FON241: Chapter 18: Life cycle part 2

Dysgeusia

Abnormal taste perception. increasing age, taste perception dims as well, which is one reason why older adults seem to add so much salt to their foods or complain about the blandness of their foods. The ability to perceive sweetness and sourness also declines, but to a lesser extent. Some elderly experience dysgeusia, or abnormal taste perception, which can be caused by disease or medication use.

Glycosylation

Addition of glucose to blood and tissue proteins; typically impairs protein structure and function.

End of life care

Advances in medical care can prolong the lives of seriously ill persons, resulting in challenging legal and ethical issues. Healthcare providers must be well informed on end-of-life issues, including the provision of food and fluids, in order to help elderly clients and families make difficult decisions that honor the client's personal wishes. Ideally, an advance directive such as a living will is available to guide decision making. The legalities surrounding end-of-life care are in continual flux as courts and legislative bodies enact, then modify, decisions on enteral nutrition (tube feeding), hydration, and other nutritional issues. Religious and cultural considerations often overlay legal issues, contributing to their complexity. Healthcare providers, with agreement from the patient and/or appropriate legal authority, can provide palliative care to terminally ill individuals.With palliative care, no attempt is made to cure or treat the underlying condition; the care provided is designed primarily to minimize patient discomfort, offer social and spiritual support, and extend assistance to family and friends. Individuals who are facing imminent death rarely express hunger and have little or no thirst. If requested, specific foods or fluids are provided, even if they have no nutritional value, to comfort the patient. Hospice organizations are growing in number and availability and can provide palliative care to terminally ill individuals, either in their own home or in a care facility. Pallative CAre: Reducing an individual's pain and discomfort without any attempts at treatment or cure

Sarcopenia

Age-related progressive loss of muscle mass, muscle strength, and muscle function. With aging, body fat increases and muscle mass declines. It has been estimated that women and men lose 20% to 25% of their lean body mass, respectively, as they age from 35 to 70 years. Decreased production of certain hormones, including testosterone and growth hormone, and chronic diseases contribute to this loss of muscle, as does poor diet and an inactive lifestyle. Older adults with sarcopenia are often so weak that they are unable to rise from a seated position, climb stairs, or carry a bag of groceries. Along with adequate dietary intake, regular physical activity, including strength or resistance training, can help older adults maintain their muscle mass and strength, delaying or preventing the need for institutionalization

Error Theories of Aging

Aging is a cumulative process determined largely by exposure to environmental insults; the fewer the environmental insults, the slower the aging process. argue that senescence occurs as a result of cell and tissue damage caused largely by environmental insults. These mechanisms include the following: • As cells age, cell membrane function declines, allowing waste products to accumulate within the cell and decreasing normal uptake of nutrients and oxygen. • Gerontologists have also linked the aging process to a progressive accumulation of free radicals, which are known to damage DNA and various cell proteins. • Cellular aging has also been linked to a progressive failure in DNA repair.6 Throughout the life cycle, human DNA is subjected to various insults including free radicals, toxins, and random coding errors. Normally, the cell detects and repairs damaged DNA.With aging, however, the repair process becomes less efficient, leading to abnormal protein synthesis, which then results in cell, tissue, and organ senescence. • Tissue and organ senescence has been linked to the process of glycosylation. This abnormal attachment of glucose to proteins results in loss of protein structure and function. As a result, lung tissue, blood vessels, and tendons become rigid and inflexible. Changes identified by the error theories of aging are directly or indirectly linked to nutrient or energy status. Thus, consumption of adequate levels of antioxidant nutrients could theoretically delay some of these changes. In truth, the programmed and error theories of aging are not mutually exclusive

Programmed theories of aging

Aging is biologically determined, following a predictable pattern of physiologic changes, although the timing may vary from one person to another. aging follows a biologically driven time line, similar to that of adolescence. In programmed theories of aging, nutrition has little, if any, potential or practical impact on senescence. For example, there is no doubt that genes exert tremendous influence on the aging process. Siblings of centenarians are four times more likely to live into their 90s than others. Researchers have even found a genetic mutation dubbed the "I'm Not Dead Yet" gene, which prolongs the life span of certain laboratory animals. Although researchers may never develop a "fountain of youth," they are well on their way to understanding how genetics contributes to cell senescence and human aging

What three levels does aging occur?

