Nutrition Through the Lifecycle Chapter 9: Nutrition and Older Adults PDF

Chapter 9 Nutrition and Older Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Aging is a natural phenomenon – Reflects physiological...

Chapter 9 Nutrition and Older Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Aging is a natural phenomenon – Reflects physiological changes that the body undergoes over the course of a lifetime – Heterogeneous process; everyone ages differently; affected by genetics, lifestyle, and disease – Older adults need fewer calories, but nutrient needs remain the same or even increase Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Copyright © 2017 Cengage Learning. All Rights Reserved.  What Counts as Old Depends on Who Is Counting Societal and governmental definitions use various chronological ages – Dietary Reference Intakes category: 70 and older – U.S. Census Bureau uses young old, aged, and oldest old for 65 and older – World Health Organization: 60 and older – Eligibility for Medicare: 65 and older – Older American Act Nutrition Program: 60 and older – RNI? 19-29, 30-50, 51-59. 60-65, >65 Copyright © 2017 Cengage Learning. All Rights Reserved.  What Counts as Old Depends on Who Is Counting Copyright © 2017 Cengage Learning. All Rights Reserved.  Food Matters: Nutrition Contributes to Long and Healthy Life CDC suggest that longevity depends on: – 10 percent access to high-quality health care – 19 percent genetics – 20 percent environment (e.g., pollution) – 51 percent lifestyle factors Besides not smoking, a diet and exercise contribute most to longevity Copyright © 2017 Cengage Learning. All Rights Reserved.  Calorie Restriction to Increase Longevity Animal studies show that an energy-restricted diet that meets micronutrient needs can prolong healthy life – Laboratory mice and rats fed calorie-restricted diets live longer and have fewer age-associated diseases – Studies of caloric restriction (CR) in primates have shown conflicting results lemurs, monkeys, and apes, with the latter category including humans Copyright © 2017 Cengage Learning. All Rights Reserved.  A Picture of the Aging Population: Vital Statistics Life expectancy varies by state and county – Florida: 18.7% are 65 and older – Alaska: 9% older adult population Global population trends: life expectancy and life span – Span remains stable: 110–120 years Health objectives for older adults Copyright © 2017 Cengage Learning. All Rights Reserved.  A Picture of the Aging Population: Vital Statistics (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  A Picture of the Aging Population: Vital Statistics (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Theories of Aging Aging theory tries to explain physical and mental changes that accompany aging – Programmed aging purposely caused by evolved biological mechanisms Hayflick’s theory of limited cell replication Molecular Clock theory aging occurs due to the accumulation of damage and – Wear-and-tear theories deterioration to cells, tissues, and organs over time. Free-radical or oxidative stress theory Rate-of-living theory - Programmed aging theories - focus on genetic and intrinsic factors that determine lifespan - Stochastic aging theories - emphasize external damage and its accumulation as key drivers of aging Copyright © 2017 Cengage Learning. All Rights Reserved.  Physiological Changes Normal aging is associated with changes in most physiological systems – May eventually lead to functional and structural deterioration Copyright © 2017 Cengage Learning. All Rights Reserved.  Physiological Changes Xu, Weili & Wong, Glenn & Hwang, You & Larbi, Anis. (2020). The untwining of immunosenescence and aging. Seminars in Immunopathology. 42. 559-572. 10.1007/s00281-020-00824-x. Copyright © 2017 Cengage Learning. All Rights Reserved. Copyright © 2017 Cengage Learning. All Rights Reserved.  Body-Composition Changes Lean body mass (LBM) – Sum of fat-free tissues: muscle; mineral, such as in bone; and water Sarcopenia – Age-associated loss of skeletal muscle mass and function – Fat-free or lean body mass of two to three percent per decade from age 30–70 disease associated with the ageing process. Loss of muscle mass and strength, which in turn affects balance, gait and overall ability to perform tasks of daily living Copyright © 2017 Cengage Learning. All Rights Reserved.  Body-Composition Changes Copyright © 2017 Cengage Learning. All Rights Reserved.  Body Composition Changes (cont’d.) Muscles: use it or lose it – Regular physical activity helps maintain functional status Weight gain – Mean body weight increases gradually during adulthood – Weight and body mass index (BMI) peak between 50 and 59 years, then stabilize and start slowly dropping around age 70 Copyright © 2017 Cengage Learning. All Rights Reserved.  Changing Sensual Awareness: Taste and Smell Taste and smell senses decline with age – Decline in ability to identify smells varies by gender Women retain their sense of smell better – Disease and medications affect taste and smell more than aging – Can be dangerous for elders – gas smell, fire smell Copyright © 2017 Cengage Learning. All Rights Reserved.  