The latest data on the potential of essential nutrients to prevent cataracts and age-related macular degeneration – the two leading causes of blindness in the elderly – are presented in detailed tables. The Older Americans Update 2006 and 2008: Key Indicators of Well-Being lists diet quality as one of seven modifiable “health risks and behaviors.”
INTRODUCTION
An ecological perspective is a useful conceptual framework that considers multiple levels of influence that influence the eating behavior of older adults. Older adults' eating behavior is simultaneously influenced by intrapersonal (i.e., individual characteristics), interpersonal (i.e., interpersonal processes and primary groups), institutional (i.e., norms and structures), community (i.e., ., social networks and norms) and public policies. factors (local, state and federal policies and laws).
INTRAPERSONAL LEVEL
This may be especially true regarding individuals' perceptions of what constitutes healthy food choices or the appropriate amount of food to consume. Furthermore, traditional models of educating individuals to make changes in eating behaviors that place the clinician in the role of expert and the older person in the role of receiver of information do not sufficiently capitalize on individuals' knowledge of their food and their preferences and concerns. eating. and how the identities of individuals are expressed through the consumption of special foods (26).
INTERPERSONAL LEVEL
For example, individuals may be encouraged to engage in healthy behaviors and discouraged from engaging in unhealthy behaviors or vice versa depending on the social network and support system. As noted by Rimer and Glanz, the opinion, thoughts, behavior, advice, and support of those surrounding an individual can be very influential; and this may be especially true for older adults who are dependent on caregivers (15).
INSTITUTIONAL LEVEL
For example, as described in the previous section, older adults who live alone may skip meals compared to those who live with others. At the same time, it may be necessary to enable the elderly to overcome the embarrassment associated with eating chicken with fingers instead of a fork.
COMMUNITY LEVEL
Older adults view themselves as the center of attention when others point out, for example, that they are not eating enough or are taking too long to eat. At the individual and interpersonal levels, there is a need to sensitize older adults and their caregivers to community resources that already exist.
POLICY LEVEL
In contrast, older adults are more likely to participate in the USDA Commodity Supplemental Food Program (68). This may also increase the knowledge of older people about the benefits of any available nutritional programs.
IMPLICATIONS OF AN ECOLOGICAL APPROACH AND OPPORTUNITIES FOR INTERVENTION
Thirty-three states participate in the commodity food program that targets older adults with incomes less than 130% of the poverty level. It also involves identifying older adults' preference for using particular services and barriers to use.
RECOMMENDATIONS
In addition to social factors, there are many more factors that influence the eating behavior of the elderly. Longitudinal study of homebound older adults experiencing increased food insufficiency: Effect of diabetes status and implications for service delivery.
INTRODUCTION
Behavioral theories can guide clinicians in developing the best strategies for promoting a therapeutic nutritional change. Integration of behavioral theories into clinical care may facilitate improved chronic disease self-management by supporting the adoption and maintenance of healthy nutritional practices.
BENEFITS OF BEHAVIORAL THEORIES IN PRACTICE
OVERVIEW OF COMMON BEHAVIORAL THEORIES/MODELS USED IN NUTRITION INTERVENTIONS FOR OLDER ADULTS
Discuss the positive effects of dietary changes on health, lifestyle and quality of life. Repeat the desire to support the diet. Relapse prevention Congratulate on success Discuss concerns For a brief relapse (e.g., consuming too much sodium while on vacation), encourage cycling right back to the recommended diet and use the experience as an opportunity to learn rather than as discouragement. Made a diet change.
EXAMPLES OF NUTRITION INTERVENTIONS GROUNDED IN BEHAVIORAL MODELS
The intervention included patient-centered assessment and exercise and nutrition counseling based on Social Cognitive Theory. Patients randomized to the intervention received nutrition information based on the Stages of Change Model (29,30).
PRACTICAL APPLICATIONS OF BEHAVIORAL THEORY IN DIETARY INTERVENTIONS FOR OLDER ADULTS
Stages of Change Model Assess the patient's ''readiness'' to engage in dietary behavior to improve health. Stop asking open-ended questions to the patient about how specific dietary change(s) can be accomplished.
RECOMMENDATIONS
Effects of the Mediterranean Lifestyle Program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Long-term effects of the Mediterranean Lifestyle Program: a randomized clinical trial for postmenopausal women with type 2 diabetes.
INTRODUCTION TO THE CHALLENGE
The shift to a predominantly older population is taking place alongside the phenomenon of the world 'getting smaller'. Such interventions can reduce health care needs and costs and improve the future quality of life for the world's older citizens.
