12) Adulthood and the Elderly (Part I) Flashcards
When does young adulthood occur?
Between 20 to 35 years old
When does middle adulthood occur?
50 to 69 years old
Define adulthood.
The stage at which growth and sexual maturity are complete
When is sexual maturity reached? When is physiological maturity reached?
- Sexual maturity: teenage years
- Physiological maturity: early 30s
What is physiological maturity?
The achievement of maximum height and the formation of peak bone mass
How does muscle mass vary throughout an individual’s life span?
Increases until 30s, then gradually declines
When does the loss of trabecular bone mass begin?
In an individual’s 30s
How does anabolism compare to catabolism prior to adulthood, during adulthood, and after the age of 30?
- Prior to adulthood: anabolism > catabolism
- Adulthood: anabolism = catabolism
- After the age of 30: catabolism > anabolism
When are maximal strength, endurance and agility reached?
Five years after reaching maximum height
What may aid in slowing down catabolism related to aging?
Physical activity
Why is there an increased propensity of accumulating body weight and fat during middle adulthood?
- A decrease in muscle mass decreases BMR
- A decrease in BMR decreases caloric requirements
- An adjustment to caloric requirements must be made
In both sexes, the average body weight increases until reaching their ___.
60s
Weight gain (accelerates/decelerates) with age.
accelerates
How do obesity rates vary throughout the life span?
Increase until 65 years old, then subsequently decline
What is a greater waistline associated with?
An increased risk of diabetes, hypertension and cardiovascular disease
Which sex is at a greater risk of obesity? Why?
Women due to a greater fat mass and lower lean-body mass
Which sex actually possesses a lower obesity rate? How does that vary across the life cycles?
- Women possess a lower obesity rate
- Except when they hit 75 years old
A BMI greater than __ is the upper limit beyond which the morbidity of obesity becomes a concern due to weight-related diseases.
25
Give examples of weight-related diseases.
- Diabetes
- Cardiovascular disease
- Hypertension
- Liver disease
- Certain cancers (prostate, colon, breast)
Which diseases does the diet contribute significantly?
- Heart disease
- Cancer
- Stroke
- Diabetes
Which diseases are there a strong, but not clearly identified, nutrition effects?
- Osteoporosis
- Dementia
- Hypertension
What are the effects of our society’s shift from our natural diet? What is the composition of our current diet?
- Greater intake of animal fats
- Decreased quantities of complex carbohydrates and fiber
- These diets are linked to cancer, cardiovascular disease, obesity, and dental caries
What was the purpose of the Mozaffarian (2016) study?
Combined several meta-analyses to determine the effects of certain foods on death from coronary heart disease, stroke and diabetes
What is the relative risk?
The ratio of the probability of an event occurring (i.e. disease) in an exposed group (consuming the food) to the probability of the event occurring in a comparison, non-exposed group
What does a relative risk lower than 1 indicate?
Individuals consuming the food have a LOWER risk than individuals not consuming the food
What was the purpose of the Micha & al. (2010) study?
Analyzed the risk of coronary heart disease associated with the quantity of red meat and processed meat
What was the conclusion of the Micha & al. (2010) study?
- Red meat does not have an effect on the risk of CHD
- Processed meat does have an effect
How does the nutritional content of red meat and processed meat differ?
Processed meats are higher in sodium and nitrate-derivatives
What harmful effect does grilling red meat produce?
Linked with the production of heterocyclic amines, producing a carcinogenic effect
Which foods are harmful to cardio-metabolic health?
- Refined grains
- Starches
- Sugars
- Processed meats
- High sodium foods
- Industrial trans fats
Which foods are beneficial to cardio-metabolic health?
- Fruits
- Nuts
- Fish
- Vegetables
- Vegetable oils
- Whole grains
- Beans
- Yogurt
How does following a low-fat diet and a Mediterranean diet differ in terms of the incidence of cardiovascular disease and diabetes?