Changing Sensual Awareness: Chewing and Swallowing Oral health depends on: – Gastrointestinal secretions (saliva) – Skeletal systems (teeth and jaw) – Mucus membrane – Muscles (tongue and jaw) – Taste buds – Olfactory nerves (smell and taste) Copyright © 2017 Cengage Learning. All Rights Reserved.  Changing Sensual Awareness: Appetite and Thirst Appetite – Hunger and satiety cues weaken with age Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted Thirst – Thirst-regulating mechanisms decrease with age Elderly people don’t seem to notice thirst as clearly as younger people do Leptin crosses the blood-brain barrier and activates its receptor the hypothalamus is the key region involved in the regulation of appetite. Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutritional Risk Factors Methods for identifying risk – Consider total saturated fats, fruits, vegetables, whole-grains, and caloric intake – Compare dietary intake to nutrient intake recommendations – Screen a population at risk and determine how environmental factors predict nutritional health Nutrition Screening Initiative’s DETERMINE checklist Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutritional Risk Factors (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutritional Risk Factors (cont’d.) Risk factors for older adults – Hunger, poverty, low food, and nutrient intake – Functional disability Functional disability has been defined as acquired difficulty in performing basic everyday tasks or more complex tasks needed for independent living – Social isolation or living alone – Urban and rural demographic areas – Depression, dementia, and dependency – Poor dentition and oral health – Diet-related acute or chronic diseases – Polypharmacy, minority, and advanced age Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Older Adults As age increases, the number of calories required decreases – MyPlate for older adults – Groups like University of Florida and Tufts have developed adaptations The “discretionary calories” excess calories to enjoy once your required nutrient needs are met. Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Older Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Older Adults (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Older Adults (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations Nutrient recommendations change as scientists learn more about effects of foods on human functions – Specific nutrient recommendations for those over 51 were established in 1997 Estimating energy needs – Decrease in physical activity and basal metabolic rate from early to late adulthood results in 70-100 fewer calories needed Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Nutrient recommendations for older adults – Energy sources Carbohydrate and fiber Protein Fats and cholesterol Recommendations for fluid Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Age-associated changes: nutrients of concern – Vitamin A: older adults more vulnerable to vitamin A toxicity and possible liver damage – Vitamin D, Calciferol: age-associated metabolic changes affect vitamin D status – Vitamin E: potent antioxidant – Vitamin K: plays a blood coagulation role – Vitamin B12: higher intakes than RDA; many are unable to use efficiently Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) – Folate, folic acid: absorption may be impaired – Iron: women’s needs decrease after menopause; most eat more iron than the RDA – Calcium: adequate intake needed for bone and tooth building and maintenance – Magnesium: needed for bone and tooth formation, nerve activity, glucose utilization, and synthesis of fat and proteins – Potassium: water balance role Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Nutrient supplements: why, when, who, what ,and how much? – Risk factors for use Lack appetite resulting from illness, loss of taste or smell, or depression Diseases or bacterial overgrowths in the gastrointestinal tract Poor diet due Avoidance of specific food groups Use of substances that affect diet, absorption, or metabolism Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Who takes supplements and why? – White, female, with more education and with higher incomes are most likely Want to take responsibility for own health What to take? – Consider safety How much to take? – Physiological doses Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Dietary supplements, functional foods, and complementary medicine – Often involve herbs, stimulants, functional foods, and nutraceuticals Nutrient recommendations: using the food label – In nutrition labeling and dietary guidance “one size does not fit all” Nutrient amounts for older adults are different than those for younger Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations (cont’d.) Cross-cultural considerations in making dietary recommendations – Cultural differences are reflected in approaches to dietary guidance – Nutritionists must communicate effectively and avoid misinterpretation in intercultural settings Copyright © 2017 Cengage Learning. All Rights Reserved.  