GLOBAL LIFE EXPECTANCY TRENDS
Together with the continued increases in life expectancy (see next section), this is responsible for the rapid increase in the proportion of the world's population comprised of older cohorts, ie the ``aging'' of the globe. One of the main goals of nutritional intervention is to maximize the years of healthy life expectancy.
PROFILE OF GLOBAL MORTALITY AND MORBIDITY CAUSES Other than for deaths associated with HIV/AIDS, the causes for mortality on a
The number of cases of T2D has increased so rapidly over the past two decades that the term ``diabetes'' has been coined to describe the co-epidemic of T2D and obesity (5).
INTERACTIONS OF HEALTH BEHAVIORS WITH EXPECTED MORBIDITY AND MORTALITY
Through the restaurant franchise 'East Dawning', the company successfully markets 'fast Chinese food' to Chinese consumers. Such marketing of high-calorie, cheap and tasty food – even if the food served mimics local cuisine – can lead to a dramatic change in diet and possibly a growing problem of chronic diseases associated with excessive consumption of calories, fat and sodium.
CROSS-CULTURAL ISSUES: FOCUS ON CHINA
Food producing, processing and manufacturing industries, as well as the culinary/food service industries, ``respond to humanity's inherent demand for sugary, salty and fatty foods''(7) by making access to them easy and affordable. This approach is being test marketed by Yum Brands (a company based in Louisville, KY that also owns Kentucky Fried Chicken, Pizza Hut and Taco Bell).
CHINA: UPDATE ON TRANSITIONS IN DIET AND DISEASE PATTERNS
O BESITY
OW/OB rates are generally higher in urban than rural areas, but Zhang et al. (16) recently reported an 18.6% prevalence of OW in a Chinese rural population. The prevalence of hypertension in China has been increasing in recent decades, while awareness, treatment, and control rates remain unacceptably low (18).
T YPE 2 D IABETES (T2D)
Hypertension, a major risk factor for stroke, accounts for 11.7% of total mortality in the Chinese population and does not vary substantially by gender, degree of urbanization, or geographic region ( 13 ). Given the country's large total population, this increase has already created a huge public health burden, with particularly huge consequences for the elderly population.
RAPID GROWTH OF THE ELDERLY POPULATION IN CHINA .1 Prolonged Life and Changes of Population Structure
S PECIAL C ONCERNS A BOUT A LZHEIMER ’ S D ISEASE AND Q UALITY OF L IFE For a country with an already large and rapidly growing proportion of elderly, the
55 years from Beijing, Xian, Shanghai and Chengdu revealed that China had 3.1 million Alzheimer's patients, accounting for 5.9% of the population over 55 years of age. The Peking Union Medical College Hospital study also found that only 23.3% of China's AD patients sought medical care, of which 21.3% ultimately received medical treatment(31).
TRADITIONAL VIEWS OF AGING IN CHINA: A POSITIVE MODEL BUT CONCERNS FOR THE FUTURE
At the same time, the living arrangements of the elderly in China remain highly dependent on the family. This is an almost inevitable consequence of China's strict (one-child) population policy and increasing life expectancy.
COMING CHALLENGES FOR SOCIAL SERVICES AND THE HEALTH CARE SYSTEM IN CHINA
However, these facilities are insufficient in number, of varying standards and often too expensive for many older adults and their families. Community-based long-term care services for the elderly in China—both informal and locally supported by the government—have also begun to emerge, especially in urban areas(48).
IMPLEMENTATION OF PREVENTIVE NUTRITION: GLOBAL IMPLICATIONS
In the period from March 2007 to March 2008, the global food price index showed a sharp increase (see Fig. 3.17), with prices escalating for almost all food categories(62). The United Nations has identified the promotion of healthy aging as one of the key nutritional challenges that will dominate the global agenda in the coming years (68).
RECOMMENDATIONS
We recommend that both traditional and new avenues be pursued very actively - the future health and well-being of the entire world may well be at stake. Drinking patterns and health status in the general population in five areas of China.
INTRODUCTION
This chapter reviews a number of recently developed nutritional screening tools and laboratory tests used to assess nutrition. Keywords: Simplified Nutrition Assessment Questionnaire; mini nutritional assessment; anorexia; weight loss; albumen; anemia; waist circumference;
BODY MASS AS AN INDICATOR OF NUTRITIONAL STATE
NUTRITIONAL QUESTIONNAIRES
DETERMINE (13–15)
ASSESSMENT OF DIETARY INTAKE
Recently, a picture-sorted food frequency questionnaire has been developed for elderly people of low socio-economic status(26,27). Although this tends to perform better, approx. 40% of the elderly still under-consume food.
