Lesson 13 Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years

. Similarly, a person with a high sodium intake will excrete more sodium in the urine, and therefore more lithium.

Individuals using lithium are advised to maintain a consistent sodium intake from day to day in order to maintain stable blood concentrations of lithium.

Dentures, even when they fit properly, are less effective than natural teeth, and inefficient chewing can cause choking.

Inefficient chewing leaves larger pieces of food moving from the stomach into the small intestine, thus limiting enzyme accessibility.

Arthritis

Inflammation of joints

Overall low food consumption and chronic blood loss from diseases can cause deficiency in this nutrient

Iron

Finally, single people might want to invite someone to share meals with them whenever there is enough food

It's likely that the person will return the invitation, and both parties will get to enjoy companionship and a meal prepared by others.

An integral component of the Older Americans Act (OAA) is the OAA Nutrition Program

Its services are designed to improve older people's nutrition status and enable them to avoid medical problems, continue living in communities of their own choice, and stay out of institutions.

As is true for people of all ages, polyunsaturated fats provide valuable nutrients, and saturated fats raise the risks of atherosclerosis and other degenerative diseases.

Limiting fat too severely may lead to nutrient deficiencies and weight loss—two problems that carry greater health risks in the elderly than being overweight.

Senile Dementia

Loss of brain function beyond the normal loss of physical adeptness and memory that occurs with aging

Sarcopenia

Loss of skeletal muscle mass, strength and quality

When the number of neurons in the cerebellum diminishes, balance and posture are affected.

Losses of neurons in other parts of the brain affect still other functions.

When the number of neurons in one part of the cerebral cortex diminishes, hearing and speech are affected.

Losses of neurons in other parts of the cortex can impair memory and cognitive function.

Many medications that older adults commonly use can impair zinc absorption or enhance its excretion and thus lead to deficiency.

Low zinc status impairs immune function and increases the risk of pneumonia and death.

rheumatoid arthritis (ROO-ma-toyd) has possible links to diet through the immune system.

In rheumatoid arthritis, the immune system mistakenly destroys bone and cartilage as if they were made of foreign tissue.

Creative chefs think of various ways to use foods when only large amounts are available.

Many frozen dinners offer nutritious options. Adding a fresh salad, a whole-wheat roll, and a glass of milk can make a nutritionally balanced meal.

When recommended by a physician or registered dietitian nutritionist, vitamin D and calcium supplements for osteoporosis or vitamin B12 for pernicious anemia may be beneficial.

Many health-care professionals recommend a daily multivitamin-mineral supplement that provides 100 percent or less of the Daily Value for the listed nutrients. - . They reason that such a supplement is more likely to be beneficial than to cause harm.

Despite real fluid needs, many older people do not seem to feel thirsty or notice mouth dryness.

Many nursing home employees say it is hard to persuade their elderly clients to drink enough water and fruit juices

Nutrition program that allows older adults to live independently by proving home-delivered meals

Meals on Wheels

The drug methotrexate, used to treat cancer and some inflammatory conditions, acts by interfering with folate metabolism and thus depriving rapidly dividing cancer cells of the folate they need to multiply.

Methotrexate resembles folate in structure and competes with folate for the enzyme that converts folate to its active form.

regular physical activity is the most powerful predictor of a person's mobility in the later years.

Mobility, in turn, is closely associated with longevity.

Cataracts may develop as a result of ultraviolet light exposure, oxidative stress, injury, viral infections, toxic substances, and genetic disorders.

Most cataracts, however, are vaguely called senile cataracts—meaning "caused by aging."

The accumulation of beta-amyloid seems to be a problem of impaired clearance more than excessive production with Alzheimer's disease

Much treatment research focuses on lowering beta-amyloid levels. Interestingly, the fat cell hormone leptin that decreases appetite and increases energy expenditure also promotes beta-amyloid clearance and lowers the risk of Alzheimer's disease.

Neurons

Nerve cells

In general, older people tend to lose bone and muscle and gain body fat. True False

True

Nutrition can contribute to, or prevent the development of age-related vision, joint and brain diseases. True False

True

Physiological, psychological, social, and economic changes can affect nutrient status in older adults. True False

True

Some medications stimulate appetite and cause weight gain.

Unintentional weight gain may result from the use of some antipsychotics, antidepressants, and corticosteroids (for example, prednisone).

Atrophic gastritis can interfere with hydrochloric acid and intrinsic factor production needed for absorption of this nutrient

Vitamin B12

Aging affects 7-dehyrocholesterol production in our skin, a precursor for this nutrient, and the liver and kidney are less efficient in converting it to its active form

Vitamin D

Getting enough vitamin D poses a problem for many older adults

Vitamin D-fortified milk is the most reliable source of vitamin D, but many older adults drink little or no milk.

Older adults can also take advantage of the Senior Farmers Market Nutrition Program, which provides

low-income older adults with coupons that can be exchanged for fresh fruits, vegetables, and herbs at community-supported farmers' markets and roadside stands. -This program increases fresh fruit and vegetable consumption, provides nutrition information, and even reaches the home-bound elderly, a group of people who normally do not have access to farmers' markets.

Preventative nutritional factors for this disease include omega-3 fatty acids, antioxidant and B vitamins and the carotinoids lutein and zeaxanthin

macular degeneration

Most people can achieve adequate vitamin and mineral intakes simply by including foods from all food groups in their diets

- but older adults often omit fruits and vegetables. - Similarly, few older adults consume the recommended amounts of milk or milk products.

The consequences of energy restriction in animals include a delay in the onset, or prevention, of chronic diseases such as

- cancer and atherosclerosis and age-related conditions such as neuron degeneration.

. Aside from an inadequate diet, two other factors may lead to iron deficiency in older people:

- chronic blood loss from diseases and medicine -poor iron absorption due to reduced stomach acid secretion and antacid use

congregate meals

nutrition programs that provide food for the elderly in conveniently located settings such as community centers.

A variety of tools can be used to diagnose alcohol abuse, but simply asking a question or two can identify hazardous drinking behaviors and potential problems in the elderly.