Aging occurs at the molecular, cellular, and tissue levels

Constipation

Although constipation is four to eight times more common in older adults than in younger adults, elderly who are healthy and physically active are not at greater risk.9 Certain medications, chronic diseases, laxative abuse, and possibly low fiber and fluid intakes contribute to risk of constipation, as does immobility, for instance with wheelchair- or bed-bound elderly. Initial treatment usually revolves around dietary intervention: increased fluid intake and an emphasis on insoluble fiber from foods such as wheat bran. However, medication may be necessary, especially in patients with underlying disease. Use of laxatives by older adults should be monitored by a healthcare provider.

RECAP

Approximately 7% of U.S. elderly experience food insecurity. Disease, disability,death of a spouse, lack of transportation, and language barriers increase the risk for social isolation, which in turn increases the risk for malnutrition.Many social service agencies and programs exist to help older Americans with nutritional needs. Minority elderly present additional challenges, such as overcoming language barriers and providing culturally appropriate foods.As older adults face end-of-life decisions, healthcare providers must be ready to assist them and their families with difficult decisions related to the provision of food and fluid.

Arthritis

Arthritis is one of the most prevalent chronic diseases among the elderly, affecting as many as half of all adults over the age of 65. It can affect one or multiple joints, cause pain on a daily or intermittent basis, and limit range of motion of one or more joints. The two most common forms of arthritis among the elderly are osteoarthritis and rheumatoid arthritis. Osteoarthritis has been called a disease of "wear and tear." People with arthritis who are overweight or obese are strongly advised to lose weight and to participate in water exercise or other acceptable forms of physical activity. Pain medications and anti-inflammatory drugs may be prescribed. In extreme cases, hip or knee replacement surgery is required in order to reestablish normal mobility and function

Body Fat and the elderly

Body fat increases from young adulthood through middle age, peaking at approximately 55 to 65 years of age. Females experience a sharper increase in percent body fat compared with males. Percent body fat tends to decline in persons over the age of 70 years.With aging, body fat shifts from subcutaneous stores, just below the skin, to internal or visceral fat stores.10 Older women tend to deposit more fat in their abdominal region compared with younger women; this shift in body fat stores is most dramatic after the onset of menopause and coincides with an increased risk for heart disease, diabetes, and metabolic syndrome. Older men are also at higher risk for increases in abdominal fat as they age. Maintaining an appropriate energy intake and remaining physically active can help keep body fat to a healthful level.

Polypharmacy

Concurrent use of five or more medications. Prescription drugs interact not only with each other but also with nutrients (Table 18.4). Some medications affect appetite, either increasing or decreasing food intake, and others alter nutrient digestion and absorption. Several drugs negatively affect the activation or metabolism of nutrients such as vitamin D, folate, and vitamin B6, and others increase the kidney's excretion of nutrients. For example, older adults taking the blood-thinning drug warfarin (Coumadin) should avoid consuming excess vitamin E, as vitamin E magnifies the effects of this drug. Both ibuprofen (Advil or Motrin) and acetaminophen (Tylenol) are commonly prescribed for muscle, joint, and headache pain, but taking these drugs with alcohol increases the risk for liver damage and bleeding, so alcohol should not be consumed with these medications. Some medications should be taken before or between meals, whereas others are best utilized when taken with meals. Foods as diverse as grapefruit juice, spinach, and aged cheese are known to react negatively with specific drugs. Pharmacists and registered dietitians are able to provide information on such drug-food interactions and can give recommendations on dietary choices and the potential need for nutrient supplements.

ETOH use and Elderly

Excessive consumption of alcohol also speeds up the aging process by interfering with nutrient intake and utilization, injuring the liver, increasing risk for osteoporosis, and contributing to accidental injuries and deaths

Food Insecurity

Food insecurity occurs when a family is not able to ensure a consistent, dependable supply of safe and nutritious food.41 "Very low food security" is a more severe economic state in which the family actually experiences reduced food intake and disruption of normal eating patterns. It is estimated that approximately 7% of elderly men and women in the United States experience some form of food insecurity at least once during the course of a year. A small number turn to food banks or food pantries for short-term assistance. Elderly adults can be embarrassed by their inability to provide for themselves and may resort to stealing food or going without adequate food. The most common cause of food insecurity and hunger among older adults is lack of income and poverty. Older adults in poverty often live in areas with few or no supermarkets, may not be able to afford transportation to buy healthful food, and may fear leaving their home to shop for groceries. Their homes may lack working refrigerators and/or stoves, limiting the types of foods that can be bought, stored, and prepared. Healthcare and social service providers should carefully probe for information on the ability of low-income elders to afford an adequate and healthful food supply.

