a small particle size even with the additional chewing.
Because of the impaired chewing ability, texture and hardness determine the acceptability of food for many denture wearers rather than the taste and smell.
Generally, the intake of harder food (raw vegetables or fruits, fibrous meat, hard bread etc) is lessened whereas the intake of soft food (ground beef, cereals, pastries) is put up.
Whether these changes in food selection negatively affect the nutritional status depends on the nutrient density of food substituted.
Wearing of denture by people without teeth for several years improves the quality of their diet.
Fruits raw vegetable, bread, cheese, and meat are more frequently eaten by these persons after denture placement.
The condition of an individual’s denture also may influence food selection. When new complete denture replaced old ones that had poor retention, the nutrition and chewing performance of an elderly is improved. They can chew better and chew different foods.
The use of dental implants in the treatment of seniors increases the variety of food eaten. Chewing ability is markedly improved following the insertion of a lower fixed prosthesis on the dental implants.
Inability to distinguish the taste quality of food reduces an elderly enjoyment of eating and may lead to
Nearly all the denture wearers complain a transient decline in taste acuity when dentures are first inserted. This is usually attributed to denture base coverage of the hard palate.
The comfort of wearing dentures is dependent on the lubricating ability of saliva in the mouth.
If the oral mucosa is dry, denture retention is compromised and mucosal soreness or ulceration develop.
Because salivary flow facilitates mastication, the formation of the food bolus and swallowing, it is a major contributor to the pleasure of eating.
Xerostomia (dry mouth) is a clinical manifestation of salivary gland dysfunction. There are several causes of dry mouth, the use of medication, therapeutic radiation to head and neck, diabetes, depression, alcoholism, pernicious anemia, menopause Vit A or Vit B complex deficiency and autoimmune disease such as Sjogren’s syndrome.
However, the ability to taste usually improves as an older individual adapts to the dentures when compared with a dentate adult or partial denture wearers.
Denture wearers are significantly less able to detect differences in texture and sweetness of certain food.
The management of dry mouth depends on the cause of the condition.
If a drug is suspected to be the cause of consulting with
Saliva substitutes are available but regrettably have not proven to be acceptable to many people and furthermore are more expensive.
Milk has been proposed as a saliva substitute.
Milk not only aids in lubricating the tissues and increase the pleasure of eating but also has a buffering capacity.
This may be an important benefit when overdenture abutment teeth (implant) are present.
Because dry mouth may result in inadequate nutritional intake.
The use of milk not only serves as a saliva substitute but is an excellent source of nutrients.
Little research exists on the effect of tooth loss on the incidence of choking on food.
The purpose of mastication is to reduce the food particles in size so they can be swallowed and to increase the surface area exposed to digestive juices and enzymes.
Individuals with poor masticatory ability often swallow large pieces of food.
Complete denture wearers may not detect a foreign object in the mouth due to impaired tactile sensitivity. These adults are at greater risk of having large pieces of food or bone lodge in the air or food passage.
Inadequate mastication appears to cause gastrointestinal disturbances. For example, the use of laxatives, antacids, anti-reflux drugs, and antidiuretics was significantly higher in elderly edentulous Canadians with poor masticatory performance.
A nutrition diet high in fiber helps to prevent constipation in elderly.
NUTRITION NEEDS AND STATUS OF ELDERLY
The nutrition needs of the elderly vary depending on health status and level of physical activity. Thus it is difficult to generalize about energy, vitamin and mineral requirement appropriate for all older individuals.
Depending on the level of body functioning an individual may need more or less of nutrients proposed in the recommended dietary allowances (RDA) for his or her chronological age.
Energy needs decline with age due to a decrease in basal metabolism and decreased physical activity. With aging lean body mass is replaced by fat. This leads to a decrease in the metabolic rate.
The onset of a chronic disease usually leads to a decline in physical exercise.
The best means of reducing calorie intake is to replace food high in fat with complex carbohydrate. These should be the mainstay of the elderly’s food.
Oral symptoms of poor nutrition in the elderly are usually due to a nutrition lack of the vitamin B complex (Iron or protein) vitamin B12 deficiency.
Lack of gastric intrinsic factor required for absorption of the vitamin leads to Vit B12 deficiency.
Achlorhydria (absence of hydrochloric acid in the gastric secretions) common in the elderly also results in decreased B12 absorption.
There is a wide variation in Vit C intake in adults. In one survey one-fourth of the elders are associated with low ascorbic acid intake. Heavy smokers, alcohol abusers or person with high aspirin intake have a higher daily requirement for ascorbic acid.
The seniors with dentures should be encouraged to consume a Vit C rich food such as citrus fruits, peppers, melons, mangoes etc daily.
Two minerals of calcium and zinc are of particular concern in older adults.
Tissue healing and immune function are affected by zinc status.
Alcohol abuse appears to be serious nutrition, health problem among some of the elderly.
Deficiencies of thiamine, niacin, pyridoxine, folate (all B complex Vit) and ascorbic acid are commonly seen in alcoholics.
Osteopenia (reduced bone mass) in males without a history of the bone disease may be due to chronic alcohol intake when efforts to resolve tissue intolerance to a prosthesis are unsuccessful the misuse of alcohol should be considered.
CALCIUM AND BONE HEALTH
Bone loss is a normal part of aging that affects the upper and lower jaw as well as the spine and long bones. Skeletal sites where trabaculae bone (alveolar bone, vertebrae, wrist and neck of the femur) is more prominent than cortical bone are affected first.
