Nutrition through the Life Span: Later Adulthood

Question 1

Arthritis

Answer 1

• more prevalent as the population has become increasingly obese
• certain foods can provide relief for rheumatoid arthritis
• omega-3 fatty acids commonly found in fish oil may help prevent rheumatoid arthritis

Question 2

Cataracts and Macular Degeneration

Answer 2

• age-related thickenings in the lenses of the eye that impair vision
• healthy diet (not supplements) including fruit and vegetables rich in antioxidants (vitamin c and e and carotenoids) can slow progression or reduce risk of developing cataracts
• cataracts correlated with obesity
• 50% of adults have cataracts by 75
• supplement containing antioxidant vitamins C and E and the mineral zinc has been shown to reduce the risk of progression of macular degeneration in those who already have the disease
• folate, vitamin B6 and B12, lutein, and zeaxanthin may help prevent or slow progression

Question 3

Brain

Answer 3

• cognitive loss and forgetfulness attributed to aging is due in part to nutrient deficiencies
• blood supply decreases
• number of neurons diminishes
• folate, vitamin B6, and B12 slow brain atrophy and improve cognition and memory
• vitamin c and e can limit free radical attack
• maintaining appropriate body weight may be the most important nutrition concern for the person with Alzheimer’s disease
• may be prevented, diminished, or delayed through diet

Question 4

nutrition and longevity

Answer 4

Aging is an inevitable, natural process
- healthy lifestyle habits can slow aging within the limits set by heredity
Role of nutrition in slowing aging
- maintains a healthy body and improves the quality of life in later years
nutrition and disease prevention
- appropriate energy intake: helps prevent obesity, diabetes, and related cardiovascular diseases
- may influence the development of some forms of cancer
Adequate intakes of essential nutrients: prevent deficiency diseases

Question 5

Chronological age

Answer 5

a person’s age in years from his or her date of birth

Question 6

Physiological age

Answer 6

a person’s age as estimated from his or her body’s health and probable life expectancy

Question 7

Physical activity

Answer 7

• active older adults: weigh less; have greater flexibility, more endurance, better balance, and better health; life longer
• Ideal situation: daily activity. intense enough to prevent muscle atrophy and to speed up the heartbeat and respiration rate

Question 8

Mouth

Answer 8

tooth loss, gum disease, and reduced salivary output impede chewing and swallowing. Swallowing disorders and choking may become likely. Discomfort and pain associated with eating may reduce food intake

Question 9

Digestive tract

Answer 9

Intestines lose muscle strength, resulting in sluggish motility that leads to constipation. Stomach inflammation, abnormal bacterial growth, and greatly reduced acid output impair digestion and absorption. Pain may cause food avoidance or reduced intake

Question 10

Hormones, Sensory organs, body composition, urinary tract

Answer 10

Hormones: pancreas secretes less insulin and cells become less responsive, causing abnormal glucose metabolism
Sensory organs: diminished senses of smell and taste can reduce appetite; diminished sight can make food shopping and preparation difficult
Body composition: weight loss and decline in lean body mass lead to lowered energy requirements. May be preventable or reversible through physical activity
Urinary tract: increased frequency of urination may limit fluid intake

Question 11

Nutrition and Disease Prevention

Answer 11

Variety in food intake, as well as ample intakes of certain fruits and vegetables
- may be protective against certain types of cancer
Moderation in sugar intake
- helps prevent dental caries
Appropriate fiber intakes
- may prevent GI tract disorders
Moderate sodium intake and adequate intake of potassium, calcium, and other minerals
- helps prevent hypertension
Adequate calcium intake throughout life
- helps protect against osteoporosis

Question 12

Difficulty of setting nutrition standards

Answer 12

• individual differences become more pronounced as people grow older
• different chronic diseases
• different medications

Question 13

Energy needs decline with advancing age

Answer 13

• reduced activity
• basal metabolic rate declines
• Sarcopenia: age-related loss of skeletal muscle

Protein:
- RDA: 0.8g/kg; but may need 1.0-1.2 g/k
- with lower total kcal, may need greater percentage of kcal from protein

Question 14

Carbohydrate

Answer 14

• ample amounts of carbohydrate to prevent protein use for energy
• fiber has role in alleviating constipation

Question 15

Fat

Answer 15

• moderate intake
• enhanced flavors
• provides essential fatty acids

Question 16

Vitamins and Minerals: B12

Answer 16

• deficiency associated with poor cognition, anemia, and other devastating neurological effects
• malabsorption due to atrophic gastritis - pernicious anemia (low energy)
• need to give it by injection

Question 17

Vitamins and Minerals: Iron

Answer 17

• deficiency may occur with low food energy intakes and other factors such as blood loss. Animal meats can be hard for older adults

Question 18

Vitamins and Minerals: Zinc

Answer 18

Deficiency can depress appetite and blunt sense of taste
- many medications impair absorption or enhance excretion

Question 19

Vitamins and Minerals: Calcium and Vit D

Answer 19

intakes low, especially among women
- vitamin D -skin doesn’t absorb and kidneys have harder time converting it to its active form

