A. Biological Changes in the Elderly:

1. Reduction in muscle mass and increase in fat mass can lead to a decrease in body fluids, causing the skin to appear wrinkled and dry. The face becomes wrinkled with persistent lines, making the elderly appear thin.
2. Decline in sensory perception, including smell, hearing, vision, and touch. Decreased sensory function is related to zinc deficiency, leading to reduced appetite in the elderly. Sensitivity to sweet and salty tastes usually decreases, causing the elderly to prefer sweet and salty foods.
3. Cataracts in the elderly are often associated with a lack of Vitamin A, C, and folic acid.
4. Missing teeth can cause chewing difficulties, leading to reduced food intake in the elderly.
5. Digestive system fluids and enzymes that aid digestion decrease with aging. Appetite and the ability to absorb nutrients, especially fats and calcium, also decrease. Reduced saliva secretion diminishes the ability to chew and swallow food. In the stomach, factors influencing the absorption of vitamin B12 decrease, potentially causing anemia.
6. Reduced intestinal mobility leads to digestive problems such as bloating, abdominal pain, and constipation. This can result in decreased appetite and acid reflux.
7. Decreased motor skills make it difficult for the elderly to eat.
8. Decline in brain cell function leads to decreased short-term memory, slower information processing, difficulty organizing and sequencing tasks, causing difficulties in daily activities, known as dementia.
9. Reduced saliva capacity to produce large amounts of saliva also decreases, leading to sodium dilution. Additionally, unconscious urinary incontinence causes the elderly to drink less, potentially leading to dehydration.

B. Nutritional Problems in the Elderly:

Nutritional problems in the elderly are a series of issues that have manifested since their youth, which become apparent in old age. Various studies indicate that nutritional issues in the elderly mostly involve excess nutrition, which is a risk factor for degenerative diseases such as coronary heart disease, diabetes mellitus, hypertension, rheumatoid arthritis, kidney problems, liver fat, and others.

However, malnutrition issues also occur in the elderly, such as Chronic Energy Deficiency (CED), anemia, and other micronutrient deficiencies.

1. Obesity: This condition is usually caused by excessive consumption, high-fat content, and calorie intake surpassing the body's requirements. Metabolism slows down in the elderly. If not balanced with increased physical activity or reduced food intake, excess calories are converted into fat, leading to obesity. Abdominal obesity is particularly dangerous because excess belly fat is associated with an increased risk of coronary heart disease. According to Monica (1992), obesity increases the risk of coronary heart disease by 1-3 times, hypertension by 5 times, diabetes mellitus by 2.9 times, and gallbladder disease by 1-6 times.
2. Chronic Energy Deficiency (CED): Prolonged loss or lack of appetite in the elderly can lead to weight loss. In old age, the skin and tissues become wrinkled, making them look thinner. In addition to macronutrient deficiencies, micro-nutrient deficiencies are often present. Several causes of CED in the elderly include: a. Unpleasant taste due to decreased taste and smell functions. b. Missing teeth, disrupting the chewing process. c. Stress/depression, loneliness, chronic illnesses, side effects of medications, smoking.
3. Micronutrient Deficiencies: Usually accompany CED in the elderly, but micronutrient deficiencies can also occur in well-nourished elderly individuals. Deficiencies in iron, Vitamin A, B vitamins, Vitamin C, Vitamin D, Vitamin E, magnesium, calcium, zinc, and lack of fiber often occur in the elderly.

C. Several Chronic Degenerative Diseases Related to Elderly Nutrition Status:

a. Coronary Heart Disease: Excessive saturated fat and cholesterol consumption can increase the risk of coronary heart disease. Coronary heart disease is initially caused by fat accumulation on the inner walls of the heart's blood vessels (coronary vessels). Over time, various processes such as tissue accumulation, calcification, blood clotting, etc., narrow or block these blood vessels.

b. Hypertension: Excess body weight increases the heart's workload to pump blood throughout the body, leading to higher blood pressure. Moreover, elderly blood vessels often experience atherosclerosis (thicker and stiffer), causing increased blood pressure. If blockages occur in the brain's blood vessels, it can lead to strokes. If blockages occur in the heart, it can cause heart attacks, resulting in chest pain or death of heart muscle (angina pectoris or myocardial infarction) that can be fatal.

c. Diabetes Mellitus: A chronic disease characterized by blood glucose levels exceeding normal values (fasting blood sugar >_ 126 mg/dL and/or random blood sugar above 200 mg/dL). Diabetes is generally caused by damage to the pancreatic beta cells, affecting insulin function, resulting in insufficient insulin or impaired insulin function in glucose transport into cells. In overweight individuals, hyperglycemia occurs because the insulin produced by the pancreas is not sufficient for the body's needs. Type I DM: Diabetes is caused by insulin deficiency due to damage to pancreatic cells. Generally, normal or below normal, accompanied by the triad of diabetes: polyphagia, polyuria, polydipsia (excessive eating, excessive drinking, and excessive urination). Type II Non-Insulin Dependent Diabetes Mellitus (NIDDM): in addition to cell damage and pancreatic issues, there is also insulin dysfunction. 75% of Type II DM patients are obese or have a history of obesity.

d. Osteoarthritis (Bone Calcification): This disease is part of arthritis, primarily affecting the joints, especially in the hands, knees, and hips. People affected by osteoarthritis often have difficulty moving their joints, and their mobility becomes limited due to the reduced function of cartilage to support the body.

e. Osteoporosis (Bone Fragility): Peak bone mass is reached around the age of 35 for women and 45 for men. Prolonged calcium deficiency can lead to osteoporosis. Postmenopausal women are more vulnerable due to the influence of declining estrogen hormones. Consequently, bones become brittle and break easily from falls or trauma.

f. Gouty Arthritis: Metabolic abnormalities in protein cause an increase in uric acid levels in the blood. Uric acid crystals accumulate in joints, causing pain and joint swelling. Gout patients need to limit fat, protein, purine intake, and increase water intake, a minimum of 8 glasses a day

Author: ERNYATI PAKPAHAN S.Gz RD

REFERENCES :

- Darmojo, R. Boedhi.,dkk. 1999. Buku Ajar GeriatriJakarta : Balai Penerbit FKU