ANTHROPOMORPHIC MEASURES
UTILITY OF SERUM PROTEIN, CHOLESTEROL AND HEMOGLOBIN
DEHYDRATION
IMMUNE ASSESSMENT AND NUTRITION
ASSESSING FRAILTY, STRENGTH AND MOBILITY
ASSESSING DISABILITY
SCREENING FOR OSTEOPOROSIS
MEASUREMENTS OF VITAMINS AND TRACE ELEMENTS
RECOMMENDATIONS
Construct validity and test-retest reliability of older adults in the community: risk assessment for the Eating and Nutrition Questionnaire. The Mini Nutritional Assessment (MNA) for classifying the nutritional status of elderly patients: MNA introduction, history and validity.
INTRODUCTION
Furthermore, without the simple pleasures of taste and smell, the overall quality of life is greatly reduced, especially for those later in life whose other senses (sight, hearing and touch) have also declined during the aging process. The purpose of this chapter is to review the literature on the chemical senses of taste and smell changing with age.
TASTE
For recognition thresholds (RTs), the ratio of RT (older)/RT (young) revealed that RTs in older subjects were higher by the following amounts: 5.8 times higher for sodium salts; 7.5 times higher for bitter compounds; 2.1 times higher for sweeteners; 6.8 times higher for sour-tasting acids; 3.0 for astringent compounds; 3.0 times higher for polysaccharides/gum; and 2.0 times higher for metallic compounds. For amino acids, age-related losses tended to be higher for two amino acids with side chains containing basic groups (L-histidine and L-lysine) and their monohydrochloride derivatives.
SMELL
The range of olfactory impairments in older adults is generally greater than that of taste. The number of odor sensations that can be distinguished is greatly reduced in the elderly, who first lose the ability to distinguish accurately between odors with similar properties (e.g. different types of nuts) and finally, with greater loss, between odors of different qualities (e.g. orange compared to lamb).
OTHER AGE-RELATED SENSORY LOSSES
Loss of the ability to distinguish between the color and arrangement of food at the table greatly reduces the enjoyment of the eating experience and the motivation to eat. The function of the hearing system is to transmit information about sound waves (pressure variations) in the air.
CHALLENGES FOR ASSESSING SENSORY FUNCTIONING IN OLDER PERSONS: COMPARISON OF TASTE AND SMELL
Subjects were asked to write on the blank lines as many of the associated words as they could remember. Subjects were sequentially presented with a set of four odorants and asked to identify which of the four had the smell they were asked to remember.
FINAL COMMENT
Fourth, initial or first sensory (and cognitive) evaluation of repetitions rarely yielded the best performance for most tests (see Table 5.2 for data on the no-medication group). This finding is important because it highlights that sensory sensitivity varies from day to day, and multiple sensory assessments are necessary to determine the range (maximum to minimum) of sensory performance.
RECOMMENDATIONS
All subjects were tested three times over a 2-month period to investigate and compare short-term intra-individual fluctuation or stability of the five senses and cognition over a short period of time when little change in perception was expected. Awareness of safety issues when temperature or tactile sensations are dim is important to ensure patients do not burn the inside of their oral cavity or fingers with overheated foods and drinks.
INTRODUCTION
The evidence available so far supports a possible protective role of several nutrients, including vitamins C and E and the carotenoids lutein and zeaxanthin. Dietary components that may be important in preventing cataracts and AMD are vitamins C and E and the carotenoids, lutein and zeaxanthin.
PHYSIOLOGICAL BASIS OF CATARACTS AND AMD
In the early stages of the disease, lipid material accumulates in deposits beneath the retinal pigment epithelium (RPE). Lutein and zeaxanthin are concentrated in the macula or central area of the retina and are called macular pigment.
HUMAN STUDIES ON DIETARY INTAKE AND BLOOD LEVELS OF ANTIOXIDANTS AND EYE DISEASE
- V ITAMIN E
- L UTEIN AND Z EAXANTHIN
- O MEGA -3 F ATTY A CIDS
- AMD .1 V ITAMIN C
- V ITAMIN E
- O MEGA - 3 F ATTY A CIDS
- Z INC
Men in the highest fifth of lutein and zeaxanthin intake had a 19% lower risk of cataracts compared to men in the lowest fifth. Women in the highest quintile of lutein intake (median 0.95 mg/d) had a 27% lower prevalence of nuclear. Table 6.3.