"In the past year, how often did you drink four (for women, and five for men) or more drinks? What is the maximum number of drinks you consumed on any given day?" Such questions help identify regular heavy use of alcohol and binge drinking.

When people cut back on their usual energy intake by 10 to 20 percent, body weight, body fat, inflammatory proteins, growth factors, and blood pressure drop, and blood lipids and insulin response improve—favorable changes for preventing chronic diseases such as some cancers, type 2 diabetes, hypertension, and heart disease.

(For perspective, a person with a usual energy intake of 2000 kcalories might cut back to 1600 to 1800 kcalories.) - Some research suggests that intermittent fasting may provide similar benefits

Eating high-fiber foods and drinking water can alleviate constipation—a condition common among older adults, especially nursing home residents.

(Physical inactivity and medications also contribute to the high incidence of constipation.)

Although the home-delivery program ensures nutrition, its recipients miss out on the social benefits of the congregate meals. Therefore, every effort is made to persuade older people to come to the shared meals, if they can.

- All persons aged 60 years and older and their spouses are eligible to receive meals from these programs, regardless of their income. - Priority is given to those who are economically and socially needy. An estimated 3 million of our nation's older adults benefit from these meals.

While older adults need fewer kcalories as they age, their nutrient needs remain high.

- For this reason, it is important that they select mostly nutrient-dense foods -There is little leeway for added sugars, solid fats, or alcohol; such nutrient-poor selections can easily lead to weight gain and malnutrition.

A number of dietary factors affect the activity of the anticoagulant drug warfarin (Coumadin).

- One important interaction is with vitamin K, which is structurally similar to warfarin. -Warfarin acts by blocking the enzyme that activates vitamin K, thereby preventing the synthesis of blood-clotting factors.

On average, energy needs decline an estimated 5 percent per decade.

- One reason is that people usually reduce their physical activity as they age, although they need not do so. - Another reason is that the basal metabolic rate declines 1 to 2 percent per decade in part because lean body mass and thyroid hormones diminish.

Some foods affect the activities of enzymes that metabolize drugs or may counteract the drugs' effects in other ways.

-For example, compounds in grapefruit and grapefruit juice interfere with enzymes that metabolize a number of drugs. -As a result of reduced enzyme action, blood concentrations of the drugs increase, leading to stronger physiological effects.

Many liquid preparations contain sugar or sorbitol to make them taste better

-For people who must regulate their intakes of carbohydrates, such as people with diabetes, the amount of sugar in these medicines may need to be considered. -Large doses of liquids containing sorbitol may cause diarrhea. -he lactose added as filler to some medications may cause problems for people who are lactose intolerant.

Antibiotics and antacids often contain sodium.

-People who take Alka Seltzer, for example, may not realize that a single two-tablet dose may exceed their recommended sodium intake for a whole day. - In addition, antacids neutralize stomach acid, and many nutrients depend on acid for their digestion - Taking any antacid regularly will reduce the absorption of many nutrients.

An overwhelming sense of grief and sadness at the death of a spouse, friend, or family member may leave a person, especially an elderly person, feeling powerless to overcome depression.

-When a person is suffering the heartache and loneliness of bereavement, cooking meals may not seem worthwhile -The support and companionship of family and friends, especially at mealtimes, can help overcome depression and enhance appetite

Adequate amounts can alleviate constipation, which is common due to inactivity and medications

Fiber

People who have the means to shop and cook for themselves can cut their food bills simply by being wise shoppers.

. Large supermarkets are usually less expensive than convenience stores. -Shopping when not hungry and having a grocery list helps reduce impulse buying, and specials and coupons can save money when the items featured are those that the shopper needs and uses.

Moderation, on the other hand, may be valuable.

. Many of the physiological responses to energy restriction seen in animals also occur in people whose intakes are moderately restricted.

The adverse effects of using methotrexate therefore include symptoms of folate deficiency.

. These adverse effects can be reduced by using a pre-activated form of folate (called leucovorin or folinic acid), which is often prescribed along with methotrexate to ensure that the body's rapidly dividing cells (such as cells of the digestive tract, skin cells, and red blood cells) receive adequate folate.

Another person who takes aspirin only for pain will also experience slow blood clotting. The anticlotting effect might be dangerous if it causes abnormal bleeding.

A single two-tablet dose of aspirin doubles the bleeding time of wounds, an effect that lasts from 4 to 7 hours

The lower energy expenditure of older adults means that they need to eat less food to maintain their weight

Accordingly, the estimated energy requirements for adults decrease steadily after age 19

The OAA Nutrition Program provides for congregate meals at group settings such as community centers.

Administrators try to select sites for congregate meals where as many eligible people as possible can participate

Being overweight or obese may accelerate the onset and progression of brain shrinkage that naturally occurs as a person ages.

Adults who are overweight or obese have significantly reduced white brain matter compared with those of normal weight.

Hundreds of drugs and nutrients interact, and these interactions can lead to nutrient imbalances or interfere with drug effectiveness.

Adverse nutrient-drug interactions are most likely if drugs are taken over long periods, if several drugs are taken, or if nutrition status is poor or deteriorating. Adverse nutrient-drug interactions are most likely if drugs are taken over long periods, if several drugs are taken, or if nutrition status is poor or deteriorating.

One key aspect of healthy aging is maintaining good vision

Age-related eye diseases that impair vision, such as cataracts and macular degeneration, correlate with poor survival that cannot be explained by other risk factors.

Examples of Foods with a High Tyramine Content

Aged cheeses (cheddar, Gruyère) Aged or cured meats (sausage, salami) Beer Fermented vegetables (sauerkraut, kimchi) Fish or shrimp sauce Prepared soy foods (miso, tempeh, tofu) Soy sauce Yeast extract (Marmite, Vegemite)

Drugs May Alter Food Intake by

Altering the appetite (Amphetamines suppress appetite; cortico-steroids increase appetite.) Interfering with taste or smell (Amphetamines change taste perceptions.) Inducing nausea or vomiting (Digitalis may do both.) Interfering with oral function (Some antidepressants may cause dry mouth.) Causing sores or inflammation in the mouth (Methotrexate may cause painful mouth ulcers.)

