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Chapter 17 – Life Cycle Nutrition: Adulthood and the Later Years
Learning Objectives
After completing Chapter 17, the student will be able to:
1. List the lifestyle behaviors that have an impact on health and aging.
2. Discuss the research on energy restriction and aging.
3. Describe physiological aging and lifestyle factors which can modify the process.
Assignments and Other Instructional Materials
The following ready-to–use assignments are available in this chapter of the instructor’s manual:
• New! Case study
Other instructional materials in this chapter of the instructor’s manual include:
• Answer key for How To (p. 585) activity
• Classroom activities
• Worksheet answer keys (as appropriate)
Lecture Presentation Outline
4
“Of special interest to…” symbol key: = Hot Topic = Personal Health
= Health Care Professionals = Science Majors
Key to instructor resource annotations (shown to the right of or below outline topics):
PL = Available on Power Lecture DVD–ROM (ISBN 0538797592)
TRA = Transparency acetates: 12e TRA = 12th edition, 11e TRA = 11th edition, 10e TRA = 10th edition
Website = Available for download from book companion website: HN = student handout
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I. Nutrition and Longevity 10e TRA 163
Good nutrition and regular physical activity can increase life expectancy, support good health, prevent or
prolong the onset of disease, and improve the quality of life. There are many healthy habits that can increase
life span. A person’s physiological age and chronological age may be different. The benefits of energy
restriction in humans in the later years are being studied.
A. Observation of Older Adults
1. Healthy Habits
a. Eating well-balanced meals, including breakfast, regularly.
2. Physical Activity 12e TRA 22
a. Many benefits including lower weight, greater flexibility, increased endurance, better balance and
health, and a longer life span.
B. Manipulation of Diet
1. Energy Restriction in Animals
2. Energy Restriction in Human Beings
a. Applying results in animal studies to human beings is problematic.
b. Extreme starvation is not worth the price.
c. Moderation of energy intake may be valuable.
A. Physiological Changes IM CA 17-2
1. Body Weight
a. Two thirds of the adults in the U.S. are overweight or obese.
b. Older adults with low body weight may be unprepared to fight illness and disease.
2. Body Composition
3. Immunity and Inflammation
a. Compromised immune systems can occur with age.
4. GI Tract
a. Slower motility resulting in constipation.
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5. Tooth Loss
a. Tooth loss and gum disease can interfere with food intake.
b. Edentulous is lack of teeth.
c. Conditions that require dental care
1. Dry mouth.
d. Ill-fitting dentures
6. Sensory Losses and Other Physical Problems
a. Vision problems can make driving and shopping difficult.
b. Taste and smell sensitivities may diminish.
B. Other Changes
1. Psychological Changes
a. Depression and loss of appetite commonly occur together.
b. Support and companionship of family and friends are helpful.
A. Water
1. Dehydration increases risks for urinary tract infections, pneumonia, pressure ulcers, confusion and
disorientation.
2. Fluid needs are not recognized.
B. Energy and Energy Nutrients
1. Energy needs decrease by around 5% per decade.
2. Protein to protect muscle mass, boost the immune system, and optimize bone mass.
C. Vitamins and Minerals IM CI 17.1
1. Vitamin B12 from fortified foods and supplements is especially needed for those with atrophic gastritis.
2. Vitamin D from fortified milk and sunshine is needed to prevent bone loss.
3. Folate status may be compromised by medical conditions or medications.
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IV. Nutrition-Related Concerns of Older Adults IM CI 17.3
Older adults may have many problems that might be preventable through good nutrition. There is a strong need
to solve vision-, arthritis-, and brain-related problems.
A. Vision
1. Cataracts are thickenings of the eye lenses.
a. Consuming foods or taking supplements of vitamin C, vitamin E, and carotenoids may decrease
B. Arthritis
1. Osteoarthritis (also called degenerative arthritis)
2. Rheumatoid Arthritis
3. Gout
a. Uric acid deposits in the joints.
4. Treatment
a. Relief from discomfort and improve mobility.
C. The Aging Brain
1. Nutrient Deficiencies and Brain Function
a. Neurotransmitters need precursor nutrients.
b. Senile dementia.
c. Neurons diminish as people age.
2. Alzheimer’s Disease
a. Abnormal deterioration of the brain.
V. Food Choices and Eating Habits of Older Adults
Older people benefit from the social interaction and the nutrients provided through food assistance programs.
Older adults should purchase foods carefully and prepare foods creatively.
A. Food Assistance Programs IM CI 17.2
1. Congregate meals are group settings at community centers.
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1. Foodborne Illness
a. Greater risk in older adults.
VI. Highlight: Nutrient-Drug Interactions
Both prescription and nonprescription (over-the-counter) drugs may have nutrition-related consequences.
Individuals need to consult with all of their physicians and pharmacists to avoid harmful drug interactions.
A. The Actions of Drugs
1. Modifies one or more of the body’s functions.
2. Desirable and undesirable effects.
B. The Interactions between Drugs and Nutrients Website HN 17-1
1. Drugs Alter Food Intake
a. Altering appetite.
2. Drugs Alter Nutrient Absorption
3. Diets Alter Drug Absorption
a. Stimulating secretion of gastric acid.
b. Altering rate of gastric emptying.
c. Binding to drugs.
d. Competing for absorption sites.
4. Drugs Alter Nutrient Metabolism
5. Diet Alters Drug Metabolism
a. May increase the side effects of drugs.
b. May increase drug action to excessive levels.
5. Drugs Alter Nutrient Excretion
a. Altering reabsorption in the kidneys.
C. The Inactive Ingredients in Drugs – Other ingredients in drugs may include sugar, sorbitol, lactose, and
sodium.
