chapter 18

The Elderly Nutrition Program, an important aspect of the Older Americans Act, provides nutrition services through the Congregate Meal Program and Home Delivered Meal Program (often referred to as Meals on Wheels). Anyone age ___ or older can participate; however, priority usually is given to those with the greatest ______ needs.

- 60 - economic, social, and health

Intake of omega-3 fatty acids is often _____ recommendations. Eating ___ twice weekly as well as flaxseed and canola oil can help adults meet omega-3 fatty acid needs and reduce the risk for age-related _____ degeneration.

- below - fish - macular

Heredity defines who you are _____ and, to some extent, it defines how long you will live (longevity) -If your parents and grandparents lived a long time, you are likely to have the potential to live to an ____, too. One of the most obvious genetic characteristics influencing longevity is _____. In the case of humans, as well as most other species, females tend to live longer than males.

- biochemically - old age - gender

- The heart often pumps blood less efficiently in older people, usually because of insufficient ______. - it is thought that inactive lifestyles may contribute as much to the risk of ______ as does smoking a pack of cigarettes per day. - Exercising regularly, not smoking, and eating a low-fat diet rich in nutrients and moderate in sodium can help protect the ______

- physical activity - cardiovascular disease - cardiovascular system

______ is one's pattern of living—it includes food choices, exercise patterns, and substance use (e.g., alcohol, drugs, tobacco). - Lifestyle choices can have a major impact on health and ______, as well as on the expression of genetic potential.

- lifestyle - longevity

Some also may have increased fluid output because they are taking certain ______ (i.e., diuretics and laxatives), have an ostomy, and/or experience an age-related decline in the ______ ability to concentrate urine. - ______ is very dangerous and, among other symptoms, can cause disorientation and mental confusion, constipation, impacted fecal matter, and death.

- medications - kidneys' - Dehydration

bone loss in women occurs primarily after ______. Bone loss in men is slow and steady from middle age throughout later life. - Many older people may suffer from undiagnosed -________, a condition primarily caused by insufficient vitamin D. Osteoporosis can limit the ability of older people to move about, shop, prepare food, and live normally. - Consuming adequate vitamin D, calcium, and protein and not smoking, drinking alcohol moderately or not at all, and engaging in weight-bearing exercises can help preserve _______. Medications also can help lessen bone loss.

- menopause - osteomalacia -bone mass

Another genetic characteristic that can influence longevity is ______. Individuals with a "thrifty metabolism" require fewer calories for metabolic processes and are able to store body fat more easily than those with faster metabolic rates. Throughout history, it was the individuals with thrifty metabolism who tended to live the _____ because they efficiently stored fat during times of plenty and thus had the energy stores needed to survive frequent periods of food scarcity. However, today people with a thrifty metabolism living in technologically advanced countries where food is abundant and periods of scarcity are virtually nonexistent may find that their thrifty metabolism actually _____ longevity.

- metabolic efficiency - longest - reduces

some recent studies indicate that consuming protein in amounts slightly higher than the RDA, but within the AMDR, may help preserve ______. Adults who have limited food budgets, have difficulty chewing meat, or are lactose intolerant may not get enough ______. - The waste products produced when protein is used for energy or stored as fat must be removed by the _____; excessive protein intake may accelerate kidney function decline.

- muscle and bone mass - protein - kidneys

_____ of all adults have a chronic and potentially debilitating disease. _____ out of 4 adults have at least 2 chronic conditions—this rises to ___ out of every 4 people over age 65.

- 1/2 - 1 - 3

Each meal meets at least _____ of the daily recommendations. The social aspect of the Congregate Meal Program provides opportunities for ______ that often improve appetite and general outlook on life. These programs also may provide shopping assistance, counseling, nutrition education, and referral to other social, rehabilitative, and transportation services.

- 1/3 - socialization

Complementary health approaches typically fall into 2 categories: 1. ________ products: using substances found in nature, such as vitamins, minerals, probiotics, fish oil, and herbs to treat or prevent disease. An herb is any plant or part of a plant used primarily for medicinal purposes. 2. ________ practices: using techniques such as yoga, tai chi, qi gong, chiropractic and osteopathic manipulation, meditation, massage, hypnotherapy, healing touch, and movement therapies.

- Natural - Mind-body

_______ losses may make it difficult to shop for and prepare food. - Loss of ______ makes it a challenge to grasp cup handles and manipulate eating utensils. As a result, older adults may avoid foods that can be easily spilled (e.g., soups and juices) or that need to be cut (e.g., meats, large vegetable pieces) and restrict food intake to easy-to-eat _____. - Some may even withdraw from social interaction and eat alone, which can lead to ______ nutrient intake.

