Biological Changes Associated With Aging PDF

# Biological Changes Associated with Aging - Society's view of aging and older people culture oriented toward youth - No cartoons for elderly - We do our best not to look old, many ads for wrinkle creams & products to darken gray hair - Elderly are depicted negatively - Slowed by age b...

# Biological Changes Associated with Aging - Society's view of aging and older people culture oriented toward youth - No cartoons for elderly - We do our best not to look old, many ads for wrinkle creams & products to darken gray hair - Elderly are depicted negatively - Slowed by age both physically & mentally - **Trouble walking up steps, picking up heavy grocery bags, standing up straight, or remembering recent events (SENILE)** ## Effects on the Elderly - Biological changes occur as we age - First signs are gray hair, receding hairline, wrinkles - Internal changes are more consequential: - Fat replaces lean body mass = gain weight - Bone & muscle loss occurs - Lungs lose their ability to take in air, & respiratory efficiency declines - Functions of the cardiovascular & renal systems decline - The number of brain cells declines, as does brain mass overall; - Vision and hearing decline ## Effects on the Elderly - **Cognitive and psychological changes also occur.** - Learning and memory begin declining after people reach their 70s. - Depression and other mental/emotional disorders can set in. - Dementia, (Alzheimer's disease, can occur) - Statistics - About half of people 65 or older have arthritis or high blood pressure - Almost one-fifth have coronary heart disease - More than one-fifth have diabetes - About 60% of women in their 70s have osteoporosis ## Physical Aspects of Aging - **Intrinsic aging**: from within the person - Changes caused by the normal aging process that are genetically programmed & essentially universal within a species. - **Universality** is the major criterion used to distinguish normal aging from pathologic changes associated with illness. - However, we age quite differently & at different rates, so chronologic age is often less predictive of obvious aging characteristics than other factors, such as one's genetics & lifestyle. - **Extrinsic aging**: from influences outside the person - Air pollution & excessive exposure to sunlight → extrinsic factors that may hasten the aging process that **can be eliminated or reduced.** ## Cellular & Extracellular Changes - Cellular & extracellular changes of old age = change in physical appearance & decline in function. - Measurable changes in shape & body makeup - Body's ability to maintain homeostasis becomes increasingly diminished - Organ systems cannot function at full efficiency due to cellular & tissue deficits - Decrease regeneration capacity of cells → accumulate a pigment → lipofuscin - Builds up when a cellular "garbage-disposal system" (autophagy) breaks down - Degradation of elastin & collagen → connective tissue become stiffer & less elastic. - These changes result in diminished capacity for organ function & increased vulnerability to disease & stress. ## CV System - **Heart disease** is the leading cause of death in the elderly. - **Heart failure**: leading cause of hospitalization, major cause of morbidity & mortality among the elderly - **Age-related changes**: reduced efficiency → contribute to decreased compliance of heart muscle - **Age-related changes**: increases the workload of the heart: - **Myocardial hypertrophy**: changes LV & function - **Fibrosis & stenosis of the valves**: thicker & stiffer - **Decreased pacemaker cells** - **Heart muscle & arteries lose their elasticity**: reduced stroke volume - **Accumulation of Calcium & fat deposits w/in arterial walls**: increase arterial resistance - **Veins become increasingly tortuous** ## Vascular Aging Diagram - **Young:** - Endothelium - Intima - Media - **Old:** - Endothelial cell senescence - Reduced NO-bioavailability - Activation of smooth muscle cells - Cardiomyocyte cell death - Hypertrophy - Fibrosis ## Aortic Stenosis Diagrams - **Degenerative calcific aortic stenosis**: elderly (>70 yrs) - **Rheumatic aortic stenosis**: young and middle-aged adults - **Bicuspid aortic stenosis**: young and middle-aged adults - **Unicuspid aortic stenosis**: infants and children ## Enlarged Tortuous Veins on Legs? - **Important Note**: It is difficult to differentiate b/n age-related vs disease-related changes in CV function because of the significant