Nutrient malabsorption is most likely to occur with medications that upset GI function or damage the intestinal mucosa.

Antineoplastic and antiretroviral drugs are especially detrimental, whereas nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics can have similar, though milder, effects.

As the population ages, it is expected that the prevalence of arthritis will increase to 78 million by 2040.

Arthritis pain and fear of further damage limit physical activity.

Conversely, the absorption of many lipophilic drugs is improved when the drugs are taken with a fat-contaning meal.

As mentioned earlier, minerals may bind to some antibiotics, reducing absorption of both the minerals and the drugs.

In addition to programs designed specifically for older adults, the Supplemental Nutrition Assistance Program (SNAP) offers services to eligible people of all ages.

As mentioned earlier, though, the participation rate for eligible seniors is only about 30 percent.

sarcopenia (SAR-koh-PEE-nee-ah), can be significant in the later years, and its consequences can be quite dramatic

As muscles diminish and weaken, people lose the ability to move and maintain balance—making falls likely.

As people age, the immune system loses function.

As they become ill, the immune system becomes overstimulated.

High-fiber diets support good physical, mental, and social health

Average fiber intakes among older adults are lower than current recommendations (14 grams per 1000 kcalories).

The importance of body weight in defending against chronic diseases differs for older adults.

Being moderately overweight may not be harmful

Lactose intolerance can cause avoidance of dairy, resulting in deficiency in this nutrient and osteoporosis

Calcium

As always, abundant carbohydrate is needed to protect protein from being used as an energy source.

Carbohydrate-rich foods such as legumes, vegetables, whole grains, and fruits are also rich in fiber and essential vitamins and minerals.

All of these actions slow GI motility. Constipation is much more common in the elderly than in the young.

Changes in GI hormone secretions also diminish appetite, leading to decreased energy intake and unintentional weight loss.

Drugs May Alter Nutrient Absorption by

Changing the acidity of the digestive tract (Antacids may interfere with iron and folate absorption.) Damaging mucosal cells (Cancer chemotherapy may damage mucosal cells.) Binding to nutrients (Bile acid binders bind to fat-soluble vitamins.) Foods and Nutrients May Alter Drug Absorption by Stimulating secretion of gastric acid (The antifungal agent ketoconazole is absorbed better with meals because of increased acid secretion.) Altering rate of gastric emptying (Intestinal absorption of drugs may be delayed when they are taken with food.) Binding to drugs (Calcium binds to tetracycline, reducing both drug and calcium absorption.) Competing for absorption sites in the small intestine (Dietary amino acids interfere with levodopa absorption.) Drugs and Nutrients May Interact and Alter Metabolism by Acting as structural analogs (Warfarin and vitamin K are structural analogs.) Using similar enzyme systems (Phenobarbital induces liver enzymes that increase metabolism of folate, vitamin D, and vitamin K.) Competing for transport on serum proteins (Fatty acids and drugs may compete for the same sites on the serum protein albumin.) Drugs May Alter Nutrient Excretion by Altering nutrient reabsorption in the kidneys (Some diuretics increase the excretion of sodium and potassium.) Causing diarrhea or vomiting (Diarrhea and vomiting may cause electrolyte losses.) Foods May Alter Medication Excretion by Inducing activities of liver enzymes that metabolize drugs, increasing drug excretion (Components of charcoal-broiled meats increase metabolism of warfarin, theophylline, and acetaminophen.) Diet and Drug Interactions May Cause Toxicity Increasing side effects of the drug (Caffeine in beverages can increase adverse effects of stimulants.) Increasing drug action to excessive levels (Grapefruit components inhibit the enzymes that degrade certain drugs, increasing drug concentrations in the body.)

Atrophic Gastritis

Chronic inflammation of the stomach and impaired mucus membrane and glands functioning, resulting in inadequate hydrochloric acid and intrinsic factor production and secretion - two substances require for vitamin B12 absorption

The primary risk factor for Alzheimer's disease is age, but the exact cause remains unknown. They also show evidence of the minerals that trigger free-radical attacks—iron, copper, zinc, and aluminum.

Clearly, genetic factors are involved.

Cataracts

Clouding of the eye lenses that impairs vision and can lead to blindness

Gout

Common form of arthritis characterized by deposits of uric acid crystals in joints

Drugs and nutrients share similar enzyme systems in the small intestine and the liver.

Consequently, some drugs may enhance or inhibit the activities of enzymes that are needed for nutrient metabolism.

However, when food groups are eliminated and variety is limited, poor nutrition follows. People without teeth typically eat fewer fruits and vegetables and have less variety in their diets.

Consequently, they have low intakes of fiber and vitamins, which exacerbates their dental and overall health problems.

The increasing availability of over-the-counter drugs allows people to treat themselves for many ailments from arthritis to yeast infections

Consumers need to ask their physicians about potential interactions and check with their pharmacists for instructions on taking drugs with foods.

Alzeimer's Disease

Degenerative disease of the brain involving memory loss and major structural changes in neuron networks

Osteoarthritis

Degenerative disease that occurs when cartilage in a joint deteriorates

Maintaining appropriate body weight may be the most important nutrition concern for the person with Alzheimer's disease.

Depression and forgetfulness can lead to changes in eating behaviors and poor food intake.

Macular Degeneration

Deterioration of the macular are of the eye that can lead to loss of central vision and blindness

Consequently, the person may eat less food and drink fewer beverages, resulting in weight loss, malnutrition, and dehydration.

Dietary intervention for dysphagia is critical to survival and highly individualized based on the person's abilities and tolerances.

Dysphagia

Difficulty swallowing

Risk Factors for Malnutrition in Older Adults

Disease Do you have an illness or condition that changes the types or amounts of foods you eat? Eating poorly Do you eat fewer than two meals a day? Do you eat fruits, vegetables, and milk products daily? Tooth loss or mouth pain Is it difficult or painful to eat? Economic hardship Do you have enough money to buy the food you need? Reduced social contact Do you eat alone most of the time? Multiple medications Do you take three or more different prescribed or over-the-counter medications daily? Involuntary weight loss or gain Have you lost or gained 10 pounds or more in the last 6 months? Needs assistance Are you physically able to shop, cook, and feed yourself? Elderly person Are you older than 80?

