Adulthood Flashcards
Stage one is classified as
Early adulthood
Early Adulthood age?
mid 20s-30s
What is early adulthood involved in?
transition to adulthood
Stage 2 is classified as
Midlife
Midlife age?
40-64
Midlife is a period of?
active family responsibilities
- managing schedules and meals becomes a challenge
Which stage are common multigenerational caregivers?
midlife
Stage 3 is classified as
Older age
What age range is associated with older age?
65+
What transition is associated with older age?
transition to retirement
When does growing stop?
by the 20s
when does bone density continue until?
30’s
When does muscular strength peak?
25-30
Body composition - what decreases with age?
size and mass of muscle
Body composition - what increases with age?
body fat
hormonal changes with age in women
- decline in estrogen (menopause)
- increase in abdominal fat
- increase in risk of cardiovascular disease and accelerated loss of bone mass
hormonal changes with age in men
gradual decline in testosterone and muscle mass
Body composition changes in adults
- positive energy balance (taking in too many calories)
- increase in weight and adiposity
- decrease in muscle mass
- fat redistribution (gains in central and intra-abdominal space, decrease in subcutaneous fat)
At what age does bone loss occur?
~40
Between the ages of 20-64 health and wellbeing are influenced by?
- diet
- physical activity level
- body weight
- smoking
Health promotion in adults
- can draw on past experiences to address personal (health) problems
- with guidance, can be motivated to work towards long term goal
- -> lowering blood glucose levels or achieving healthy body weight
- diet and lifestyle habits of family also greatly affect outcomes
Common health conditions (19-64)
- high blood pressure
- diabetes mellitus
- heart disease
- intestinal/ulcers
- osteoporosis
At what % should caloric intake decrease per decade during early adulthood?
~2%
- due to decreased metabolic rate and physical activity levels
What is recommended for long term maintenance?
combination of nutrient dense/lower energy foods with increased physical activity
- soups, salads, lean meats, low fat yogurt
What is 1lb of body weight equivalent to?
3500 calories
To lose 1 lb per week, an adult would need to create a negative balance of how many calories?
500
A positive balance of just 100 extra calories per day will result in a gain of how many pounds/year?
10
It is difficult to meet vitamin and mineral needs at calorie levels below?
1800 kcal
Protein range?
10-35%
-0.8g/kg BW
Fat range?
20-35%
Carb range?
45-65%
What is a key energy source?
carbohydrate
fibre requirement for females and males 51+
21-30g per day
In athletes, protein requirement can be increased to?
1-1.3g/kg BW
What must be considered regarding protein intake:
- eating enough animal protein
- eating high quality, complete protein
- have enough for additional needs (would healing, tissue repair, surgery, fracture, infection)
Essential fatty acids
EPA and DHA
fat allows for absorption of?
fat soluble vitamins (A,D,E,K)
What is calcium required for?
maintenance of bone density
Calcium RDA for 19-50 year olds
1000mg/day
Calcium RDA for >50
1200 mg/day
Why should calcium be supplemented with increased with age?
- age related loss of calcium from bone
- inadequate dietary intake
- impaired absorption and utilization
What is vitamin D important for?
- aids in calcium metabolism and immune function
Factors that put older adults at risk for vitamin D deficiency?
- limited exposure to sun
- institutionalization or long working hours
- certain medications
Vitamin D RDA for 51-70?
400 IU/day
Vitamin D RDA for 71+?
600 IU/day
Health Canada recommends what supplement for adults over 50?
a vitamin D supplement containing 400IU
What is vitamin B12’s role?
cofactor for many cellular processes
Despite adequate intake, what % of older adults have low serum B12 levels?
~40%
What is atrophic gastritis?
Associated with increased age and decreased absorption in stomach
- impairs B12 absorption
B12 deficiency can result in?
impaired cellular function and physical coordination
What is iron required for?
oxygen transport around the body
When do iron needs in women decrease?
after menopause
iron deficiency may be due to?
- iron loss from disease/medication
- poor diet
What does iron deficiency lead to?
anemia
The acceptable macronutrient distribution range for total fat intake is?
20-35%
At what age are multivitamins recommended?
> 50
supplements and multivitamins may be useful with those who?
- lack appetite
- have disease of digestive tract
- have poor diet
- avoid specific food groups
- takes medications or other substances that affect absorption/metabolism
Total body water ? with age?
decreases
How many glasses of fluid are recommended for older adults?