Several factors are thought to contribute to age-related bone loss that leads to osteoporosis(condition in which bones become brittle and fragile). Genetic background, hormonal status, bone density at maturity, a disturbance in the bone remodeling process, a low exercise level and inadequate nutrition in the elderly.
Loss of bone affects women earlier than a man because of estrogen at menopause and a smaller skeleton.
In women, bone loss begins during the fourth decade of life or whenever estrogen secretion declines or ceases. Women with lower bone mineral density tend to have fewer teeth.
The relationship of systemic bone loss to jaw bone loss is unclear. Resorption of the alveolar ridge is a widespread problem among denture wearer and results in unstable dentures. Some remodeling of the bone appears to occur in response to chewing forces.
However, bone resorption is accelerated and bone height is diminished when teeth are lost.
A greater degree of such residual ridge resorption is observed in women than man. Such bone loss is accelerated in the 1st 6 months following tooth extraction with resorption much greater in the mandible than the maxilla.
The loss of alveolar bone frequently makes it more difficult to construct a stable and retentive mandibular denture than maxillary one.
It has been proposed that alveolar bone loss may precede loss of mineral from the vertebrae and long bones and that the dentist may, therefore, be the first health care provider to detect the loss of bone mass.
The amount of bone mass in the mandible has been positively correlated with total body calcium and the bone mass of the vertebrae and wrist of the healthy postmenopausal women by researches concern. In the elderly local factors have a great influence on alveolar bone resorption.
Dietary calcium intake is critical to maintaining the body skeleton. Denture wearer with excessive bone resorption reports lower calcium intake and poorer calcium phosphorous ratios.
The recommended intake for a man over 64 years and postmenopausal women taking no estrogen and calcium.
Adults must drink 3-4 glasses of low-fat milk per day, eat 5-7 g of hard cheeses or consume very large quantities of non-dairy food.
Adequate intake of Vit D enhances calcium absorption in the intestine. The trace element of fluoride is being used in the treatment of osteoporosis.
Based on the nutrient deficiencies reported in elderly it may be reasonable to prescribe a low dose multivitamin-mineral supplement for certain people even though clinical signs of nutrient deficiency are lacking.
For a elderly patient, a generic one a day tablet that includes zinc, folacin, and Vit B6 may be recommended. If the intake of dairy food cannot be increased to meet daily needs a calcium supplement is advised, because it is bulky, calcium must be taken in a separate tablet.
The use of megadose of vitamins or minerals by the elder’s is a practice of great concern. Thus the denture wearer should be cautioned against indiscriminate use of any nutrient or fiber.
DIETARY NUTRITION COUNSELING FOR ELDERLY
Goals to be achieved by nutrition and dietary counseling :
1. A healthy nutrition diet for the elderly population person’s over 70 years of age are more likely to have poor diets. And nutrition risk increases with advancing age seen in elderly.
2. To lower the rate of bone resorption usually, it takes place because of low calcium & vitamin intake.
Only expectation of elderly seeking new dentures is that they will be able to eat a greater variety of food. Such a person often is receptive to suggestions aimed at improving the quality of their diet.
Nutrition screening for the elderly begins at the 1st appointment so that counseling and follow up can occur during the course of treatment. With continued guidance and encouragement from the dental team.
Elders are more apt to make permanent changes in their food patterns.
Nutrition care can be provided by dentist and dental hygienist who has a background in basic nutrition.
The main objective of nutrition diet counseling for the elderly is to correct the imbalance in the nutrient intake that interferes with the maintenance of oral tissue health. It is often different to identify patients in need of nutritional care base on a usual inspection or an interview.
Most elders tell us that they eat a healthy diet. However certain denture wearer is known to be at greater risk of being malnourished.
Dietary evaluation and counseling should be included in treatment if the elder has any of the following physical or social conditions – Greater than 75 years of age, low income, little social contact, involuntary weight loss, daily use of multiple drugs or need for assistance with daily self-care.
Risk factors for malnutrition in the elderly
– unplanned weight gain or loss of >10 1b in the last 6 months.
– Undergoing chemotherapy or radiation therapy.
– Poor dentition or ill-fitting prosthesis.
– Oral lesions – Glossitis, cheilosis or burning tongue.
– Severely resorbed jaw.
– Alcohol or drug abuse.
– Eating less than 2 meals/day.
If an elderly reports weight loss or gain greater than 10 pounds during the past 6 months or untreated or poorly controlled hypertension, a diabetic state or oral tissue changes suggestive of poor nutrition.
An elder who express concern about obesity or low body weight or who report poor adherence to diabetic reduced sodium or low cholesterol diet can be referred to a consulting registered dietician.
nutrition in elderly guidelines
Providing nutrition care for the elderly entails the following steps :
– Obtaining a nutritional history and accurate record of food intake over 3-4 or 5 days period.
– Evaluating the diet.
– Teaching about the components of the diet that will support the oral mucosa as well as bone health and total body health.
– Guidance in the establishment of goals to improve the diet.
– Follow up.
Nutrition guideline for the elderly
· Eat a variety of food
· Build a diet around complex carbohydrate, fruits, vegetables, whole grams, and cereals.
· Eat at least 5 servings of fruit and vegetables daily.
· Select fish, poultry, meat or dried peas and beans every day.
· Obtain adequate calcium.
· Limit intake of bakery products high in fat and simple sugar.
· Limit intake of processed food high in sodium and fat.
· Consume 8 glasses of water daily.
The success of a complete denture prosthesis is mainly influenced by oral conditions.
So an elder has to be well nourished and consumed a well-balanced diet. Dietary guidance based on an assessment of the elderly nutrition history and diet should be an integral part of comprehensive prosthodontic treatment by a dentist.