Applying the results of animal studies to human beings is problematic, however, and conducting studies on human beings raises numerous questions—beginning with how to define energy restriction.

Does it mean eating less or weighing less? Is it less than you want or less than the average? Does eating less have to result in weight loss? Does it matter whether weight loss results from more exercise or from less food? Or whether weight loss is intentional or unintentional?

For underweight people, even a slight weight loss (5 percent) increases the likelihood of disease and death, making every meal a life-saving event.

Drinking liquid nutritional supplements and snacking between meals can help older adults obtain needed nutrients and energy

Nutrients and medications may interact in the following ways:

Drugs can alter food intake and the absorption, metabolism, and excretion of nutrients. Foods and nutrients can alter the absorption, metabolism, and excretion of drugs. Combinations can be toxic.

Treatment for Alzheimer's disease includes providing care to clients and support to their families.

Drugs may be used to improve or at least to slow the loss of short-term memory and cognition, but they do not cure the disease. Other drugs may be used to control depression, anxiety, and behavior problems.

For older adults, a low body weight is more detrimental than a high body weight as risk of mortality increases with a BMI of less than 23. True False

True

Late in the course of Alzheimer's disease there is a decline in the activity of the enzyme that assists in the production of the neurotransmitter acetylcholine from choline and acetyl CoA. Acetylcholine is essential to memory, but supplements of choline (or of lecithin, which contains choline) have no effect on memory or on the progression of the disease.

Drugs that inhibit the breakdown of acetylcholine, on the other hand, have proved beneficial.

The following conditions help determine whether a visit to the dentist is needed:

Dry mouth Eating difficulty No dental care within 2 years Tooth or mouth pain Altered food selections Lesions, sores, or lumps in mouth

What does osteoarthritis cause?

During movement, the ends of bones are normally protected from wear by cartilage and by small sacs of fluid that act as a lubricant. With age, cartilage begins to deteriorate, and the joints may become malformed and painful to move.

To prevent dehydration, older adults need to drink at least six glasses of water or other beverages every day

Emphasizing foods with high-water content, such as melons and soups, can also be helpful.

Being unable to swallow a mouthful of food can be scary, painful, and dangerous

Even swallowing liquids can be a problem for some people.

Medications that reduce stomach acidity may interfere with the absorption of vitamin B12, folate, and iron.

Examples include antacids, which neutralize stomach acid by acting as weak bases, and antiulcer drugs (such as proton pump inhibitors and H2 blockers), which interfere with acid secretion.

Although the age group with the most binge drinkers is adults younger than 35, the age group that binge drinks most often is adults 65 and older.

Excessive alcohol use among elderly adults is associated with other risk factors as well, including illicit drug use, tobacco use, and misuse of prescription medications—all factors exacerbating overall health, independence, and health-care costs.

Muscle mass and muscle strength tend to decline with aging, making older people vulnerable to falls and immobility.

Falls are a major cause of fear, injury, disability, and even death among older adults.

Both kcalorie and nutrient requirements decrease as older adults age. True False

False

Nutrients have little effect on drugs, but drugs can interfere with nutrient absorption, metabolism and excretion. True False

False

Vitamins B12, C and D are nutrients of concern for older adults. True False

False

Loneliness is directly related to nutritional inadequacies, especially of energy intake.

Feeling lonely is also associated with a decline in activities of daily living and mobility as well as an increased risk of death.

Medications can compromise status of this nutrient

Folate

Some behaviors seem to have the greatest influence on people's health and therefore on their physiological age include: When followed, most people seem to live longer and have a better quality of life as they age

Following a healthy plant-based eating pattern, such as the Mediterranean diet (rich in fruits, vegetables, whole grains, poultry, fish, and low fat milk products) Engaging in physical activity daily Not smoking Not using alcohol, or using it in moderation Maintaining a healthy body weight Sleeping regularly and adequately Having a sense of purpose Relieving stress (through meditation, prayer, naps, or other calming activity) Belonging to a community of loving family and friends (home, church, or other social networks)

Supplements are just that—supplements to foods, not substitutes for them.

Foods are the best source of nutrients for everybody.

Some medications bind to nutrients in the GI tract, preventing their absorption.

For example, bile acid binders (such as cholestyramine, or Questran), which are used to reduce cholesterol levels, also bind to the fat-soluble vitamins A, D, E, and K.

Simple changes in food texture might improve chewing efficiency and benefit digestion

For example, chopped beef is more rapidly digested and absorbed than beef steak, resulting in increased amino acid availability.

Nutrients and other dietary substances may bind to drugs and inhibit their absorption.

For example, high-fiber meals may decrease the absorption of some tricyclic antidepressants.

Drugs that increase urine production may reduce nutrient reabsorption in the kidneys, resulting in greater urinary losses of the nutrients.

For example, some diuretics accelerate the losses of calcium, potassium, magnesium, and thiamin; thus, dietary supplements may be needed to avoid deficiency.

Some food components influence drug excretion by altering the amount of drug reabsorbed by the kidneys.

For example, the amount of lithium (a mood stabilizer) reabsorbed by the kidneys correlates with the amount of sodium reabsorbed. - Consequently, both dehydration and sodium depletion, which increase sodium reabsorption, may result in lithium retention.

Several drugs impede nutrient absorption by interfering with the intestinal metabolism or transport into mucosal cells.

For example, the antibacterial drug trimethoprim and the antimalarial drug pyrimethamine compete with folate for absorption into intestinal cells.

Besides the active ingredients, medicines may contain other substances such as sugar, sorbitol, lactose, and sodium.

For most people who use medicines on occasion and in small amounts, such ingredients pose no problem. -When medicines are taken regularly or in large doses, however, people on special diets may need to be aware of these additional ingredients and their effects.

Recommendations to lower uric acid levels and the risk of gout include limiting alcohol and excessive amounts of meat, seafood, and sugar-sweetened beverages.