6+
To individualized fluid recommendations:
1 ml of fluid/1 kcal consumed (minimum of 1500ml)
Average life expectancy in Canada?
82
What % of Canadian adults are overweight or obese?
62%
Excessive abdominal fat associated with higher risk of?
- high blood pressure
- type 2 diabetes
- heart disease
- stroke
Where is most of the fat stored in “apple” shape?
visceral fat - fat surrounding organs
Where is most of the fat stored in “pear” shape?
subcutaneous fat
What is waist circumference used to measure?
central adiposity
Male waist cutoff
> 102cm
female waist cutoff
> 88cm
Recommendations for physical activity
- 30-60 minutes per day (depending on type of activity)
- 150 minutes/week moderate to vigorous aerobic activity
- strength training 2x/week
- start slowly (10 minutes at a time and build up tolerance)
- short spurts of 10 minutes count towards daily goal
What can increase lean muscle mass and bone density in adults?
Weight bearing and resistance training
What helps to maintain functional status?
regular physical activity
What % of population is inactive?
50%
Who are more likely to be active?
men, higher educated, from the west coast
Who are less likely to be active?
women, immigrants, those from central/eastern Canada
From 1997-2009 what % of population inactive –> highly active?
9%
Other key risk factors to poor health?
- daily smoking, high cholesterol,
Quality of life will be improved by
- treating ‘modifiable’ risk factors
- controlling food intake
What is a ket risk factor for the prevention and management of most chronic diseases?
Food intake
Diets that prevent chronic disease
Mediterranean and calorie restriction
Mediterranean diet
Have significantly longer lives
- emphasis on grains, V and F, dairy and olive oil
Where did “my big fat diet” take place?
Namgis First Nation of Alert Bay
- give up sugar and junk food
- return to a traditional style of eating for a year to fight obesity and diabetes
Chronic conditions with modifiable risk factors include witch of the following?
heart disease, cancer, stroke, diabetes (ALL OF THE ABOVE)
Diet components involved in “my big fat diet”
- low carb
- high protein
- high fat
- no fruit/starchy veggies
- no sugar
- no junk food
- use of traditional food
- hooligan grease permitted
What is the fastest growing population in Canada
The elderly
By 2030, what proportion of Canadians will be 65+ years?
1 in 5
In older adults, it is important to focus on?
maintenance and repair
Which chronic diseases are common in older adults?
heart disease, stroke, type 2 diabetes, cancer, obesity, osteoporosis, arthritis
What does adequate nutrition lead to?
Successful aging
What makes up lean body mass (LBM)?
sum of fat-free tissues, mineral as bone and water
Sarcopenia
loss of LBM associated with aging
How much does LBM decrease from ages 30 to 70?
2-3%
Older people have lower?
mineral, muscle and water reserves
Nutritional considerations
- sensory changes
- physical limitations
- cognitive factors
taste and smell ? with age
decline
true or false - women retain their sense of smell better than men?
true
cognitive disorders
- Alzheimer’s (5th leading cause of death)
- vascular dementia
- parkinson’s disease
- alcohol related and AIDs related dementia
Dementia
progressive decline, characterized by forgetfulness, memory decline, difficulty with decision making and mental ability
Effects of cognitive disorders
- confusion
- anxiety
- agitation
- loss of oral muscular control
- impairment of hunger/appetite regulation
- changes in smell/taste
- dental, chewing, swallowing problems
For cognitive disorders, it is important to:
- ensure food safety
- ensure safe use of kitchen tools and equipment
Dietary focus
- nutrient dense foods
- maintain hydration
- supply needed energy
Change in eating patterns
- meal prep
- appetite decreases
- smaller, less frequent meals
Changes to sensual awareness - hunger
- 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
Changes to sensual awareness - thirst
- thirst regulating mechanisms decrease with age
- studies support that dehydration occurs more quickly after fluid deprivation and rehydration is less effective in older men
meal intake impacts:
- weight changes
- nutrient intake
- disease management
- immunity
- risk of falls
- physiological health
Factors impacting nutritional intake
- disease condition
- functional disability
- inadequate food intake
- swallowing difficulty
- poly-pharmacy
- depression/anxiety
Poly-pharmacy
taking multiple medications at a time
Oral health depends on
- GI secretos (saliva)
- skeletal systems (teeth/jaw)
- muscle membrane
- muscles (tongue/jaw)
- taste buds
- olfactory nerves (smell/taste)
Strategies to promote intake?
