The week 4 signature Diet Analysis assignment has been designed for you to analyze and assess your own diet using the US Dietary Guidelines for Americans.
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PPTS_CH11.pptxChapter 11 Promoting Health and Preventing Disease in Older Persons
Nutrition, Longevity, and Demographics of Older Persons
Aging is a biological, psychological, and social process that most individuals will experience.
The average life expectancy at birth increased from 47 years in 1900 to 77.8 years in 2004.
Most deaths occurred after age 65.
The goal to increase life expectancy and the number of years of healthy life is known as compression of morbidity.
Nutrition, Longevity, and Demographics of Older Persons Continued
Compression of morbidity can be achieved by slowing the biological changes that accrue over time and delaying the diseases of aging.
Research suggests that a diet based on rice, fish, vegetable protein sources, fruits, vegetables, and some meat contributes to longevity.
Successful aging is trying to discover the rewards of a life fully lived to the end.
Nutrition, Longevity, and Demographics of Older Persons Continued
The four features of successful aging identified by Fisher are:
Interactions with others
Autonomy and sense of purpose
Personal growth
Self-acceptance
Nutrition, Longevity, and Demographics of Older Persons Continued
Kerschner viewed older adults as representing:
An opportunity rather than a crisis
A solution rather than a problem
An asset rather than a burden
A resource rather than a drain on resources
A group that can make social, economic, and cultural contributions
Leading Causes of Death and Disability in Older Persons
Heart disease and cancer are the leading causes of death for all persons age 65 or older and in all ethnic groups.
Other chronic health conditions are:
Cerebrovascular diseases (stroke)
Chronic lower respiratory diseases
National Goals—Healthy People 2010: The goal of the DHHS Healthy People 2010 initiative is to help individuals of all ages increase life expectancy and improve their quality of life.
Theories of Aging
The theories proposed to explain the aging process are:
Genetic
Environment
Lifestyle factors
Genetic, Environment, and Lifestyle Theory—genes determine the competence with which cells are maintained and repaired.
Theories of Aging Continued Genetic, Environment, and Lifestyle Continued
Environmental factors include pollution, poor living conditions, lifestyle habits related to diet, smoking, alcohol abuse, and level of physical activity. These all influence the expression of the genetic code.
Free Radicals Theory—free radicals are unstable oxygen compounds formed normally during metabolism and can damage cells.
Theories of Aging Continued
Exposure to oxidizing agents such as environmental pollutants, ozone, smoking, and solar radiation can also damage the cells.
Free radicals cause oxidative damage to proteins, lipids, carbohydrates, and DNA and may indirectly destroy cells by producing toxic products.
Cell damage due to free radicals has been implicated in diseases, such as cardiovascular disease and cancer.
Theories of Aging Continued
Unstable oxygen compounds can be neutralized when they combine with an antioxidant.
Antioxidants enzymes produced by the body are catalase, glutathione, peroxidase, reductase, and superoxide dismutase.
Dietary antioxidants include selenium, vitamins E and C, and other phytochemicals.
Phytochemicals are plant substances such as beta-carotene, lycopene, and flavonoids, that contribute to normal metabolism.
Theories of Aging Continued
Caloric Restriction Theory is the nutritional model that has been successful in prolonging life in mice, rats, and other rodents.
Studies show that dietary restriction in rats increased longevity, but led to diminished sexual maturation and fertility, lower bone strength, and lower bone calcium and phosphorus contents.
The best caloric restriction approach is to add more fruits and vegetables to a diet.
Eating nutrient-dense foods and avoiding obesity enhances prospects for longevity.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process
Social and economic factors affects aging and can affect the nutritional status such as:
Alcohol Use
Increased Use of Medications and Aging
Dependent Living
Income Level
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Alcohol Use: Consumption increases the risk of malnutrition in older persons.
Limit alcohol intake to no more than one drink: 4 to 5 ounces of wine or 12 ounces of beer.
Symptoms of alcoholism in older persons include trembling hands, sleep problems, memory loss, and unsteady gaity.
Thirteen percent of elderly men and 2 percent of elderly women suffer from alcoholism.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Increased Use of Medications and Aging: Persons at highest risk for Drug Nutrient Interactions (DNI) are those that:
Take many drugs, including alcohol
Require long-term drug therapy
Have poor or marginal nutrition status
Almost half of older Americans take multiple medications daily (polypharmacy).