For most people, however, such strategies are insufficient, and drugs are needed to control symptoms.

The brain normally changes in some characteristic ways as it ages.

For one thing, its blood supply decreases. For another, the number of neurons, the brain cells that specialize in transmitting information, diminishes as people age

This surge in norepinephrine results in severe headaches, rapid heartbeat, and a dangerous increase in blood pressure.

For this reason, people taking MAO inhibitors are advised to restrict their intakes of foods rich in tyramine

Changes in hormones and loss of strength and elasticity in intestinal walls can slow this process of moving food through the GI tract

GI motility

Interestingly, longevity appears to depend on restricting energy intake and not on energy balance or body composition.

Genetically obese rats live longer when given a restricted diet even though their body fat is similar to that of other rats allowed to eat freely.

The bacterial overgrowth that accompanies this condition uses up the vitamin B12, and without hydrochloric acid and intrinsic factor, digestion and absorption of vitamin B12 are inefficient.

Given the poor cognition, anemia, and devastating neurological effects associated with a vitamin B12 deficiency, an adequate intake is imperative.

Volunteers may also deliver meals to those who are home-bound either permanently or temporarily; these home-delivered meals are known as Meals on Wheels.

Home-delivered meals help older adults live independently in the community.

People with tooth loss, gum disease, and ill-fitting dentures tend to limit their food selections to soft foods

If foods such as corn on the cob and apples are replaced by creamed corn and applesauce, then nutrition status may not be greatly affected.

Frozen vegetables are more economical in large bags than in small boxes. After the amount needed is taken out, the bag can be closed tightly with a twist tie or rubber band.

If the package is returned quickly to the freezer each time, the vegetables will stay fresh for a long time.

The amount of warfarin prescribed is dependent, in part, on how much vitamin K is in the diet.

If vitamin K consumption from foods or supplements changes substantially, it can alter the effect of the drug.

Rheumatoid Arthritis

Immune system disease involving inflammation of joints and related structures

Malnutrition limits a person's ability to function and diminishes quality of life by:

Impairing muscle function Decreasing bone mass Limiting immune defenses Reducing cognitive abilities Delaying wound healing Slowing recovery from falls, illness, and surgery Increasing hospitalizations

Older adults can learn about the available programs in their communities by contacting the Eldercare section of the Department of Health and Human Services.

In addition, the local senior center and hospital can usually direct people to programs that provide nutrition and other health-related services.

Consequently, iron-deficiency anemia is less common in older adults than in younger people.

In fact, elevated iron stores are more likely than deficiency in older people, especially for those who take iron supplements, eat red meat regularly, and include vitamin C-rich fruits in their daily diet.

Importantly, walking and other weight-bearing exercises do not worsen arthritis.

In fact, low-impact aerobic activity and resistance strength training offer improvements in physical performance and pain relief, especially when accompanied by even modest weight loss.

These physiological changes influence nutrition status, just as growth and development do in the earlier stages of the life cycle.

In general, older adults who follow healthy eating patterns have fewer physical impairments

Brain scans indicate that the volume of white brain matter of overweight or obese adults is similar to those of normal weight adults who are 10 years older.

In other words, the brain degeneration of an overweight 50-year-old adult is comparable to that of a 60-year-old adult.

Risk of nutrient depletion is higher if multiple drugs with the same effect are used, if kidney function is impaired, or if medications are used for a long time.

Note that some diuretics may cause certain minerals to be retained, rather than excreted.

One other diet-related factor may play a role in the development of cataracts—obesity.

Obesity appears to be associated with cataracts, but its role has not been identified. Risk factors that typically accompany obesity, such as inactivity, diabetes, or hypertension, do not explain the association.

For adults older than 65, the lowest mortality correlates with a slightly higher BMI (23.5 to 27.5).

Older adults who are obese, however, may still face serious medical complications, at least until age 85

To avoid mealtime disruptions, control distractions such as music, television, children, and the telephone.

One study reported that simply having an aquarium in the dining area increased food intake and helped maintain body weight, perhaps because it provided a naturally attractive and calming environment.

Some antibiotics, notably tetracycline and ciprofloxacin (Cipro), bind to the calcium in foods and supplements, reducing the absorption of both the drug and the calcium.

Other minerals, such as iron, magnesium, and zinc, may also bind to antibiotics

Biochemical markers of beta-amyloid deposits and impaired brain metabolism are apparent decades before the onset of symptoms of Alzheimer's disease.

Oxidative stress seems to be a contributing factor, but antioxidant supplements do not seem to be effective in preventing the progression of the disease.

Nutrient interactions and risks are not unique to prescription drugs.

People who buy over-the-counter drugs also need to protect themselves.

risk factors for age-related macular degeneration include oxidative stress from sunlight.

Preventive factors may include supplements of the omega-3 fatty acids, some B vitamins (folate, vitaminB6 , and vitamin B12), antioxidants (vitamin C, vitamin E, and beta-carotene), zinc, and the carotenoids lutein and zeaxanthin.

Adequate amounts can maintain muscle mass and strength and minimize risk for sarcopenia

Protein

In addition to the physiological changes that accompany aging, adults change in many other ways that influence their nutrition status.

Psychological, economic, and social factors play major roles in a person's ability and willingness to eat.

Restricting energy intake in animals not only produces fewer free radicals, but also increases antioxidant activity and enhances DNA repair.

Reducing oxidative stress may at least partially explain how restricting energy intake lengthens life expectancy.

Although not an inevitable component of aging, depression is common among older adults, especially among those in poor health and those living in long-term nursing homes.

Relatively few receive adequate treatment from either antidepressant medication or mental health counseling.

Even without a fall, older adults may become so weak that they can no longer perform life's daily tasks, such as climbing stairs, carrying packages, and opening jars.

Resistance training helps older adults to maintain independence by improving mobility and muscle strength to perform these tasks.

Nutrition program that provides low-income seniors with coupons that can be exchanged for fresh produce at community supported farmers' markets

Senior Farmers Market Nutrition Program

Some medications can make eating difficult or unpleasant. They may suppress appetite, alter taste sensations, induce nausea or vomiting, cause mouth dryness, or create inflammation or lesions in the mouth, stomach, or intestinal lining.