- Low-fat diet: no significant effect
- Mediterranean diet: clinical benefit
- The quality of fat consumed is more effective than the total amount
An insufficient intake of _________ is related to an increased disease risk.
fruits and vegetables
What are two significant aspects that accelerate aging and the risk of chronic disease? (2)
1) Diets that are high in saturated fat, alcohol, sodium, sugar and low in fiber
2) Lifestyles that include smoking, little exercise and high stress
Why is it vital to educate individuals in their middle years about exercise and food habits? (3)
- Allowing for the delay of the onset of aging and chronic disease
- An increase in optimal function for a longer period of time
- An increase in the quality of life in the present
Which organizations participated in the development of the Unified Dietary Guidelines?
- American Heart Association
- American Cancer Society
- American Dietetic Association
- National Institutes of Health
What are the six Unified Dietary Guidelines? (6)
- Eat a variety of foods
- Choose most of what you eat from plant sources
- Eat greater than 5 servings of fruits and vegetables daily
- Eat greater than 6 servings of bread, pasta and cereal grains daily
- Eat high-fat foods sparingly, especially those from animal sources
- Keep your intake of simple sugars to a minimum
What are the causes of the aging population?
- Gradual increase in overall life expectancy
- Declining birth rates
What is the ratio of women (mostly widowed) to men (mostly married) over 85 years of age?
2:1
What is usual aging?
- The process that is accelerated by diet and lifestyle factors
- Ex: poor exercise habits, tobacco abuse
What is successful aging?
- Age-related changes that are not increased due to lifestyle or disease
- Characterized by sound nutritional habits, regular exercise and good blood pressure control
What are causes of death of successful aging?
- Cardiovascular disease
- Cancer
- Infection
What is immunosenescence?
Age-related alterations in immune response
What is the best-characterized feature of immunosenescence?
Decline in T-cell function
Is immunosenescence preventable? How?
- Yes
- Multi-vitamin and mineral supplements may halve the infection rate
What are the effects of vitamin E on macrophages?
- Inhibits PGE2 production in macrophages, which reverses the altered cytokine profile of T-cells
- Allows for the Th-1 response to occur
What are the effects of PGE2 on the Th-1 response?
In high concentrations, PGE2 inhibits T-cell proliferation and the Th-1 response
Differentiate the Th-1 response and the Th-2 response.
- Th-1 response: more effective at getting rid of intracellular pathogens
- Th-2 response: more effective at atopic reactions (eczema or allergies)
What is the best predictor of the total number of visits to a hospital or physician in the elderly?
Malnutrition
Which age-related diseases my be inhibited or counteracted by nutrient supplementation?
- Cataracts
- Dementia
Which vitamins may decrease the incidence of cataracts? Where are they contained?
- Vitamin C and vitamin E
- Green vegetables
What are three beneficial effects of green vegetables?
1) Boost immune function
2) Decrease the incidence of cataracts
3) Improve mental ability, while preventing certain forms of dementia
Which disease may be counteracted by a folate supplementation?
Dementia
What may be possible for changes in folate metabolism in dementia patients?
Physical changes (i.e. weight loss) very early
Which substances increase cognitive performance among the elderly?
Fish and fish oils
What are the two causes of a decrease in lean body mass and increase in adipose tissue with aging? (2)
1) Decrease in physical activity
2) Hormonal changes
What are three hormonal changes that occur with aging? (3)
1) Decrease in GH
2) Decrease in estrogen (females) and testosterone (males), affecting BMD
3) Decrease in testosterone, affecting muscle mass
How does total body water vary in the elderly? Why?
- Decrease
- Due to a decrease in lean body mass and an increase in adipose tissue
What causes a decrease in BMR in the elderly?
- Increase in visceral fat
- Decrease in lean body fat and bone mineral density
What is a greater indicator of health risk than the BMI?
- Percentage of body fat
- Because BMI does not differentiate between muscle mass and fat mass
What is skinny-fat?
Frail with muscle loss, due to low BMI and high body fat
The identification of metabolic abnormalities and risk of cardiovascular disease is optimally analyzed with which methods?
Waist circumference and triacylglycerol levels
What is the hypertriglyceridemic waist?
Abnominal obesity and elevated fasting triacylglycerols
What are the effects of an increase in visceral fat and fat accumulation in the liver?