- Neuromuscular coordination - coordination - finger foods - inadequate

______ lifestyle choices may make it possible to keep the rate at which the body restores homeostasis high. Taking steps to avoid _____ the body's capabilities also can help preserve optimal function of body tissues and systems (e.g., get flu shots, avoid excessive protein intake). Getting prompt ______ when the body's capabilities are stressed by illness helps preserve optimal functioning, too. In the case of already damaged tissues and systems, avoiding stressful practices helps _____ pushing an aging body beyond its capabilities.

- Prudent - stressing - medical attention - prevent

The diets of adult ______ tend to fall short of the recommended amounts of vitamins D and E, folate, magnesium, potassium, calcium, zinc, and fiber. The diets of adult men tend to be low in the same nutrients, except vitamin __, which does not become problematic until age __. - The iron intake of most women during their childbearing years (ages 19 to 50) is _________ to meet their needs; however, due to a reduced iron need after menopause, older women do get enough iron.

- Women - D - 50 - insufficient

The total fat intake of adults of all ages is often at or _____ the recommendations. It's a good idea for almost all adults to reduce their total fat intake because of the strong link between high-fat diets and obesity, heart disease, and certain _______. In addition, reducing fat intake "frees up" some calories that can be better "spent" on complex ______.

- above - cancers - carbohydrates

As mentioned previously, the production of HCl, intrinsic factor, and lactase declines with advancing age and, as a result, impairs the _____ of several nutrients. - _____ is the main intestinal problem for older people. To prevent constipation, older people should meet fiber needs, drink enough fluids, and exercise. - Fiber medications are generally unnecessary but may be useful when total energy consumption does not allow for enough ______.

- absorption - Constipation - fiber intake

Dietary intakes of certain carotenoids have been shown to have a variety of important ______ and health protective effects. - Specifically, beta-carotene (lutein and zeaxanthin) along with vitamin C, vitamin E, and zinc have been linked with the prevention of _____ and age-related _______. - Diets high in fruit and vegetables, the major sources of carotenoids and other beneficial phytochemicals, are consistently shown to protect the body from a wide variety of age-related conditions.

- anti-aging - cataracts, macular degeneration

Other complementary approaches outside the 2 main categories include practices such as Ayurvedic medicine (a natural healing process from India), naturopathy, homeopathy, traditional _____ medicine, and traditional healers.

- Chinese

When menopause occurs, _____ needs decline. A diet rich in vitamin ____ and _______ can help stave off the rapid loss of bone minerals that occurs after menopause. - ______ production may decline as men age, leading to a loss of lean body mass, which results in a decreased metabolic rate and lowered calorie needs.

- iron - d, calcium - Testosterone

the kidneys filter wastes more slowly as they lose _____. The deterioration significantly decreases the kidneys' ability to excrete the products of protein breakdown, such as _____. As a result, individuals often need to avoid excess protein and keep intake at the RDA or slightly _______.

- nephrons - urea - below

Insufficient income is particularly a problem among those ages ___ and up; as a result, they frequently have trouble making sure they remain well nourished. The ______ Foods Program and Supplemental Nutrition Assistance Program (______) are 2 federal U.S. programs that can help low-income individuals of all ages procure the foods they need.

65 - Commodity - SNAP

provides nutrition education and supplements the food budgets of low-income households so that participants can purchase a greater quantity of food than they could afford to buy on their food budgets alone. The budget supplement, delivered in the form of electronic benefit transfer cards (like debit cards) can be used like money to purchase foods, food producing plants and seeds, hot meals in group homes and shelters, and, in some areas, hot meals in certain authorized restaurants. benefits cannot be used to purchase alcohol or nonfood items (e.g., soap, paper goods).

Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program)

Many who use alternative medicines have illnesses for which conventional medicine _____ offer a cure, such as arthritis, terminal stages of AIDS or cancer, and stress-related conditions.

cannot

______, too, may play a role in keeping this disease at bay. Individuals with diets rich in omega-3 and omega-6 foods and low in saturated and trans fatty acids seem to have a _____ risk of Alzheimer disease

- Dietary fats - reduced

The micronutrients that need special attention because they tend to be present in less than optimal amounts in the diets of many adults are _______. - many nutrition experts recommend a daily balanced multivitamin and mineral supplement for older adults, especially for those __ years of age and older. Supplements or fortified foods can be especially helpful when it comes to meeting vitamin __ and vitamin B-__ needs.

