FSN 315 Final

Describe the AREDS 1 study.

AREDS = Age Related Eye Disease Study, coordinated by National Eye Institute AREDS 1: tested nutrient supplement on AMD and cataracts. Four groups were used: 1. Given Antioxidants (Vit C, E, Beta Carotene, Cu) 2. Zinc only 3. Zinc and Antioxidants 4. Placebo

What is wet Age Related Macular Degeneration?

Abnormal growth of blood vessels behind retina; leak blood and fluid; damage macula. More server than dry AMD and is more rapid in vision loss: often beginning and intermediate stages bypassed.

Describe AREDS 2 study.

Added omega 3, lutein and zeaxanthin, lutein/zeaxanthin tried to substitute for beta carotene. Tried removal and lower levels of zinc.

What are risk factors for Age Related Macular Degeneration?

Age, gender (> in women), smoking, family history, *CVD*, *HTN*, race, *obesity*(--> causes faster progression)

What are risk factors for cataracts?

Age, smoking, *alcohol* in excess, *diabetes*, UV/sun exposure

Outline risk factors for osteoarthritis.

Aging, excessive weight, trauma to joint, muscle weakness, repetitive joint use.

What enzyme breaks down alcohol?

Alcohol hydrodgenase

Why is muscle mass in the elderly important?

Allows for ADL's/maintain independence, helps recover from illness/trauma, muscle may lead to debility/disability*?* 54% of non institutionalized elderly report 1/> disability, 73% 80+ report 1/> disability

What are some treatments for GERD?

Antiacids, diet changes (avoid trigger foods), eat small frequent meals, sit up right after eating, wearing looser clothes, lose weight if overweight.

Describe rheumatoid arthritis.

Autoimmune disease causing chronic inflammation of membrane around joints and erosion of cartilage and bone. Occurrence increases w/age, peak ~65-74 years. More common in women, affects more joints than osteoarthritis (whole body affected).

Describe the AREDS 1 study results.

Beta Carotene increased cancer risk in smokers, and Zinc caused upset stomach. No significant effect on slowing progression/development of early AMD *or cataracts*. All supplements decreased risk of advanced AMD and reduced risk in people with intermediate AMD/1 eye only AMD. Combo supplement was most effective.

Describe osteoarthritis.

Bone on bone rubbing, most common type (more in women, 1/3 in 65+ cases). A deteriorating and degenerative condition, usually localized around specific joints (knee, hip, wrist, fingers). Causes pain and < QOL.

Describe skeletal aging in elders.

Bone strength depends on bone mass, which relates to bone mineral density, bone quality, structure and turnover. 60-80% bone strength genetically determined but nutrition/lifestyle play role. Bone growth peaks at 28 and declines around 50. Bone loss with age is universal but not identical; estrogen loss during menopause accelerates bone loss in women.

Describe blood lipids and CVD.

Cholesterol peaks in men 45-54 years and women 55-64. Elevated LDL and low HDL both risk factors, many elderly take cholesterol lowering medications. TLC diet can also be useful tool. LDL raised by: high fat diets, sat/trans fats. Levels lowered by decreasing intakes of sat/trans fat, eat more plants. Soy can also help lower LDLs because it's a plant sterol, high in fiber, and helps body make less cholesterol. HDL low levels by: high triglycerides, overweight, obesity, physical inactivity, DM2, smoking, high carb intakes.

What is gout?

Complex form of arthritis caused by presence of elevated uric acid levels, which are caused by purine metabolism. This purine metabolism forms insoluble monosodium urate crystals which can lead to uric acid buildup in joints. Affects more men than women, increases with age.

Describe Late Life Depression.

Correlates with increased risks of morbidity, self neglect, decreased cognitive/physical/social functioning. Significant predictor for suicide (65+ account for 20% suicides), and higher in women than men. Highly under diagnosed, many chronic diseases associated with > risk LLD (CVD, diabetes, dementia, Parkinson's, anxiety, sleep disorders). May be associated with pseudodementia (depression and neurological disease) Also physiologically different than depression in younger patients (may be related to mini strokes/blood clots due to CVD). May also lead to neurotransmitter deficits and interruption of connection involved in mood. May be associated with greater inflammation with age.

Describe Sarcopenia in the elderly.

