Chapter 13: Unique Nutrition Issues in the Older Adult

quality of life, unacceptable, unpalatable

Academy of Nutrition and Dietetics recognizes food as an "essential component of ___________ _____ ________; an _____________________ or ____________________ diet can lead to poor food and fluid intake, resulting in weight loss and undernutrition and a spiral of negative health effects."

appetite, modification, physiological, psychological, medication

Age-related risks for malnutrition -- impaired _____________, diet ___________________, ___________________ changes, _____________________ changes, and _________________ use.

diet

Both serum lipids and oxidation reactions are modified by _________.

age, basal metabolic rate, lean body mass, physical activity

Calories: energy intake declines with ______, reduction in _________ ________________ ________, reduction in ________ _________ _______ and decreased ___________ _____________.

chewing, swallowing, frequency, consistency, hydrochloric acid

Changes in GI tract include ____________ and _________________, bowel _______________ and __________________, decreased _______________________ _________.

forget, appetite, self-feed, movement, substance abuse, mini mental state examination

Cognitive changes: ___________ to eat or if they ate, affect _______________, affect ability to ________-________, impair _________________, increases risk of ________________ __________, assess with ________ ___________ _________ _______________________ (MMSE).

gastrointestinal tract, taste, smell, side effects, diet, depression, mental

Conditions that may take away appetite: changes in ______________________ _________, decreased _________ and __________ acuity, medication ________ ___________, ________ modifications, and ___________________ or altered ___________ status.

food intake, anorexia

Declining ________ ____________ and _______________ are predictors for under-nutrition in older adults.

overall

Diminished appetite may lead to significant risks to ____________ health.

aspiration, dehydration, malnutrition

Dysphagia (swallowing difficulty) -- increased risk of ________________ and increased risk of _________________ and ___________________.

determine your nutritional health checklist, mini nutritional assessment

Early detection -- nutrition screening tools are very important (______________ ________ ________________ _________ _________________ -- meals per day, diet modifications, medication user, social interaction at meals; _______ _________________ _____________________ -- food intake and meals/day, psychological stress, neuropsychological problems, medication use).

African Americans, non-Hispanic whites

Edentulousness was highest in ____________ ______________ and lowest in _______-_____________ ___________.

serum lipoproteins, free radical oxidation

Elevated __________ __________________ (esp. LDL) and ________ _____________ _______________ lead to cell damage.

40, 50

Estimated that ______% of nursing home residents and _______% of hospitalized elderly patients are malnourished.

60, 1:5, 217, 81

First "baby boomers" turned _____ in 2006 and represents shifting demographics so that by 2030, ___:___ Americans will be 65 years old, with a _______% increase in minority elders as compared to ______% more white elders.

taste, temperature, texture, aroma

Flavor affected by ________, ___________________, _____________, and __________.

urine, feces, 50, 30, dietary fiber, alpha-tocopherol, beta-carotene, vitamin C, zinc

Incontinence and visual function: incontinence refers to inability to control the discharge of _________ or _________; ______% of elders living in institutions and up to ______% of community-based elderly suffer with incontinence; ____________ _________ may assist in incontinence; _________-__________________, ________-________________, ____________ _____ and __________ may help prevent age-related eye disease.

medication

Increased disease leads to increased ________________ use.

liberalized, food selection, eating, congregate, assistance, utensils, finger, enhancers, nutrients, snacks, supplements, environment, praise, stimulants

Interventions for impaired appetite: _________________ diet, freedom in _______ _____________, ____________ with others, _________________ meals, providing ________________, specialized _____________, ___________ foods, flavor __________________, adding ______________ to food, nutrient-dense _____________, commercial ____________________, pleasant eating ____________________, __________, and ____________________.

presbyosmia

Loss of sense of smell.

nutrients, protein-energy under-nutrition

Malnutrition -- any insufficient dietary intake of essential _____________; __________-__________ _________-_______________ (PEU).

age, income, educational

NHANES -- oral health is an increasing problem with _______; compounded by poor _____________ status and lower __________________ level.

screening system, assessment

No single ______________ ___________ or _________________ is optimal in defining malnutrition in older people.

lowest

Non-treated decay was ___________ in non-Hispanic whites.

cardiovascular, peripheral vascular, cerebrovascular, incontinence, visual, osteoporosis

Nutrition-related health problems -- ______________________ disease, _______________ ______________ and _______________________ disease, ____________________ (urinary, fecal), ____________ function, and _____________________.

economic, loneliness

Nutritional risk is associated with _________________ hardship and ____________________.

congregate, home-delivered

Older Americans Act elderly nutrition programs funded through Title III & Title IV aimed at combating barriers: _________________ meals, ________-________________ meals (lunch 5 days per week).

5, 10

Older adult must be evaluated for unintended weight loss of ____% in 1 month or ______% in 6 months.

alcohol, homocysteine, omega-3

Other cardiovascular disease risk factors: excess _____________, high _______________________, and low __________-____ fatty acid intake.

