CHAPTER 5

NUTRITION AND AGING P.110

- RISK FOR MALNUTRITION OR OVERNUTRITION

CHNAGES IN BODY COMPOSITION

NORMAL AGING AND NUTIRION

SARCOPENIA DECREASE BONE MINERAL DENSITY

ORAL AND GI CHANGES WITH AGING

DENTITION EDUNTULISM XEROSTOMIA ATROPINE GASTRITIS ACHLORYDIA (IRON AND VIT B12 DEF) APPETITE DYSREGULATION
CHOLECYSTOKININ ELEVATED EARLY SATIETY- WT LOSS

CONSTIPATION THIRST DYSREGULATION ANGIOTENSIN IMPAIRED SENSORY CHANGES (VISION, HEARING, TASTE/SMELL (DYSGEUSIA)

SOCIAL AND ECONOMIC CHANGE AFFECTING NUTRITION:

SEDENTARY LIFESTYLE POVERTY

NUTRITIONAL REQUIREMENTS AND AGING:

DIETARY REFERENCE INTAKE (DRIS) FOOD GUIDE PYRAMID (RDA)

 EERS - 1600 CALORIE

UNIQUE NUTRIENT RECOMMENDATION

MALES DEC 7 CAL/DECADE OVER 30Y/O FEMALES DEC 10 CAL/DECADE OVER 30 Y/O

VITAMIN D (BONE MINERALIZATION AND SERUM CA LEVEL MAINTAIN)

DEF: RICKETS, OSTEOMALACIA 70 Y/O ABOVE 600 IU OR 15 UG

51-70 Y/O 400 IU OR 10 UG

CALCIUM 50 Y/O 1200-1500 MG VIT B12 (CYANOCOBALAMINE) CELL DIVISION

2.4 UG DEC ATROPHIC GASTRITIS AND ALTERED GI PH SX: MACROCYTIC ANEMIA AND NEUROLOGICAL PROBLEM

 VIT B6 (PYRIDOXINE) METABOLISM OF CHON, FAT

50 Y/O 1.5 MG/DAY FEMALE; 1.7MG/DAY MALE DEF: + ALCOHOLICS = GLOSSITIS,CHEILOSIS, DEPRESSION, CONFUSION

FLUID: RDA 1.0-1.5ML/CAL OF ENERGY

51 Y/O (FOODS/BEV) 3.7 L MALES/ 2.7 L WOMEN
13 CUPS FOR MEN, 9 CUPS FOR WOMEN

SUPPLEMENT SAVVY- BEYOND THE RDA

FOLIC ACID, VIT B12, VIT B6 HYPERHOMOCYSTEINEMIA VIT E OR GINKO BILOBA AND ALZHEIMERS DISEASE
INCREASE DOSE 2,000 IU DELAY PROGRESS OF ALZHEIMERS
+ ANTIPLATELET/ANTICOAGULANT BLEEDING

ANTIOXIDANTS AND AGE RELATED MACULAR DEGENERATION

(AMD) BLINDNESS (60Y/O) + ZINC (SE: DIARRHEA. CRAMPING) 80MG, 500MG VIT C, 400 IU VIT E,15MG BETA CAROTENE

ALCOHOL + VITAMINS (DEF THIAMIN, RIBOFLAVIN, FOLATE, VIT

B6, MAGNESIUM) ABSORPTION/METABOLISM PROBLEM

NUTRITIONAL ASSESSMENT PARAMETERS

ANTHROPOMETRIC:
HEIGHT NOTE FOR EDEMA, UNINTENTIONAL WT LOSS OF 5% OVER A MONTH OR 10% OVER 6 MONTHS

- STAND, CHAIR SCALE, BED SCALE WEIGHT: - STANDING OR RECUMBENT - ARM SPAN/ DEMI ARM SPAN - SLIDING CALIPER (90 DEGREE ANGLE TO THE LEG) BMI WT (KG)/HT2 (M) - BELOW 22 IN UNDERNUTRITION - ABOVE 25 IN OVERNUTRITION BODY FAT MEASUREMENT: TRICEP SKINFOLD, SUBSCAPULAR ILEAC CREST, THIGH MUSCLE MASS MEASUREMENT: MIDARM CIRCUMFERENCE = TRICEP SKINFOLD

