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Chpt 19 Nutrition Chapter Notes.doc

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University of Guelph
NUTR 2050
Jess Haines

CHAPTER 19: Nutrition and Older Adults Heart Disease: Coronary Heart Disease, Cerebrovascular Disease, Peripheral Artery Disease • Cardiovascular disease (CVD) is the leading cause of death in older adults, but is potentially reversible by adopting a healthy lifestyle. Prevalence • Heart disease varies by race and gender • CVD prev. raises with age • The American Heart Association statistic o Age 60-79; men 73.3%, women 72.6% o Age 80; men 79.3%, women 85. 9% Risk Factors • Risk factors in old age remain the same as in younger adults, except factors have less predictive value • Of adults aged 65+, 86% had one or more risk factors • These include; o Hypertension o Elevated LDL cholesterol o Diabetes mellitus • Race associated, older African Americans nearly 3X more likely for risk than average pop Nutritional Remedies for Cardiovascular Disease • Day to day context for adopting therapeutic lifestyle changes is likely quite different for elderly • Nutritional habits alter progression only if individual adheres to eating plan • Intensive LDL-lowering therapy is used for older adults with established CVD • Consumption of fish, fish oils and omega-3 polyunsaturated fatty acids for cardio protection. Associated with significant reduction in deaths from cardiac causes. Stroke Definition CHAPTER 19: Nutrition and Older Adults • Stroke and TIA’s (transient ischemic attack) are serious conditions involving reduced cerebral blood flow (brain ischemia) • TIA’s brief episode of neurological dysfunction; sudden confusion, trouble speaking/understanding, sudden dizziness, trouble walking. Often precede a stroke. • During ischemic stroke; obstruction clogs a blood vessel and prevents oxygen and other nutrients from reaching parts of the brain • Hemorrhagic stroke occurs when a weakened blood vessel breaks, such as rupture of an aneurysm. Leaking blood accumulates, putting pressure on the surrounding tissue and eventually destroys brain cells. Prevalence • Adults 65+, 8% female, 10% males have had stroke. • 6 months after stroke 36% females, 16% males were disabled. • At younger ages, incidents higher for men. At age 85 incidents greater in women. th • Individuals with first stroke at age 70+, approximately 1/4 (22-27%) die within a year Etiology • Factors that lead to stroke; blocked arteries, easily clotting blood cells, and weak heartbeats that are unable to circulate blood through body (pools form and clot). Hypertension contributes b/c force of blood may break weak vessels. Effects of Stroke • Deprive brain of needed oxygen/nutrients causing brain/nerve cells to die • Leads to loss of function for parts of the body (ex. either left or right side, unable to speak walk or swallow. Nutrition also likely to be affected) • Nutrition likely affected • Although dead brain cells cant be replaced, new nerve pathways in grey matter can develop Risk Factors • Long term high blood pressure (systolic/diastolic) • Family history • African American, Asian, Hispanic ethnicity • Physical inactivity • Cigarette smoking doubles risk • Comorbid conditions; diabetes mellitus, carotid artery disease, atrial fibrillation, CHAPTER 19: Nutrition and Older Adults transient ischemic attacks (TIAs), sickle cell anemia and depression. • Living in poverty • Excessive use of alcohol (more than 70g/day=2.5x more likely); use of cocaine and illicit intravenous drugs Nutritional Remedies • Focus of dietary advice is to normalize blood pressure. Medical nutritional therapy used to promote rehabilitation Hypertension Definition • High blood pressure (HBP) defined as “untreated systolic pressure of 140mm Hg or higher, or diastolic of 90mm Hg or higher, or taking antihypertensive meds”. • Prehypertension increases risk of CVD (systolic 120-139mm Hg/ diastolic 80-89mm Hg). • Puts more force on potential vessel blockages and increases chances of blood vessel breakage. Prevalence • Only chronic condition that has higher prevalence in older adults than arthritis. Western societies prevalence rises with age. • Before 45, men more likely. Evens out again and then woman more likely at age 64+ • Death rates much higher for blacks than whites. Hispanics similar or lower than whites. • Uncontrolled hypertension is major public health challenge: prevalence high, consequences serious but manageable. However only 34% of individuals with it, have it under control. Etiology • Family history/ ethnic background increases risk. • Salt intake can contribute, 20% of hypertension in Western societies is attributed to salt intake Effects of Hypertension • Prolonged high bp puts extra pressure on blood vessels and organs in the body, wearing them out before natural aging process. Damaged kidneys are common sign Risk Factors • Nutritional; drinking alcohol to excess, high-saturated-fat diets leading to dyslipidemia and atherosclerosis, lifestyles resulting in overweight and obesity and diet low in calcium CHAPTER 19: Nutrition and Older Adults Nutritional Remedies • Weight management, moderation of alch, limiting sodium while maintaining adequate potassium magnesium and calcium. • Dietary Approaches to Stop Hypertension (DASH diet) is effective in decreasing bp and risk of stroke in adults under 65over age 50 participants benefit more than under 50. Benefits of DASH; o Other non drug interventions; using weight reduction and/or reducing sodium o Greatest overall reduction was from reducing sodium to 1500 mg/day o Choosing foods with less processing can help limit sodium intake (approx.. 