- calcium, vitamin D, iron, zinc, magnesium, folate, and vitamins B-6, B-12, and E. - 70 - D, 12

Declines in carbohydrate metabolism are so common that ___% of those age 65 years or older have diabetes. A diet rich in ____ helps adults reduce their risk of colon cancer and heart disease, lower their blood cholesterol levels, avoid constipation, and age successfully. The typical American adult gets slightly more than ____ the recommended amount of dietary fiber.

- 20 - fiber - 1/2

The Administration on Aging administers the Older Americans Act. This act is designed to help adults ages ___ years and older remain living independently in their homes and communities. Each community decides which programs and services will be provided. Community-based nutrition, health, and supportive services may include adult day care, _____ activities, transportation, ______ services, and ______ activity programs.

- 60 - senior center - information and counseling - health and physical

________ is an irreversible, abnormal, progressive deterioration of the brain that causes victims to steadily lose the ability to remember, reason, and comprehend. Alzheimer disease often takes a terrible toll on the mental and eventual physical health of older people. About 5.4 million adults in the U.S. have the disease—it is the ____ leading cause of disease in the U.S.

- Alzheimer disease - 6th

Calcium-fortified foods, cheese, yogurt, fish eaten with bones (e.g., canned sardines or salmon), and dark green leafy vegetables can help those with lactose intolerance meet ______ needs—but these foods often do not provide vitamin ___. Just ___ to ___ minutes per day of sunlight can make a large difference in vitamin D status.

- Calcium, D - 10, 15

____________" or "integrative" health is using a non-mainstream approach to health management in addition to conventional medicine. "___________" means using a non-mainstream approach instead of conventional medicine. Complementary approaches are most common. An example is using ______ along with medications to control pain.

- Complementary - Alternative - acupuncture

Yet another example of a genetic characteristic that may influence longevity is the rate of ___-cholesterol production. Individuals who inherit an increased ability to produce abundant HDL-cholesterol may have a decreased risk of _____ and a longer life. In contrast, those who inherit a reduced ability to produce HDL-cholesterol have a greater risk of premature ______ and a shorter life

- HDL - cardiovascular disease - heart disease

________, a form of failing eyesight in old age, is quite common, affecting about 1.75 million adults in the U.S. A major risk factor is ________. Diets rich in ______ help reduce the risk of macular degeneration. - The risk of developing _______ is decreased by consuming a diet rich in fruits and vegetables.

- Macular degeneration - cigarette smoking - carotenoids - cataracts

______ increases muscle strength and mobility, improves balance and decreases the risk of falling, eases daily tasks that require some strength, improves sleep, slows bone loss, and increases joint movement, thus reducing injuries. - It also has a positive impact on a person's _____ outlook. - Strength training (resistance) helps reverse some of the decline in daily function associated with the _______ typically seen in older adulthood.

- Physical activity - mental - muscle loss

To pinpoint those over age 65 at risk of nutrient deficiencies, the American Academy of Family Physicians, the Academy of Nutrition and Dietetics, and the National Council on Aging developed the Nutrition________ Initiative checklist. Older Americans, family members, and health-care providers can use the checklist to identify those at ______ before health deteriorates significantly.

- Screening - nutritional risk

Breathing becomes shallower, faster, and more difficult as the amount of active lung tissue decreases. _____ often leads to emphysema and lung cancer. The decrease in lung efficiency contributes to a general downward spiral in body function; breathing difficulties limit ______ and endurance and frequently discourage ______. Besides not smoking, eating an _____ rich diet and being physically active help preserve lung function.

- Smoking - physical activity - eating - antioxidant

________ aging (also called delayed aging), on the other hand, describes physical and physiological function declines that occur only because we grow older, not because lifestyle choices, environmental exposures, and chronic disease have aggravated or sped up the rate of aging - Those who are successful agers experience age-related declines at a _____ rate and the onset of chronic disease symptoms at a _____ age than usual agers.

- Successful - slower - later

Inadequate magnesium intakes may contribute to the loss of _____ strength, _____ weakness, and ______ confusion seen in some elderly adults. It also can lead to sudden death from poor _____ rhythm and is linked to cardiovascular disease, osteoporosis, and diabetes. The best source of magnesium is the ____; supplements can cause loose stools and diarrhea.

- bone, muscular, mental - heart - diet

Preventive measures for Alzheimer disease focus on maintaining _______ through lifelong learning, a diet rich in _______ and ______ , and exercise. The role of nutrition in preventing or minimizing the risk of this disease is being investigated. Getting enough _______ nutrients, such as vitamins C and E, helps protect the body from the damaging effects of free radicals. Adequate intakes of folate and vitamins B-6 and B-12 are especially important because elevated blood ______ also is a risk factor.