influence of behavioral factors ## Cross-cultural studies of CV changes - CV changes that in the past were thought to be age related do not consistently appear - Higher BP in older adults in Western societies does not occur in less-developed societies & may be a result of different lifestyle behaviors rather than normal age-related changes. ## Normal Circumstances - CV system can adapt to the normal age-related changes, & an older person is unaware of any significant decline in CV performance ## When Challenged - CV system of an older person is less efficient: - under conditions of stress & exercise - when life-sustaining activities are needed ## Physical Aspects of Aging: CV System - **Careful assessment**: - Elderly present with different Sx vs younger patients - More likely to have dyspnea or neurologic Sx associated w/ heart disease - May experience mental status changes - Report vague Sx... fatigue, nausea, & syncope - Rather, the typical substernal chest pain → older patients may report burning or sharp pain or discomfort in an area of the upper body - RN implication: Sx r/t digestion & breathing, upper extremity pain = t/c cardiac dse - Absence of chest pain in an older patient ≠ absence of heart disease - Complicating the assessment ... elderly patients have >1 underlying disease ## Levine Sign - Definition: clenched fist of either hand brought to the chest wall with the thumb aspect of the fist positioned towards the chest or superiorly ## Palm Sign - Definition: extended palm of either hand touching the chest. ## Arm Sign - Definition: deliberately touching the left arm with the right hand. ## Pointing Sign - Definition: pointing to a single specific point w/ 1 or 2 fingers ## Levine, Palm, & Arm Signs - Prospectively specified as indicative of chest pain or discomfort due to cardiac ischemia. ## Pointing Sign - Prospectively specified as indicative of nonischemic chest pain. ## Physical Aspects of Aging: CV System - **Hypotension** - Risk of orthostatic & postprandial hypotension increases significantly after 75 years of age (Miller, 2009) - RN implication: patient experiencing hypotension should be counseled to: - Rise slowly (from a lying, to a sitting, to a standing position) - Avoid straining when having a bowel movement - Consider having 5-6 small meals each day, rather than three, to minimize the hypotension that can occur after a large meal - Avoid extremes in temperature (hot showers & whirlpool baths) ## Blood Pressure Categories - **Normal**: Less than 120 & Less than 80 - **Elevated**: 120-129 & Less than 80 - **High Blood Pressure (Hypertension) Stage 1**: 130-139 & 80-89 - **High Blood Pressure (Hypertension) Stage 2**: 140 or higher & 90 or higher - **Hypertensive Crisis**: Higher than 180 or higher than 120, see your doctor immediately ## Physical Aspects of Aging: CV System - **Clinical Implications**: - **Orthostatic hypotension** is an exam finding, not a disease - Decrease in SBP of 20 mm Hg or a drop of 10 mm Hg in DBP with standing - A concurrent increase in HR may be dampened in older adults generally, & particularly those on beta-blocker therapy. - The patient may or may not have any symptoms - Observed postural instability - History of falls with position change - Subjective report of feeling "dizzy," lightheaded, weak, nauseated - The presence or absence of symptoms should be noted - Etiologies include medication side-effects, neurogenic and non-neurogenic etiologies - Treatment is aimed at the underlying etiology - If the pathology cannot be corrected, or the offending drug stopped or dose reduced, cautious and carefully justified drug treatments can be considered in symptomatic patients ## Physical Aspects of Aging: CV System - **Blood Pressure Regulation**: - Both systolic and diastolic blood pressures increase with age. - Arterial compliance is reduced due to age-related changes such as fragmentation of elastin, increased collagen, subintimal calcification and thickening, and smooth muscle cell proliferation. - Roughly 70% of hypertensive adults > age 60 have isolated systolic hypertension (ISH). - ISH is most likely due to decreased arterial compliance. - Compliance is also worsened by disease such as atherosclerosis. - ISH - and the resulting widenend pulse pressure - is a greater risk factor for myocardial infarction, heart failure, and stroke, than diastolic blood pressure. # Cardiovascular Changes with Age | Cardiovascular Changes with Age | Increase | Decrease | No Effect | |------------------------------------|----------|----------|-----------| | Heart Anatomy | X | X | | | Left Ventricle muscle | X| X (by 90%) | | | Sinus node cells (functional cells) | X| | | Lipofuscin | X| | | Calcium deposition in valve | X| | | Electrophysiology | X| | | Intrinsic sinus rate | X| | | PR interval | X| | | Supraventricular and ventricular ectopy | X| | | Mechanical Function | | X| | | Ejection Fraction | | X| X | | Resting Cardiac Output | | X| X | | Adrenergic Responses | | | | | Chronotropic | | X| | | Inotropic | | X| | | Recovery time after exertion | | X| | # Physical Aspects of Aging: Respiratory System - One system that seems to be the most able to compensate for the functional changes of aging: - In general, healthy, nonsmoking, older adults show very little decline in respiratory function; however, there are substantial individual variations. - Age-related changes that occur are subtle & gradual, & healthy older adults are able to compensate - Calcification& weakening of the muscles of the chest wall → diminished respiratory efficiency: - Reduced maximal inspiratory & expiratory force - Lung mass decreases, & residual volume increases # Physical Aspects of Aging: Respiratory System | Changes: singly of in combination | Implications | | :------------------------------------------ | :---------------------------------------- | | Stiffening of chest wall, calcification of costal cartilages, kyphosis (↓ size of intervertebral space) | Reduce chest wall compliance → ↓ efficiency of ventilator exchange | | ↓ respiratory muscle strength | ↑ work of breathing, increase diaphragm & abdominal muscle dependency | | ↓ elastin in alveolar wall | ↓ inspiratory & expiratory pressure | | ↓distal bronchiole diameter, rearrangement in collagen | ↓ alveolar elasticity recoil | | ↑ residual volume | ↑ closing volume (RV) | | Diminished ciliary & macrophage activity, drier mucus membranes | ↓ vital capacity, tidal volume <br> ↓cough & airway ciliary action → reduced mucus/foreign matter clearance → increased risk of infection & bronchospasm w/ airway obstruction | | ↓, cough reflex | ↑ risk for aspiration | # Normal Respiratory System Changes Related to Aging - **Anatomical changes of the spine and chest wall structures** - As we age our bones become thinner and weaker. This can result in structural changes to the rib cage and spine such as kyphosis and scoliosis.¹ - These structural changes can reduce the functional space needed for the lungs to properly expand and contract, causing breathing to become more difficult and labored. ## Physical Aspects of Aging: Respiratory System - Stress (ex: illness) may increase the demand for 02 & affect the overall function of other systems - Respiratory dses manifest more subtly in older adults than in younger adults & do not necessarily follow the typical pattern of cough, chills, & fever. - Older adults may exhibit: - Headache - Weakness - Lethargy - Anorexia - Dehydration - Mental status changes - Smoking: most significant RF for respiratory & other dses - RN Implication: major focus of health promotion activities should be on smoking cessation & avoidance of environmental smoke ## Physical Aspects of Aging: Respiratory System - **Pneumonia & influenza**: 5th leading cause of death ... people older than 65 - Education to promote the use of recommended vaccines is an essential nursing intervention - Pneumococcal vaccine prevents 85% to 90% of all cases of pneumonia & it is effective in preventing 75% of cases in people older than 65 years of age - Influenza vaccination is less effective in preventing influenza in the elderly than in the younger population, but it reduces influenza-related deaths, hospitalizations, & other complications - RN implications: Activities that help elderly maintain adequate respiratory function: - Regular exercise, appropriate fluid intake, pneumococcal vaccination, yearly influenza immunizations, avoidance of people who are ill - Hospitalized older adults should be frequently reminded to cough & take deep breaths (postoperatively), → (+) decreased lung capacity & decreased cough efficiency = predispose to atelectasis & respiratory infections # Affects of Respiratory Changes on The Elderly - **Poor Sleep Quality**: Respiratory changes with aging can cause frequent coughing and SOB, disrupting the ability to have uninterrupted sleep and rest - **Effects on Support System**: Frequent visits to medical providers, chronic