Www.sjsu.edu



Chapter 18 Older Adults, pp. 484-487, 497-498, 506-508 & AND position paper on agingKey ConceptsEating and enjoying a varied diet contributes to mental and physical well-being.Diseases/disabilities are not an inevitable consequences of aging.Functional status vs. chronological age.Body composition changes can alter lifestyle & lifestyle alters body composition“Normal” aging causes inevitable & irreversible physical changes over timeEveryone ages differentlyWhat Counts as Old?There is no one age that defines “old” 50—Eligibility for AARP 60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program65—Eligibility for full Social Security & MedicareU.S. Census Bureau uses:65 to 74 - “young old”75 to 84 - “old”85 & older - “oldest old”ConcernsCumulative effects of lifelong habits determine nutritional status in old ageStruggle to keep autonomy and independenceCompression of morbidityLife expectancy Life span?Life Expectancy at Birth and at 65?More are living longerCurrently, ~15% are >65By 2030, ~19% will be >65Persons ≥85 are the fastest growing groupLife ExpectancyFrom Table 18.1 Life expectancies in selected countries, 2017 estimatedHealthy People 2020Emphasize fitness and health consequences of obesityRelate to disease prevention and managementEat more vegetables and whole grainsNutrition-Related ChangesBody composition changesInevitable? Reversible?LBM ? & fat ?SarcopeniaWeight: ?? or ?Changing sensual awarenessTaste & smell ?Appetite & thirst become less sensitiveOral health: chewing & swallowingIll-fitting dentures, poor dentitionNutritional Risk Factors?taking action before chronic diseaseRisk factors for older adults are:Hunger, poverty, low food & nutrient intakeFunctional disabilitySocial isolation or living aloneUrban & rural demographic areasDepression, dementia, dependencyPoor dentition & oral healthDiet-related acute or chronic diseasesPolypharmacyMinority, advanced ageScreening toolDietary RecommendationsAdaptations for older adults:MyPlate, Tufts University, University of FLAll focus on:Nutrient dense foodsAdequate fluidsPhysical activity that matches functional abilityDiverse audience Tufts University’s modified food guide for 70+ y.o.UF MyPlate for older adultsEnergyMaintain weightEnergy needs go down d/t changes in:PABMRHormonesBody compositionNutrient dense foodsProteinOften low intakes in inactive, older adults living aloneMay need 1 to 1.5 g/kg/dNitrogen balance is easier to achieve when: Protein is high qualityAdequate calories are consumed Elders participate in resistance exerciseFluidsTotal amount of water decreases with agesmaller margin of safety for staying hydratedOften consciously limit intakeCombined w/ HTN meds~1 mL of fluid/kcal consumed, with a minimum of 1500 mLNutrients of Particular Concern:?altered metabolism with agingVitamin AToxicity & possible liver damageNot usually deficientVitamin DFactors that put older adults at risk for deficiency:Skin changesLimited exposure to sunlight2. Institutionalization or homebound3. Certain medications interfere with vitamin D metabolismbarbiturates, cholestyramine, Dylantin, laxativesRecommended Dietary Allowances (RDAs) for Vitamin DNutrients of Concern:?Low Intake Vitamin E: antioxidantVitamin K: bone fracturesFolate, folic acid: homocysteineCalcium:Colon CA, ovwt, HTNPotassiumMagnesiumDeficiency d/t ETOH, malabsorption d/o, DMB12Despite adequate intake, ~ 40% of older adults have serum B12 levelsMay be d/t HCL & pepsinInadequate intrinsic factor productionSynthetic or purified B12 is much better absorbed Not bound to proteinFood sources: beef, milk & fishBound to proteinFortified cereals and soy well absorbedOr injections/supplemental B12 Iron?Some too much, some too littleNeeds after menopauseMost older adults consume excessExcess iron contributes to oxidative stress Deficiency may be a problem for someBlood loss from disease or medications acid secretion/antacid use calorie intakeSupplementsDiets may be low in: choline, calcium, magnesium, potassium, and vit