- brain activity - berries, olive oil - antioxidant - homocysteine

In addition to less than optimal dietary zinc intake during adulthood, zinc absorption _____ as ________ production diminishes with age. Poor zinc status may contribute to the ____ sensation losses, _____ lethargy, and delayed _____ healing many elderly adults experience.

- declines - stomach acid - taste - mental - wound

A _____ in insulin release or sensitivity to insulin, for instance, means that it takes longer for ______ levels to return to normal after a meal. Maintaining a healthy weight, exercising regularly, eating a diet low in fat and high in fiber, and avoiding foods with a high ______ can enhance the body's ability to use insulin and restore elevated blood glucose levels to normal after a meal.

- decrease - blood glucose - glycemic index

There are over 100 forms of arthritis, a disease that causes the __________ of the once smooth cartilage that covers and cushions the bone joints and/or the formation of ______ deposits (spurs). These changes in the joints cause them to _____ and become ______ and painful to move. - _______ becomes more common with age and, by age 80, almost everyone has this condition—it is the leading cause of disability among older persons. - _____ arthritis, which is not as common, is more prevalent in younger adults.

- degeneration and roughening - calcium - ache, inflamed - Osteoarthritis - Rheumatoid

Poor _____ health contributes to digestive and food intake problems. About ___% or more of older people in North America have lost all their teeth. Attention to _____ and care throughout life greatly lowers this risk. _____ (gum) disease commonly causes tooth loss - Replacement dentures enable some people to chew normally, but many older adults—especially men—have denture problems. When people have problems chewing, serving ___________, easier-to-chew foods and allowing extra time for chewing and swallowing encourage more eating.

- dental - 19 - dental hygiene - Periodontal - softer

Eventually, cells lose their ability to regenerate vital internal parts and they ____. This unavoidable dying of deteriorating cells is actually beneficial because it likely prevents diseases such as _____. - Unfortunately, there are negative consequences to this natural cell progression because, as more and more cells in an organ system die, organ function decreases. For example, kidney structures (nephrons) that filter blood to remove waste and reabsorb water, glucose, amino acids, and other nutrients are continually lost as we age. In some people, this loss exhausts the kidneys' reserve capacity and ultimately leads to _____.

- die - cancer - kidney failure

Some of the changes listed (e.g., tooth loss, loss in taste and smell perceptions) can influence _____. - Other changes (e.g., menopause, loss of lean body tissue) can alter nutrient and/or ______. - Still other changes (e.g., reduced stomach acidity, diminished kidney function) can cause changes in ______.

- dietary intake - calorie needs - nutrient utilization

Even though the return to homeostasis is slowed, this slowdown usually is not a major problem unless _____ strikes and stresses the body's capabilities. This slowdown makes an elderly person more vulnerable to ________. In the absence of disease, the slowed restoration of homeostasis usually is not a major problem until the end of the ______ approaches.

- disease - illness and death - life span

Meeting nutrient needs delays the onset of certain ______; improves the management of some existing diseases; speeds recovery from many illnesses; increases mental, physical, and ______ well-being; and often decreases the need for and length of _____. - common dietary excesses are...

- diseases - social - hospitalization - calories, fat, sodium, and, for some, alcohol

Some aspects of the _____ that exert a powerful influence on the rate of aging are income, education level, health care, shelter, and psychosocial factors. - shelter that protects individuals from physical danger, climatic extremes, and solar radiation helps ____ the aging process. - Allowing people to make at least some decisions for themselves and control their own activities (autonomy) and providing _____ support (informational and emotional resources) promote successful aging and psychological well-being.

- environment - slow - psychosocial

Many adults, especially those in the later years, ____ to consume adequate quantities of water. In fact, many are in a constant state of mild dehydration and at risk of ______. Low fluid intakes in older adults may be caused by a fading sensitivity to _____, chronic diseases, and/or conscious reductions in fluid intake in order to reduce the frequency of urination.

- fail - electrolyte imbalances - thirst sensations

After age 30 or so, total calorie needs of physically inactive adults _____ steadily throughout adulthood. This is caused by a gradual decline in _______. To a great extent, adults can exert considerable control over this reduction in calorie need by _____.

- fall - basal metabolism - exercising

in addition to changes in the GI tract, the functions of the _______ organs decline as we age. For instance, the ____ functions less efficiently. A history of significant ______ consumption or liver disease will cause the liver to function even less efficiently. As liver efficiency declines, its ability to detoxify many substances, including medications, alcohol, and vitamin and mineral supplements, drops. The possibility for vitamin _____ increases.