THE EFFECT OF NUTRIENT SUPPLEMENTS ON EYE DISEASE RISK Supplemental vitamins C and E have been long available to the general public
The investigators concluded that in regular users of multivitamin supplements, the risk of nuclear darkening was reduced by a third. In a study conducted by Seddon et al. (40) the prevalence of AMD was also similar among those who received vitamin E supplementation for more than 2 years.
CLINICAL SUMMARY AND TREATMENT GUIDELINES
There were 216 cases of disease in the antioxidant groups and 53 in the placebo group. There was no association with treatment group and the development of early stages of the disease.
CONCLUSION
Cho, E., et al., Prospective study of dietary fat and the risk of age-related macular degeneration. Cho, E., et al., Prospective study of zinc intake and the risk of age-related macular degeneration.
INTRODUCTION
The high incidence of atrophic gastritis in older adults increases the risk for vitamin B12 malabsorption and deficiency. Evaluation of anemia in older adults should include assessment of iron stores, copper, zinc, B12 and folate levels.
DYSPHAGIA
The most common malignancy in the older adult population (especially in the Caucasian male) is adenocarcinoma of the gastroesophageal junction. Dysphagia aortica is a rare condition caused by compression of the esophagus by an aortic aneurysm or severely calcified aorta(5).
GASTROESOPHAGEAL REFLUX DISEASE (GERD) AND HEARTBURN
Pressure in the LES can be decreased by any number of drugs, such as calcium channel blockers (Norvasc, Procardia, and Cardizem), alpha antagonists (Cardura or Flomax), or beta antagonists with alpha blocking properties (Coreg) (9). The management of GERD in the geriatric population is similar to the care and treatment used in younger patients(9).
GASTRITIS AND PEPTIC ULCER DISEASE
Elevated levels of homocystine in the blood may be due to folate or B12 deficiency and may increase the risk of arteriosclerotic cardiovascular disease. Treatment of B12 deficiency seen in type A gastritis may be more difficult and require higher doses of B12 than type B gastritis, especially if the goal is to lower homocystine levels (2,16).
DIARRHEA
The traditional "soft" diet used in the past has been shown to have no effect on symptom relief, cure or recurrence of PUD. Stool cultures, endoscopy with appropriate biopsy, and review of all medications should be the first steps in the management strategy.
OTHER GI DISORDERS .1 Fecal Impaction
Small intestinal bacterial overgrowth (SBBO), or blind loop syndrome, may be increased in the geriatric population. A defecation proctogram may be needed to determine if the anorectal angle is increased.
GASTROINTESTINAL BLEEDING
The management of the GI bleeding, whether it ultimately proves to be of an upper or lower tract source, involves adequate volume resuscitation and appropriate transfusion of blood products. For these latter patients, it is important to withhold additional feeding for at least 48 hours to allow stabilization of the clot after treatment.
HEPATITIS
For patients with bleeding esophageal varices, especially if undergoing esophageal band ligation, it is important to wait 48 hours before feeding (because feeding may increase blood flow and subsequent splanchnic pressure, which may accelerate bleeding). Initially, it is important to rule out underlying liver disease such as hepatitis C or primary biliary cirrhosis.
ANEMIA
Elderly patients presenting with abnormal liver enzymes should undergo a complete workup similar to any other age group. Evaluation of abnormal liver enzymes should include studies of iron and copper, markers of viral hepatitis, and markers for autoimmune disease.
RECOMMENDATIONS
Softley A, Myren J, Clamp SE, Bouchier IA, Watkinson G, de Dombal FT: Inflammatory bowel disease in elderly patients. A variety of acute and chronic diseases predispose the elderly to electrolyte disturbances, as often reflected by high or low concentrations of the mineral in the serum, for example, hyponatremia, hyperkalemia, hypercalcemia and hypomagnesemia.
INTRODUCTION
Although we now have specific recommendations for daily intake of calcium and magnesium, ie. Recommended Dietary Allowances (RDAs), Dietary Reference Intakes (RDIs), or Adequate Intakes (AIs) to avoid deficiencies, no similar recommendations exist for sodium or potassium as deficiencies. of these minerals generally do not develop on normal diets unless certain pathological conditions exist. Most vitamin-mineral combinations contain small amounts of these trace elements, usually in sufficient amounts to prevent deficiencies from developing, but not enough to produce toxicity.