Serving Minority Elderly

For example, members of certain minority groups are at a greater risk for nutrition-related chronic diseases and their complications compared with non-Hispanic whites: Hispanics have higher rates of diabetes; African Americans experience greater rates of stroke, kidney failure, high blood pressure, colon cancer, and glaucoma; and Native Americans are at higher risk for diabetes, obesity, and alcohol abuse. Dietary counseling and other therapies can be used to lower the risk of such chronic diseases and for their treatment. In order to meet the needs of minority elderly, nutrition professionals must develop an awareness of the cultures they serve, maintain flexibility in foods/meals provided or prescribed, and work toward effective communication with their minority clients.

Geriatric Failure to Thrive

Inappropriate, unexplained loss of body weight and muscle mass; usually results from a combination of environmental and health factors.

Physical Activity

Lack of physical activity accelerates loss of muscle mass and bone density, increases risk of falls, and impairs the ability to perform simple activities of daily living

Normal Weight, Glucose and Obesity in the Elderly

Maintaining a normal weight is associated with healthy and successful aging. Excess body weight, at any age, speeds up the deterioration of joints, increasing the risk of osteoarthritis and contributing to functional limitations.20 In addition, successful control of blood glucose—in part through weight management—can delay the glycosylation of blood and tissue proteins.When people with diabetes fail to control their blood glucose levels, they experience chronic hyperglycemia and develop complications that seem to mimic the aging process. Obesity also accelerates age-related declines in cardiovascular health

Vision Loss

Many older adults have difficulty reading food labels, including nutrient information. Driving skills decline, limiting the ability of some older Americans to acquire healthy, affordable foods. Older adults with vision loss may not be able to see the temperature knobs on stoves or the controls on microwave ovens and may therefore choose cold meals, such as sandwiches, rather than meals that require heating. The visual appeal of a colorful, attractively arranged plate of food is also lost to visually impaired elderly, further reducing their desire to eat healthful meals

Changes in sensory information as we age include:

Odor, taste, tactile, and visual perception all decline with age; as they do, an older adult's food intake and nutritional status can decline as well. More than half of elderly adults experience significant loss of olfactory (odor) perception, a condition more common than loss of taste perception. Loss of olfaction also restricts the ability to detect spoiled food, increasing the risk of food poisoning. Although often a simple consequence of aging, loss of odor perception can also be caused by zinc deficiency or occur as a side effect of medication. If this is the case, a zinc supplement or change of medication may be a simple solution.

atrophic gastritis and Achlorhydria

Older adults are at risk for a reduced secretion of gastric acid, intrinsic factor, pepsin, and mucus.9 Atrophic gastritis, Destruction of gastric (stomach) secretory glands, resulting in decreased production of mucus, hydrochloric acid, pepsin, and intrinsic factor., contributes to bacterial overgrowth and gastric inflammation. Achlorhydria,Lack of gastric acid secretion., a severe reduction in gastric hydrochloric acid production, limits the absorption of minerals such as calcium, iron, and zinc and food sources of folic acid and vitamin B12. Lack of intrinsic factor, produced by the same cells that secrete gastric hydrochloric acid, reduces the absorption of vitamin B12 (see Chapter 12). These elderly, therefore, benefit from vitamin B12 supplements. Older adults may also experience a delay in gastric emptying, resulting in a prolonged sense of fullness and a reduced appetite. Although this may be viewed as a positive factor in people who are overweight or obese, it can lead to inappropriate weight loss

RECAP Recommendations for the Elderly

Older adults have lower energy needs due to their loss of lean tissue and lower physical activity levels. They should consume 20% to 35% of total energy as fat and 45% to 65% as carbohydrate. Protein recommendations are currently the same as for younger adults, although some research suggests the need for slightly higher intakes. Micronutrients of concern for older adults include calcium, vitamin D, the B-vitamins, and the antioxidants.Older adults are at risk for chronic dehydration and hypernatremia, so ample fluid intake should be encouraged.

Social Isolation

Older adults may become socially isolated for many reasons. Those who are restricted to bed or wheelchairs, have impaired walking, or are in poor health are prone to isolation even if they live in a household with others. The death of a spouse can precipitate isolation, especially among the very old who have also lost siblings and friends Lack of Transportation recent immigrants with language barriers, isolation can occur after the death of a bilingual spouse or as bilingual children move out of the household. These adults may lack the communication skills to navigate public transportation, shop, and secure social services. Ideally, communities with large immigrant populations can provide translators to help integrate these elderly into the community at large. Social isolation increases the risk for alcohol and substance abuse, depression, and malnutrition. Personal healthcare habits decline, household maintenance is put off, and behavior becomes increasingly erratic. Isolated older adults are at high risk for victimization, such as telephone scams, and premature institutionalization. Religious, neighborhood, and social service agencies offer many programs to ensure that older adults are not forgotten within their homes.