- accessory - liver - alcohol - toxicity

Vitamin B-12 is particularly a problem for the older population because a deficiency may exist even when intake appears to be _____. As people age, the stomach slows its production of ______, which leads to poor absorption of vitamin B-12 and eventually pernicious anemia. - Adults age 51 and older need to meet vitamin B-12 needs with foods or _____ fortified with synthetic vitamin B-12

- adequate - acid and intrinsic factor - supplements

Alcohol abuse is a problem among a small but significant group of older individuals who may continue this pattern from earlier in life or develop heavy drinking patterns and ______ in later life. Later development of this problem sometimes arises from the loneliness and social isolation caused by _________ or the loss of a spouse. Some symptoms of alcoholism in older persons include _____, sleep problems, memory loss, and unsteady gait; these symptoms might be easily disregarded because they also are common symptoms of old age in general.

- alcoholism - retirement - trembling hands

Loss of muscle mass leads to a decrease in ______, muscle strength, and energy needs. Less muscle mass also leads to ____ physical activity, which makes the prognosis for maintaining muscle even worse. Clearly, it is best to avoid this vicious cycle.

- basal metabolism - lower

_____ can be defined as the time-dependent physical and physiological changes in body structure and function that occur normally and progressively throughout adulthood as humans mature and become older. - From the beginning of adulthood until age __ or so, body systems are at their peak efficiency rate. Stature, stamina, strength, endurance, efficiency, and health are at their lifetime _____. The rates of cell synthesis and breakdown are ______ in most tissues.

- Aging - 30 - highs - balanced

Babies born today can expect to live about __ years if they are male and __ if they are female—many will live even longer, and some will live the full life span possible for humans. The maximum life span for humans is generally accepted to be about 115 to ___years.

- 83 - 87 - 120

For example, vitamin ___ needs are higher for persons in older stages of adulthood. - Based on the needs for various nutrients, the Food and Nutrition Board divided the adult years into 4 stages: ages 19 to ___, 31 to ___, 51 to __, and beyond ___ years. - The intervals encompassing ages 19 through 50 are often referred to as _____ adulthood, 51 to 70 as _______ adulthood, and beyond 70 as ______ adulthood.

- D - 30, 50, 70, 70 - young - middle - older

Pregnant and nursing women, children under 2 years of age, those over age 65, and anyone with a chronic disease should not take _______ unless their physician consents to the practice and monitors them for potential complications.

- herbal supplements

Dosage forms of _____ include capsules, tablets, extracts or tinctures, powders, dried plant parts (herbs), teas, creams, ointments, and vapors (aromatherapy). - The ___ requires herbal supplement labels to include the herb name, quantity, dosage per day, and ingredients

- herbs - FDA

Interactions between complementary and alternative therapies and __________ drugs can be drastic and include complications such as delirium, clotting abnormalities, rapid heartbeat, and even death

- pharmaceutical

Incontinence, the inability to control the muscle responsible for holding urine in the bladder, affects up to ___% of older adults living at home and about ___% of those in nursing homes. The fear of being unable to control one's bladder or the embarrassment of having to wear leak-proof, protective underwear causes many to _______ fluid intake (resulting in dehydration and constipation) and become socially isolated.

- 20, 55 - restrict

Striving to have the greatest number of healthy years and the fewest years of illness is often referred to as ______. In other words, a person tries to ____ the onset of disabilities caused by chronic disease and to compress significant sickness related to aging into the last few years—or months—of life.

- compression of morbidity - delay

As lean tissue declines with age, body ____ often increases. Much of this increase results from overeating and limited physical activity, although even athletic men and lean women typically gain some degree of midsection fat after age ___. A small fat gain in adulthood may not compromise health, but large gains are problematic. - Loss of muscle mass (_____) is very prevalent in elderly individuals and greatly increases their risk of illness and death.

- fat - 50 - sarcopenia

people age 65 and up, particularly those in long-term care facilities and hospitals, are the single largest group at risk of _______. They may become underweight and show signs of numerous ______ deficiencies (e.g., vitamins B-6 and B-12 and folate).

- malnutrition - micronutrient

Declining eyesight, frequently caused by ______ degeneration and _____, can affect a person's abilities to grocery shop, locate desired foods, read labels for nutritional content, and prepare foods at home. - Vision losses also may cause people to curtail social contacts, reduce _____, and not practice daily personal health and grooming routines.

