Chp. 1- Demographic & Health Characteristics of Older Adults
Among older adults, the number of people aged ______ and older is also growing rapidly. -what is this group called?
85 and older -these are the oldest old or frail elderly.
Chronic diseases disproportionately affect ethnic minorities compared to non-Hispanic whites, partly due to poverty and ________?
lack of access to health care services..
The ______ _______ ________ score, is based on scientific literature and the AoA Performance Measure Project, is a predictor of nursing home placement.
nursing home predictor score.
What is the relationship b/w nutrition and aging?
nutrition can influence how a person ages; in turn, the process of aging affects nutrition
What types of challenges would confront health care providers, including RDs, if people were to develop chronic diseases later in life than usual, i.e., in their 80's or 90's rather than in their 70's?
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Many middle-aged adults are now caring for their parents. Could this increased responsibility on the part of adult children make these caregivers more vulnerable to health problems? Explain.
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What implications do these statistics have for the health and nutritional status of the Hispanic population in the U.S.?
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How can problems with the ADLs and IADLs compromise the nutritional status of older adults? In what ways can the RD be helpful in resolving these problems?
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It has been published that people are entering long term care facilities at an older age, in worse health, and staying for a shorter amount of time. Why do you think this trend might be true?
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What sociodemographic characteristics appear to be associated with the decrease in disability among older adults?
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It is projected that by 2020 there will be 54.8 million persons aged 65 and older, 72 million in 2030, 81.2 million in 2040, and 89 million in 2050. Describe the trend associated with these numbers?
*Trend= number of older adults is continually increasing in years to come
High poverty rates exist for which ethnic groups?
-Hispanics (at least 2x as high for Latino's compared to whites) -African-Americans -Native Americans
At age 65, a ____1____ American can expect to live an average of 1.3 years longer than an ____2____American of the same age?
1. white american 2. African american
In 2010, the life expectancy at birth was 3.6 years greater for ____1___ compared to ___2___?
1. whites 2. African Americans
what are some recommendations of food sources you could make for an older adult patient who has a very low income?
-fresh, frozen, canned, or dried F/V are excellent sources of many nutrients as well as fiber -ex: frozen precut vegetables that can be resealed or single servings of canned fruit
Characteristics of older adults living in rural areas include:
-having lower incomes -more likely to suffer from poor health -have less education compared to their urban counterparts. -obesity is also widespread
Research has shown that abstaining from tobacco, being physically active, and consuming a healthy diet drastically reduces the chances of developing what conditions?
-heart disease -cancer -diabetes -other chronic illnesses.
what are some of the factors that contribute to the decline that occurs with aging that can be modified to restore wellness?
-lifestyle -behavior -diet -environment
Many older adults who maintain a functional quality of life can:
-live independently -maintain close relationships with family and friends -maintain an active lifestyle -successfully managing chronic health issues, medical care, and shopping, cooking, and consuming nutritious meals.
what are some barriers to adequate food intake for older adults?
-multiple chronic/acute illnesses -changes in absorption/digestion -lifelong habits/food preferences -social factors -changes in functional status/dependency -impaired mental status -problems with oral health/chewing/swallowing
Modified MyPlate for older adults addresses the unique dietary needs of adults older than 70 years by emphasizing what?
-nutrient dense foods choices -importance of fluid balance -regular physical activity -choosing adequate amounts of fiber-rich foods -whole grain products -whole F/V -easy to prepare foods *may still need to supplement w/ calcium, vit D, and B-12
What are some barriers to quality healthcare for minority populations?
-older adults in minority groups have experienced effects of health disparities -language and communication -limited access to healthcare -decreased socioeconomic status -different cultural norms
What are the physiologic changes that accompany aging?