Side effects, such as abdominal discomfort, constipation, and diarrhea may worsen when food is eaten.

Heart healthy diets that include the omega-3 fatty acid DHA and vitamin E may benefit brain health as well, although supplements may not be beneficial in treating Alzheimer's, given that they are often initiated "too late" in the disease process.

Similarly, physical activity supports heart health and slows cognitive decline. Just as saturated fatty acids contribute to heart disease, they also worsen cognition and memory and contribute to Alzheimer's disease.

If vegetables are packaged in large quantities, the grocer can divide the package so that a smaller amount can be purchased.

Small cans of fruits and vegetables, even though they are more expensive per unit, are a reasonable alternative, considering that it is expensive to buy a regular-size can and let the unused portion spoil.

The DRI Committee recommends 1200 milligrams of calcium daily for women older than 50 and men older than 70, but the calcium intakes of older people in the United States are well below recommendations.

Some older adults avoid milk and milk products because they dislike these foods or associate them with stomach discomfort

Consider aspirin. One action of aspirin is to limit the production of certain prostaglandins (biologically active compounds derived from the omega-3 fatty acid EPA).

Some prostaglandins help produce fevers, some sensitize pain receptors, some cause contractions of the uterus, some stimulate GI motility, some control nerve impulses, some regulate blood pressure, some promote blood clotting, and some cause inflammation.

Protein is especially important for the elderly to support a healthy immune system, prevent muscle wasting, and optimize bone mass

Some research suggests that the optimal protein intake for older adults is greater than the current recommendations that apply to all adults.

A person cannot use aspirin to produce one of its effects without producing all of its other effects.

Someone who is prone to strokes and heart attacks might take aspirin to prevent blood clotting, but it will also ease that person's sense of pain.

Overall, older adults today have higher incomes than their cohorts of previous generations.

Still, 9 percent of the people older than age 65 live in poverty; without the help of Social Security, it would be 40 percent.

Thus the lack of key nutrients may contribute to the loss of memory and cognition that some older adults experience.

Such losses may be preventable or at least diminished or delayed through diet and exercise. Healthy eating patterns, such as the Mediterranean diet, seem to slow cognitive decline and lower the risk of dementia.

Nutrition program formerly known as the Food Stamps that offers services to eligible people of all ages, including seniors

Supplemental Nutrition Assistance Program

To maintain vitamin D status, especially in those who engage in minimal outdoor activity, adults 51 to 70 years old need 15 micrograms daily, and those 71 and older need 20 micrograms.

Supplements may be needed to achieve adequate levels of vitamin D.

Optimal nutrition with sufficient protein at each meal along with regular strength-building physical activity can help maintain muscle mass and strength and minimize the changes in body composition associated with aging

Supplements of omega-3 fatty acids, amino acids, and vitamin D may also stimulate muscle protein synthesis in older adults and help prevent sarcopenia.

Sensory losses can also interfere with a person's ability or willingness to eat.

Taste and smell sensitivities tend to diminish with age and may make eating less enjoyable.

To function properly, the enzymes involved in neurotransmitter synthesis require vitamins such as vitamin C and pantothenic acid.

The B vitamins folate, vitamin B12, and vitamin B6 slow brain atrophy and improve cognition and memory; seafood and their essential fatty acid DHA counteract the cognitive decline commonly seen in elderly adults.

Nutrients influence the development and activities of the brain.

The ability of neurons to synthesize specific neuro-transmitters depends in part on the availability of precursor nutrients that are obtained from the diet.

Another possible link between nutrition and rheumatoid arthritis involves the oxidative damage to the membranes within joints that causes inflammation and swelling.

The antioxidant vitamins C and E and the carotenoids defend against oxidation, and increased intakes of these nutrients may help prevent or relieve the pain of rheumatoid arthritis.

The RDA for older adults is the same as for younger adults, but with the added suggestion to obtain most of a day's intake from vitamin B12 -fortified foods and supplements.

The bioavailability of vitamin B12 from these sources is better than from foods.

Dementia affects an estimated 15 percent of adults older than 70 years of age in the United States and represents a financial burden of between $157 billion and $215 billion.

The brain, like all of the body's organs, ages in response to both genetic and environmental factors—such as physical activities, intellectual challenges, social interactions, and nutritious diets—that enhance or diminish its amazing capacities

Inflammaging

The combination of inefficient and overactive immune response in aging that results in chronic inflammation that accompanies frailties, illness and death

Some interactions between foods and drugs can cause toxicity or exacerbate a drug's side effects.

The combination of tyramine, a compound in some foods, and monoamine oxidase (MAO) inhibitors, which treat depression and Parkinson's disease, can be fatal.

The risk of foodborne illness is greater for older adults than for other adults.

The consequences of an upset stomach, diarrhea, fever, vomiting, abdominal cramps, and dehydration are oftentimes more severe, sometimes leading to paralysis, meningitis, or even death. For these reasons, older adults need to carefully follow the food safety suggestions

Individuals using warfarin are advised to consume similar amounts of vitamin K daily to keep warfarin activity stable

The dietary sources highest in vitamin K are dark-green, leafy vegetables.

Major influences on drug absorption include the stomach-emptying rate, level of acidity in the stomach, and direct interactions with dietary components.

The drug's formulation may also influence its absorption, and pharmacists often provide instructions advising whether the medication should be taken with food or on an empty stomach.

As is true of vitamin B12, folate intakes of older adults typically fall short of recommendations.

The elderly are also more likely to have medical conditions or to take medications that can compromise folate status

In the GI tract, numerous changes take place, contributing to poor appetite, early satiety, and malnutrition

The intestinal wall loses strength and elasticity with age, and GI hormone secretions change

The iron needs of men remain unchanged throughout adulthood.

The iron needs of women decrease substantially at menopause when blood loss through menstruation ceases.

Urine acidity can also affect drug excretion because of the effects of pH on a compound's chemistry.

