Adulthood/ older adults Flashcards
What are the 4 segments of adulthood & their characteristics?
early adulthood 20- 39 years
Becoming independent/ leaving parental home
Planning, buying & preppring food
Renewed interest in nutrion “for the kids”
Midlife 40s:
Active family responsibilities
managing schedules & meals becomes a challenge
Reviewing life’s accomplishment
Recognition of one’s mortality (interest for non-communicable diseases)
Sandwich: 50s:
Multigenerational caregivers (caring for children + aging parents + maintaining carrere)
High prevalence of chronic disease
Later adulthood: 60+: Transition to retirement More leisure time Greater attention to PA & nutrition Added significance for food choices & lifestyle factors (esp for chronic disease)
What are
Coronary Heart Disease (CHD)
Coronary Artery Disease (CAD)
Ischemic Heart Disease (IHD)?
damage that occurs when blood vessel become narrow & blocked
What is a myocardial infarction/ heart attack?
death of heart muscle due to interruption of blood supply
What is Atherosclerosis?
narrowing of heart vessel due to fatty plaque that intrudes into the lumen, blocking blood flow
What are statins.
MEDICATIONS THAT LOWER BLOOD CHOLESTEROL
How is Atherosclerosis initiated?
- Endothelial cells damaged
- Initiates the expression of cellular adhesion molecules
- Capture circulating monocytes U translate into intima
- Become macrophages (collect more fat) -> form foam cells (causes enlargement of plaque)
- foam cells accumulate & causes toxic lipid cause
- Plaque ruptures
- platelets come to repair damage (cause thrombus formation: blood clot)
Why does Atherosclerosis have the potential to cause angina?
blood has to pump harder & faster ->
Heart attack occurs when greater portion is blocked
What are some heart attack symptoms in men & women?
Men:
Nausea & vomiting
Jaw, neck, back pain, chest pressure, shortness of breath
Women: nausea/ vomiting, jaw, neck & upper back pain, sometimes chest pain, pain in lower chest & upper abdomen
Shortness of breath, fainting, indigestion, extreme fatigue
What is a coronary artery bypass graft?
Attach another vein to heart; open up heart; stop heart
What is an antioplasty?
insert a capita into the femoral or radial artery
Inflate ballon which breaks up fatty plaques & stent is left behind to leave the artery open
Why do women fare worse with CHD?
- Women develop CHD 10years later than men as estrogen increases HDL & decreases LDL
- During menopause lose protective risk (same risk as men)
- more likely to have hyperlipidaemia, DM & HT
- Less likely to undergo tertiary care interventions to participate in cardiac rehabilitation
What are risk factors for CVD?
- Nutrition: dietary modification: most effective reduction of risk
- Glucose
- BP
- Cholesterol
- Smoking,
- weight
- sedentary
What are other modifiable risk factors of CVD?
- Low SES
- Mental ill-health
- Psychosocial stress
- Alcohol use
- Use of certain medications
- Left ventricular hypertrophy
What are non- modifiable risk factors of CVD?
advancing age
Hereditary/ family history
Gender
Race/ ethnicity
What is the relationship between blood cholesterol & heart disease?
- Risk of CHD decreases with 1 mmol/L lower serum cholesterol concentration
- Reduction in mortality for each 1 mmol/L decrease In LDL cholesterol
How does fat become lDL?
- Fat is packaged into chylomicrons
- fatty acids cleaved off
- Travel to liver
- Packaged into lipoproteins
- Fat is delivered to cells, as it loses flat becomes denser
LDL -> disadvantageous to heart health
How is HDL protective?
picks up cholesterol form tissues & brings back to liver
What are the clinical guidelines for cholesterol?
Tot cholesterol <4 mmol
LDL cholesterol <2 mmol
HDL cholesterol > 1 mmol?L
Total: HDL: <4
What is an Atherogenic diet?
- promote deposit of plaque 2. characterised by high sat/trans fat
- low in V & F
Effect of different fats on cholesterol?
- Sat fat: increase all types (have neglible effect of steriac fatty acid)
- Trans-unsat: decrease HDl & increase LDL
3/ PUFA: decrease LDL & VLDL (sig reduces risk)
Why does stroke occur?
Occurs when the bloody supply is interrupted/ reduced. Preventing brain tissue from getting oxygen & nutrients (brain cells die in minutes)
What are the complications of stroke?
- Paralysis or loss of muscle movement
- Difficulty talking/ swallowing
- Memory loss/ thinking difficulties
- Cognitive dysfunction
emotion problems - Pain/Changes in self-care ability & behaviour
What are the 3 types of stroke?
- Ischemic: blood flow obstructed
- Transient ischemia attack: temporary ministroke
- Haemorrhagic stroke: weakened blood vessels ruptures spilling blood into brain
What is strokes modifiable risk factors?