Decline in muscle mass/strength that occurs in healthy aging. Represents a loss in muscle fibers and reduced fast twitch fiber size. 35% all disabilities can be related to sarcopenia. Occurs at accelerated rate after 25: age 20-50 10% muscle loss, by age 80 up to 40% muscle loss, up to 50% in 80+. More frequent in men than women, end point of muscle wasting usually death and asphyxiation due to respiratory muscle collapse. Costs of sarcopenia > than those of largely publicized diseases (osteoporosis)

Describe fecal incontinence in elderly.

Decrease in the resting and squeeze pressure in the anal canal, commonly see anal-rectal dysfunction. Incontinence common cause and symptom of institutionalization, 30-60% of patients in any home. Can lead to: dehydration/malnutrition if people can't control poop they don't want to eat or drink. Also, adult diapers or a rectal tube must be used. Adult diapers make resident sit in fecal matter so degrades skin, meaning they need more nutrients. Rectal tubes are immobile but cleaner.

What are types of mood disorders common in elderly?

Depressive Disorders: Major Depressive Disorder (MDD) and Late Life Depression Bipolar disorder

What are the treatments/preventative steps for osteoporosis?

Diet, exercise (like the silver sneakers; best to tell them to talk to doctor before attempting exercise), fall avoidance education, medications.

What are the stages of Age Related Macular Degeneration?

Early: no cause of vision loss, drusen (protein clots) present on macula. Intermediate: much > drusen, changes in vision possible but not common. Advanced stages: Dry AMD/Wet AMD.

How can one prevent Age Related Macular Degeneration?

Eat healthy (lots of leafy greens and fish), don't smoke, maintain normal blood pressure, watch weight, exercise.

What are the CVD dietary recommendations according to the American Heart Association?

Eat wide variety frutis/veggies/whole grains, lean and fat free dairy, fish, legumes, poultry meats. Match energy needs to overall calorie needs and no more to maximize weight loss. Reduce sat fat to <10% kcal, cholesterol <300mg, salt less than 6 g/day, limit alcohol and eat two servings of fish

What are some statistics for elderly and med prescriptions?

Elderly currently consume 25% prescription drugs and 50% all over the counter drugs. Spend $15 billion on prescription drugs. Elderly is most actively medicated group. Free living elderly avg. 3/> drugs per day, institutionalized avg 10.

How can health care professionals aid in combatting muscle loss?

Encourage kcal/protein intakes, esp. in elderly as they may need more to grow/keep muscle mass. Encourage physical activity as is safe Help elderly adapt to muscle loss Be aware any body area can be affected

What are some ways to help elders with alcoholism?

Encourage less drinking/limiting drinking to certain days/week, limit situations where alcohol will be served, eat before drinking to curb absorption, try sipping juice/water instead, count drinks you do have, ask for family/friend support.

Why does alcohol have more of an effect on elderly? What could this mean for other bodily functions?

First Pass Metabolism usually breaks alcohol down in stomach and small intestine before going to the liver to be absorbed, but FPM is decreased in elderly so more alcohol makes it to the liver. Alcohol breakdown in liver takes precedence over other liver digestion functions.

What are some nutrient losses associated with alcohol?

Folate, B12, Calcium, Vitamin A.

What have studies found about milk consumption to help bones?

Found that increased milk consumption (3/> glasses) correlated with increased fracture and mortality risks.

Describe osteoporosis in women.

Fractures > common because menopause causes increase in rate of bone deterioration. (lgst decline in bone loss over first 5 years of menopause due to > osteoclast activity and bone resorption). The less bone mass you have before menopause the greater the consequences so prevention is key! Can be stopped by estrogen replacement therapy but this increases risk for stroke/blood clots/CVD/Breast cancer

What is GERD? What causes it?

Gastro Esophageal Reflux Disease, Will damage esophagus even if no symptoms are felt. More common in elderly b/c of meds that irritate it. Can also be caused by slow gastric emptying, improper lower esophagus sphincter closing, or trigger foods (chocolate, fatty foods, alcohol, caffeine, mint, sometimes spicy foods).

What is dry Age Related Macular Degeneration?

Gradual breakdown of light-sensitive cells in macula that convey visual information to the brain, and of the supporting tissue beneath the macula which can cause vision loss.

What are some ways to treat high blood pressure?

Healthy weight, decrease sodium intake, limit alcohol/quit smoking, drug therapy, DASH diet.

Describe fractures caused by osteoporosis.