 PLASMA CHON (ALBUMIN, PREALBUMIN, TRANSFERRIN)

LESS THAN 3.0-3.5 MG/DL MILD MALNTN

LABORATORY VALUES

NEPHROTIC SYNDROME, LIVER DISEASE, OVER/UNDER DEHYDRATION HALF LIFE: 21 DAYS; PRE ALBUMIN AND TRANSFERRIN 2-3DAYS AND 8 DAYS

FOLATE AND VITAMIN B12 ASSESSMENT CHOLESTEROL: LESS THAN 160MG/DL NURSING ASSESSMENT: PHYSICAL EXAMINATION, NURSING HISTORY (DIET
RECALL, FOOD FREQ, FOOD RECORD), SCREENING TOOLS SCREENING TOOLS: NUTRITION SCREENING INITIATIVE (NSI) P.132 DETERMINE CHECKLIST MINI NUTRITIONAL ASSESSMENT AND SUBJECTIVE GLOBAL ASSESSMENT P.133

COMMON NUTRITIONAL CONCERNS UNINTENTIONAL WT LOSS

DEHYDRATION SADNESS AND CLINICAL DEPRESSION ANOREXIA POLYPHARMACY PAIN CHRONIC DISEASES (AEROPHAGIA) DYSPHAGIA DEPENDENCY ON OTHERS COGNITIVE IMPAIRMENT SENSORY CHANGES IMPROPER DIET POVERTY

END OF WK 5 FIRST MEETING PREPARE FOR A QUIZ TOMOR

CHAPTER 6 PHARMACOLOGY AND OLDER ADULT

CULTURAL DIVERSITY AND MEDICATION SAFETY PHARMACOKINETIC ALTERATIONS IN THE OLDER PERSONS - DEC BODY WATER INC FAT - HEPATIC BLD FLOW DEC 65 Y/O TOXICITY FIRST PASS
EFFECT

- DECREASE IN SERUM ALBUMIN LEVELS OR BINDING CAPACITY - KIDNEYS DEC PHARMACODYNAMICS

 PHARMACODYNAMIC ALTERATION - DEC NO. OF RECEPTOR AND RECEPTOR BINDING OR ALTERED

CELLULAR RESPONSE TO RECEPTOR INTERACTION

IMPACT OF CONCURRENT CONDITION AND THERAPY OR DRUG

THERAPY

ADVERSE DRUG REACTION AND LATROGENESIS/ SE

- SX SAME AS THE DISEASE

- INAPPROPRIATE DOSING, DRUG-DRUG INTERACTION,

POLYPHARMACY, NON COMPLIANCE

REPORT ADVERSE EFFECT PREVENTION OF ADVERSE EFFECT IN OLDER ADULTS POLYPHARMACY

 ADVRSE EFFECTS: - COGNITIVE EFFECT (DELIRIUM, DEMENTIA,

DEPRESSION)

- ANTICHOLINERGIC SYNDROME (AGITATION,

CONFUSION, DISORIENTATION, POOR ATTENTION, HALLUCINATIONS AND PSYCHOSIS)

- GASTRIC AND ESOPHAGEAL IRRITATION

CHAPTER 8 SLEEP AND THE OLDER PROBLEMS: ADULT

1. DIFFICULTY FALLING ASLEEP 2. MORE FREQ AWAKENINGS 3. DEC AMT OF NIGHT TIME SLEEP 4. MORE FREQ DAYTIME NAPPING - PROPER SLEEP ARCHITECTURE AND ADEQUATE TOTAL SLEEP
TIME THROUGH OUT THE NIGHT CYCLE INTO REM