Question 20

Vitamins and Minerals: Folate

Answer 20

intakes typically fall short. more likely to have medical conditions or take medications that compromise folate status

Question 21

water

Answer 21

• dehydration risk
• may not notice thirst
• fear of incontinence
• total body water decreases with age (even mild stresses such as fever or hot weather can precipitate rapid dehydration)
• Women: 9 cups fluids per day
• Men: 13 cups fluids per day

Question 22

Determining risk for malnutrition

Answer 22

• disease?
• eating poorly?
• tooth loss?
• economic hardship?
• multiple medications?
• reduced social contact?
• involuntary weight gain?
• needs assistance?
• elderly person? > 80

Have you lost weight in the last 6 months without trying?
Have you been eating less than normal in the last two weeks?

Question 23

Pharmacokinetics:
Pharmacodynamics:

Answer 23

• focuses on the movement of drugs throughout the body after they are administered: absorption, metabolism, distribution, excretion
• the area of pharmacology concerned with how drugs produce change in clients and the differences in client responses to medications

Question 24

Infancy (birth to 12 months)

Answer 24

• nursing care and pharmacotherapy are directed towards:
  safety of the infant
  proper dosing of prescribed drugs
  teaching parents how to administer medications properly
• gluteal IM site is contraindicated
• oral medications should be administered slowly
• medications are often prescribed in milligrams per kg per day (mg/kg/24h)
• because the liver and kidneys are immature, drugs will have a greater impact due to their prolonged duration of activity
• immunizations needed; natural immunity from mother in utero begins to decline

Question 25

Pediatric Clients

Answer 25

• check medication calculations with another member of the healthcare team
• confirm client identity
• verify unusually large or small volumes or dosage units for a single client dose
• when a client, parent, or caregiver questions whether a drug should be administered, listen attentively, answer questions, and double-check the order
• dose should be individualized: age, height, weight, maturational state, body surface area

Question 26

Calculating pediatric Drug Dosages

Answer 26

• Body weight method (calculates the number of milligrams of drug, based on the child’s weight in kilograms; a unit of time is usually included)
• Body surface area method (uses childs height, and weight plotted on a nomogram, to determine surface area)

Question 27

Drug interactions: Pediatrics

Answer 27

Drugs most likely to contribute to drug interactions:
- those with high potency
- those with narrow therapeutic index
- those with extensive protein binding
- those that effect vital organ functions: hepatic metabolism

Question 28

Toddlerhood (1-3 years)

Answer 28

• curiosity
• child-resistant containers
• check dosing
• storage of drugs and harmful agents
• never tell children that medicine is candy
• be mindful what you mix medications with
• Give short and concrete explanations, followed by immediate medication administration

Question 29

Preschool child (3-5 years)

Answer 29

• refining gross and fine motor skills; developing language abilities
• can sometimes comprehend that medications are administered to help them fell better
• may benefit from play-acting

Question 30

School-aged child (6-12)

Answer 30

• rapid, physical, mental, and social development; thinking processes become more progressively logical and consistent
• longer more detailed explanations may be of value; child has some reasoning
• help child feel like they are participating

Question 31

Adolescents (13-18)

Answer 31

• able to think in abstract terms
• appreciate thorough explanations of their treatment; may be reluctant to admit lack of knowledge
• be sensitive to need for self-expression, privacy, individuality
• examples of medical concerns requiring medications: skin problems, headaches, menstrual symptoms, sports-related injuries
• education regarding: contraception, appetite suppressants, laxatives, amphetamines, anabolic steroids

Question 32

Young adulthood (18-40 years) & Middle adulthood (40-65)

Answer 32

• medication adherence is positive within this age range; clear comprehension of benefit in terms of longevity and feeling well
• assessment and education surrounding substance abuse
• health impairment related to cardiovascular disease, hypertension, obesity, arthritis, cancer, and anxiety may begin to surface in middle age

Question 33

Older adults

Answer 33

older adults take more medications and experience more adverse drug events than any other group

Question 34

Altered Pharmacokinetics: older adults

Answer 34

• increased gastric pH, delayed gastric emptying, decreased peristaltic rate may affect: absorption
• laxatives used to compensate for slower peristalsis may cause medications to be rapidly excreted from the body before they can provide their full therapeutic benefit
• the liver’s production of enzymes decreased, thereby decreasing hepatic drug metabolism, and resulting in increased serum drug concentration. More drug is available for distribution and the effects of the drug may be prolonged
• the aging liver produces less albumin, this results in less plasma protein binding, and increased levels of free drug in the blood stream
• the ration of body fat to water increases; affecting distribution and the storage of fat-soluble drugs and vitamins
• the ration of fat to muscle increases, slowing metabolism
• an aging cardiovascular system causes decreased CO and less efficient blood circulation, which decreases distribution
• percentage of body water decreases, contributing to dehydration and changes in drug concentration and distribution
• blood flow to kidneys decreases resulting in decrease in the amount of drug being delivered to the kidney for excretion