Hip fractures most devastating: 1 in 5 die within year of fracture, 1 in 4 become disabled, 1 in 5 must move to a nursing home within a year, and many become isolated/depressed.

What are the treatments for Age Related Macular Degeneration?

In the advanced stage treatments are limited. Before that AREDS (an antioxidant supplement) is often used.

What are the main possible GI changes related to aging?

Increased gastric pH (less acidic), delayed gastric emptying, reduced GI blood flow, slowed intestinal transit. Decreased nerve function, which can lead to delayed gastric emptying and slower muscle contraction or movement of food through GI.

What is Age Related Macular Degeneration?

Increased rates with age and caucasians, *most common case of elderly vision loss*. Loss of central vision, peripheral vision can be maintained. The macula (small spot near retina center) becomes damaged, thus hindering sharp central vision. Not total blindness but loss of central vision can affect many IADLs and ADLs.

Describe metabolic syndrome.

Increases the risk of atherosclerosis/CVD. Classified by at least 3: insulin resistance/increased fasting blood glucose, high cholesterol (LDL/total), low HDL cholesterol, high blood pressure, obesity, especially abdominal obesity. CVD in adults with metabolic syndrome doubles from 10 to 20. Women have 60% increased risk of developing metabolic syndrome after menopause.

Describe characteristics of depressive disorders.

Involve changes in the brain neurochemistry; can be caused by genetic disposition, traumatic events (loss of loved one, home loss, health decline), hormonal imbalance (menopause), chronic disease, substance abuse. Obesity and depressive disorders are risk factors for each other.

Why is there an interest in the connection between antioxidants and AMD?

It's plausible: oxidation processes are involved in both cataracts and AMD, and there's Vit c concentrated in eye lens. Eye esp. retina rich in PUFAs, which susceptible to oxidation. Also noticed a lowering of risk in those who ate more carotenoids, esp. lutein/zeaxanthin, dark leafy greens, sometimes Vit C/E.

What does osteoarthritis mean for nutritional status?

Limits mobility and dexterity so decreased/painful activity levels. Meds needed to treat osteoarthritis and pain, along with side effects.

Describe nutrition implications of depression.

Loss of appetite is #1 cause of weight loss in elderly, which leads to compromised health/nutritional status.

What prevention and treatment is there for osteoarthritis?

Manage weight/exercise, low energy diet, sustainable weight loss (1-2 lbs/week aiming for 10% current weight). Diet treatment: may benefit from PUFAs and antioxidants, Vit C/Omega 3/Vit E (all 3 inconclusive), Vit D (low levels associated with progression of disease but not start). Glucosamine and chondroitin: can be used for pain relief but also reduces loss of space between joints.

Describe the liver's changes in the elderly.

Many changes are caused by systemic disease, but also liver shrinks with age and blood flow to liver decreases by up to 1.5%, which leads to decreased breakdown of food/alcohol, and decreased albumin/total body protein synthesis.

What type of dietary interventions can be made for CVD in elderly?

Many recommendations can help lower CVD risk/ TLC diet Must be careful with elderly bc they might lose weight/appetite, and < QOL

How can one treat Late Life Depression?

Meds sometimes, but usually not tested for elderly age demographic so effectiveness changes. Counseling, promoting social engagements, nutrition therapy, pet therapy and preschool therapy all also help.

Besides Ca and Vit D, what are some other nutrients important for bone health?

Mg and K: good bone mineral density Vit K: bone synthesis/metabolism B12 and B6: both play role in DNA synthesis Na: higher levels lead to increased Ca losses. Omega 3 and PUFA: diets high in them help increase bone mineral density Adequate protein needed for bone health. Coffee increases Ca loss so should be drank with milk.

Outline the normal activities bones perform.

Modeling - growing/shaping from baby to adult Repair - after fracture/break Remodeling - always changing w/calcium/breaks

What are the possible benefits for elders consuming alcohol?

Moderate drinking has some benefits for elderly, decreases CVD risk, may increase appetite and QOL, may increase HDL cholesterol.

Describe cataracts.

Most are related to aging, higher incidence with caucasians, > 1/2 people 80+ have had cataracts and surgery to correct. They cloud the lens of the eye from the misaligning of the organized arrangement (clumping) of proteins and water within it. Cause browning/yellowing of retina, and vision overall appears fuzzy.

What is drinking in moderation in elderly?

No more than 7 drinks/week or no more than 3/any one day

What can cause nutrient drug interactions in elderly?