coughing, the use of durable medical equipment and portable oxygen tanks, and monitoring medications among other elements are all aspects of patient care that can place hardship upon family and social support systems # Normal Respiratory System Changes Related to Aging - **Decreased Immune System**: Eventually with aging most people experience a decrease in their body's immune response - This decrease or weakening of the immune system puts the elderly at increased risk of contracting respiratory infections and diseases³ ## Physical Aspects of Aging: Skin - **Skin functions**: protection, temperature regulation, sensation, & excretion - **Aging**: changes that affect the function & appearance of the skin. - **↓ of epidermal proliferation, & the dermis becomes thinner**: - Elastic fibers are reduced in number, & collagen becomes stiffer - Subcutaneous fat diminishes particularly in the extremities, but gradually increases in other areas abdomen (men) & thighs (women) → overall increase in body fat in older people - ↓ numbers of capillaries in the skin → diminished blood supply - **Loss of resiliency & wrinkling & sagging of the skin.** - Skin becomes drier & more susceptible to burns, injury, & infection. - Hair pigmentation may change & balding may occur (strong genetic influence) - Reduce tolerance to temperature extremes & sun exposure ## Lifestyle Practices - Lifestyle practices are likely to have a large impact on skin changes. - **Strategies to promote healthy skin function**: - Not smoking, avoiding exposure to the sun, using a sun protection factor (SPF) of 15 or higher, using emollient skin cream containing petrolatum or mineral oil, avoiding hot soaks in the bathtub, & maintaining optimal nutrition & hydration. - **Older adults should be encouraged to have any changes in the skin examined, because early detection and treatment of precancerous or cancerous lesions are essential for the best outcome.** ## Changes in Aging Skin - **Epidermis**: cell production, melanocytes, Langerhans cells density, #cells, blood vessels - **Dermis**: sweat, sebaceous glands, hair follicles ## Functional Consequences - Wound healing, immunity, tanning, elasticity, clearance of foreign substances, thickness - ↑ blisters, infection, roughness, dryness, cancer, fragility, insensitivity ## Changes in Intrinsically Aged Skin - **Thinning of epidermis by 10% to 50%**: Increased vulnerability, fragility - Atrophy of the stratum spinosum - Increased heterogeneity in size of basal cells - Decreased mitotic activity, increased duration of cell cycle and migration time - Slow replacement of lipids - **Increased vulnerability, fragility**: - Flattening of the dermoepidermal junction - Reduced thickness of dermis - **Decreased desquamation, delayed wound healing**: - Degeneration of elastic fibers - Increased coarseness of collagen - **Disturbed barrier function**: - Atrophy of hair bulbs/ decline in hair growth - Decrease in pain sensation - Decreased sweat and sebum - Loss of subcutaneous adipose tissue - Increased fragility of skin - **Decrease and heterogeneity of melanocytes**: - Graying of hair, guttate amelanosis, lentigines - **Decrease of Langerhans cells**: - Diminished cutaneous immune function - **Reduction of dermis thickness, decrease of fibroblasts**: - Reduced strength and resiliency - **Reduction and disintegration of collagen and elastic fibers, deposition of exogenous substances (eg, amyloid P)**: - Reduced strength and resiliency - Sensitization to deformational forces, fine wrinkle formation - **Reduction of cutaneous microvasculature**: - Reduction of cutaneous vascular responsiveness, disturbed thermoregulation and supply with nutrients - **Decrease of skin appendages and their function (eg. sebaceous glands, sweat glands, apocrine glands)**: - Decreased lipid and sweat production, disturbed reepithelization of deep cutaneous wounds - **Reduction of nerve endings**: - Reduced insulation and energy production - Disturbed sensory function ## Physical Aspects of Aging: Skin Diagrams - **Younger:** Epidermis, subcutaneous fat layer - **Older:** Epidermis, subcutaneous fat layer ## Not on back of hand or forearm for an elder client - **Forehead, collarbone, or sternum (center of chest)** ## Solar Elastosis: UV Radiation - Leathery skin/ Roughness - Inelastic - Deep wrinkles - Yellowish - Depigmentation/hyperpigmentation - **Photoaging superimposed on normal aging** ## Physical Aspects of Aging: Reproductive System - Sexuality: no longer considered pertinent only to the young... research about sexuality among the elderly women... not been extensive - **Ovarian production of estrogen & progesterone ceases with menopause**: - Changes occurring in the female reproductive system include: - Thinning of the vaginal wall, along with a shortening of the vagina & a loss of elasticity - Decreased vaginal secretions = vaginal dryness, itching, & decreased acidity - Involution (atrophy) of the uterus & ovaries - Decreased pubococcygeal muscle tone = relaxed vagina & perineum - Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding & painful intercourse. ## Physical Aspects of Aging: Reproductive System - **In older men**: - Testes become less firm but men up to 90 years of age continue to produce viable sperm - About 50 years of age, production of testosterone begins to diminish - Decreased libido & erectile dysfunction may develop but are more likely to be associated with factors other than age-related changes - **Risk factors**: - Cardiovascular disease - Neurologic disorders - Diabetes - Respiratory disease - Pain - Medications: vasodilators, antihypertensive agents, tricyclic antidepressants ## Physical Aspects of Aging : Reproductive System - Both older men and women: - May take longer to become sexually aroused - Longer to complete intercourse - Longer before sexual arousal can occur again - Although a less intense response to sexual stimulation and a decline in sexual activity occurs with increasing age, sexual desire does not disappear. - **Men**: decline in sexual function r/t health conditions or interference from medications. - **Women**: lose of partner; absence of a partner ... primary factor causing lack of sexual activity - Many are unaware of the causes of decreased libido or erectile dysfunction & often reluctant to discuss decreased sexual function → methods of improving the quality of sexual interactions, but the assessment & communication require sensitivity & expert knowledge in the field of sexual dysfunction. ## Physical Aspects of Aging: Genitourinary System - Function adequately in older people... a decrease in kidney mass, primarily because of a loss of nephrons. - Loss of nephrons does not typically become significant until about 90 years of age - 1/3 of elderly show no decrease in renal function - **Changes in renal function may be due to a combination of aging & pathologic conditions (HTN)** - **Most common changes**: - A decreased filtration rate - Diminished tubular function with less efficiency in resorbing & concentrating the urine - Slower restoration of acid-base balance in response to stress ## Changes in the Body: Urinary System - Reduction renal blood flow & filtration - Reduced bladder capacity - Urinary frequency, urgency, & nocturia common - UTl = confusion - Incontinence not a normal part of aging ## Physical Aspects of Aging: Genitourinary System - The urinary system maintains fluid and electrolyte homeostasis remarkably well unless it is challenged. - Between the ages of 30 and 80 years, renal mass decreases by 25% to 30%, and fat and fibrosis, in part, replace the functional parenchyma. - 30% to 50% of glomeruli are destroyed by age 70 (mostly in the renal cortex) - The basement membrane is thickened - Tubule size and number are decreased - Vascular changes resulting in blood shunting from afferent to efferent arterioles - Renal blood flow decreases 10% per decade - Significant linear decreases in creatinine clearance with age (roughly 7.5 to 10 mL/minute per decade) ## Physical Aspects of Aging: Genitourinary System - Older adults taking medications may experience serious consequences due to decline in renal function because of impaired absorption, decreased ability to maintain fluid & electrolyte balance, and decreased ability to concentrate urine. - Certain genitourinary disorders are more common in older adults than in the general population: - **Urinary incontinence**: 1 in 10 older adults = suffer from urinary incontinence (women > men) ...not a normal consequence of aging - Embarrassing... evaluated... in many cases it is reversible or can be treated - **BPH (enlarged prostate gland)**... common in older men... gradual increase in urine retention and overflow incontinence. - **UTI**: due to changes in the urinary tract - Adequate consumption of fluids is an important nursing intervention that reduces the risk of bladder infections & also helps decrease urinary incontinence ## Physical