- retina, cataracts - physical activity

Those who eat alone, regardless of the reason, _____ eat as much or as nutritiously as they should. Both young and old people who eat without companionship tend to feel unmotivated to shop for or prepare foods. Many develop an apathetic attitude toward life, which over time causes__________ status to decline

- seldom - health and nutritional

Older adults become intoxicated on a _____ amount of alcohol than when younger because they metabolize alcohol more slowly and have lower amounts of body water to dilute the alcohol. Both men and women over the age of 65 should limit alcohol consumption to no more than __ standard drink (alcohol drink-equivalent) per day. - Even small amounts of alcohol can react negatively with common _______ many older persons take

- smaller - 1 - medications

In addition to having adverse effects on the liver, large amounts of alcohol increase the risk of ______ and may aggravate _______ in older adults.

- stroke, hypertension

About ___% of persons 65 years old or older experience depression. The ratio is even higher for those with chronic disease and among those in hospitals and ______. Left untreated, depression can lead to a continual decline in ______, which results in weakness, poor nutrition, mental confusion, and increased feelings of isolation and loneliness

15 - nursing homes - appetite

Then, after about age __, the rate of cell breakdown slowly begins to ____ the rate of cell renewal, leading to a gradual decline in organ size and efficiency

30 - exceed

proposed various causes, including alterations in cell development or protein production in the brain, strokes, altered blood lipoprotein composition, obesity, poor blood glucose regulation (e.g., diabetes), high blood pressure, high blood cholesterol, and high free radical levels.

Alzheimer disease

free of charge, surplus agricultural products (e.g., cheese, peanut butter, canned foods) produced by U.S. farmers to low-income households. The foods provided vary, depending on the farm products available at the time.

Commodity Supplemental Food Program

provides nutritious meals and snacks to low-income children enrolled in child-care centers or residing in emergency shelters, as well as adults who are functionally impaired or ages 60 and older in nonresidential adult day-care centers.

The Child and Adult Care Food Program

helps provide low-income older adults with coupons that can be exchanged for fresh fruits, vegetables, and herbs at farmers' markets, roadside stands, and other community-support agriculture programs.

The Senior Farmers' Market Nutrition Program

______ aging refers to the age-related physical and physiological changes commonly thought to be a typical or expected part of aging, such as increasing body fatness, decreasing lean body mass, rising blood pressure, declining bone mass, and increasingly poor health. - Many of these changes really represent the aging process accelerated by ______ choices, adverse environmental exposures, and/or chronic disease. - For instance, blood pressure does not tend to rise with age among people whose diets are traditionally low in _____. Also, lean body mass is maintained much better in older people who ______ than in those who don't.

usual - unhealthy lifestyle - sodium - exercise

The rate at which a person ages is individual; it is determined by ______. Most of the factors that influence the rate of aging are directly linked to choices that are under our control, with the exception of heredity.

- heredity, lifestyle, and environment

The challenge of the adult years is to maintain the body, ______ its function, and avoid ______ disease—that is, to age successfully. 1. Consume a variety of _____ foods and beverages that result in a diet low in saturated and trans fats, cholesterol, added sugars, salt, and alcohol (if used). Healthy meal patterns emphasize vegetables, fruits, whole grains, reduced fat milk or milk products, and lean protein foods. 2. Maintain body weight in a _____ by controlling energy intake, increasing physical activity, and reducing time spent in sedentary behaviors.

- preserve, chronic 1. nutrient dense 2. healthy range

Although pancreatic function may decline with age, this organ has a large _______. - One sign of a failing pancreas is high ______, although this can occur as a result of several conditions. The pancreas may be secreting less insulin, or cells may be resisting insulin action (as is commonly seen in obese people with upper body fat storage). - Where appropriate, improving nutrient intake, engaging in regular physical activity, and achieving and maintaining a healthy weight can improve ______ action and ______ regulation.

- reserve capacity - blood glucose - insulin, blood glucose

body systems and organs usually retain enough _____ to handle normal, everyday demands throughout one's lifetime. Problems caused by diminished capacity typically don't arise unless _____ demands are placed on the aging body. - For example, alcohol intake can overtax an aging _____. The stress of shoveling a snow-covered sidewalk can exceed the capacity of the ______. Coping with an illness also can push an older body beyond its capacity.

- reserve capacity - severe - liver - heart and lungs

Some medications may impair nutrient ______—diuretics and laxatives may cause excessive excretion of _______. - Even vitamin and mineral supplements can affect ______. Iron supplements taken in large doses can interfere with the functioning of zinc and copper. Folate supplements can mask vitamin B-12 deficiencies.