1. Decreased muscle mass decreases the need for energy 2. Decreased bone density increases the need for calcium and vitamin D 3. Decreased immune function increases the need for vitamin E, zinc, and vitamin B6 4. Increased gastric pH increases the need for vitamin B6, folate, calcium, iron,and zinc 5. Decreased capacity of skin for cholecalciferol synthesis increases the need for vitamin D 6. Increased winter-time production of parathyroid hormone increases the need for vitamin D 7. Decreased calcium bioavailability increases the need for calcium and vitamin D 8. Decreased efficiency in metabolic use of vitamin B6 increases the need for vitamin B6 9. Increased oxidative stress increase the need for beta-carotene and vitamins C and E 10. Increases in blood homocysteine levels increase the need for folate, vitamin B12 and vitamin B6 11. Decreased vitamin absorption increases the need for nutrient-dense foods that provide all of the vitamins 12. Decreased gastric motility increases the need for high-fiber foods and water
By the year 2040, older adults will make up what percentage of the population?
21%
In the year 2000 there were an estimated ______ million persons aged 65 and older living in the U.S.
35 million trend: less older adult population in past years
What age-related factors and other barriers can make it more difficult for older adults to adhere to dietary guidelines and DRI recommendations?
1. Efficiency of organ and system functions (e.g., kidneys, GI, liver, pancreas) 2. /Sedentary lifestyle over a lifetime 3. Presence of disease (e.g., diabetes, osteoporosis, cancer, heart disease) 4. Effects of multiple medications (e.g., suppress appetite, dry mouth, sleepy, forgetful, nausea) 5. Personal food likes and dislikes (e.g., avoid one or more food groups) 6. Traditional cultural food habits (e.g., avoidance of one or more food groups) 7. Allergies and intolerances (e.g., lactose, glutten, peanut) 8. Genetic disorders (e.g., malabsorption, glycogen storage, PKU, celiac disease) 9. Drug and alcohol abuse 10. Sensory changes (e.g., taste, smell, sight) 11. Impaired mobility, decreased muscle mass, decreased bone density, decreased endurance, impaired balance) 12. Damaged dentition 13. Mental health disorders (e.g., depression, apathy about eating) 14. Cognitive abilities (e.g., manage budget, follow a recipe, interact with others) 15. Food-related beliefs and attitudes (e.g., vegetarianism, adherence to fad diets) 16. Income level (e.g., enough money to purchase an adequate diet) 17. Living arrangement (e.g., living alone or with others) 18. Social interactions (e.g., loneliness versus socially active)
The population of U.S. older adults is diverse in the following ways:
1. Ethnic or cultural background 2. Health status 3. Physical fitness 4. Food choices 5. Income and education levels 6. Employment status 7. Degree of social activity 8. Lifestyles 9. Family responsibilities
List factors that influence the aging process, health status, and quality of life:
1. Genetics: through predisposition or inheritance to illness 2. Medical health status: through presence of acute or chronic disease 3. Medeication use: through appetite and food intake 4. Physical and functional status: through limitations on balance and endurance 5. Cognition: through illnesses like Alzheimers and depression 6. Beliefs: through ads, culture, and religion 7. Environmental factors: through polution, overcrowding, infections, economic constraints 8. Lifestyle: through socialization, diet quality, smoking, alcohol abuse, physical activity
These demographic and health statistics underscore the importance of ensuring adequate nutritional intake for all older adults as an essential factor for preventing the following:
1. Loss of functional independence* 2. Malnutrition 3. Increased susceptibility to illness 4. Impaired immune function 5. Prolonged hospital stays
The modified MyPlate for Older Adults (older than 70 years) emphasizes the following in its pictorial representations:
1. Nutrient-dense food choices 2. Adequate fluid intake and fluid balance (e.g., high-moisture foods like Jell-o) 3. Regular PA 4. Consuming fiber-rich foods: whole grains and fresh fruits and vegetables 5. Fresh, frozen, dried, and canned fruits and vegetables 6. Forms of foods that can be more easily consumed 7. Foods that are easier to prepare 8. Foods with a longer shelf life 9. Foods that yield minimal waste: bags or resealable frozen chopped produce, single servings of canned fruits and vegetables) 10. The flag symbol indicates that supplements are sometimes appropriate (e.g., calcium, vitamins D and B12)
What are the six core services funded by the AOA?