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Situations contributing to increased risk of DNI are:
taking more drugs for longer periods
drugs may be more toxic
variability in responding to drugs
bodies have less capability to handle drugs efficiently
poor nutritional status
making mistakes in self-care because of illness, mental confusion, or lack of drug information
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Increased Use of Medications and Aging Continued
Drugs can affect nutritional status by changing food intake patterns.
Medications may interfere with an individual’s ability to prepare meals.
Dependent Living: The number of older U.S. adults living alone increased in the past three decades.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Dependent Living Continued
Older adults that live alone are vulnerable to poverty and social isolation, which affects the quality of food intake and could lead to malnutrition.
Income Level: About 3.6 million elderly persons live below the poverty level.
The highest rates of poverty occur among the oldest of the old, minorities, women, older foreign born, persons living alone, and those with disabilities.
Food is the most flexible expense in the budget, limiting the types and amounts consumed.
Physiologic Changes That Can Affect Nutritional Status
Aging causes multiple physiologic changes that affect nutrient needs and nutritional status.
Changes in lean body mass
Aging bone
Changes in taste, smell, appetite, and digestive juices
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Lean Body Mass: Body weight decreases after age 60 in men and age 65 in women by an average of 0.5 percent yearly.
Older adults gain body fat and lose about 53 to 60 percent of total body water.
Aging Bone: a decrease in bone density. After age 40, adults lose stature with a mean height loss of 4.9 cm (1.9 inches) in women and 2.9 cm (1.1 inches) in men.
Risking osteoporosis, which is a major cause of morbidity in developed countries.
Nutrients that contribute to bone density are protein, vitamins C, D and K, phosphorous, and calcium.
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Taste, Smell, Appetite, and Digestive Juices: The secretion of digestive juices is diminished.
Gastric acid is reduced that leads to bacterial growth, causing formation of gas.
A reduction in the absorption of pH-dependent nutrients such as vitamins C, B12, B6 and folic acid.
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Taste, Smell, Appetite, and Digestive Juices Continued
A decrease in parietal cell secretion of an intrinsic factor, which binds vitamin B12 hence, impairing its bioavailability.
Sensory perceptions of taste, smell, hearing, and vision may change.
Hunger and satiety cues are fewer than in younger adults.
This type of satiety is associated with a decreased intake of one food and a switch to another food during that ingestion period.
The sensory-specific satiety mechanism promotes more variety and a more well-balanced eating, which is diminished in older persons.
Physiologic Changes That Can Affect Nutritional Status Continued
Chemosensory losses that occur with age include the following:
Ageusia: Absence of taste
Hypogeusia: Diminished sensitivity of taste
Dysgeusia: Distortion of normal taste
Anosmia: Absence of smell
Hyposmia: Diminished sensitivity of smell
Dysosmia: Distortion of normal smell
Anorexia in the Elderly
Anorexia and weight loss are common in the elderly, especially in individuals suffering from medical or mental illnesses.
The standard for monitoring body weight is the loss of 10 pounds or more over a period of 6 months or the loss of 5 percent or more of total body weight over a period of 1 year.
Anorexia in the Elderly
Failure to thrive is a syndrome in infants and children who are neglected; characterized by a failure to grow both physical and socially.
In older persons, this condition is characterized as a failure to maintain as the individual regresses in physical well-being and mental function.
Weight loss is the first major symptom of failure to thrive in older adults, plus physical disability, loss of skills for self-care, social withdrawal, diminished mental function, and death.
Water Requirements
Phillips et al. defined dehydration as losing nearly two percent of initial body weight.
This can occur after not drinking any fluid and consuming only dry foods for 24 hours.
The regulation of body water relies on thirst and an individual’s response to that thirst.
Dehydration can be diagnosed in those with high serum sodium levels (> 150 milliequivalents per liter) or a high ratio of blood urea nitrogen to creatinine (> 25).
Water Requirements Continued
The symptoms of dehydration include:
A swollen tongue
Constipation
Electrolyte imbalance
Nausea and vomiting
Hypotension
Mental confusion, sunken eyeballs
Increased body temperature and decreased urine output, pressure ulcers, and urinary tract infections
Water Requirements Continued
A general guideline of total fluid intake for older adults is 3.7 liters per day for men and 2.7 liters per day for women
Alzheimer’s Disease
The prevalence of Alzheimer’s disease varies from about 3 percent in persons age 65 years to almost 50 percent in those over 85 years.
Alzheimer’s disease begins with cognitive loss that gradually becomes worse with the extension of cerebral lesions.