Aspects of Aging: Genitourinary System Diagrams - **Younger Reproductive System**: Ovary, Uterus, Cervix, Vagina - **Older Reproductive System**: Ovary, Uterus, Cervix, Vagina - **Young Male Reproductive System**: Bladder, Prostate, Penis, Testicle - **Older Male Reproductive System**: Bladder, Prostate (enlarged), Penis, Testicular tissue mass decreased ## Physical Aspects of Aging: Genitourinary System - Older people are at higher risk of volume depletion: - Basal levels of ADH are somewhat increased with age, yet basal serum sodium and basal osmolality are unchanged - Reserves of body water are decreased because water constitutes a decreasing percentage of body mass with increasing age - CNS regulation of body fluids status is altered with aging. The older person has a decreased thirst drive, which may be mediated by decreased endogenous opioids (endorphins) or decreased responsiveness to them - Maximum urine osmolality decreases & achievement of the maximally concentrated urine is delayed; thus, the volume of water excreted in the urine during water deprivation is higher - The number of very long nephrons that maximally concentrate urine decreases, and the interstitium around the loops of these long nephrons has a somewhat lower tonicity, which contributes to the propensity of the older person to develop dehydration - It is more difficult for older persons to excrete a fluid load, which also predisposes them to hyponatremia or even CHF ## Physical Aspects of Aging: Gastrointestinal System - **Digestion of food**: less influenced by age-related changes: - Older people ... may have difficulty purchasing, preparing, & enjoying their meals - Decrease in strength of muscles of mastication, taste & thirst & perception - Difficulties with chewing & swallowing: generally associated w/ dse - **A modest slowing of gastric motility**: delayed emptying of stomach contents & early satiety. - **Atrophy of protective mucosa** ## Physical Aspects of Aging: Gastrointestinal System - **Risk of malabsorption, fluid & electrolyte imbalances, poor nutrition** - **Increased risk of GERD, maldigestion** - **Increased risk of NSAID-induced ulcers** ## Physical Aspects of Aging: Gastrointestinal System - **Liver size & blood flow are reduced**: hepatic reserve decrease - Decrease cytochrome P450 oxidation - Decrease pancreatic mass - Weakening of muscular layer - Decrease gut-associated lymphoid tissue ## Physical Aspects of Aging: Gastrointestinal System - **Decreased metabolism of drugs.** - Decrease drug clearance (prolonged half life of drug) - Risk of adverse drug reactions - Dyspepsia - Diverticulum, diverticulosis - Infection, malignany ## Physical Aspects of Aging: Gastrointestinal System Diagrams - **Small intestine:** Nutrition absorption (colon) decreases (e.g., vitamin D, calcium), motility remains intact - **Large intestine**: Constipation and fecal incontinence is common - **Liver:** Altered drug metabolism, risk of drug interactions - **Gallbladder/Biliary Tree:** Cholelithiasis - **Small bowel:** Altered drug metabolism, mucosal immunity, IgA plasma cell migration - **Anal Sphincter**: Internal sphincter muscle thickness decreased, internal sphincter pressure decreased, external sphincter connective tissue decreased - **Pancreas:** Exocrine secretion (colon), Delayed transit, mucosal proliferation, ischemic colitis, colitis (infections, irritable bowel syndrome), angio-dysplasia, polyps, carcinoma, diverticula, hemorrhoids ## Physical Aspects of Aging: Gastrointestinal System - **Difficulty in swallowing/ dysphagia**, increases with age & is a major health care problem in elderly patients. - **Normal aging alters some aspects of the swallowing function** - **Interruption or dysfunction of neural pathways**: a significant risk factor for development of pneumonia → can be life-threatening - **May also result from dysfunction of the striated & smooth muscles of the GIT in patients with Parkinson's disease & in patients with disorders such as multiple sclerosis, poliomyelitis, amyotrophic lateral sclerosis (ie, Lou Gehrig's disease)** → Aspiration of food or fluid is the most serious complication & can occur in the absence of coughing or choking ## Physical Aspects of Aging: Gastrointestinal System - **Constipation**: common pathologic condition that affects elderly people: - Less effective colonic contraction & impaired sensation to defecate - Mild constipation: abdominal discomfort & flatulence - Severe: leads