- utilization - water and minerals - nutritional status

______ of all people over age 65 take several medicines each day. The rate of supplement use increases throughout adulthood, until by age 50 approximately _____ of all adults are using supplements daily. - ____________ declines that occur during aging (e.g., reduced body water, reduced liver and kidney function) cause the effects of medications and nutrient supplements to be ______ and persist longer in older adults.

1/2 - 1/2 - Physiological - exaggerated

Decreases in body weight are common in adults age __ and older. - It may indicate ______, reduced tolerance to medication, or withdrawal from life. Weight loss also may indicate that nervous system and hormonal factors are depressing feelings of _____. - The effects of current medication, as well as changes in taste and smell, may inhibit _____, too. In addition, many older people live ____, a circumstance associated with depressed appetite.

70 - illness - hunger - appetite - alone

The DRIs for adults are divided by gender into 4 age groups to reflect how nutrient needs change as adults grow older. These changes in nutrient needs take into consideration aging-related physiological alterations in body_________. - the _____ and vitamin __ recommendations for older adult age groups exceed those of the youngest group to help offset changes such as reductions in the ability to absorb calcium and synthesize vitamin D in the skin. - In contrast to the rising need for calcium and vitamin D, the ____ RDA for women declines in older age groups to reflect the decrease after menopause.

composition, metabolism, and organ function - calcium, D - iron

The dietary intake of most of the population _____ of recommendations for vitamin E. Low vitamin E intake means the body has a reduced supply of ______, which may increase the degree of cell damage caused by free radicals, promote the progression of chronic diseases and ______, and speed aging. - In addition, low vitamin E levels can lead to declines in ______ abilities.

- falls short - antioxidants - cataracts - physical

Potassium is a nutrient of concern for most adults. Adequate intakes of this mineral is needed for maintaining _____ balance, transmitting _____ impulses, and contracting ______. Adequate intakes also may help keep _______ normal. Fruits, vegetables, whole grains, legumes, and meats are good sources of potassium.

- fluid, nerve, muscle - blood pressure

The ______ also functions less efficiently in later years. _____ can block the flow of bile out of the gallbladder into the small intestine, thereby interfering with ____ digestion. - _____ is a major risk factor for gallbladder disease, especially in older women. A low-fat diet or surgery to remove the gallbladder may be necessary.

- gallbladder - Gallstones - fat - Obesity

Certainly, some of the declines we blame on aging may be inevitable, such as gradual reductions in tissue and organ cell numbers, graying hair, and reduced lung capacity. - However, many of the so-called usual or degenerative age-related changes can, in fact, be minimized, prevented, and/or reversed by ______ (e.g., eating nutritious diets, exercising regularly, getting enough sleep) and avoiding adverse environmental factors (e.g., avoiding excessive exposure to sunlight and cigarette smoke). - These discoveries have led researchers to introduce the concepts of "______ aging" and "______ aging."

- healthy lifestyles - usual - successful

The only diet-related treatment known to offer some relief is to maintain a ______. This is because excess body weight adds extra stress to already painful arthritic joints. Although those with arthritis are ___ likely to benefit from dietary changes, they can experiment with their diets, provided they avoid practices that will result in inadequate, unbalanced, or excessive nutrient intakes, to see if such changes provide relief. - It is important to keep in mind, though, that altering dietary practices may work for some, but ___ dietary changes have been found to be of help to all arthritis sufferers

- healthy weight - not - no

In-home care can include health and personal care, ______ assistance, and caregiver support services, such as nutrition advice and help with coordinating _____ needs.

- home maintenance - care

A slowing in the restoration of the internal balance of the body _____ is at least partially diet-related. Other health problems, such as arthritis and Alzheimer disease, are considered by some to be _____, even though scientific evidence currently indicates otherwise.

- homeostasis - diet-related

In later years, folate and vitamins B-6 and B-12 are especially important because they are required to clear ____ from the bloodstream; elevated blood concentrations of homocysteine are associated with increased risk of the cardiovascular disease, stroke, bone fracture, and _____ decline seen in some elderly people

- homocysteine - neurological

Consuming adequate protein, vitamins (especially folate and vitamins A, D, and E), iron, and zinc helps maximize ______ function. Recurrent _____ and poor _____ are warning signs that a deficient diet (especially protein and zinc) may be hindering the function of the immune system. - On the other hand, overnutrition appears to be equally harmful to the immune system. For example, _____ and excessive fat, iron, and zinc intake can suppress immune

- immune system - sicknesses - wound healing - obesity

_____ deficiency anemia, the most common type of malnutrition during the adult years, is found most frequently in _____ in their reproductive years because their diets do not provide enough iron to compensate for the iron lost monthly during menstruation. - Other common causes of iron deficiency in adults of all ages include _____ injuries that cause bleeding (e.g., bleeding ulcers or hemorrhoids) and the use of medicines, such as aspirin, that cause blood loss. - Impaired iron _____ due to age-related declines in stomach acid production may contribute to iron deficiency in older adults.

