Chapter Review

CHAPTER 21 BRING IT HOME

Assisted living case study

Eleanor is an 84-year-old white female residing in an assisted living facility in North Dakota. She eats two meals each day in the dining hall and has a small kitchen with a refrigerator and microwave in her residence. She is able to place an order once a week for the delivery of foods and beverages from a local supermarket, but has limited finances and limited space for food storage. Eleanor’s recent visit to her primary care provider revealed mild dehydration and a weight loss of several pounds since her visit one year ago (Eleanor’s BMI is 20 kg/m2). Eleanor had previously been given a diagnosis of osteoporosis at age 78 with a recent bone scan showing progressive bone loss.

  1. Identify at least five nutrition-related concerns from Eleanor’s brief profile.

  2. What possible challenges may be compromising Eleanor’s ability to meet nutritional and fluid requirements?

  3. What are some of Eleanor’s risk factors for osteoporosis that may be contributing to bone loss?

  4. Based on what you’ve learned about nutrition-related concerns and recommendations in the aging adult, list 3 to 5 specific food or dietary strategies for Eleanor.

Take It Further

The role of diet in healthy aging is of interest to the growing numbers of seniors and is the focus of many ongoing research projects. Visit PubMed at http://www.ncbi.nlm.nih.gov/pubmed. Using the search terms “nutrition” and “aging,” browse through recent articles and studies. Choose one article that addresses a nutrient, dietary component, or nutritional consideration with regard to aging. Read the abstract and briefly describe study findings or implications.

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KEY IDEAS

  • Nutrition and physical activity play key roles in maintaining health and preventing chronic disease, as well as in potential longevity and quality of life, in the aging adult.

  • There are physical, psychological, social, and economic factors that can influence and potentially compromise the dietary intake and nutritional status of the older adult.

  • Energy needs in older adults generally decline because of decreased physical activity and metabolic rate; however, nutrient needs do not decrease (they may even increase), making it especially important to consume nutrient-dense foods.

  • Age-related changes in body composition and body fat distribution occur to varying degrees, but physical activity helps offset losses in skeletal muscle mass (sarcopenia).

  • Age-related gastrointestinal changes may occur, including the bacterial composition of the gut, diminished gastric acid secretion, and slower motility in the small intestine.

  • Nutrients of concern in older adults due to diminished intake or possible changes in absorption and utilization include protein, calcium, vitamin D, vitamin B6, vitamin B12, folate, iron, zinc, fiber, and omega-3 fatty acids.

  • Although fluid requirements are the same for older adults, the risk of dehydration is higher than in younger adults due to diminished thirst sensation, increased fluid loss, and side effects of certain medications.

  • Poor nutrition and physiological changes with advanced age, along with possible depressed immunity and a decreased ability to fight and recover from illness, surgery, or infection, can lead to suboptimal nutritional status or even malnutrition.

  • Nutrient inadequacies may contribute to cognitive decline with age. In addition, some studies show that certain dietary nutrients, like omega-3 fatty acids and some phytochemicals, may reduce the risk of dementia.

  • Based on current research, the best diet to delay age-related disease onset avoids excess calorie intake and is low in saturated fat and high in whole grains, legumes, nuts, fruits, and vegetables.

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NEED TO KNOW

Review Questions

Question 21.12

1. All of the following are true regarding life expectancy EXCEPT that it:

  1. is based on a statistical average calculated on a population.

  2. represents the number of years a person is expected to live.

  3. represents the actual number of years an individual lives.

  4. is a calculation that includes those who die during or shortly after birth.

1. c

Question 21.13

2. The DRI for ______ is higher for older adults than for their younger counterparts.

  1. calories

  2. iron

  3. vitamin A

  4. vitamin B6

  5. vitamin C

2. d

Question 21.14

3. The DRI for calcium:

  1. decreases slightly with age with reduced physical activity and reduced lean mass.

  2. increases from 1,000 mg to 1,200 mg for adults 51 years and older.

  3. increases from 1,000 mg to 1,200 mg in females only after age 70.

  4. remains the same after age 30 when peak bone mass is achieved.

3. b

Question 21.15

4. Why might older adults be prone to vitamin D deficiency?

  1. a suboptimal intake of vitamin D

  2. reduced exposure to sunlight and ultraviolet light

  3. diminished production of vitamin D in the skin

  4. increased vitamin D dietary requirements

  5. all of the above

4. e

Question 21.16

5. Sarcopenia can be defined as:

  1. small, abnormally shaped red blood cells.

  2. the condition of porous and brittle bones that occurs with age.

  3. the age-related reduction in skeletal muscle mass.

  4. elevated levels of disaccharides in the blood.

5. c

Question 21.17

6. The elderly at highest risk of malnutrition appear to be those:

  1. living at home.

  2. living with family members.

  3. in acute-care facilities (hospitals).

  4. in long-term care facilities.

6. d

Question 21.18

7. Gastric acid production and secretion decreases with age, which potentially results in all of the following, EXCEPT:

  1. the digestion and absorption of certain nutrients.

  2. diminished growth of intestinal bacteria.

  3. malabsorption of naturally occurring vitamin B12 from food.

  4. increased risk of foodborne illness.

7. b

Question 21.19

8. With regard to protein intake in the older adult, recent studies demonstrate:

  1. the DRI for protein increases by 50% after age 70.

  2. the benefits of protein intake are best with lean animal foods.

  3. there is no evidence of any benefit of protein intakes above the DRI of 0.8 g/kg body weight.

  4. that slightly increased protein intake can reduce loss of lean body mass.

8.d

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Question 21.20

9. All of the following are TRUE with regard to fluid status in the older adult, EXCEPT:

  1. diminished sensation of thirst.

  2. diminished kidney function with increased fluid loss.

  3. increased DRI for water after age 70.

  4. increased risk for dehydration.

  5. the use of certain medications can increase fluid loss.

9. c

Question 21.21

10. Studies demonstrate that the best diet to delay age-related chronic disease includes which of the following characteristics?

  1. avoids excess calories

  2. high in vegetables

  3. high in legumes

  4. low in saturated fat

  5. all of the above

10. e