Food Safety Recommendations Older adults are vulnerable to foodborne illness – Compromised immune systems Leading hazardous practices – Improper holding temperatures – Poor personal hygiene – Contaminated food-preparation equipment – Inadequate cooking time Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations Exercise is the true fountain of youth – Builds lean body mass – Helps to maintain balance and flexibility – Contributes to aerobic capacity and to overall fitness – Improves cognitive performance Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations (cont’d.) Physical activity guidelines – Level of fitness and chronic conditions determine frequency, intensity, and duration of exercise sessions Muscle strengthening that involves all major muscle groups on two or more days per week At least 150 minutes per week of moderate intensity aerobic activity Drink water when exercising Ensure adequate protein for muscle building Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrition and Older Adults: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction: The Importance of Nutrition Aging adults want to stay healthy until death – Increasing prevalence of chronic illnesses in old age – Having a chronic health problem does not prevent someone from having the perception of being healthy Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction: The Importance of Nutrition (cont’d.) Table 19.1: Percentage of people age 65 and older who reported selected chronic conditions, 2012–2013, by sexa Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction: The Importance of Nutrition (cont’d.) Quality of life (QOL) – Measure of life satisfaction on factors such as social contacts, economic security, and functional status Medical nutrition therapy (MNT) – Part of a comprehensive treatment plan – Can encourage health-promoting food choices once diseases have been diagnosed Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrition and Health “A sound mind in a sound body” – Whole body approach to health Lifestyle interventions have a huge potential to affect premature deaths – Prevalence of multiple chronic conditions increases with age – Good health habits contribute to delayed mortality and to higher functional status Copyright © 2017 Cengage Learning. All Rights Reserved.  Heart Disease Leading cause of death in older adults – Modifiable risk factors Prevalence – Varies by age, race, and gender Risk factors – Same as in younger adults, but less predictive value in old age ability of a particular test or indicator to accurately predict the presence or development of a disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Heart Disease (cont’d.) Nutritional remedies for cardiovascular disease – Assertive treatment can modify the course of heart disease at any age – Older adults may have more comorbid conditions – Nutrition interventions are not inherently different for older or younger adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Heart Disease (cont’d.) a balanced and nutritious diet, reducing sodium intake, limiting saturated and trans fats, and increasing intake of fruits, vegetables, whole grains, and lean proteins, are applicable to both older and younger adults. Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke Serious conditions involving reduced cerebral blood flow – Transient ischemic attacks: temporary and insufficient blood supply to the brain – Ischemia: blockage of blood vessel leading to lack of blood supply – Aneurysm: ballooning of the blood vessel wall – Thrombus: blood clot Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke (cont’d.) – Cerebral embolism: piece of a blood clot formed elsewhere that travels to the brain – Carotid artery disease: arteries that supply blood to the brain and neck become damaged – Atrial fibrillation: degeneration of heart muscle causing irregular contractions Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke (cont’d.) Prevalence – Adults 65 and older: eight percent of females and nine percent of males have had a stroke Etiology – Blocked arteries – Easily clotting blood cells – Weak heartbeat that is unable to circulate blood Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke (cont’d.) Effects of strokes – Deprivation to brain of oxygen and other nutrients that cause cell death – Loss of speech and ability to walk and eat Quick recognition and treatment results in faster treatment and recovery Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke (cont’d.) Risk factors – Age – Long-term high blood pressure – Family history – African American, Asian, and Hispanic ethnicity – Physical inactivity – Cigarette smoking – Comorbid conditions – Living in poverty – Excessive use of alcohol – Drug abuse Copyright © 2017 Cengage Learning. All Rights Reserved.  