Nutritional deficiency, drug toxicity, loss of drug efficacy/disease control, unwanted body weight changes.

What are the risk factors for gout?

Old age, nonwhite ethnicity, excessive weight, excessive alcohol, meat and fish consumption, high protein diets, diuretic use, metabolic syndrome.

What are the two types of arthritis?

Osteoarthritis (bones rub together) Rheumatoid Arthritis (bone erosion/inflammation of surrounding joint)

Describe the prevalence of depressive disorders.

Overall depressive disorders less prevalent in older adults than younger ones but Late Life depression can still occur. Depressive disorders not normal part of aging, but present in 15% adults in communities, and 50% in institutions.

Outline the potentially modifiable and non-modifiable risk factors for osteoporosis.

Potentially Modifiable: early estrogen deficiency, long term low Ca/Vit D intake, low weight, inactivity, low peak bone mass, smoking/excessive alcohol. Non-Modifiable: age, gender, race (caucasian/asian), body size (petite/thin boned), genetics

Describe diarrhea in elderly.

Prevalence not more common but more severe/serious. Caused by Clostridium difficile (which elderly more likely to contract and die from) or diabetic diarrhea. Treatment is depending on nutritional/pharmacological cause.

Compare primary and secondary osteoporosis.

Primary: results from accelerated bone loss @ old age/from suboptimal peak bone mass Secondary: due to meds/disease (kidney/liver disease, COPD, anorexia)

Describe Adverse Drug Reactions.

Responsible for morbidity and mortality in elderly, over 50% of all cases might be preventable. Elderly more at risk for adverse drug reactions (side effects, drug interactions, allergic reactions), cause 20,000 deaths 80% of which could be prevented. Most likely to occur with combining Rx drugs with OTC/herbal meds.

How can nutrition affect CVD?

Saturated/Trans fats prevent regulation of lipoprotein levels Weight increases blood pressure and lipoprotein levels. Sodium increases blood pressure in some B6/12 folate possibly can lower homocysteine levels and vitamin E could be effective as an antioxidant.

Describe Osteoporosis overall.

Skeletal fragility b/c of low bone mass and disruption of bone architecture. Bones easily fracture even without trauma, affects all bones in body (common in hips/wrist/spine). Can cause falls, fractures, and costs annually $18 billion.

Describe obesity and its relation to CVD in elderly.

Some studies say that there's an increased CVD risk @ both ends of weight spectrum, most studies suggest that obesity increases risk for CVD. Low HDL = obesity, more women are obese than men and more 60+ obese than younger. Middle age obesity prevention most important. Obesity links to HTN 75% of time, and obesity can decrease QOL by causing bone/joint stress and pain. Wt. loss can have benefits and risks.

Describe ulcers. What treatments are there for them?

Stomach ulcer incidence and perforation increases in elderly due to nonsteroidial anti-inflammatory drugs used frequentlly. Perforation can lead to bleeding internally and infection. Can be treated by surgery or antacids but antacids cause diarrhea.

What are some nutritional interventions to be taken with gout?

Stop drinking (beer hard liquor > likely to cause flare ups than wine), healthy weight, restricting meat and fish, purine restrictive diets (purines in plants and dairy don't cause flare ups like meats), following diabetic type diets, increasing fluids. Coffee helps decrease gout (decaf same as regular), tea/caffeine alone doesn't help reduce gout. Fructose elevates gout risk, usually unnatural fructose/added fructose/high fructose corn syrup. Thus diet soda doesn't increase gout risk. Up to 500 mg Vit C/day may decrease uric acid levels.

Describe CVD and its risk factors in the elderly.

Symptoms often attributed to "slowing down"/ normal aging. Prevalence of modifiable risk factors (diets high in fat/cholesterol, activity level, smoking, hypertension, high cholesterol or triglycerides) increases with age. Non modifiable: genetics, gender (more common in men), age, body comp

Explain how calcium and Vitamin D relate to bone loss.

The skeleton contains 99.5% of total body Ca, and intakes of Ca lower than recommended for females of all ages. Elderly may have reduced Ca absorption (which hurts bones b/c not ingesting enough still pulls Ca from bones to compensate), and elderly usually have low Vit D level (less skin production/don't go outside), which also results in low Ca absorption. Low vit D and Ca levels cause increased bone resorption, loss of mineral bone density, and increased osteoclast activity.