1. Supportive services 2. Nutrition services 3. Health services 4. the National Family Caregiver Support Program (NFCSP) 5. Services that protect the rights of older adults 6. Services for Native Americans
The federal and state programs that offer assistance to older adults have different eligibility age criteria as follows:
1. The Older Americans Act (OAA): 60 years 2. USDA programs: 60 3. Dietary Reference Intakes (DRIs): 51 to 70 years and 70years and older 4. Medicare: 65 years 5. Social Security: 65 years (for people born before 1938), and gradually increase to 67 years (for people born after 1938) 6. AARP: 51 years
The types of age-related declines in PHYSICAL FUNCTION can include the following:
1. Vision 2. Hearing 3. Cardiovascular functions 4. Renal function 5. Respiratory function 6. Musculoskeletal function 7. Endocrine and metabolic function
Emphasizing a ___1___ and ____2.___ diet is essential to promoting health and preventing nutrition-related complications that could contribute to increased functional dependency and frailty?
1. a nutritionally adequate and 2. nutrient-dense diet
The population of older adults projected between the years of 2020-2050 is expected to be:
1. better educated 2. more nutrition conscious 3. wealthier than previous generations. trend: older adult populations are getting smarter over time (esp. w/in the next 30 years)
These disparities in the occurrence of ____1____ are also reflected in disparities in the ____2_____ of older adults?
1. chronic diseases 2. life expectancies
What are the two the serious medical conditions that occur at higher rates among African-Americans and Hispanics than among non-Hispanic whites?
1. diabetes 2. hypertension 3. Arthritis 4. Strokes
The oldest old are at increased risk of being?
1. hospitalized or institutionalized 2. having or developing severe undernutrition.
The Healthy People 2020 introduced the topic area Older Adults in response to the rapidly aging population. The Older Adults topic area has 12 objectives that include the following:
1. increasing the number of older adults who receive Medicare benefits, 2. increasing the number of older adults who receive diabetes self-management benefits 3. increasing the proportion of healthcare workers with geriatric certification (including dietitians).
where do older adults mostly live? list the areas in order from most lived (#1) in to least lived in...
1. metropolitan areas 2. outside main cities 3. inside major cities 4. outside of urban regions
Even though we have DRIs for persons aged 51 to 70 and aged 71 and older, not every older adult will have precisely the same ____1____ needs or the same access to ___2____?
1. nutrient needs 2. a good diet and quality health care
While some age-related factors may make it more difficult for older adults to follow current dietary guidelines, ___1___ changes and ___2___ factors also make it important for older adults to eat a varied diet to maximize their intakes of all of the nutrients.
1. physiologic changes 2. lifestyle factors
The average adult aged 75 has ___1___ chronic health problems and uses ___2___prescription drugs?
1. three 2. five
What percentage of older adults now live in rural communities?
About 20%
Which ethnic group suffer rates of diabetes that are three times the national average?
American Indians
Why do you think that so few medical, nursing, pharmacy, and social work students are attracted to the field of geriatrics? Why do you think that RDs have been working in this field for decades?
Because they are considered a "dying population," which may not make their efforts seem worth their time (this is obviously wrong) -There are not enough universities training students in this area of medicine -There needs to be more funding and interventions taking place to prolong the life of older adults
Most Hispanic Americans (72 percent) live in which four states?
California, Florida, New York, and Texas.
Successfully managing the state of aging and health is a challenge. Explain why?
Caring for an aging population puts a strain on the medical community and the health care system as health care costs rise to meet new health care demands.
True or False? The number of pharmacists, nurses, and social workers who receive any training in geriatrics is large.
False--> it is also SMALL general information: a. Fewer than 1 percent of RNs, pharmacists, and physician assistants, and about 2 percent of advanced RNs are certified in geriatrics. b. Only 3 percent of psychologists and 4 percent of social workers devote the majority of their practice to older adults. c. The largest training gap in any medical education field is in geriatrics. d. 60 percent of nursing schools have no geriatrics faculty at all.