Stroke (cont’d.) Nutritional remedies – Risk can be reduced by increasing fruit and vegetable intake – Overall goal is to normalize blood pressure Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertension High blood pressure (HBP) – Risk factor for CVD and stroke – No consensus on definition Prevalence – Under 45 years of age: more common in men – Over 64 years of age: more common in women Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertension (cont’d.) Etiology – Family history and ethnic background increase risk – Salt intake is a major contributor Effects – Extra tension on blood vessels wearing them out before natural aging process – Damaged kidneys are a common sign Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertension (cont’d.) Risk factors – Drinking too much alcohol – High salt intake – Obesity – High-saturated-fat diets Nutritional remedies – Weight management – Moderation of alcohol intake – Limiting sodium intake Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertension (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes: Special Concerns for Older Adults Individuals with diabetes are at greater risk – Heart disease and its complications – Atherosclerosis – Several comorbid conditions Effects of diabetes – Greater risk Amputations, macular degeneration, visual loss, cataracts, glaucoma, and hands and feet neuropathies, decline in organ function, etc. Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes: Special Concerns for Older Adults (cont’d.) Nutritional interventions – Special concerns for older adults Carbohydrate and fiber recommendations do not change for old age People with diabetic kidney disease should not reduce dietary protein below RDA Assess dietary adequacy and supplement Monitor functional status and modify the care plan Ask about special foods and alternative and complementary therapies Sugar alcohols (e.g., xylitol) have fewer calories Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity Definition – BMI of 30.0 or higher – Extreme obesity is BMI of 40 or higher Prevalence – Body composition changes with age – Population mean body weight and BMI tend to peak around age 60 and decline after age 70 Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity (cont’d.) Etiology/effects/risk factors of obesity – Relationship between obesity and mortality is inconclusive – Lowest mortality BMI: 24.0 to 30.9 Nutritional remedies – A healthy eating program based on enough nutrient- dense calories to support gradual weight loss – Adequate physical activity to promote functional independence Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis Definition – “Porous bone” – Results from reduced bone mass Prevalence – Varies by age and ethnicity Higher in women Less common in Blacks – No symptoms Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis (cont’d.) Etiology – Inadequate bone mass – Increased bone loss Effects of osteoporosis – Falls and fractures – Shrinking height, kyphosis (hump) Risk factors – The typical osteoporosis patient is a petite, elderly white female Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis (cont’d.) Nutritional remedies – Calcium Adequate intake minimizes bone loss – Balancing nutrients for bone health Other dietary components contribute to complex relationships among hormones, muscles, and bones Some nutrients interfere with calcium metabolism – Exercise Weight-bearing exercise builds bones and muscle Copyright © 2017 Cengage Learning. All Rights Reserved.  Osteoporosis (cont’d.) Other issues impacting nutritional remedies – Hormones: direct the dynamic system of bone remodeling – Medications: serotonin reuptake inhibitors (SSRIs) are associated with bone loss Copyright © 2017 Cengage Learning. All Rights Reserved.  Oral Health Changes in oral health – Most likely to be a result of disease, medical treatment, or medications rather than aging Xerostomia (i.e., dry mouth) and periodontal disease (PD) can interfere with food tolerance PD results from bacterial infections of the gingiva – Good oral health for older adults also includes caries prevention Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Gastroesophageal reflux disease (GERD) – Definition: occurs when stomach contents flow back into the esophagus – Prevalence: 25-35 percent of the U.S. population – Etiology and effects: caused by either acid in the esophagus leading to a weakened lower esophageal sphincter (LES) or weakened sphincter Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Nutritional risk factors – Excess alcohol – Obesity – Smoking – Coffee (both regular and decaf) Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Nutritional remedies – Omit irritating foods Varies from person to person – General guidelines Low-fat diet Avoid large meals Remain upright after eating Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Stomach conditions affect nutrient availability: vitamin B12 malabsorption – Definition and etiology: two types of vitamin B12 deficiency Pernicious anemia: due to lack of the intrinsic factor being released from the stomach cell wall Atrophic gastritis: prolonged inflammation followed