to fecal impaction that contributes to diarrhea around the impaction, fecal incontinence, & obstruction. - **Predisposing factors**: - Lack of dietary bulk - Prolonged use of laxatives, use of some medications - Inactivity - Insufficient fluid intake, & excessive dietary fat - Ignoring the urge to defecate may also be a contributing factor ## Physical Aspects of Aging: Gastrointestinal System Diagram - **Oesophagus**: Oesophageal peristalsis decreases, Oesophageal sphincters lose tension - **Nose and mouth**: Reduction in sense of smell and taste, Gum recession, Difficulty in swallowing - **Liver**: Shrinkage of liver occurs with loss of hepatocytes, Reduced ability to detoxify substances including drugs, Changes in bile constitution - **Stomach**: Reduced elasticity of stomach wall, Decreased bicarbonate production and gastromucosal protection, Delayed gastric emptying - **Pancreas**: Decreased secretion of pancreatic protease and lipase - **Small intestine:** Compromised gut-associated lymphoid tissue capacity ## Physical Aspects of Aging : Gastrointestinal System - **Practices that promote gastrointestinal health include**: - Regular tooth brushing & flossing - Receiving regular dental care - Eating small, frequent meals - Avoiding heavy activity after eating - Eating a high-fiber, low-fat diet - Drinking enough fluids - Avoiding the use of laxatives & antacids - **Understanding that there is a direct correlation b/n loss of smell & taste perception & food intake helps caregivers intervene to maintain elderly patients' nutritional health** ## Physical Aspects of Aging : Nutritional Health - **Increasing age alters nutrient requirements:** - ↓ physical activity & slower metabolic rate reduce the number of calories needed by older adults to maintain an ideal weight. - Elderly require fewer calories & a more nutrient-rich diet in response to alterations in body mass & a more sedentary lifestyle. - **Recommendation**: reducing fat intake while consuming sufficient protein, vitamins, minerals, & dietary fiber for health & disease prevention. - Encouraging a varied diet that is low in sodium & saturated fats & high in vegetables, fruits, & fish ## Physiological Changes Associated with Aging That Affect Nutrition Status | System Affected | Physiological Change | | ------------ | ------------ | | Body Composition | Body fat increases while LBM decreases. Loss of LBM can affect ability to perform ADLs. | | Body Structure | A decline in bone density can cause fractures and result in a period of decreased physical activity and social interaction.| | Enzymes | Production of some pancreatic enzymes declines, which could affect digestion and absorption. | | GI Tract | Older adults have an increased risk of GERD, which can affect swallowing and foods consumed. Abnormal bacterial overgrowth might impair digestion and absorption. Liquids seem to empty from the stomach more slowly with age. There may be decreased digestion and absorption of protein and decreased absorption of calcium and vitamin D. Colon dysmobility may result in constipation. | ## Physical Aspects of Aging : Nutritional Health - **Age-related changes that alter pleasure in eating include a decrease in taste & smell**: - Likely to maintain a taste for sweetness but require more sugar to achieve a sweet flavor - Lose the ability to differentiate sour, salty, and bitter tastes. - Apathy, immobility, depression, loneliness, poverty, inadequate knowledge, & poor oral health also contribute to suboptimal nutrient intake. - **Undernutrition may also be a problem for older adults**: - 40% to 60% of hospitalized & 40% to 85% of nursing home patients are malnourished. - Recent unintentional weight loss may be a result of an illness or other factors, such as depression, that may have serious consequences & affect a person's ability to maintain health & fight illness. ## Physical Aspects of Aging : Nutritional Health - Education regarding healthy foods versus foods with inadequate nutrients is helpful. - No more than 30% of dietary calories should be consumed as fat. - Protein intake may need to be increased in later adulthood to maintain adequate nitrogen equilibrium. - Carbohydrates, a major source of energy, should supply 55% to 60% of the daily calories. - Simple sugars should be avoided, & complex carbohydrates should be encouraged. - Potatoes, wholegrains, brown rice, & fruit are sources of minerals, vitamins, & fiber & should be encouraged. - Drinking 8 to 10 