For older adults, what are some key factors to maintaining a functional quality of life and preventing chronic health problems?
Healthy eating and an active lifestyle -preventative care for older adults can help promote high quality of life and positively affect healthcare costs
By 2030 ___________ older adults are projected to be the largest racial-ethnic minority group of older Americans?
Hispanic
This group is less educated than other groups of older Americans and they are more severely affected by poverty than the general population of older adults.
Hispanic
Which ethnic group is the fastest growing?
Hispanic
Which ethnic minority group of older adults are projected to be the largest racial/ethnic minority group of older Americans?
Hispanic older adults
Which ethnic population group is less educated than other groups of older Americans? -(42.2 percent have completed high school, compared with 76 percent of the total population of older Americans.) -(8 percent of older Hispanic adults have completed college, compared with 19 percent of all older Americans.)
Hispanic older adults
What happens to people's perceived health status which as they age?
It declines from excellent-good to fair-poor as they age.
What is the belief regarding the current and future workforce serving older adults?
It is widely believed that colleges and universities are not well prepared to fulfill the up-coming need for well trained health care providers that can meet the health needs of older adults.
What is happening to the cost of medicare?
Medicare costs are projected to increase (from 555 billion dollars in 2011 to 902 billion dollars in 2020.)
Native American men or women are more likely to be obese and are less likely to exercise?
Native American WOMEN
Describe a trend in family medicine regarding geriatrics?
One trend in family medicine is to make geriatrics a curricular requirement, and a higher percent of medical schools are requiring training in this area. -some medical schools have established departments of geriatric medicine within internal medicine or family medicine divisions.
Diets high in fruits and vegetables (a.) decrease or (b.) increase the possibility of developing with some cancers, diabetes, and CVD?
a.) decrease
What are some benefits of preventative care for older adults?
Preventive care for older adults can help promote a high quality of life and positively affect healthcare costs.
While some services such as, _______ & ________ are available to older adults, not all services are equally available to all subgroups of older adults.
State and federal Services
__________ is a common cause of death among Native Americans; this is related to hypertention, diabetes, and heart disease?
Stroke
Describe the trend for health care costs in regards to an aging population?
The costs of caring for an aging population will increase health care spending (about 25 percent by 2030.)
where should majority if not all of the nutrients an older adult consumes come from? a.) food b.) supplements c.) fluid intake d.) yo momma
a.) food
What is the Administration on Aging (AOA)?
The AOA is one of the largest providers of home and community-based care for older adults and their caregivers.
What does the nursing home predictor score measure?
The nursing home predictor score measures the older adult needs for transportation and congregate meals; the higher the score, the greater the need for services. higher score = more need of services
The types of age-related declines in COGNITIVE function can include the following:
The speed at which information is processed -cognitive impairments are very different from one individual to the next
Are organizations that focus on older adults doing anything to help?
These organizations are continuing to provide funding of research related to health of older adults.
What is the main purpose of the AOA?
To ensure that services are provided to economically and socially vulnerable older adults.
True or False. The biologic change that transpires over time has little to no consequence on the ADLs
True. These decline more often due to sickness rather than to natural aging.
True or False. The population of older adults is also growing rapidly
True... The total number and overall percentage of older adults is unparalleled.
Which ethnic group is diabetes is more common among? a.) older Hispanics b.) non-Hispanic whites. c.) African Americans d.) Native Americans e.) Pacific Islanders
a.) older Hispanics
Although whites show a lower incidence of hypertension and diabetes, whites have higher rates of __________ compared to Hispanics?
cancer
The AOA targets health disparities in the following areas, among others:
a. Diabetes b. Cardiovascular disease c. Adult immunization d. Alzheimer's e. Oral health
Name the leading causes of death among U.S. adults aged 65 and older according to the CDC (2013):
a. Heart disease b. Cancers c. Stroke d. Chronic lower respiratory diseases e. Influenza and pneumonia f. Alzheimer's disease g. Diabetes
Who is more likely to die from heart disease? a.) African American women b.) White women
a.) African American women are 40 percent more likely
Most age-related biologic functions peak BEFORE ______ and progressively degenerate linearly from that point onward.