- NREM STAGE OF SLOW WAVE SLEEP AND ABOUT EVERY 90 MIN. - SLEEP PATTERN REGULATED BY THE SUPRACHIASMATIC
NUCLEUS HYPOTHALAMUS- CIRCADIAN RHYTHM

 SLEEP DEPRIVATION: - DAYTIME FATIGUE - VISUAL/AUDITORY HALLUCINATION - IRRITABILITY - EXACERBATE ALZHEIMERS DISEASE - IMPAIRED LEARNING ABILITY - DELAYED HEALING SLEEP PROBLEMS: - TRANSIENT, INTERMITTENT AND CHRONIC SLEEP ARCHITECTURE:
NREM GH/PROLACTIN/TSH PHYSIOLOGIC RESTORATION
DEEP SLEEP STIMULATE PHYSICAL RESTORATION (DEC IN ELDERLY)

 STAGES OF SLEEP:
1 LIGHT 2 BRAIN WAVES SLOW AND EYE MVMT STOP 3 SLOWING BRAIN WAVES AND SLEEP SPINDLES 4 DELTA WAVES CHAR BY LARGE, SLOW PATTERN OF BRAIN ACTIVITY REM BRIEF MUSCLE CONTRACTION

- INC HEART RATE/BP

- BREATHING IS IRREG AND SHALLOW, EYES FROM SIDE TO SIDE, LIMBIC TEMP PARALYZED - DREAM SLEEP - LEARNING, MEMORY CONSOLIDATION, DAYTIME CONCENTRATION

NORMAL SLEEP AND AGING

AGE RELATED CHANGES IN NERVOUS SYSTEM CAN AFFECT SLEEP - CHEMICAL, STRUCTURAL, FUNCTIONAL LEVELS
- SEROTONIN, NOREPINEPHRINE (BRAIN ALERT DURING
SLEEP) - SENSORY INPUTS - DECLINE IN CEREBRAL METABOLISM RATE AND BLOOD FLOW - REDUCTION OF NEURON CELL - MEURAL DEGENERATION AND ATROPHY

 ABNORMAL SLEEP BEHAVIOR: 1. RESTLESS LEG SYNDROME 2. SLEEP WALKING/TERRORS 3. SLEEP RELATED EPILEPTIC SEIZURE HEALTH PROBLEMS AND SLEEP DISRUPTION: - PERSONAL, ENVIRONMENTAL CARACTERISTICS OR COMBINE, PAIN SLEEP DISRUPTION:
1. DEMENTIA REDUCE STAGE 3 AND REM, NO STAGE 4

- ALZHEIMERS DIS PSYCHOTROPIC DRUGS SE: FALLS,

SWALLOWING DIFF, CONSTIPATION, DIZZINESS, DAYTIME SLEEPINESS ----ALTER SLEEP ARCHITECTURE
2. SNORING SLEEP APNEA (10 SECS) 20-30X/HR PROB WITH CNS/OBSTRUCTION

 URINARY PROBLEMS SLEEP PROBLEMS IN HOSP AND NURSING HOMES: 1. ALCOHOL AND CAFFEINE (INC TIME OF AWAKENING AND LENGTH OF
TIME IT TAKES TO FALL ASLEEP)

- SEDATE CNS DISRUPT REM - NICOTINE ( EXTENDS TIME TO FALL ASLEEP AND REDUCES SLEEP TIME
AND REM

2. SLEEPING MEDS HYPNOTIC MEDS (SHORT TERM USE) 2 WKS OR LESS

- LONG HALF LIVES EXCESSIVE DAYTIME SLEEPINESS - ANTIDEPRESSANT AFFECTS SLEEP (IN THE EVENING) NURSING INTERVENTIONS MEDICATIONS

END OF PRELIMINARY TOPICS GOODLUCK GOD BLESS