The medication quinidine, used to treat arrhythmias, is excreted more readily in acidic urine. Foods or drugs that cause urine to become more alkaline may reduce quinidine excretion and raise its blood levels.

The omega-3 fatty acids commonly found in fatty fish reduce joint tenderness and improve mobility in some people with rheumatoid arthritis.

The same diet recommended for heart health—a Mediterranean-type diet low in saturated fat from meats and milk products and high in vegetables, olive oil, and omega-3 fats from fish—helps prevent or reduce the inflammation in the joints that makes rheumatoid arthritis so painful.

A person who has ample freezer space can buy large packages of meat or whole chickens when they are on sale.

Then the meat or chicken can be portioned and immediately wrapped into individual servings for the freezer. All the individual servings can be put in a bag marked appropriately with the contents and the date.

With an energy-restricted diet, many of the genetic activities of older mice parallel those of younger mice.

These "slow-aging" genetic changes are apparent in as little as 1 month on an energy-restricted, but still nutritionally adequate, diet.

Regular dental care over a lifetime protects against tooth loss and gum disease, which are common in old age.

These conditions make chewing difficult or painful.

The anti-inflammatory medication colchicine, a treatment for gout, inhibits vitamin B12 absorption.

These drug-induced interactions commonly result in megaloblastic anemia.

many health problems that accompany obesity and the BMI guidelines for a healthy body weight (18.5 to 24.9)

These guidelines apply to all adults, regardless of age, but they may be inappropriate for older adults.

Several popular herbs contain natural compounds that affect blood coagulation or warfarin metabolism and therefore should be avoided during warfarin treatment

These herbs include St. John's wort, garlic, ginseng, ginkgo, dong quai, and others.

One study reported that the physiological age of 38-year-old adults ranged from 30 to 60 years.

These young adults who were aging at a rapid pace were not as physically able, mentally sharp, or youthful looking as their peers.

Healthy older adults who have not been active can ease into a suitable routine, becoming as physically active as their abilities allow.

They can start by walking short distances until they are walking at least 10 minutes continuously, and then gradually increase their distance to a 30- to 60-minute workout at least 5 days a week.

Depressed people, even those without physical frailties, lose their ability to perform simple physical tasks.

They frequently lose their appetite and the motivation to cook or even to eat.

For patients with diseases that cause wasting, such as cancer or AIDS, weight gain may be desirable.

They may be prescribed appetite enhancers, such as megestrol acetate (Megace), a progesterone analog, or dronabinol (Marinol), which is derived from the active ingredient in marijuana.

Older adults may find it difficult and bothersome to get a drink or to get to a bathroom.

Those who have lost bladder control may avoid drinking too much water.

In addition to aging and diseases, the immune system is compromised by nutrient deficiencies.

Thus, the combination of age, illness, and poor nutrition makes older people particularly vulnerable to infectious diseases.

Tyramine occurs naturally in foods and is also formed when bacteria degrade the protein in foods.

Thus, the tyramine content of a food usually increases when a food ages or spoils. . Individuals at risk of tyramine toxicity are advised to buy mainly fresh foods and consume them promptly.

Perhaps the best that a caregiver can do nutritionally for a person with Alzheimer's disease is to supervise food planning and mealtimes.

To minimize confusion, offer a few ready-to-eat foods, in bite-size pieces, with seasonings and sauces.

Isoniazid, an antibacterial agent used to treat and prevent tuberculosis, inhibits the conversion of vitamin B6 to its coenzyme form (pyridoxal phosphate), which is involved in neurotransmitter synthesis.

To prevent the peripheral neuropathy that commonly develops from a vitamin deficiency, supplements of vitamin B6 are routinely given during the course of isoniazid treatment.

Dehydration is a common problem for many older adults.

Total body water decreases as people age, so even mild stresses such as fever or hot weather can precipitate rapid dehydration in older adults.

Treatment for arthritis—dietary or otherwise—may help relieve discomfort and improve mobility, but it does not cure the condition.

Traditional medical intervention for arthritis includes medication and surgery. Alternative therapies to treat arthritis abound, but none have proved safe and effective in scientific studies.

Decreased thirst sensation is a contributing factor to dehydration and inadequacy in this nutrient

Water

Obesity increases the risk of arthritis.

Weight loss may relieve some of the pain for overweight persons with osteoarthritis, partly because the joints affected are often weight-bearing joints that are stressed and irritated by having to carry excess pounds.

The strategies adults use to meet two goals that motivate them to make changes—promoting health and slowing aging

What to eat, how physically active to be, and other lifestyle choices greatly influence both physical health and the aging process.

monoamine oxidase (MAO) Inhibitors block an enzyme that normally inactivates tyramine, as well as the hormones epinephrine and norepinephrine.

When people who take MAO inhibitors consume excessive tyramine, the increased tyramine in the blood can cause a sudden release of accumulated norepinephrine.

Medications can interfere with absorption and increase excretion leading to loss of taste and blunted appetite

Zinc

gout

a common form of arthritis characterized by deposits of uric acid crystals in the joints.

Alzheimer's disease

a degenerative disease of the brain involving memory loss and major structural changes in neuron networks; also known as senile dementia of the Alzheimer's type (SDAT), primary degenerative dementia of senile onset, or chronic brain syndrome.

rheumatoid arthritis

a disease of the immune system involving painful inflammation of the joints and related structures.

osteoarthritis

a painful, degenerative disease of the joints that occurs when the cartilage in a joint deteriorates; joint structure is damaged, with loss of function; also called degenerative arthritis.

physiological age

a person's age as estimated from her or his body's health and probable life expectancy.

chronological age

a person's age in years from his or her date of birth.

Fresh fruits and vegetables generally cost less when they are in season. A person can buy individual pieces of fresh fruit at various stages of ripeness:

a ripe one to eat right away, a semiripe one to eat soon after, and a green one to ripen on the windowsill.

Active older adults reap additional benefits from various activities as well:

aerobic activities improve cardiorespiratory endurance, blood pressure, and blood lipid concentrations; moderate-endurance activities improve the quality of sleep; and strength training improves posture and mobility.