age 30
what are the key triggers of functional decline as individuals age?
ailments (sickness) rather than natural aging (biological function)
Older Native Americans have a high prevalence of which diseases when compared with the general population aged 55 and older?
arthritis, congestive heart failure, stroke, asthma, prostate cancer, hypertension, and diabetes
Advances in technology and medical care have contributed to which of the following: a.) DECREASED life expectancy and the explosion of the older adult population b.) INCREASED life expectancy and the explosion of the older adult population c.) nothing, no contributions
b.) INCREASED life expectancy and the explosion of the older adult population
why do older adults find it hard to meet their nutritional needs?
because of INCREASED requirements for some nutrients and an overall DECREASE energy need
At times, why might older adults might find it difficult to meet their nutritional needs?
because of increased requirements for some nutrients and an overall decreased energy need.
what are some recommendations you could make for older adults who have limited income, live alone, is functionally limited, or has health problems regarding food choices?
choosing foods that are: -easier to prepare -have a longer shelf life -minimize waste
What are examples of foods that would suit the needs of older adults on restricted incomes and with some physical limitations?
choosing foods that are: -easier to prepare -have a longer shelf life -minimize waste -fresh, frozen, canned, or dried F/V are excellent sources of many nutrients as well as fiber -ex: frozen precut vegetables that can be resealed or single servings of canned fruit
_______ is one of the only major risk factors that can be changed positively (or negatively) to influence the risk of disease?
diet
Diets high in _______ & _______ DECREASE the possibility of being diagnosed w/ some cancers and chronic diseases such as diabetes & CVD?
fruits & vegetables (F/V) -F/V offer necessary vitamins and minerals, fiber, carotenoids, and other phytochemicals known to promote health
What are the barriers to accessing health care for Native Americans?
geographic isolation, poverty, and the lack of trust for mainstream medicine.
One of the Healthy People 2020 goals is to...?
improve access to comprehensive, quality healthcare services for persons of all ages.
What group makes up among the nearly 43 million Americans who are uninsured?
minority older adults who are less likely to receive regular or good quality health care.
Unhealthy behaviors like tobacco use and high alcohol consumption are more widespread in rural or urban areas?
more widespread in RURAL areas
What are some ADVANTAGES for older adults to live in rural communities?
not really any advantages -possibly stronger ties w/in the community
How does counseling different ethnic groups relate to the push towards cultural acceptance/knowledge?
oDifferent foods/preferences oCulturally competent counseling oDo not assume that just because the patient is of a particular ethnicity, that they eat traditional foods associated with their respective culture oLanguage barriers- translator or providing oDo not patronize your clients or assume that a Latino/African Americans who didn't graduate from college do not have any knowledge about nutrition
The poverty rate for which ethnic group is 20 percent, which is more than twice the percentage for the total U.S. older population, which is 9 percent?
older African Americans
Hypertension occurs more often among which ethnic group than among any other group of older adults?
older African Americans -the rate for older African Americans is 84 percent compared to 71 percent in the overall population of older adults.
Nearly 21 percent of all older adults have been diagnosed with diabetes; but the rate of diabetes among ________ is much higher (24.5 percent) than that for non-Hispanic whites (21.9 percent).
older black adults
In regards to gender distribution of older adults, which gender (men or women) outnumbers the other?
older women outnumber older men
What is an important problem for Hispanic older adults?
poverty -the poverty rate is 17 percent, more than twice that of the total older American population (7.4 percent).
Since 2007 the AOA has been working with senior centers and faith-based centers to begin evidence-based prevention programs that have proven effective in the following ways: reducing the risk of disease, injury, and disability in older adults.
reducing the risk of disease, injury, and disability in older adults. -often these techniques are simple things that older adults can use to self-manage and to prevent problems like reducing the risk of falls, making healthy food choices, and techniques for improving physical and mental functioning.