Increases the quantity of hepatic triacylglycerol secretion and insulin resistance
Which hormones undergo changes in production and sensitivity with aging?
- GH
- IGF-1
- Corticosteroids
- Sex hormones
- Insulin
An increase in __________ fat mass increases the risk of insulin resistance.
intramyocellular
What occurs to the HPA axis if an individual is under chronic stress? What is the hypothesized outcome?
- Repeated activation of the HPA axis
- May lead to an increase in reactive-oxygen species and a decrease in the capacity of antioxidants to protect neurons from the toxic effects of oxidative stress
What is critical to sustain muscle mass past the age of 30 years old?
- Adequate caloric and protein consumption
- Physical activity
What is the increase in adipose tissue associated with that may affect muscle protein metabolism and function? How?
- Low-grade inflammation
- Increases levels of inflammatory cytokines, which promotes muscle wasting by increasing the degradation of myofibrillar proteins and decreasing synthesis
Define sarcopenia.
Age-related loss of muscle mass and function
What are likely consequences of an accelerated muscle loss after the age of 75?
Occurrence of frailty and the likelihood that the individual will be subjected to falls or fractures
How does the contractility of muscle fibers vary with age?
- The efficiency of the contractility decreases with age
- Associated with loss of muscle mass and function
What has been demonstrated to be an effective intervention in the treatment and prevention of sarcopenia?
Resistance training
Do changes in bone mineral density predate changes in lean body mass, or the opposite? Why?
- Changes in lean body mass predate the drop in bone mineral density
- As the muscle is losing its elasticity, the actual mechanical stress on the skeleton is decreased, leading to a decrease in BMD
How can body compositions of the elderly be reverted?
By acting on the muscle mass and increasing physical activity
Give examples of chronic diseases that require dietary intervention to correct or improve their conditions.
- CVD
- Cancer
- Diabetes
- Hypertension
- High blood cholesterol
- Obesity
- Dementia
- Visual impairments
- Osteoporosis
What may influence nutrient requirements in the elderly due to a chronic disease?
- Change in food habits
- Increased use of drugs
Define frailty.
Frailty is a classification that includes 3 or more of the following characteristics:
- Muscle weakness
- Slow walking speed
- Exhaustion
- Low physical activity levels
- Unintentional weight loss
Does sarcopenia occur before the onset of frailty, or the opposite?
Frailty occurs before the onset of sarcopenia
Which conditions may result in changes in food habits?
- Hypertension requires low-salt (low-taste) diets
- Individuals with arthritis will have difficulty procuring and preparing food
What are the six theories of aging? (6)
1) Cellular mutations
2) Decreased hormonal secretions
3) Cross-linking of protein molecules
4) Free radicals
5) Immune system deterioration (immunosenescence)
6) Pre-programmed aging under genetic control
What factors may decrease DNA repair activity?
Environmental stressors (drugs, UV light, mutagens, radiation)
What are the effects of an accumulation of DNA damage?
- Errors during DNA replication accumulate
- Alteration of mRNA and protein synthesis
- Decreasing cellular function
True or False: The DNA methylation status in an individual’s tissues is sufficient to accurately infer chronological age.
True
Is the DNA methylation predicted age associated with other life course predictors of aging (e.g. education, childhood IQ, social class, diabetes, BP)?
DNA methylation is independent of these other factors
What is the mechanism by which DNA methylation occurs?
The addition of a methyl group to a cytosine residue in a cytosine-phosphate-guanine group
The secretion of which hormones decrease with age?
- GH
- Testosterone
- Estrogen
- Insulin
What are the effects of a decreased secretion of GH?
Increases adipose tissue and decreases lean body mass
What are the effects of a decreased secretion of testosterone?
Decreases the ability to maintain protein stores and bone mass
What are the effects of a decreased secretion of estrogen?
Decreases the ability to maintain bone mass
Glycation causes cross-linking between protein molecules, forming ________________.
advanced glycation end-products (AGEs)
What are the effects of the accumulation of AGEs?
Increase intracellular damage and apoptosis
What are sources of free radicals?