RECAP Old people diseases

Osteoporosis, dental problems, arthritis, vision disorders, GI distress, and age-related dementia are examples of "two-way streets" in which nutritional status influences an older adult's risk for the condition, and the condition itself has the potential to influence nutritional status. An older adult's nutritional status and intake can also influence the effectiveness of certain medications, and many of the drugs used by the elderly contribute to nutrient deficiencies. Appropriate use of nutrient supplements can enhance the nutritional status of older adults; however, use of herbal and other nontraditional supplements, including high-potency vitamin or mineral supplements, should be discussed with a healthcare provider.

Biologic Aging

Physiologic age as determined by health and functional status; often estimated by scored questionnaires. Whereas chronologic age is immovable, biologic age can be greatly influenced by personal choices and decisions. It is now possible to predict one's biologic age through a series of scored questions related to smoking habits, alcohol consumption, sun exposure, weight status, level of physical activity, and other factors. A similar approach is used to estimate potential longevity.

Micronutrients for the Elderly

Preventing or minimizing the consequences of osteoporosis is a top priority for older adults. The requirements for both calcium and vitamin D are higher than for younger adults because of a reduced absorption of calcium from the gut, along with an age-related reduction in the production of vitamin D in the skin. An increasing number of older adults are at risk for vitamin D deficiency because they are institutionalized and are not exposed to adequate amounts of sunlight. Others may limit intake of milk and dairy products due to lactose intolerance or perceived concerns over the fat content of these foods living in the community are also at risk for vitamin D deficiency due to the widespread use of sunscreen; these creams and lotions are important to prevent skin cancer, but they block the sunlight needed for vitamin D synthesis in the skin. It is critical that older adults consume foods that are high in calcium and vitamin D and, when needed, use vitamin D supplements. Iron needs decrease with aging as a result of reduced muscle mass in both men and women and the cessation of menstruation in women. The decreased need for iron in older men is not significant enough to change the recommendations for iron intake in this group; thus, the RDA for iron is the same for older men as for younger, 8 mg/day The RDA for iron in older women is also 8 mg/day, but this represents a significant decrease from the 18 mg/day RDA for younger women. Although zinc recommendations are the same for all adults, zinc is especially critical for optimizing immune function and wound healing in older adults. Intakes of both zinc and iron can be inadequate in older adults if they do not regularly eat red meats, poultry, and fish. These foods are relatively expensive, and older adults on a limited income cannot afford to eat them regularly. Also, the loss of teeth and/or use of dentures may increase the difficulty of chewing meats. older adults have increased oxidative stress, the recommendations for vitamin C and vitamin E are the same as for younger adults because there is insufficient evidence that consuming amounts higher than the current RDA has any additional health benefits. B-vitamins, specifically vitamin B12, vitamin B6, and folate. As discussed in detail in Chapters 8 and 10, inadequate intakes of these nutrients increases the level of the amino acid homocysteine in the blood, a state that has been linked to elevated risk of age-related dementia, including Alzheimer's disease, and loss of cognitive function in the elderly.26 The RDA for vitamin B12 is the same for younger and older adults; however, up to 30% of older adults cannot absorb enough vitamin B12 from foods due to atrophic gastritis (see page 712). It is recommended that older adults consume foods that are fortified with vitamin B12 or take B12 supplements, because the vitamin B12 in these products is absorbed more readily.Vitamin B6 recommendations are slightly higher for older adults, as these higher levels appear necessary to reduce homocysteine levels and optimize immune function in this population Vitamin A requirements are the same for adults of all ages; however, older adults should be careful not to consume more than the RDA, as absorption of vitamin A is actually greater in older adults. The elderly are at greater risk for vitamin A toxicity, which can cause liver damage and neurologic problems. However, consuming foods high in betacarotene or other carotenoids is safe and does not lead to vitamin A toxicity

RA

Rheumatoid arthritis (RA) typically strikes younger adults and is not associated with obesity or overuse syndromes. It often affects both hands, wrists, or knees. Because many people with RA are underweight, the nutritional goals focus on appropriate weight gain and a healthful, balanced intake of all nutrients. A wide range of medications is used to treat RA, but some of these interfere with nutrient utilization. Arthritic adults may turn to nontraditional treatments. Glucosamine has shown some promise in relieving the symptoms of osteoarthritis;33

Dysphagia

Some older adults, including those with Parkinson disease, experience dysphagia (difficulty swallowing foods). Smooth, thick foods such as cream soups or applesauce are easy to swallow but foods with mixed textures, such as gelatin with fruit pieces, should be avoided.Milkshakes, fruit nectars, and other thick or viscous beverages are better tolerated than thin liquids such as water and coffee. Dysphagia requires professional assessment and treatment, drawing upon the expertise of an occupational therapist, a physician, and a dietitian. If not accurately diagnosed and treated, dysphagia could lead to malnutrition, inappropriate weight loss, aspiration of food or fluid into the lungs, and pneumonia.