B vitamin, glycemic, sodium, potassium, magnesium, calcium

Peripheral vascular and cerebrovascular disease: may respond to ____ ____________ supplementation to reduce homocysteine levels; _____________ control improves postprandial insulin; ___________ restriction and generous intakes of _________________, _________________ and ____________ may lower blood pressure.

health, age, dietary intake, harm, good, intake, quality of life, nutrients, medical conditions, desire, joy

Previously prescribed dietary restriction may no longer be necessary based on current __________, ______, and ___________ ___________, do more _________ than __________, optimize ____________ and ____________ _____ ________ in decision making, and recognize how diet-related decisions provide ______________, impact ____________ ______________, and impact ____________ to eat and _______ of food/eating.

wound healing, pressure ulcers, immune, osteoporosis, muscle, muscle strength

Protein-energy malnutrition (PEM) raises risk for poor __________ ___________, _____________ __________, depressed ___________ function, ___________________, and loss of ___________ and ____________ ____________.

anorexia of aging

Reduction in food intake as physical activity and metabolic rate decline (even in healthy older adults).

metabolic rate, nutrient

Reductions in food intake and physical activity affect _________________ _______ (down regulate), while ______________ needs remain unchanged or may even increase.

speech pathologist, registered dietitian

Referral to specialist for dysphagia: __________ ________________ to determine needed diet modification (texture, consistency, viscosity); ______________ ______________ to develop and monitor meal plan.

age, Asian, Caucasian, female, menopause, family history, body weight, medications, smoking, sedentary, alcohol, calcium, vitamin D

Risk factors for osteoporosis: _____, _________, _________________, ___________, early __________________, ___________ ____________, low _________ ___________, __________________, _____________, ________________, heavy _____________ consumption, poor ____________ intake for years, and poor ____________ _____ intake.

cultures

Risks are not consistent across ______________.

xerostomia, taste, sedation, diarrhea, constipation, appetite, need, status

Side effects of medications: _______________ (dry mouth), altered _________, ______________, _______________ or __________________, decreased _______________, and altered nutritional _________ and ____________.

coughing, throat clearing, hoarse, breathy, drooling, pocketing, multiple

Signs and symptoms of swallowing difficulty: ______________ before, during or after swallowing, frequent __________ _____________, ___________, _____________ voice, ______________, _______________ of food, and _____________ attempts to swallow a single bite.

80.1, disease, disability, bone loss, heart disease, osteoporosis, hormone replacement therapy

Special Considerations for Older Women: long life expectancy -- ________ years; ___________ and _______________ increase with age; menopause and side effects: risk for _______ ________ and _________ ______________; ____________________ risk; ____________ __________________ _____________ (HRT) based on individual risk:benefit ratio considers family history and symptoms.

Food Safety Inspection Service, Food and Drug Administration, National Institute on Aging

Targeted safety education for seniors -- resources available (_______ __________ ________________ ___________ of the US Dept. of Agriculture, US ________ ______ ________ _____________________, and _______________ _______________ ______ ___________).

extracted, long-term care, Medicare, Medicaid

White Healthy People 2010 Objective 21-4 is to reduce proportion of adults aged 65-74 who have natural teeth _______________ and Objective 21-11 aims to increase use of oral healthcare systems among ________-_________ _________ residents, _______________ and _______________ does not cover dental services, regardless of cause or complexity.

aging, incontinence, allergies, hypertension, depression, Sjorgen, tart candies, moist, water

Xerostomia (dry mouth) -- not a normal part of _________; often a side-effect of medications for ___________________, ____________, __________________, __________________; side-effect of _____________ syndrome (dryness of mucous membranes); treatment: stimulate salivary glands with ________ ___________, __________ foods, and drinking ___________).

non-Hispanic whites

_____-_____________ __________ have greater risk of tooth decay compared with African Americans and Mexican Americans.

30, 65

______% of Americans 70-80 years old, _____% of Americans over 80 years old experience presbyosmia.

fluid

________ -- altered thirst responses, decreasing renal function and medications raise risk of dehydration.

food-borne illness

________-_________ ____________ risk rises with loss of taste and smell.

vitamin B12

___________ _______ -- associated with gastritis and development of pernicious anemia, irreversible neurologic damage, and elevated homocysteine.

thiamin

____________ -- poor intakes, not increased need, risk for peripheral neuropathy.

vitamin D

____________ ____ -- for those institutionalized or homebound, DRI is 3x higher than younger adult.

vitamin B6

____________ ______ -- age-related changes related to the metabolism and absorption results in impaired immune function and impaired cognition.

smoking

____________ increases tooth decay and tooth loss.

appetite

_____________ is associated with well-being.

disability, disease

_______________ and _____________ affects desire and ability to shop, cook, eat, be physically active, socialize.

edentulous, dentures, mouth, xerostomia, dysphagia, visual, motor, arthritis, mental

_________________, ____________, _________ pain, _________________, ________________, ___________ impairment, impaired __________ skills, ________________, altered ___________ status.