eight-ounce glasses of water per day is recommended unless contraindicated - A multivitamin each day helps meet daily nutritional needs ## Physical Aspects of Aging : Nutritional Health - Calorie needs decrease as you get older: - **Calories** - Amnt of calories needed depends on physical activity - Sedentary lifestyle: limited to the activities of daily living... walk briskly >3 miles a day = active - **Protein** - Men: 56 grams of protein a day from meat, chicken, fish, beans & dairy products - Women: 46 grams of protein - **Fiber** - M: 28 grams of fiber daily ... variety of fruit, vegetables & whole grains - W: 22 grams of fiber a day. ## Physical Aspects of Aging : Nutritional Health - **Vitamins and Minerals** - Some micronutrient needs increase as you age - Adults older than 50-70: daily calcium intake to 1200 g, & 600-600 IU of vitamin D to maintain bone health from fish, egg yolks, fortified foods & supplements every day. - Amount of stomach acid production decreases with age or certain medications → risk for vitamin B-12 deficiency & symptoms like depression & fatigue - Supplements & fortified foods, such as orange juice, milk & yogurt are usually well-absorbed by the body. - Amount of vitamin B-6 needed increases w/ age - Men: 1.7 milligrams daily if you are male - Women: 1.5 milligrams ....Eat chicken, fish, potatoes & fruit ## Physical Aspects of Aging : Nutritional Health - Caloric needs: calories per kilogram (kcals/kg) of body weight per day - Typical standards: - 25 to 30 kcals/kg/day for normal, healthy individuals - 30 to 35 kcal/kg/day for patients with moderate illness, injury, or malnutrition - 35 to 40 kcals/kg/day for patients with critical illness or injury - Ex: patient weighing 125 lb, w/moderate illness - 1st: convert 125 pounds to kilograms (125lbs/ 2.2 = 56.8kg) - 2nd: compute caloric reqmt: 1,704 kcals (56.8 x 30) to 1,988 kcals (56.8 x 35) | Age | Carbohydrate | Protein | Fat | |-----|:-------------:|:--------:|:-----:| | 1-3 Years | 45-65% | 5-20% | 30-40% | | 4-18 Years | 45-65% | 10-30% | 25-35% | | Adults (19 years and older) | 45-65% | 10-35% | 20-35% | ## Physical Aspects of Aging : Nutritional Health - Carbohydrates: major source of energy ... stored in muscles & liver for later use - High carb: fruits, grains (rice, oats, barley, etc) & roots (potatoes, yams, carrots, etc). - Carbohydrates provide 4 Calories of energy per gram. - Proteins: grow tissue & muscle, repair organs & to create hormones & enzymes - Proteins are also used for energy when carbohydrates are unavailable - High levels of protein: poultry, fish, beans, diary, nuts & legumes - Proteins provide 4 Calories of energy per gram. - Fats: to absorb vitamins - High percentage of fat: cooking oils, butter, nuts & cheese - Fats provide 9 Calories of energy per gram. ## Protein Needs - The American Dietetic Association (ADA) recommends daily protein intake for healthy adults as .8-1.0 g of protein/kg body weight. - Example: Jay weighs 168 pounds. How much protein does he need per day? - (168)/(2.2g/kg) = 76.4 kg - 76.4 kg (.8 g/kg) = 61 g - 76.4 kg (1.0 g/kg) = 76 g 61-76 grams of protein per day ## Fat Needs - Fat intake should equal 30% of your total days calories. - Example: Jackie consumes 1600 calories per day. How many calories and grams of fat should she be consuming each day? 1 gram of fat = 9 calories - 1600 calories (.30) = 480 calories from fat - (480 calories)/(9 calories/g) = 53 grams of fat per day ## Carbohydrate Needs - The USDA recommends that 45 to 65 percent of your total daily calories come from carbohydrates. - For example: To consume 60% of total daily calories from carbohydrate sources: - A moderately active 18-year old male who requires 2800 calories a day would need to consume 1680 calories from carbohydrate sources. (2800 *.6) - A moderately active 18-year old female who requires 2000 calories a day would need to consume 1200 calories from carbohydrate sources. - Fruits, vegetables, grains, and milk are carbohydrate sources. ## Physical Aspects of Aging : Musculoskeletal System - Intact musculoskeletal & neurologic systems are essential for the maintenance of safe mobility, performance of ADLs (basic personal care activities), & instrumental activities of daily living (IADLs) (activities that are essential for independent living) → remain safe & live independently in the community - **Age-related changes that affect mobility**: - Alterations in bone remodeling, leading to decreased bone