Dementia

Some research suggests that long-term intake of antioxidants such as vitamin E and certain unsaturated fatty acids may lower risk of dementia and cognitive decline.35 Elevated serum homocysteine, linked to deficiencies of folate and vitamin B12, has also been linked to Alzheimer's disease and dementia.36 Mid-life obesity also increases the risk of cognitive decline. 37 These studies emphasize the critical importance of consuming a balanced, healthful diet throughout life. Dementia is one of the "nine Ds" of geriatric weight loss. Odor and taste perception are often significantly impaired, and many people with dementia refuse to eat. Alzheimer's disease can trigger agitation and pacing, increasing energy expenditure. As the disease progresses, the person loses the ability to manipulate utensils and eventually even to swallow. Helping people with dementia to eat adequately can be challenging. Finger foods, such as cut-up fruit, cheese or meat cubes, vegetable slices, and small pieces of bread, can be eaten without utensils. Between-meal snacks and liquid nutritional supplements can also improve dietary intake.

Sunling exposure and Elderly

Sunlight exposure is the primary risk factor for age-related discoloration and thinning of the skin as well as skin cancer. Although its use decreases skin production of vitamin D, most healthcare providers recommend lifelong use of sunscreen in order to limit suninduced skin damage.

Fluid Recommendations for the Elderly

The AI for fluid is the same for all adults.Men should consume 3.7 L (about 15.5 cups) of total water per day, which includes 3.0 L (about 13 cups) as total beverages, including drinking water.Women should consume 2.7 L (about 12.7 cups) of total water per day, which includes 2.2 L (about 9 cups) as total beverages, including drinking water. In general, the elderly do not perceive thirst as effectively as do younger adults. Thus, they are at increased risk for chronic dehydration and hypernatremia (elevated blood sodium levels). Some older adults will intentionally limit their beverage intake because they have urinary incontinence or do not want to be awakened for nighttime urination.

RECAP Elderly

The U.S. population continues to age at an unprecedented rate. The very elderly, 85 years and above, represent the fastest-growing segment of the U.S. population. Scientists are beginning to understand some of the basic cellular changes that contribute to aging and how diet and nutrition might influence the aging process.With aging, sensory perception declines, muscle mass is lost, fat mass increases,bone density decreases, and nutrient metabolism is impaired.Body organs can lose functional capacity and are less tolerant of stressors. These age-related changes influence the nutritional needs of older adults and their ability to consume a healthful diet.Tobacco use, alcohol abuse, excessive sun exposure, overweight, and inactivity accelerate the aging process.

Life expectancy

The expected number of years remaining in one's life; typically stated from the time of birth. Children born in the United States in 2003 could expect to live, on average, 77.6 years

life span

The highest age reached by any member of a species; currently, the human life span is 122 years.

Lactose Intolerance

The one exception is the digestion of lactose: Only about 30% of older adults retain an "adequate" level of lactase enzyme activity. African American, Hispanic, Native American, and Asian elderly are at very high risk for lactose intolerance and may need to restrict their fluid milk intake to 1/2-cup servings, use lactose-reduced milk or lactase enzyme supplements, or eliminate milk from their diet entirely. Although tolerance for dairy foods may decrease with aging, the need for calcium does not. Older adults may need to turn to calcium-fortified fruit juices and cereals, calcium-enriched tofu, and other sources to ensure an adequate intake. Finally, although gastrointestinal (GI) function remains largely unaffected by aging, nutrient availability may be severely compromised if an older adult has a disease of the liver, pancreas, or GI tract that impairs digestion of food and absorption of nutrients

Senescence

The progressive deterioration of bodily functions over time, resulting in increased risk of disability, disease, and death