- Environmental exposure (e.g. radiation)
- Natural body processes (e.g. mitochondrial respiratory chain)
How has a lower caloric intake been linked to the formation of reactive oxygen species?
A lower caloric intake decreases the utilization of the electron transport chain, decreasing the accumulation of free radicals
Define immunosenescence.
A decrease in naive T-cells due to thymic involution, resulting in a decrease in cell-mediated immunity and immune competence, dysregulating the immune system
What are the effects of the dysregulation of the immune system in the elderly?
An increase in autoimmune disorders and chronic inflammatory diseases
What is the death gene?
p53 gene
What is the function of the p53 gene?
Halts DNA replication and cellular proliferation, allowing for apoptosis to occur if the DNA repair mechanism fails
What is triggered with the decline in the protective function of telomeres (due to shortening) in aging?
The activation of DNA repair machinery, and the p53 gene
What may occur to a cell with shortened telomeres?
A cell may become senescent due to the exhaustion of replication (replicative senescence), causing the cell to die
What are the effects of a senescent cell on its neighbouring cells?
A senescent cell secretes biochemicals that are detrimental to normal-functioning neighbouring cells
Which cells are particularly affected by the loss of telomere function and the activation of the p53 gene?
Cells with a rapid turnover rate (e.g. RBCs, intestinal epithelial cells), as it may need lead to decreased function
True or False: Aging itself is not a risk factor for malnutrition.
True
What are the eight risk factors for malnutrition in older adults? (8)
1) Decrease in body function
2) Chronic disease
3) Multiple medications
4) Needs assistance with self-care
5) Tooth loss or oral pain
6) Eating poorly
7) Economic hardship
8) Reduced social contact
Why does a decrease in energy needs increase the risk of malnutrition?
Because the needs of other nutrients remain unchanged
How may poor oral health cause malnutrition?
- Difficulty chewing
- Inflammation
- Monotonous diet of poor quality
What may affect an individual’s mobility, affecting their ability to shop for food and prepare meals for themselves?
- Loss of vision and hearing
- Osteoarthritis
What psychosocial and environmental changes may the elderly face?
- Isolation
- Loneliness
- Depression
- Inadequate finances
How do multiple medications and malnutrition in the elderly affect each other?
- Medications may vary the metabolism of certain nutrients
- Malnutrition worsens disease and increases the likelihood of an adverse drug interaction
Which elderly populations is malnutrition most common?
Uneducated elderly who live alone and have had a recent change in living conditions
How is economic hardship in the elderly related to malnutrition?
- There is a high rate of poverty among the elderly
- There is a consistent relationship between poverty and poor nutritional status
How is reduced social contact in the elderly related to malnutrition?
- Loss of vision and hearing increases the risk of social isolation
- Loneliness and depression may occur due to the loss of a loved one
- These factors decrease the willingness to cook
What increases the risk of peptic ulcer disease among the elderly? Which populations are particularly at risk?
- Decrease in stomach lining capacity to allow for the resistance to damage
- Particularly in individuals that consume aspirin and NSAIDs, such as ibuprofen
How does aging affect gastric acid secretion?
- Aging has little effect on gastric acid secretion, per se
- The secretion of HCl decreases in individuals with atrophic gastritis, which is more common in the elderly
The risk of bacterial overgrowth syndrome increases with age. What are the effects?
- Pain
- Bloating
- Weight loss
Which nutrients may bacterial overgrowth syndrome affect?
Absorption of vitamin B12, iron and calcium
How do lactase levels vary with age? What are the consequences?
- Decreased levels of lactase
- Leads to intolerance in dairy products, increasing the risk of calcium deficiencies
What are the four factors that render constipation more common in the elderly?
1) Slowing down of the movement of the contents through the large intestine
2) Decrease in contractions of the rectum when it is filled with stool
3) Frequent use of drugs that may cause constipation
4) Decreased exercise and physical activity
Constipation is (more/less) common than diarrhea in the elderly.
more
Diarrhea is a (more/less) serious concern than constipation.
more
Which bladder issues are more at risk with aging?
- Urinary incontinence
- Urinary retention
- Increased propensity to UTIs