by the atrophied stomach mucosa secreting less acid Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Prevalence and detection for vitamin B12 malabsorption – Criteria used to assess B12 status is not consistent – Estimations of deficiency range from under one percent to 46 percent of the population Effects – Anemia and potentially to irreversible neurological damage Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases (cont’d.) Risk factors for vitamin B12 malabsorption – Gastrointestinal disorders – Genetic family patterns – Medications – Inadequate food intake Nutritional remedies – Obtain vitamin B12 from foods fortified with crystalline or synthetic vitamin B12 or from supplements containing vitamin B12 Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases – Constipation Constipation – No one definition Prevalence: depends on definition Etiology and effects – Associated with medications and diseases – May exacerbate diverticulitis Copyright © 2017 Cengage Learning. All Rights Reserved.  Gastrointestinal Diseases – Constipation (cont’d.) Risk factors – Dehydration – Medications, such as opioid and nonsteroidal anti- inflammatory drugs – Calcium and other mineral supplements and antacids – Diets low in fiber Nutritional remedies – Increase dietary fiber and fluids Copyright © 2017 Cengage Learning. All Rights Reserved.  Inflammatory Diseases: Osteoarthritis Osteoarthritis (OA) – The most common form of arthritis Etiology – Cartilage loss – Bone hypertrophy – Changes in the synovial membrane – Hardening of soft tissues and inflammation Effects of osteoarthritis – Pain, stiffness, and swelling inflammation of one or more joints Muscle hypertrophy involves an increase in size of skeletal muscle through a growth in size of its component cells Copyright © 2017 Cengage Learning. All Rights Reserved.  Inflammatory Diseases: Osteoarthritis (cont’d.) Risk factors – Obesity – Joint injuries and muscle weakness – Continuous exposure to oxidants eg H/peroxide – Possibly low vitamin D levels Nutritional remedies – Weight loss and certain exercises have a positive impact on decreasing pain and improving physical function and health Copyright © 2017 Cengage Learning. All Rights Reserved.  Inflammatory Diseases: Osteoarthritis (cont’d.) Chondroitin and glucosamine – Demonstrated significant pain reduction Other treatments – Balancing specific fatty acids and oils – Echinacea – Ginseng Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease Definition – Dreaded aspect of “getting old” Loss of independent functioning Memory impairment Mild cognitive impairment Dementia Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease (cont’d.) Dementia – Progressive cognitive decline, characterized by impaired memory, thinking, decision-making, and linguistic ability Diseases associated with dementia – Alzheimer’s disease (AD) – Parkinson’s disease – Vascular dementia – Alcoholism VD- problems with reasoning, planning, judgment, memory and other thought processes caused by brain damage from impaired blood flow to brain Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease (cont’d.) Prevalence – AD ranks fifth in leading causes of death for adults aged 65 and older in the United States – About 11 percent of people age 65 and older and 32 percent age 85 and older have AD – Numbers are expected to increase Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease (cont’d.) Etiology of cognitive impairment – Dementia can be caused by a variety of conditions resulting in traumatic physiologic changes – Nontreatable forms of dementia Associated with degenerative diseases such as Alzheimer’s, Huntington’s, and Parkinson’s Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease (cont’d.) Effects of cognitive impairment – Confusion – Anxiety – Agitation – Loss of oral muscular control – Impairment of hunger and appetite regulation – Changes in smell and taste – Dental, chewing, and swallowing problems Copyright © 2017 Cengage Learning. All Rights Reserved.  Cognitive Impairment, Dementia, and Alzheimer’s Disease (cont’d.) Nutritional interventions for cognitive impairment – Ensuring food safety – Safe use of kitchen tools and equipment – Dietary focus: nutrient-dense diet, hydration, and supplying needed energy Copyright © 2017 Cengage Learning. All Rights Reserved.  Polypharmacy: Prescription and Over- the-Counter Medications Polypharmacy: multiple medication usage – Use of three or more constitutes a risk Medication effects on physical, mental, and financial status – Multiple medication usage can affect mental, physical, and financial security Medication effects on food consumption – Medications may require dietary restriction and can interfere with appetite, digestion, metabolism, and alertness Copyright © 2017 Cengage Learning. All Rights Reserved.  Low Body Weight/Unintentional Weight Loss No consensus or universal definition for underweight in the frail elderly – Underweight: lowest percentiles Grades of thinness – Grade one: BMI 17-18.49 – Grade two: BMI 16-16.99 – Grade three: BMI