Nutritional Assistance

They include the following: • Supplemental Nutrition Assistance Program(SNAP): This U.S. Department of Agriculture (USDA) program, formerly known as the Food Stamp Program, provides food assistance for low-income households. Participants are provided with a monthly allotment, typically as a prepaid debit card. There are very few restrictions on the foods that can be purchased under this plan. • Child and Adult Care Program: This program provides healthy meals and snacks to older and functionally impaired adults in qualified adult day-care settings. • Commodity Supplemental Food Program: This program targets low-income pregnant women, infants and young children, and older adults. Income guidelines must be met. Specific commodity foods are distributed, including cereals, peanut butter, dry beans, rice or pasta, and canned juice, fruits, vegetables, meat, poultry, and tuna. Unlike SNAP, this program is not intended to provide a complete array of foods. • Nutrition Services Incentive Program: The Administration on Aging provides cash and commodity foods to state agencies for meals for senior citizens. There is no income criteria; any person 60 years or above (plus their spouse, even if younger) can take part in this program. Although free, participants are encouraged to contribute what they can to cover meal costs. Lunch meals, designed to provide one-third of the RDA for key nutrients, are served at senior centers, churches, and other sites. Some provide "bag dinners" for evening meals, and others send home meals on Fridays for weekend use Meals also can be delivered to the homes of qualified elders through the Meals on Wheels Association of America program. • The Emergency Food Assistance Program: The USDA distributes commodity foods to state agencies for use by food banks, food pantries, and soup kitchens. Each state or agency establishes eligibility criteria, if any. The elderly are more likely to use the services of food banks and local food pantries while avoiding soup kitchens

Age-related macular degeneration (AMD)

a condition in which the macula degenerates, gradually causing central vision loss age-related macular degeneration (AMD), is the most common cause of blindness in U.S. elderly (see Figure 10.22 on page 387). Although these are different conditions, sunlight exposure and smoking are lifestyle practices that increase the risk of each. Recent research suggests, but does not definitively prove, that dietary choices may slow the progress of these two degenerative eye diseases, saving millions of dollars and preventing or delaying the functional losses associated with impaired vision. Several studies have shown beneficial effects of antioxidants, including vitamins C and E, on cataract formation, whereas others reported no significant benefit.25 Two phytochemicals, lutein and zeaxanthin, have also been identified as protective by some, but not all, studies.34 These four antioxidants, as well as zinc, may also provide protection against AMD

What are the energy needs of the elderly adult?

energy needs of older adults are lower than those of younger adults because loss of muscle mass and lean tissue results in a lower basal metabolic rate, and most older adults have a less physically active lifestyle. It is estimated that total daily energy expenditure decreases approximately 10 kcal each year for men and 7 kcal each year for women ages 19 and older.21 This means that a woman who needed 2,000 kcal at age 20 needs just 1,650 kcal at age 70. Some of this decrease in energy expenditure is an inevitable response to aging, but some of the decrease can be delayed or minimized by staying physically active. Because their total daily energy needs are lower, older adults need to pay particularly close attention to consuming a diet high in nutrient-dense foods but not too high in energy in order to avoid weight gain.

Elder Abuse

estimated that up to 2 million U.S. elderly are abused by their spouse, children, neighbors, or paid caretakers each year.40 Elder abuse can be physical, sexual, emotional, financial, neglectful, or unintentional. Denial of healthful food and adequate fluid falls within the scope of elder abuse and neglect. Although it may be difficult to detect, possible signs of such abuse include fear of the caregiver, anxiety, increased depression, and a desire for death. Home-bound elderly may demonstrate new health problems, unexplained weight loss, dehydration and malnutrition, poor personal hygiene, and suspicious physical injuries. Older adults without a trusted relative or friend may need to turn to a healthcare provider, court representative, or social service agency for protection. Every state and local municipality has laws against elder abuse and can offer assistance if abuse or neglect is suspected

Organ Changes

increasing age, however, the kidneys lose their ability to concentrate waste products, leading to an increase in urine output and greater risk of dehydration. increasing age, however, the kidneys lose their ability to concentrate waste products, leading to an increase in urine output and greater risk of dehydration. The aging liver is less efficient at breaking down drugs or alcohol, and the aging heart lacks the endurance to sustain a sudden increase in physical activity. The pancreas is less precise in regulating blood glucose levels, and bladder control may decline with aging. In most instances, older adults can adapt to these age-related changes through minor lifestyle adjustments such as eating meals and snacks on a regular basis and ensuring an adequate fluid intake. As a result of abnormal protein cross-linkages, connective tissues and blood vessels become increasingly stiff. Joint pain, elevated blood pressure, and impaired blood flow are typical consequences. The skin of older adults can become thin, dry, and fragile. Bruises and skin tears are very common and are slow to heal. The growth of nails slows and hair loss is common among elderly males and females the skin's tendency to bruise and tear may increase the risk of infection. A diet rich in vitamins C and A, zinc, copper, and protein may reduce the severity of bruising in some elderly. The number of neurons in the brain decreases with age, impairing memory, reflexes, coordination, and learning ability.Whereas some believe that dementia is an inevitable part of the aging process, a healthful diet, regular physical activity, and other lifestyle choices can promote cognitive functioning.