What special interest is there in lutein and zeaxanthin relating to eye health in elderly? Where can they be found in food?

They are both found in the eye, may be protective as antioxidants or because they provide macular pigment. Found in kale/leafy greens, possibly fish?

What is atherosclerosis?

Thickening and hardening of the arteries. Artery walls thicken with age. Three types of atherosclerotic changes: fatty streaks, plaques, lesions.

What are some treatments/prevention for cataracts?

Treatment = surgery. Prevention: regular eye exams, sunglasses/hat, not smoking. Good nutrition as prevention is under investigation (leafy green veggies, fruit, other antioxidant foods)

How can one diagnose osteoporosis?

Using a T-score: compare bone mineral density w/mean of young adult female/male (coorelates with who's being tested) Normal: T-Score no more than 1 standard dev below adult female reference score, -1 Low bone mass: <-1, >-2.5 Osteoporosis: <-2.5 Severe/Established Osteoporosis: <-2.5 PLUS fracture

Describe how to diagnose Late Life Depression.

Usually hard to do due to coexisting medical illnesses. Components of diagnosis: medical history, physical exam, lab tests (check blood for b12, folate deficiencies, anemia), interview family, screen with geriatric depression scale. In severe depressive cases: suicide threat, self destructive behavior, severe weight loss due to reduced food intake.

What is diverticular disease (diverticulosis)?

When diverticula form (pocket/polyp formed in intestine, caused possibly by weak intestine wall, inadequate dietary fiber, or increased pressure from outside.) >40% patients 60+ yrs and >60% patients 80+ years.

What is diverticulitis?

When diverticulum become perforated leading to inflammation, abscess, or infection. May cause severe GI pain, fever, bowel changes.

Describe fat metabolism in elderly.

When eating normal fat levels elderly show no absorption difference than young, but increased fat intakes decreases fat absorption in elderly. Institutionalized elderly have decreased fat absorption than non.

What are some statistics of CVD?

Women are more likely to die than men from CVD because a women's symptoms for heart attack less known. 65+ y/o, 1 in 5 chance of CV event.

Describe muscle loss in the elderly.

accelerated in aging due to imbalance of protein synthesis/degradation. Can be categorized as chachexia or sarcopenia, but both have similar implications.

What are some recommended intakes/levels for vitamin D? (serum 25 OH D)

adequate level = 30/higher 40/higher = reduced fall risk/increased physical activity 50/higher = optimum reduced fall/fracture

Describe dyspepsia in elderly.

aka indigestion, can cause upset stomach or discomfort during/after eating. Abdomen pain, fullness, nausea, bloating, heartburn, vomiting. Can be caused by GERD, peptic ulcer disease or carcinoma, also a marker for GI cancer.

Describe strokes.

blockage of blood to brain causing brain cell death and often loss of muscle control, risk increases with age. Most classify as CVD, most risk factors for CVD also for stroke.

What lifestyle factors can affect bone loss rate?

body weight, physical activity, illness, diet, meds/alcohol/tobacco

Describe Cachexia in the elderly.

disease related muscle loss (cancer, COPD, kidney disease, AIDS, Diabetes, Parkinsons). Muscle wasting associated with reduced AA stores, decreases QOL

What are some secondary causes/risks for osteoporosis?

diseases/disorders, anorexia and bulimia, prolonged bed rest, some meds esp. glucocorticoids and anticonvulsants.

Describe the AREDS 2 Study results.

found omega 3's had no benefits. Lutein/zeaxanthin was as effective as B carotene without side effect of increasing cancer. Was also effective in treating cataracts in people who were lacking in diet of lutein/zeaxanthin, where AREDS 1 didn't help cataracts.

Describe Major Depressive Disorder.

low self esteem/self worth, makes everyday activities hard. Often described as depression, but depression isn't a disease itself rather used to describe signs/symptoms related to disease.

What is the DASH diet?

low sodium, low sat fat, high fruit/veggies, high whole grains, include fish/chicken/nuts, limit red meat/sweets/sugar beverages. Can greatly decrease blood pressure.

Describe the colon in elderly.

major source of symptoms and disease; water, electrolytes, short chain fatty acids absorbed in colon. Two main problems to be found: constipation and diverticular disease.