Obesity, PA, heavy/ binge drinking, Hypertension, high cholesterol, diabetes, obstructive sleep apnea, CVD, family history
What is strokes non-modifiable risk factors?
age, ethnicity, sex (males more at risk), hormones
What is DASH (Dietary approaches to stop hypertension)?
A diet high in veges, fruits, low fat dairy products, wholegrains, poultry, fish & nuts
Less sat fat, more CHO, more protein, fibre & less cholesterol
designed to reduce BP
What is the composition of the dash diet?
8,300 Kj max sodium: 2,300 mg/day (1500 recommended) 6-8 sevrings grains 6or less servings meat, poultry/ fish Fruit & veges: 4-5 Low fat dairy: 2-3 Fats & oils 2-3 weekly: Nuts, seeds, dry beans & peas: 4-5 Less than 5 sweets
Why does visceral adiposity increase stroke risk
- Release cytokines (IL-6, TNF-a) which adversely affects cells, sensitivity to insulin, BP & blood clotting
- Releases free fatty acids: enter portal vein & travels to liver; Increases LDL & lowers HDL
What waist measurements are associated with an increased risk of CVD?
men»_space; 101cm; women >88cm
What age related changes in energy expenditure occur in adults?
ecline in early adulthood (2.9%, 2% / per decade for men & women respectively)
Why is high Triacylglycerides:
associated with increased risk CVD & diabetes
hyper triglycerides interfere with LDL & HDL metabolism (more small dense LDL & dysfunctional HDL)
What is metabolic syndrome?
3+ of the following symptoms = metabolic syndrome
- Waist circumference (M: >102; W: >88)
- Fasting glucose: >100
- HDL (M: <40; W: <50)
- BP: >130/85
- Fasting triglycerides: >150
What is metabolic syndrome a stronger risk factor for?
CVD, type 2 diabetes, stroke, fatty liver disease, chronic kidney disease etc..
What are the 3 types of diabetes?
Type 1: minimal/ no production of insulin
Type 2: Defective production of insulin/ insulin resistance
Prediabetes: blood glucose marginally elevates & vascular changes occur
What is the prevalence of diabetes?
Over 6% adults in NZ have diabetes
Ethnic differences: 15% pacific island (expected to increase to 40%)
What are the complications of diabetes?
CVD, nerve damage, kidney damage, eye damage, foot damage, skin conditions, hearing impairment, Alzheimer’s disease, depression
What is the ethology of diabetes?
Type 1: progressive autoimmune disease
Type 2: insulin resistance develops over time
What are the physiological effects of diabetes?
frequent urination, increased thirst & hunger, fatigue, weight loss, blurred vision etc.
Micro & macrovascular complications
How do we screen for diabetes?
Family history (genetic) History of gestational diabetes Elevated HbA1c racial/ ethnic background sedentary lifestyle Hypertension Low HDL, high triglycerides, CVD PCOS
What is glycated haemoglobin & what concentrationsof glaciated haemoglobin & fasting glucose are associated with diabetes?
Glucose binds to haemoglobin
- 50 mmol/mol = diabtetes
- > fasting glucose >7 - 41-49 = prediabetes -> fasting glucose >6.1 – 6.9
- <40 diabetes unlikely -> <6
What is medical nutrition therapy for diabetes?
- Diet flexibility & individualisation
- Enable to achieve glycemic, weight, lipid & BP goals
- Responsive to cultural preferences & maintain eating pleasure
- Teach how to use a glucometer
- Help increase PA
- May require pharmacotherapy (metformin)
What did we look at during a CVD risk assessment?
- Age
- gender
- ethnicity
- NZ index of deprivation
- Family history: Premature ischaemic CVD; Type 2 diabetes
What past factors are associated with CVD?
angina myocardial infarction PCI CABG Ischemic stroke TIA peripheral vascular disease Family hypercholesterolaemia Artial filtriation Duration of diabetes Urinary Smoking Fasting glucose or glycated haemoglobin BP Lipid profile Serum creatine BMI
When do we screen people with no risk factors for CVD compared to people with risk factors?
no risk factors:
M = 45; w = 55
High risk:
M = 30-35; W = 40-45
What characterises a Mediterranean diet?
- High in plant foods, fruit, veges & wholegrains (focus on local & fresh foods)
- Sugar & honey assumed occasionally
- Low red meat; high fish
- Olive oil main fat
- Social interactions while eating
What % does a Mediterranean diet reduce CVD events?
28%
What are three theories of aging?