Encouraging news was reported in a report called "The State of Aging in America" indicated the following information:
that more persons aged 65 and older are consuming five or more fruits and vegetables a day compared to other age groups. (2013)
Which cohort of adults is better educated, better positioned financially, and more nutritious conscious than previous generations have been?
the baby boomer population
Explain why the elderly population has either increased or decreased in rural areas? *Trend
the elderly population has INCREASED because.... 1.) older people are relocating to rural areas following retirement 2.) those who have spent their lives in these areas are choosing to remain in their own homes.
Regarding geographic distribution of older adults, the elderly population has increased or decreased in rural areas?
the elderly population has increased
Describe the number of health care professionals involved in geriatrics?
the number of health care professionals, (physicians, nurses, pharmacists, and social workers) prepared in geriatrics is SMALL! general information: -There are currently about 2.5 geriatricians for every 10,000 older adults in the U.s. -Fewer than 3 percent of medical students take an elective course in geriatrics. --- In 2010 only 75 residents in internal medicine or family medicine entered geriatric fellowship programs, down from 112 residents in 2005.
What tool is used by the AoA to measure success? nursing home predictor score.
the nursing home predictor score.
What group is expected to reach 6.6 million by 2020 and 14.2 million in 2040?
the oldest old or frail elderly
It is projected that by the year 2020 there will be 30.5 million women older than aged 65, compared to 24.3 million men of the same age. Describe this trend*
the trend is that there will be more women older aged 65 than there will be men of the same age in the next 3 years.
In regards to the differences in life expectancy rates of white Americans and African Americans, what the trend of this gap?
trend= This gap closes the longer whites and African Americans live.
True or False. Compared to older adults in other ethnic groups, lower percentages of Hispanics are affected by CVD, cancers, lung disease, and strokes
true
True or False. In 2012, 63 percent of Hispanics and 63 percent of African Americans rated their health as excellent or good compared to 78 percent of non-Hispanic whites.
true
True or False. The older adult minority population is projected to increase from 8 million in 2010 to 12.9 million in 2020.
true
True or False? 85 percent of the non-institutionalized population of older adults have one or more chronic health conditions that could be improved with proper nutrition, and up to half may have clinical evidence of various forms of malnutrition.
true
True or False? Efforts made by the AOA are not just being implemented, but are also being evaluated for their effectiveness by measuring the outcomes.
true
True or False? No older racial or ethnic group is doing very well when it comes to immunizations for influenza or pneumococcus
true
True or False? Numerous barriers to adequate food intake complicate the task of maximizing nutrition in older adults
true
True or False? Nutritional status affects how well we age.
true
True or False? Providing health care for an older adult is three to five times more costly than providing health care for a younger counterpart.
true
True or False? The AOA awards annual grants to state governments to support programs mandated by Congress under the Older Americans Act.
true
True or False? The AOA has increased the number of older adults served per million dollars of funding over the past 5 years by 22 percent.
true
True or False? The AOA was also effective in serving home-delivered meals to 467,387 clients.
true
True or False? The CDC lists eating fruits and vegetables daily as a health status indicator.
true
True or False? The numbers of RDs who specialize in geriatric care is higher than in other health professions.
true
True or False? The physiologic changes accompanying aging also increase the need for specific nutrients, and may justify the use of supplements.
true
True or False? Older adults use more health care services than any other age group.
true -they account for more physician visits and for more hospitalizations, and their hospital stays are longer.
True or False? In 2003, the nursing home predictor score was 46.57 and increased to 60.62 in 2011.
true trend= increase
true or false? a larger # of older adults are consuming 5+ F/V daily when compared to other age groups
true, but not compared to the general population
In 2011, was the AoA successful in showing that the services provided helped older adults to remain in their communities and homes? Yes or No
yes
What are some DISADVANTAGES for older adults to live in rural communities?
•Transportation limited/far away from hospitals •Could be less community services available (mobile units)→ telemedicine •Minimal socialization due to living in rural area •Weather effects ability to deliver services