DEHYDRATION AND HYPERNATREMIA DUE TO PRIMARY WATER LOSS
Most symptoms of dehydration are due to the shift of fluid from the brain cells causing them to shrink, causing intracranial damage to blood vessels with venous thrombosis, infarction and/or hemorrhage. The first manifestation of dehydration may or may not be thirst, followed by confusion and lethargy, and finally delirium, stupor, and coma.
SODIUM
Severe vomiting with resultant metabolic alkalosis may result in sodium loss associated with increased amounts of bicarbonate filtered and not reabsorbed in the proximal tubule, despite hyponatremia and hypovolemia. While the sodium concentration in serum water is normal, the volume of water is less in the sample, so when it is further diluted before analysis, it gives a low serum sodium value.
POTASSIUM
Dietary restriction of potassium-rich foods may be initiated in anticipation of a risk of hyperkalemia. When hyperkalemia is due to a minor allocorticoid or aldosterone deficiency, 9-fluorohydrocortisone (Florinef) can be given.
CALCIUM
PTH has its effect on the intestines by accelerating the conversion of the carrier form of vitamin D into its active form. Hypercalcemia often results in dehydration because it reduces the kidney's ability to reabsorb salt and water in the tubular parts of the kidney.
MAGNESIUM
It may also be associated with protein-calorie malnutrition, acute pancreatitis, and in a variety of conditions associated with wastage of magnesium in the urine, e.g. diuretic therapy (furosemide), endocrine disorders (hyperthyroidism, hyperparathyroidism) nephrotoxic drug therapy (aminoglycoside antibiotics, cyclosporine, cisplatin). Symptoms associated with hypomagnesemia include neuromuscular manifestations (muscle hyperexcitability, tetany, hyperacusis, seizures, vertigo, and tremors) and mental psychiatric changes (irritability, aggressiveness).
TRACE MINERALS
A typical once-daily multivitamin preparation for the elderly contains 15 mg of elemental zinc; however, zinc sulfate tablets containing 25 and 50 mg of elemental zinc are also available. While some once-daily multivitamin preparations for seniors include this amount of elemental iron in their preparations, many no longer contain iron.
RECOMMENDATIONS
Apparent molybdenum deficiency developed in a patient on TPN characterized by an intolerance to the sulfur-containing amino acids. Dietary reference intakes: the new basis for recommendations for calcium and related nutrients, B vitamins and choline.
NUTRITIONAL FRAILTY: A REVISED DEFINITION BASED ON ETIOLOGY
Three distinct causes of weight loss and physical weakness have different manifestations and overlap to varying degrees. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (endocrine disorders excluded).
CAUSES OF UNDERNUTRITION
Lee and Paffenberger (15) reviewed 17 studies of weight loss and subsequent all-cause mortality and concluded that those who ``did best'' were those who remained weight stable. Changes in body composition that occur with weight loss may also explain the negative effect of weight loss on function in older adults (18).
EARLY INTERVENTIONS TO INCREASE FOOD AND FLUID INTAKES
Odlund Olin et al.(35) were able to demonstrate similar results along with preservation of Activities of Daily Living (ADLs) by providing energy dense meals to 35 nursing home residents (median age ¼83 years). Schroeder et al.(55) found that oxandrolone (10 mg twice daily) produced significant increases in lean body mass as well as decreases in total body and body fat mass in elderly men (72 and 6 years).
INTERVENTION WITH NUTRITIONAL (PROTEIN/CALORIE) SUPPLEMENTS
In a systematic review, Koretz et al. (63) studied the effects of voluntary nutritional support (VNS) on mortality. Simmons et al (66) looked at the provision of supplements in a nursing home where 88% of patients received supplements one to three times a day and 12% of patients received supplements four to six times a day and found supplements on average less than once per participant per day.
PARTIAL OR TOTAL NUTRITION SUPPORT
Refeeding syndrome (characterized by hypophosphatemia and potentially fatal arrhythmias) is unknown and should be considered in patients who have had chronic poor intake prior to initiation of nutritional support. However, very little data exists regarding the efficacy of this form of nutritional support for the elderly.
RECOMMENDATIONS
Effect of megestrol acetate on oral food and fluid intake in nursing home residents: a pilot study. Study of the effect of a liquid nutritional supplement on the nutritional status of psycho-geriatric nursing home patients.
INTRODUCTION
DEFINITION OF SARCOPENIA
PROCESS OF SARCOPENIA
CLASSIFICATION AND PREVALENCE OF SARCOPENIA
INFLUENCE OF SARCOPENIA ON STRENGTH, FUNCTIONAL IMPAIRMENT, MORBIDITY, AND MORTALITY