75% of dietary sodium attributed to manufacturing/preservation processes o DASH combined with exercise allowed patients significant weight loss maintained for at least 2 years o Significant diastolic blood pressure reduction also seen • Dietary/lifestyle changes that address hypertension also likely to have beneficial effect on atherosclerosis. Diabetes Special Concerns for Older Adults • Nearly 1 in 5 adults aged 65+ report have diabetes (primarily type 2) • Native American, Latino, African American, Asian American and Pacific Islander adults face higher risks than Caucasians. • Greater risk for heart disease, also risk factor for atherosclerosis • Diagnosis criteria and management are same for older as younger, using individualized treatment plans that assessment of functional status, cognitive capacities and motivation. • Hyperglycemia and risk of complications ‘should be avoided in all patients” • For older adults, diabetes may exacerbate declining organ functions=less resilient. Effects of Diabetes • Leads to tenfold greater risk of amputations, muscular degeneration, visual loss, cataracts, glaucoma and neuropathies (nerve damage, pain or tingling). • Alcohol and drugs such as aspirin contribute to drops in blood sugar • Hypoglycemia in older adults may lead to weakness, confusion and possible falls and fractures. 22-31% of older adults with diabetes reported falling within 12 month span. Increase in falls are attributed to reduced peripheral nerve function, renal function and vision; all are diabetes complications. CHAPTER 19: Nutrition and Older Adults Nutritional Interventions • Diabetes self-management training works alongside medical nutrition therapy to achieve glycemic control. • Tight control of blood sugar can lead to better quality of life for older adults with diabetes and can result in fewer long-term complications. • Special concerns include; o Where nephropathy (chronic kidney disease) is present, limit protein intake o Assess dietary adequacy and supplement with vitamins and minerals to meet age appropriate DRI o Monitor functional status, modify care plan as appropriate. Ex. carb counting harder to achieve because of; altered senses, decreased mobility, trouble buying, etc. Providers must attend to psychological and physical needs of aging individual. o Ask about special foods/alternative and complimentary therapies. Clarify confusing food terms so they better understand what they are trying to achieve o Sugar alcohols in candies/gums are sweeter than sucrose/fructose and provide little energy. High doses lead to diarrhea. o Older adults with constipation or diarrhea may need potential benefits of fiber for glycemic control. Moderate carb increases have been well tolerated with diabetes. High fiber intake significantly associated with reduced inflammation. Eating at least 20g/day of fiber has been associated with less hepatic fat, lower levels in markers of inflammation and decreased risk of developing diabetes. Obesity Definition • A BMI of 30 or higher, extreme obesity BMI of 40 or higher • In older adults, BMI alone is not adequate indicator of excess body fat associated with morbidity and mortality Prevalence • Population mean body weight and BMI tend to peak at 60. As people pass 70, obesity rates tend to decline. • However, obesity rates in older adults has climbed along with the rest of the country. Etiology, Effects and Risk Factors of Obesity th • Decreased functional status may inter with fitness. Approx. 