A, D, E & KUp to 50% use suppsSome may be harmfulVit A, E, beta-carotene, calcium, ironA few may helpB12, folic acidDrug-supplement interactionsFood SafetyCompromised immune systemsVulnerable to foodborne illnessesLeading hazardous practices:Improper holding temperaturesPoor personal hygieneContaminated knives, cutting boardsInadequate cooking timeWhen in doubt, throw it outConsiderations for Educational Materials for Older AdultsLarger type sizeSerif lettering (such as Times Roman)Bold TypeHigh contrasts (black on white)Avoid blue, green & violetNon-glossy paperReading level of 5th to 8th gradeStroke & TIAReduced cerebral blood flow resulting in:Deprivation of oxygen & other nutrients to brain -> cell deathLoss of speech, walk, feed self & swallowForms:Ischemia (85% of all strokes)HemorrhagicPrevalence & EtiologyPrevalenceOf adults ≥65, 7% of females & 8% of males have had a strokeEtiologyBlocked arteriesEasily clotting plateletsWeak heartbeat unable to circulate bloodRisk FactorsAgeLong-term high blood pressureFamily historyAfrican American, Asian, HispanicPhysical inactivityCigarette smokingComorbid conditionsDiabetes mellitus Carotid artery diseaseAtrial fibrillationSickle cell anemiaDepression Transient ischemic attacksLiving in povertyExcessive use of alcohol or drugsNutritional RemediesSame as DzMore fruit and veggiesFoods with more potassium and less sodiumDASH, Prudent Healthy Diet, Mediterranean DietNormalize blood pressureReduce overweight & obesitymainly abdominal fat (VAT)DASH DietFrom Table 19.4 DASH effectiveness increases as sodium decreases, but it's not easy to consume <1500 mg HypertensionOr on anti-HTN medsEtiology: not clearFamily history~20% of cases linked to salt intakeRisk factors alcohol consumption saturated fat intakePhysical inactivity, overweight & obesitySmoking dietary calcium (maybe K+ & vit D)Nutritional RemediesMaintain healthy weight Reducing sodium to <1500-1800 mg/dOther recommendationsModeration in alcohol, if at allAdequate potassium, magnesium, & calcium consumptionFollow DASH + exercise guidelinesConstipationDefinition—no one definitionAbnormal bowel patternEtiology— muscle strength, F/V (? fiber) d/t chewing problem thirst/fluids fecal bulk d/t less food cognition: not recognize urge to defecateMedications and DzEffects—Anxiety, preoccupation & may exacerbate diverticulitisRemedies dietary fiber, fluids & muscle tone -> “Power Pudding” p. 499PABereavement / GriefThe loss felt when a long-term relationship changesDeath, dementia, relocationStages of the grieving process: shock & denial, disorganization, volatile reactions, guilt, loss & loneliness, relief, & reestablishmentMay divert attention from shopping, meal prep, eating and drinkingDehydrationCauses:Decreased thirstKidneys’ inability to concentrate urineVoluntary avoidance of fluidsSeven signs & symptomsUpper-body muscle weaknessSpeech difficultyConfusionDry mucous membranes (nose/mouth)Longitudinal tongue furrowsDry tongueSunken appearance of eyesEffects of DehydrationEffectsIncreases HRrestSusceptibility to UTIPneumoniaPressure ulcersConfusion, disorientation, dementiaFecal impactionNutritional Interventions for Dehydration1 ml/kcal w/ minimum of 1500 ml/dBeverages contribute nutrients + fluidTea has flavonoids (antioxidants)Coffee has small amounts of K+ Milk has calcium, protein, riboflavin, K+, & vitamin DCranberry juice may reduce UTIFruit & vegetable juices count toward fruit & vegetable servingsEnd-of-Life DehydrationDone voluntarily and usually unconsciouslyStops eating & drinking days or weeks before dyingWhether to Tx is less controversialReasons for voluntary dehydrationSlows body systems downLess body fluid production:congestion, edema, GI/GU actionCauses natural loss of appetite, constipationDehydration may increase levels of confusion and drowsinessReduces fear and anxiety about dyingComfort Care:Ice chips prnMorphine for painAtivan for anxietyThis lets them slip away peacefully ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download