- Programmed aging:
Hayflick’s theory of limited cell replication:
+ genetic cells divide according to programmed limit then divide (cell replication limit of 40-60 with no reason to stop replicating)
+ max life: 110-120 years - Molecular clock theory:
telemores act as protective caps on end of chromosomes (made up of 100os of TTAGGG)
+ tells us when one chromosome ends & another begins
+ end replication problem (telemoress replicate instead; shorten with every cell replication)
+ telemore attrition with age (shorten with age0
+ loss of telemores stop chromosomes ability to replicate - Free radical oxidative stress theory:
Free radical: oxygen with unpaired electron (attacks because want to pair up with someyhing)
+ oxidative stress:
Build up of reactive oxygen species from metabolic processes & environment
+ natural by-product of metabolism
+ essential to keep us safe from pathogens (used by immune system)
+ exposed to free radical from UB light, smoking & air pollution
+ ROS prolonged attacking is associated with long-term attack on tissues
+ associated with CVD, Alzheimer’s
+ can be neutralised by antioxidants
Is it possible to slow ageing though nutrition?
food restriction to 50% voluntary consumption in lab animals as reduces metabolic rate, reduces H202 & superoxide production
What are the benefits of energy rest in monkeys?
less diabetes, neoplasia, decrease CVD, scarponia & brain atrophy (age-related mortality also decreased; but more vulnerable to stressors)
What are the adverse effects of severe food restriction?
Comprised ability to withstand stress; growth, fertility, osteoporosis, muscle mass loss
What is functional age?
+ reflects the decline in function that occurs with time
+ heterogeneous
What is the ‘Third Age”?
+ golden years
+ between retirement & age-related physical, emotional & cognitive limitations
+ Retired but healthy & active
+ Have the time to increase PA & give more attention to diet & healthy lifestyles
What is The “Fourth age”
+ decline sin general health (weight & muscle loss -> frail -> vulnerable to stressors)
+ impaired nutrition
+ serious disease/ advanced aging (rest home care; if home socially isolated; rely on assisted living services; food & nutrition guidelines less relevant)
What factors contribute to nutrition-related health?
poverty
lack of transport
Inability to shop
Inability to prep and cook meals
Failure to cater to ethnic & food preferences
inability to self-feed
Social isolation & lack of social support
How does digestive function change as we age?
- absorption of macronutrients remain same
- Liver & biliary function retained but liver is smaller
- No reduction in pancreatic secretions
- No deficiency in intestinal morphology
How does Taste & smell change as we age?
+ Starts to decline after 60 + leads to decreased satiety
+ less pleasure (cant differentiate flavours)
+ cant smell spoiled food
+ 75% have impairment (women affected less than men)
+ number & structure of taste buds not affected
What dental changes occur with age & how do they effect nutrient intake?
57% edentulous; 36% functional dentition; 10% had ulcerated lesions
affects chewing, swallowing & taste
How does saliva change as we age?
Thicker & more viscous with age
What is the effect of changes in saliva flow?
affects ability to swallow
How does Oesophageal motility change as we age?
+ not to effected with age
+ rare but occur with autonomic nervous system disturbances (stroke; parkinsons)
+ slower gastric emptying early satiety
+ reduced gastric acid output
How does Atrophic gastric change as we age?
- reduced secretion of HCL & Pepsin (secondary infection from helicobacter pylori)
- Bacteria overgrowth in stomach abused by decreased HCL secretion
- Can’t absorb b12 (can’t be dissociated from food)
- bacteria colonization of upper GIT takes up B12
- low B12 affects folate, calcium & iron absorption
How does Hydration change as we age?
- Diminished sense of thirst & decrease in total body water
2. Kidney function decline: less able to concentrate urine & more water lost
What is dehydration signs & symptoms?
upper-body muscle weakness Dry mucous membranes Speech difficulty + confusion Longitudinal tongue furrows Dry tongue Sunken appearance of eyes in sockets
What are the effects of dehydration?
- Increased resting HR
- Susceptibility to pressure ulcers, UTI, pneumia
- Leads to confusion disorientation & dimentia
What has the biggest effect on nutritional status & physical resilience in older adults?
+ muscular strength peaks at 30 then declines (2-3% per decade)
+ weight stable; fat replaces muscle
+ Decreased basal metabolic rate
What are some Sacropenial age-associated changes in body composition:
- Muscle atrophy
- Increase in body fat
- subcutaneout to visceral; fat infilitrates into skeletal muscle
What does sarcopenia lead to?
Fraility & dependance?
What is frailty?
A Geatric syndrome with 3+ conditions: 1. unintentional weightloss 2. self-reported exhaustion 3. weakness 4. slowness 5. low PA Used as a measure of biological age
What does frailty lead too>
- these lead to diability
- increased risk of falls
- increased risk of hospitalization
- leads to dependence & 5 year risk of death with fraility
How can we measure fraility?
Walking Speed
Grip Strength
What factors contribute to sacrpenia?
Nutrition
Muscle loss
How does sarcopenia mask obesity?
because they don’t look frail
as losing muscle & fat is infiltrating muscle
What is sarcopenia obesity associated with?
with higher risks of mobility disability, metabolic diseases, hypertension, CVD & mortality than either alone