Alzheimer’s disease affects many different cells involving the neurotransmitters with symptoms of memory loss, behavior and personality changes, reduced ability to think, and weight loss.
Multivitamin/Mineral Supplement
Many older persons use supplements. Supplements containing megadoses or non-nutrient substances may be toxic.
For example: Superoxide dismutase (SOD) is an enzyme that protects against oxidative damage and supposedly slows down aging can be used to treat Alzheimer’s.
Multivitamin/Mineral Supplement Continued
SOD is a protein that is broken down to amino acids in the GI tract, so oral supplements will not increase blood or tissue levels of this enzyme.
Coenzyme Q is marketed to older persons as improving the immune system; it does not boost immune function and may be dangerous for people with poor circulation.
Nutrition Screening for Older Persons
Nutrition Screening Initiative (NSI) checklist was developed to identify the risk of malnutrition among older persons.
The checklist uses the mnemonic “Determine” to help users determine poor nutritional status.
A score of 0 to 2 is considered good nutritional status, and a recheck in 6 months.
A score of 3 to 5 is moderate risk and a recheck in 3 months.
Nutrition Screening for Older Persons Continued
A score of 6 or more indicates high nutritional risk and those with that score are encouraged to see a physician, dietitian, or other health or social service.
Major indicators of poor nutritional status are shown in Table 11-5 in the text.
These can be identified through interview, observation, physical examination, anthropometric measurements, and laboratory tests.
Nutrition Screening for Older Persons Continued
Risk factors include:
Inappropriate food and nutrient intake
Poverty, social isolation
Dependency and disability
Acute or chronic diseases or conditions
Chronic medication use
Functional disability
Hunger
Living alone
Depression
Dementia
Nutrition Assessment
Older populations can be assessed using any of these forms: surveys, surveillance, screening, or interventions.
Research results show that older persons with poor dental health had lower dietary intake levels of vitamin A, carotene, folic acid, and vitamin C, and scored low on variety of diet.
A comprehensive nutrition assessment should include the ABCDs discussed in Table 11-6.
Nutrition Services That Promote Independent Living
Government programs to address nutritional needs of older adults include:
The USDA’s Food Stamp and Extension programs
Adult Day Services, Nutrition Assistance Program for Seniors (NAPS)
The Elderly Nutrition Program (ENP)
The Elderly Nutrition Program (ENP) created in 1972
Nutrition Services That Promote Independent Living Continued
The Elderly Nutrition Program provides congregate and home-delivered meals.
Meals served under the program must provide at least one-third of the Recommended Dietary Allowances.
Box 11-6 in the text presents nutrition programs for promoting health and preventing diseases in older persons.
Home Healthcare Services
Home health services can help older individuals avoid institutionalization due to illness.
About 28 percent of older persons over 65 years are unable to perform one or more Activities of Daily Living (ADLs).
12.9 percent reported difficulties with Instrumental Activities of Daily Living (IASLs) without the assistance.
Home Healthcare Services Continued
Activities for Daily Living: Older person’s ability to care for him- or herself is evaluated using ADLs and IADLs.
ADLs evaluates ability to:
Bathing oneself
Dressing oneself
Feeding oneself
Using the toilet
Home Healthcare Services Continued
IADLs evaluates ability to:
Prepare meals
Perform house-cleaning
Handle money and balance a checkbook
Shop without help
Use the telephone
Leave the house without help
Successful Community Strategies
The Seattle Senior Farmers’ Market Nutrition Program collaborated with five organizations including the University of Washington.
They supplied a market basket that contained a variety of seasonal local fresh fruits and vegetables to 480 homebound low-income seniors.
The goal was to increase the fresh fruit and vegetable intake of homebound Meals on Wheels participants.
Subjects for both the intervention and control groups were recruited via flyers that were delivered by Meals on Wheels drivers.
Successful Community Strategies Continued
The Meals on Wheels drivers volunteered to deliver the market baskets to the participants’ homes every 2 weeks.
Participants were recruited using newsletter that provided recipes for less common seasonal foods and via telephone interviews before basket deliveries.
Mailed a serving-size guide with pictures of representative foods. Participants were required to have the guide with them at the time of the telephone survey.
Discussion Topics
What are the lifestyle and socioeconomic factors that may influence the aging process?
What are the symptoms of dehydration among older adults?
What are the leading causes of death and disability in older persons?
What are the theories of aging?
What are the physiologic changes that can affect nutritional status of older persons?