1/4 adults over 75 found it difficult to walk a ¼ mile or climb 10 steps without resting. • Need fitness programs designed for these people with limitations CHAPTER 19: Nutrition and Older Adults • Cardiorespiratory fitness contributes to longevity • Healthy BMI for older adults 18.5-30= lowest mortality. Death associated with 35 and above. Although not an entirely good measure of fatness (does not assess fat or lack of fat). Sometimes higher BMI can mean lower morbidity. • Measuring excess body fat is better. Study found that abdominal obesity is better measure of premature death than BMI • Markers of waist circumference, waist-to-stature ratios and waist-to-hip ratio predicted stroke cases better than BMI • Sometimes extra weight during illness (hospitalizations) seem to be protective. American Dietetic Association suggest BMI of 19-27 Nutritional Remedies • 5 food clusters have been made in order to explain relationships of gradual weight gain experienced with aging. o Healthy (high in fruits, veg, whole grains and reduced-fat dairy, as well as low in red/processed meats, fast food and soda). o White bread o Alcohol o Sweets o Meat and Potatoes • Meat and Potatoes cluster had highest increase of BMI • Annual increase in waist circumference highest in white bread (compared to healthy pattern) • Maintaining lean mass is important- DASH ensures adequate nutrient intake • Sarcopenic Obesity- low lean body mass combined with excessive fat stores. (may complicate weight loss in older adults) • Healthy eating program based on; o Sufficient nutrient-dense calories o Balance nutrition priorities; sodium, protein and saturated fat restriction. o Physical activity promotes functional independence (only way to prevent muscle loss) Osteoporosis Definition • Means “porous bone”. Reduced bone mass and disruption of bone architecture can result from imbalance of nutrients. CHAPTER 19: Nutrition and Older Adults • Progression depends on homeostatic mechanism involved. • Estrogen or testosterone loss. • Bone mass loss greater for women, men develop later because of larger frames & testosterone falls more slowly • World Health Organization criteria for bone density= BMD. o BMD that falls 2.5 or more standard deviations below values for healthy adults signifies osteoporosis o BMD 1-2.5 standard dev. below normal (osteopenia) precedes osteoporosis/may lead to fractures. • Up to 50% of trabecular bones (wrist vertebrae and end of long bones) and up to 35% of cortical or compact bone (shafts of long bones) may be lost during a lifetime. Prevalence • 4x more common in woman than men • Blacks/Hispanics greater BMD than whites. • Osteoporosis has no symptoms, diagnosis relies on BMD or fractures • Older adults are more likely to suffer disability from a bone fracture over prostate cancer, rheumatoid arthritis, breast cancer and hypertension. • Chance of osteoporosis related fracture approx. 1 in 2 for women and 1 in4-5 for men Etiology • Bone mass gained primarily during growth periods (18-30) • Remains stable until hormone decrease • Inadequate bone mass coupled with significant bone loss leads to low bone density and increase risk of fractures Inadequate Bone Mass • Risk for developing occurs during childhood and adolescence. Better if grow bigger denser bones in youth. (**higher calcium intake important) • Inactivity leads to bone mass. Weight bearing/resistance exercises needed for bone to grow. More pressure put on the bones, the more minerals deposited into the bone matrix • Exercise also stimulates growth hormone, which in turn stimulates bone development. “Use it or loose it” Decreased Bone Loss • Skeleton for structural support and calcium reservoir for body. (Bones/teeth contain 99%, 1% found in protein in blood, soft tissues and extracellular fluids). CHAPTER 19: Nutrition and Older Adults • Reservoir needed for nerve transmission, muscle contraction and enzyme systems like those that control blood clotting. Nerve transmission takes priority over bone structure. • Calcium tightly regulated by hormone systems. When calcium levels fall, body secretes more parathyroid hormone (PTH), which acts to raise blood calcium by increasing dietary absorption, decreasing urinary excretion and releasing calcium from bone. • Bone minerals dissolved and rebuild continuously, thus adequate calcium levels are crucial. • Consistent supply of dietary supply of bone-building minerals/vitamins, coupled with regular weight bearing exercise helps maintain skeletal mineral reserves. • Bodies first priority is to maintain blood calcium levels for nerve, muscle and enzyme function. • Osteoporosis can develop from shortage of phosphorus. Varied diet provides both phos/calc. • Lack of sufficient phosphorus promotes release of calcium from skeleton • Process of aging results in slow increase in PTH and decrease in skins ability to make vitamin D; both lead to bone loss. Effects of Osteoporosis Falls and Fractures • May make impossible for older adult to remain independent. • Greater risk for those over 80 compared to those 65 and older. • 10-20% of older who break a hip die within a year, due to complications of a breakimpaired mobility which complicated all daily activities (eating & exercise) • 50% of older who fracture hip have permanent functional disabilities. Shrinking, Height, Kyphosis • most vertebrae fractures (67%) are asymptomatic. • Postmenopausal women with compression/bone fracture in spinal column have condition known as “shrinking height” • “Shrinking height” leads to dowager’s hump (aka kyphosis) meaning bent upper spine. • Shrinking in height is slow and usually not painful. Risk
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