- maintain focus on eating
- provide plenty of time to eat
- serve favourite foods
- encourage regular drinks between bites
EWCFG requirements in older adulthood
- fruits/veggies and grain categories decreases
- milk alternatives increases
On average, LBM decreases by ? per decade from 30 to 70?
2-3%
What % of older women are obese/overweight?
54%
What % of older men are obese/overweight?
65%
What percent of older Canadians do not consume 5+ fruits and veggies/day?
65%
Which nutrients are consumed at inadequate amounts in older adulthood?
vitamin C, D, folate, B6, B12, calcium, magnesium, zinc
Osteoporosis is classified as
porous bone
- decreased bone mass and disruption of bone architecture
osteoporosis is more common in
women
Does osteoporosis have any symptoms?
No
In older people who break a hip, what % die within a year?
10-20%
In older people who break a hip, what % have permanent disabilities?
50%
What % of vertebral fractures are asymptomatic?
~67%
Osteoporosis risk factors?
- petite
- women
- caucasian
- alcohol use
- smoking
- low calcium intake
- low estrogen
- sedentary lifestyle
- corticosteroid use
Is osteoporosis hereditary?
yes
Nutritional remedies for osteoporosis
- adequate calcium, increased absorption
- consume foods rich in vitamin C, D, B6, K (help to build bones)
What improves calcium absorption?
- calcium + vitamin D supplements
- don’t take calcium with antacids
Determinants of good eating behaviour
- higher income
- higher education
- more social support
- better perceived health
- better vision
- adequate dentition
- belief that nutrition can affect heath
What % of elderly experience food insecurity in Canada?
7%
Impact on poor nutrition
- food insecurity
- live alone
- depend on fixed pensions or government benefits
- lack of social support
Key issues associated with older adults who have low income status:
- poorer living conditions
- restricted budget
- lower accessibility to assistance/care
- isolated/eating alone
Older adults with low income status are more likely to:
- suffer from serious health problems related to poor nutrition
- have lower energy and overall nutrient intake
Dietary management for a frail, elderly, undernourished person should consider
calories, protein, water
How many calories should an elderly person be consuming?
Eat and exercise enough to build muscle mass and strength
How much protein should an elderly person be consuming?
1-1.5 g/kg
How much water should an elderly person be consuming?
1ml/kcal (rehydrate slowly)
Nutritional interventions for dehydration
- beverages contribute nutrients/fluid
- tea has flavonoids (antioxidants)
- milk has calcium, protein, riboflavin, vitamin D
- cranberry juice may reduce chronic UTI
- fruit and veggie juices count towards fruit/veggie servings (unless diabetic)
Nutritional risk
risk factors that are present that could lead to under nutrition
Screening
the examination of asymptomatic people in order to classify then as likely or unlikely to have the disease of the outcome you are screening for
What is SCREEN?
seniors in the community - risk evaluation for eating and nutrition
SCREEN - risk factor questions regarding
- appetite
- frequency of eating
- chewing difficulties
- swallowing difficulties
- diet restrictions
- eating alone
- money for food
- cooking difficulties
- shopping difficulties
SCREEN - food intake questions regarding
- vegetable/fruit intake
- meat and alternative intake
- milk and alternative intake
- fluid intake
What is SCREEN used to?
assess nutrition risk at baseline and follow up
SCREEN key findings:
- meals on wheels associated with less risk at follow up
- depression associated with higher risk under nutrition
- use associated with decreased risk at follow up
Positives to grocery shopping assistance
- convenience - especially for bulky/heavy items
- overcome barriers - decreased worry of falling
- cost savings - store choice, transportation
- assistance for volunteers
- promotes independence
- social interaction
Negatives to grocery shopping assistance
- waiting for a ride
- feeling rushed
- quality of food at stores chosen (discount)
Res in homecare can:
- provide counselling to help overcome barriers
- advise on use of oral nutritional supplements
What % of people use professional home care services?
0.5%
Of 500,000 clients in Ontario, how many will be seen by a dietician?
3000
Where do dieticians work with the elderly?
- long term care
- home care
- family health team
- community health centre
- diabetes education centres
- private counselling
Good nutrition habits make a greater impact when starter?
Early in life
True or false - a 70 year old is too old to learn and practice health promotion strategies
false
Food insecurity is older adults is associated with inadequate dietary intakes, especially for which of the following nutrients?
zinc, vitamin E, magnesium, calcium (ALL OF THE ABOVE)