Chronic use can impair memory and cognition

alcohol

Atrophic gastritis, a relatively prevalent condition that affects older adults, is characterized by

an inflamed stomach, bacterial overgrowth, and a lack of hydrochloric acid and intrinsic factor

Drug that alters the acidity of the GI tract and may interfere with absorption of iron and folate

antacids

Most diseases common in older adults—such as

atherosclerosis, Alzheimer's disease, obesity, and rheumatoid arthritis

These life-prolonging benefits become evident when the diet provides enough food to prevent malnutrition and an energy intake of about 70 percent of norma

benefits decline as the age of starting the energy restriction is delayed

Oxidative stress appears to play a significant role in the development of cataracts,

but supplements of the antioxidant nutrients (vitamin C, vitamin E, selenium, and carotenoids) do not seem to prevent or slow the progression.

Cataracts

clouding of the eye lenses that impairs vision and can lead to blindness.

senile plaques

clumps of the protein fragment beta-amyloid on the nerve cells, commonly found in the brains of people with Alzheimer's dementia.

purines

compounds of nitrogen-containing bases such as adenine, guanine, and caffeine. Purines that originate from the body are endogenous and those that derive from foods are exogenous.

Nutrition programs that provide food for seniors in conveniently located settings such as community centers

congregate meals

pressure ulcers

damage to the skin and underlying tissues as a result of compression and poor circulation; commonly seen in people who are bedridden or chair-bound.

Healthy eating patterns, such as the Mediterranean diet seem to slow cognitive decline and reduce the risk of this disease

dementia

macular degeneration

deterioration of the macular area of the eye that can lead to loss of central vision and eventual blindness. The macula is a small, oval, yellowish region in the center of the retina that provides the sharp, straight-ahead vision so critical to reading and driving.

These drugs increase urinary excretion of water-soluble nutrients like potassium, calcium, thiamin and magnesium

diuretics

People using antipsychotics, antidepressants, and corticosteroids (for example, prednisone).

do not feel satiated and sometimes gain 40 to 60 pounds in just a few months.

Difficulty in swallowing that may result in weight loss, malnutrition and dehydration

dysphagia

Term for inefficient and overactive response by the immune system during aging that can lead to diseases such as osteoarthritis and Alzheimer's disease

inflammaging

arthritis

inflammation of a joint, usually accompanied by pain, swelling, and structural changes.

The Nutrition Screening Initiative is part of a national effort to identify and treat nutrition problems in older adults;

it uses a screening checklist to determine the risk of malnutrition Providing access to safe, adequate food and nutrition programs and services can help ensure healthful aging.

Because energy needs decrease, protein must be obtained from low-kcalorie sources of high-quality protein, such as

lean meats, poultry, fish, and eggs; fat-free and low-fat milk products; and legumes.

Corticosteroids, which are used as anti-inflammatory agents and immunosuppressants, promote sodium and water retention and increase urinary potassium excretion.

long-term use of corticosteroids can have multiple adverse effects, which include muscle wasting, bone loss, weight gain, and hyperglycemia, with eventual development of osteoporosis and diabetes.

sarcopenia

loss of skeletal muscle mass, strength, and quality.

neurons

nerve cells; the structural and functional units of the nervous system. Neurons initiate and conduct nerve impulse transmissions.

Although aging reduces both speed and endurance to some degree,

older adults can still train and achieve exceptional performances.

An estimated 10 to 30 percent of adults older than 50 have atrophic gastritis

people with atrophic gastritis are particularly vulnerable to vitamin deficiency.

Many programs voluntarily offer additional services designed to appeal to older adults:

provisions for special diets (to meet medical needs or religious preferences), food pantries, ethnic meals, and delivery of meals to the homeless. Adding breakfast to the service increases energy and nutrient intakes, which helps relieve hunger and depression.

Some drugs are better absorbed in an acidic environment, whereas others are better absorbed in alkaline conditions.

reduced stomach acidity (due to disorders or antacid medications) may reduce the absorption of ketoconazole (Nizoral, an antifungal medication) and atazanavir (an antiretroviral medication), but increase the absorption of digoxin (Lanoxin, which treats heart failure) and alendronate (Fosamax, which treats osteoporosis).

Omega-3 fatty acids found in fatty fish reduce inflammation increase mobility in people with this disease

rheumatoid arthritis

For older adults, a low body weight is more detrimental than a high one;

risk of mortality increases for older adults with a BMI below 23.

Loss of skeletal muscle mass, strength and quality that occurs frequently during the aging process

sarcopenia

neurofibrillary tanglessnarls of the threadlike strands that extend from the nerve cells, commonly found in the brains of people with Alzheimer's dementia.

snarls of the threadlike strands that extend from the nerve cells, commonly found in the brains of people with Alzheimer's dementia.

Drug that binds to calcium reducing absorption of both calcium and the drug

tetracycline

senile dementia

the loss of brain function beyond the normal loss of physical adeptness and memory that occurs with aging.

A person's physiological age reflects his or her health status and may or may not reflect

the person's chronological age.

In addition, energy metabolism slows and body temperature drops—indications of a reduced rate of oxygen consumption.

the use of oxygen during energy metabolism produces free radicals, which have been implicated in the aging process.

Diagnosis of Alzheimer's disease depends on its characteristic symptoms:

the victim gradually loses memory and reasoning, the ability to communicate, physical capabilities, and eventually life itself.

the OAA Nutrition Program specific goals are

to provide low-cost, nutritious meals; opportunities for social interaction; homemaker education and shopping assistance; counseling and referral to social services; and transportation.

Vitamin K is structurally similar to this drug and may reduce the effective ness of the drug

warfarin

Compared with those who are inactive, older adults who are active

weigh less; have greater strength and flexibility, reduced inflammation, increased bone density, more endurance, and better balance; and they live longer.

Much attention has focused on the abnormal deterioration of the brain called Alzheimer's disease

which affects one out of eight US adults older than age 65 and almost half of adults aged 85 and older.

Diets, such as the Mediterranean diet that include an abundance of fruits, vegetables, olive oil, and moderate amounts of red wine

with their array of phytochemicals that have antioxidant activity—support good health and long life.