Overweight vs. Underweight in the Elderly

past 20 years, rates of obesity among the elderly have doubled, tripled, or even, for the state of New Mexico, increased four-fold (Table 18.3). The elderly population as a whole has a high risk for heart disease, hypertension, type 2 diabetes, and cancer, and these diseases are more prevalent in older adults who are overweight or obese. Obesity increases the severity and consequences of osteoarthritis, limits the mobility of elderly adults, and is associated with functional declines in daily activities.20 In contrast, overweight can be protective against osteoporosis and fall-related fractures in older adults. interventions for obese elderly are the same as for younger and middle-aged adults: use of dietary modifications to achieve an energy deficit while retaining adequate nutrient intakes; gradual and medically appropriate initiation of physical activity; and culturally appropriate behavior modification. The benefit of bariatric (weightloss) surgery for this population is not clear. Obese elderly experience more complications, remain in the hospital longer, and have a higher rate of in-hospital deaths following bariatric surgery compared to younger adults underweight older adults have fewer protein reserves to call upon during periods of catabolic stress, such as after surgery or after trauma, and are more susceptible to infection. Inappropriate weight loss suggests inadequate intake of both energy and nutrients. Chronic deficiencies of protein, vitamins, and minerals leave older adults at risk for poor wound healing and a depressed immune response. Because underweight is so risky for elders, geriatric weight loss is an important healthcare concern. Gerontologists have identified nine "Ds" that account for most cases of geriatric weight loss Several of these factors promote weight loss by reducing energy intake. They include drugs that decrease appetite, and eating impairments such as dementia, poor dentition, dysgeusia, dysphagia, and dysfunction. Depression, which is common after the death of family members and friends or when adult children move out of the area, also contributes to reduced food intake. Treatment of inappropriate weight loss in the elderly is often a complex and lengthy process, relying on behavioral, medical, and psychological interventions

Xerostomia

salivary production declines. In older adults with xerostomia, teeth are more susceptible to decay, chewing and swallowing become more difficult, and taste perception declines. A diet rich in moist foods including fruits and vegetables, sauces or gravies on meats, and high-fluid desserts such as puddings is well tolerated by older adults with xerostomia. In the most severe cases, older adults can use an artificial saliva, which is sprayed into the mouth

DRI's for Elderly

there is no DRI for total fat intake for older adults However, to reduce the risk for heart disease and other chronic diseases, it is recommended that total fat intake remain within 20% to 35% of total daily energy intake, with no more than 10% of total energy intake coming from saturated fat. Dietary sources of trans fatty acids should be kept to a minimum. The RDA for carbohydrate for older adults is 130 g/day.21 As with all other age groups, this level of carbohydrate is sufficient to support glucose utilization by the brain. There is no evidence to indicate what percentage of carbohydrate should come from sugars or starches. However, it is recommended that older individuals consume a diet that contains no more than 25% of total energy intake as sugars.21 The fiber recommendations are slightly lower for older adults than for younger adults because older adults consume less energy. After age 50, 30 g of fiber per day for men and 21 g per day for women is assumed sufficient to reduce the risks for constipation and diverticular disease, maintain healthful blood levels of glucose and lipids, and provide good sources of nutrient-dense low-energy foods. The DRI for protein is the same for adults of all ages: 0.8 g of protein per kilogram body weight per day.21 Although some researchers have argued for a higher protein allowance for older adults in order to optimize protein status, a recent study confirmed no apparent difference in the protein requirement between healthy elderly and younger adults.22 Protein is critically important in helping reduce the loss of muscle and lean tissue,23 maintaining immunity, enhancing wound healing and disease recovery, and helping to prevent excessive loss of bone. Protein-rich foods are also important sources of vitamins and minerals that are typically low in the diets of older adults.

Smoking cessation in the elderly

variety of cancers, direct or secondhand exposure to cigarette and cigar smoke accelerates the aging process; inhalation of the thousands of toxins found in smoke impairs lung function, damages the cardiovascular system, increases the risk for osteoporosis, and impairs taste and odor perception. Smoking also causes premature facial wrinkling and impairs dental health. Older adults should be reminded that it is never too late to quit; improvements in taste perception, physical endurance, and lung function can be detected within weeks of smoking cessation

ARe older Americans living longer and better?

yes Older Americans are now healthier, more socially and physically active, and less likely to be confined to bed or have functional limitations than older adults living several decades ago.