- iron - women - digestive tract - absorption

The primary changes in body composition that occur as the adult years progress are diminished _____, increased ____ stores, and decreased body _____, Some muscle cells shrink and others are lost as muscles age; some muscles lose their ______ as they accumulate fat and collagen.

- lean body mass - fat - water - elasticity

The total carbohydrate intake of adults of all ages in the U.S. and Canada is often _____ than recommended. - A diet richer in _____ makes it easier to meet nutrient needs and stay within calorie bounds because many highly sweetened foods are low in nutrients and high in calories. - Substituting foods rich in complex carbohydrates for sweets also makes it easier for the body to control ______ levels—a function that becomes less efficient as the increases in body fatness and inactivity associated with usual aging occur

- lower - complex carbohydrates - blood glucose

A gradual loss of the ______ that transmit signals may decrease taste and smell perceptions and impair neuromuscular coordination, reasoning, and memory. - Both _____ decline with age. - _____ impairment is greatest in those who have been exposed constantly to loud noises, such as urban traffic, aircraft noise, and music. Because they cannot hear well, older people may avoid social contacts, which increases their risk of _____ intake.

- nerve cells - hearing and vision - Hearing - poor dietary

People who must take medications should eat _______ foods and avoid any specific food or supplement that interferes with the function of the medication. For example, vitamin ___ can reduce the action of oral anticoagulants, aged cheese can interfere with certain drugs used to treat _________________, and grapefruit can interfere with medications such as tranquilizers and those that lower _____ levels

- nutrient dense - K - hypertention and depression - cholesterol

Sometimes people cope by overeating, which can lead to ______ and its associated problems. As many as ___% of depression cases may end in suicide. Depression is often treatable with _____, social support, and psychological intervention

- obesity - 15 - medication

Inadequate intake of these nutrients coupled with their reduced absorption, the reduced synthesis of vitamin D in the skin, and the kidneys' decreased ability to put vitamin D in its active form greatly contribute to the development of _______. - 1 of the richest and most absorbable sources of these nutrients, milk, contains ______. To get the vitamin D and calcium needed, many with lactose intolerance can consume _____ amounts of milk at mealtime with no ill effects.

- osteoporosis - lactose - small

For instance, excessive fatness, heart disease, and osteoporosis may impair _____ to the extent that victims are unable to shop for and prepare food. - Cancer, for example, boosts both __________ needs. - Nutrient utilization can be affected by chronic disease, too. For instance, diabetes alters the body's ability to utilize _____. In addition, the effects of heart disease on the kidneys may impair their ability to reabsorb ________.

- physical mobility - nutrient and calorie - glucose - glucose, amino acids, and vitamin C

Like those of other age groups, the food choices and nutritional adequacy of adults' diets depend on the interplay of _______. - Alterations in any of these factors, such as age-related changes in body organs and systems or diminished psychological well-being, social interaction, or financial status, can result in ______ in the quality of dietary intake, nutritional status, and health.

- physical, physiological, psychosocial, and economic factors. - deteriorations

Most likely, the ______ changes of aging are the sum of automatic _____ changes, _____ practices, and _____ influences

- physiological - cellular - lifestyle - environmental

some medications depress ________ acuity or cause anorexia or nausea that can blunt interest in eating and lead to reduced dietary intake. - Some medications alter _____. Aspirin, for example, increases the likelihood of stomach bleeding, so long-term use may elevate the need for _____, as well as other nutrients. Antibiotics may deplete the body of vitamin ___

- taste and smell - nutrient needs - iron - K

For example, it takes _____ as long for the kidneys to remove wastes and restore blood levels to normal after eating excess protein in a person age ___ than in a person age 30. Similarly, it takes older people longer to break down alcohol, drugs, and nutrient supplements. Consequently, blood levels of these substances rise higher and have a _______ effect in older adults than younger people.

- twice - 80 - stronger and longer

Caregivers of those who have Alzheimer disease need to monitor the patient's _____ to ensure maintenance of a healthy weight and nutritional state. Other tips are serving fish rich in omega-__'s _____ per week and making sure eating habits do not pose a health risk (e.g., holding food in one's mouth or forgetting to swallow). Regular physical activity also has been shown to improve ____ status in people afflicted with this disease

- weight - 3 - twice - mental