What are the symptoms of Rheumatoid Arthritis? What is rheumatoid cachexia?

pain, decreased grip strength, stiffness, physical deformities (hand deformities = reduced IADL/ADL thus QOL). Nutritional status must carefully be monitored. Rheumatoid Cachexia: loss of lean tissue and increase in lean fat mass due to hypermetabolism of RA.

What are some examples of people who should abstain from drinking? What are some other concerns for alcohol use in elderly?

people with alcoholism history, liver disease, high triglycerides (liver processes these), high BP, heart failure, or pancreatitis. Increases fall risk, car crashes and increased violence, and drug interactions. Alcohol can replace other better kcal sources, lead to malnutrition/weight gain.

What are some ways to fall-proof the home?

plenty of handrails, good lighting, wide hallways, non slip soles of shoes, keep cords and items off of floor.

Describe constipation in elderly, what treatments are there for it?

very hard stools, decreased frequency, painful/strained pooping. "normal" classified as anywhere from 3x/day-3x/week. Caused by drug side effects, neurologic disease, structural abnormalities, decreased mobility, dependence on others for assistance, depression, dehydration, dementia, and systemic disease. Treatments are: more fluids, more fiber, prune juice, increased activity level, laxatives, enemas, and stool softeners.

What does the FAST acronym stand for?

*F*ace fallen on one side? *A*rms both be raised and stay there? *S*peech slurred? *T*ime to call 911 if any of these signs

Describe nutritional intake and depression.

*Omega 3* have DHA/EPA, possible low intakes of DHA/EPA associated w/>depression. No specific supplement does recommended but if taken with antidepressive meds may help, best consumed with vitamin E and foods (fish and nuts). > *Vit B* intake associated w/< risk of LLD. If B6/B12/folate deficient, homocysteine levels elevated which can worsen depression. *Vit D* deficiency associated w/> risk LLD. Diet rich in *tryptophan* can help because tryptophan --> serotonin and depression often associated w/low serotonin levels. *low intakes associated with > risk LLD*

What are some important questions to ask when addressing diet changes in elderly?

1. Are dietary modifications of value in older people? 2. Are dietary modifications feasible for the individual? Because: kcal restriction may cause weight loss, nutrient deficiency is risk of diet restriction, some physical activity can't be done by elderly, might have to reteach how to cook healthful meals.

What are the causes of sarcopenia?

1. Possible decrease in anabolic (building) stimuli for muscles, reduced exercise, or decreased anabolic response after exercise. 2. These lack of responses can come from insulin and AA dulled response to not help build muscle as much. 3. Possible increase in catabolic stimuli to break down muscles

Outline the TLC diet in elderly.

1. Sat fat < 7% of total cal and cholesterol < 200 mg/day 2. Enhance LDL lowering w/plant sterols (2g/day) and increase soluble fiber 10-25 g/day 3. reduce body weight 4. increase physical activity to expend 200 kcal/day

What are some dietary approaches for Rheumatoid arthritis?

1. elimination diets to ID trigger foods (common: cereals [wheat], corn, oats, rye, port wine, beef, eggs, coffee, oranges); < pain/> physical function 2. Elemental diets: diet broken down into simplest form (single AA, small sugars, med. chain triglycerides) 3. Anti inflammatory diets may help (> antioxidant/plant foods, < sat fat) 4. Vegetarian/Vegan diets may improve stiffness, swelling, pain (also usually help decrease weight which can lower inflammation) 5. Mediterranean/Omega 3 diet also helpful.

Outline the process of cardiovascular disease.

50% people 65+ aren't educated on how to reduce risk of CVD. < CV function major physical impairment associated w/aging. Loss of CV function due to: age associated changes, physical deconditioning w/sedentary lifestyle, atherosclerotic changes/disease (oxidative damage, inflammation, platelet aggression)

Describe blood pressure and its relation to CVD.

70% 65+ had HTN, by 80 y/o 90%. Most powerful predictor for stroke is high blood pressure and is most readily amenable to treat. HTN also increases risk for chronic kidney disease, dementia, and congestive heart failure. Most elderly just have isolated systolic blood pressure (top number too high)

Describe how exercise relates to bone loss.

> bone mass made in response to skeletal load, bone density > in > physically active adults. Exercise may reduce rate of age-related bone loss.

What is Atrophic Gastritis?

A decrease in stomach acid strength, usually in elderly. Can lead to bacteria overgrowth, B12/iron deficiency, nausea, diarrhea, weight loss, malabsorption overall and discomfort.