Nutrient Supplementation in the Elderly

• When the amount and/or variety of food is so restricted that nutrient intake is probably deficient • If the older adult eats fewer than two meals per day or limits food choices because of dental problems • Whenever there are lifestyle or functional limitations that prevent adequate food intake • If the older adult suffers from depression, dementia, social isolation, or extreme poverty • If the older adult has a disease that impairs nutrient status or could be relieved by nutrient supplementation • If the older adult has osteoporosis, gastrointestinal diseases, or anemia high-potency nutrient supplements can pose real risks to the elderly. Older adults are more vulnerable to high-potency vitamin A supplements than younger adults, especially if they abuse alcohol.Vitamin D is also extremely toxic at high levels of intake, and megadoses of vitamin C can produce diarrhea and cramping. Inappropriate supplementation with iron leads to its accumulation in the liver, pancreas, and other soft tissues, particularly in middle-aged and older men. Nontraditional supplements such as herbs (e.g., Ginkgo biloba, St. John's wort, black cohosh, evening primrose), food derivatives (e.g., flaxseed oil, grapeseed extract, garlic, lecithin), and metabolic compounds (e.g., lipoic acid, coenzyme Q-10, dehydroepiandrosterone [DHEA]) have grown in popularity during the past decade.More than 20% of adults on prescription medication also use nontraditional dietary supplements,39 and are therefore at risk for potentially harmful drug-supplement interactions

Baby Boomers population and elderly population

2003, over 36 million people aged 65 and older lived in the United States, representing about 12% of the population.1 Around the year 2011, the aging of the baby boom generation will begin sharply increasing the number and percentage of older Americans. It is estimated that by the year 2030, the elderly will account for about 20% of Americans, or more than 71 million adults

Very Elderly, centerians and super centarians

85 years and over, known as the "very elderly" or "oldest of the old," currently represent the fastest growing U.S. population subgroup, projected to grow from 4.2 million in 2000 to more than 20 million by the year 2050. The number of centenarians, persons over the age of 100 years, and super-centenarians, over 110 years, continues to grow as well.

Sarcopenic Obesity

A condition in which increased body weight and body fat mass coexist with inappropriately low muscle mass and strength which is strongly associated with frailty, disability, and inability to perform normal activities of daily living.11 While total body weight and body fat are increased in these persons, their underlying muscle mass is not adequate in amount or strength to support normal mobility and health. Bone mineral density declines with age and may eventually drop to the critical fracture zone. Among older women, the onset of menopause leads to a sudden and dramatic loss of bone due to the lack of estrogen (Figure 18.2). Although less dramatic, elderly males also experience loss of bone due in part to decreasing levels of testosterone.

Osteoporosis

A condition in which the body's bones become weak and break easily. Due in part to a higher peak bone density, the onset in males is usually delayed until their 70s or 80s and is linked to declining testosterone levels, steroid therapy, and alcohol abuse.32 Men with osteoporosis are less likely to be diagnosed or treated for osteoporosis compared to women, although the medical community is now more aware of and responsive to the problem in men. One of the most serious risks associated with osteoporosis is that of hip fracture; about 30% of all hip fractures now occur in men.32 Close to 20% of elderly women and almost 40% of elderly men will die within 1 year of their hip fracture; males have a higher mortality rate due to the fact that they are typically much older at the time of fracture.32 Many options are available for the treatment of osteoporosis, including a combination of vitamin D and calcium supplementation, strength or resistance training, and medications

Dental Health Issues

A lack of adequate calcium, vitamin D, protein, vitamin C, and the B-vitamins all worsen dental health. As described earlier, saliva production decreases with age, increasing the risk of dental decay. Older adults should be counseled on the importance of a healthful diet in maintaining good oral health. Despite great advances in dental health over the past several decades, older adults remain at high risk for losing some or all of their teeth, suffering from gum disease, or having poorly fitting dentures, which cause mouth pain and make chewing difficult. Thus, older adults may avoid eating healthful foods such as meats and firm fruits and vegetables. Older adults can select soft protein-rich foods such as eggs, peanut butter, cheese, yogurt, ground meat, fish, and well-cooked legumes. Red meats and poultry can be stewed or cooked in liquid for a long period of time. Oatmeal and other whole-grain cooked cereals can provide needed fiber as will berries, canned corn, bananas, and ripened melons. Shredded and minced raw vegetables can be added to dishes.With planning, older adults with oral health problems can maintain a varied, healthful diet.