1. Sugar, Sorbitol, and Lactose
2. Sodium can be found in antibiotics and antacids.
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Case Study
5
Roy is an 89-year-old retired pastor who was married for 60 years before the death of his wife 6 months ago. He
now lives alone in a retirement community close by his daughter and her family. He recently stopped driving on the
advice of his physician and depends on his daughter and grandchildren to help him with groceries and transport him
1. How may the recent death of his wife affect Roy’s nutritional status? What are some ways his friends and
family may help him through this time?
2. According to Table 17-5, what risk factors for malnutrition does Roy exhibit?
3. Explain how Roy’s change in habits impacts his risk for sarcopenia. How does this impact his physical safety
and self-sufficiency?
4. Describe one or two strategies that his family may use to help Roy maintain a normal weight and improve his
nutritional status when he doesn’t feel like preparing meals.
5. Refer to Figure 17-3 and describe which components of the Modified MyPyramid for Older Adults are lacking
in Roy’s current lifestyle.
6. Suggest ways to improve Roy’s current diet with essential nutrients that are currently lacking, including
nutritional supplementation if needed.
Answer Key:
1. He may feel depressed, which may cause a loss of appetite and motivation to cook or eat. His friends and family
Suggested Classroom Activities
This chapter provides information on aging and the nutrition needs of the elderly. Instructors may want to emphasize
particular sections of the chapter and elaborate on them in response to students’ interest.
Classroom Activity 17-1: Chapter Opening Quiz
Objective: Introduction to chapter Class size: Any
Instructions: As a way of introducing any new chapter, give a quiz to the class. This is a quiz designed to be
projected overhead. For details, please see Chapter 1, Classroom Activity 1–7.
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Classroom Activity 17-2: Simulation of Aging Processes
Key concept: Physiological changes during aging Class size: Small to medium
Materials needed: Knee wraps, needles, thread, fabric (several small pieces), scissors (2 pairs), reading glasses (2
pairs), petroleum jelly, plastic/rubber gloves (2 pairs), newspaper, cotton balls
Instructions: Prior to class, collect several items and set up stations in the classroom:
• Station 1—knee wraps;
How To “Try It” Activities Answer Key
How to Estimate Energy Requirements for Older Adults
If the student is 30 years old, the student’s energy requirement will be the value for someone of their weight, height,
Critical Thinking Questions
6
These questions will also be posted to the book’s website so that students can complete them online and e-mail their
answers to you.
1. Chapter 17 points out that 70–80% of an individual’s life expectancy depends on their health and lifestyle
behaviors and the other 20–30% depend on the individual’s genetic background. This chapter also differentiates
between physiologic age and chronologic age, the former being based on your health and exercise activities as
well as lifestyle, and the latter, on birth date. One can be younger physiologically because they eat well and
exercise even if they are chronologically older (or vice versa). Given this information, assess the difference
between your physiologic and chronological age. In this assessment, outline how you are meeting each of the
principles of dietary planning based on MyPyramid.
Once you have determined your physiologic age, discuss this age and your overall life expectancy, given your
diet, exercise, health status, and lifestyle behaviors in relation to your individual genetic background. In looking
at your personal and family health history, what role do you think genetics will play in your overall life
expectancy? Does your lifestyle contribute more to your life expectancy than it would to that of others in your
family? Barring no unforeseen circumstances, what are you estimating to be your overall life expectancy?
Answer: This question is individualized to the student and allows them to focus, for a moment, on how they are
taking care of themselves and where they need to improve. It is important to point out to the students that they
2. Chapter 17 outlines some of the physiologic changes that can occur in the aging or older adult. However, many
older adults have had the benefit of wonderful health care and now remain active well into their 80s. What
advice does one give to these individuals and what precautions might one offer?
Answer: Many older adults are far from the norm in that they are living longer, exercising, eating a healthy
diet, and following up with their doctor on a regular basis. These individuals are the reason that the longevity of
older adults has increased. When I was teaching at a medical school, one of the gerontology physicians
3. Many older Americans lose their friends of many years because of death. What impact does this have on mind
and body?
Answer: Individuals that consume a diet rich in nutrients and maintain an active lifestyle often find themselves
without their friends at the end of their lives. Unfortunately, one consequence of health is loss of less healthy
friends as one ages; however one benefits from being with family, children, and grandchildren. Depression is a
major problem for older adults that lose many of their friends and family and are faced with being alone
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4. The elderly are challenged by several chronic health problems and may also experience some nutritional issues
as a result of physiologic challenges. They may also suffer from mental health issues as a consequence of aging.
Discuss the many challenges one might work around to enhance the nutritional status of an elderly client as an
RD. Make the list as exhaustive a desired.
Answer: The major chronic diseases faced not only by the elderly but many younger Americans due to the
increasing prevalence of obesity are cardiovascular disease and type 2 diabetes and its co-morbidities of renal
disease, skin breakdown, and visual problems. Other chronic diseases of the elderly include arthritis and
dementia (several varieties including Alzheimer’s). Each of these chronic problems has its own sets of dietary
and medical issues that must be solved. As the patients advance in age, so too do the number of chronic issues
and the medications the patients take, which also affects a patient’s risk for drug-nutrient interactions and senses
of taste and smell.
In this regard, the elderly lose many of their freedoms, routines, and independence over time, which becomes
very difficult for most. Individuals who were once the providers for their children are now having their children
provide for them, if they are lucky.
Imagine if you were independent for 80 years and all of the sudden you had problems seeing or remembering or
your skin was breaking down to the point that you were infected all the time? This is a major change in life for
the individuals that have provided so much to our country, etc. When working with the elderly patient, it is
important to respect their contributions and understand their losses in the aging processes while keeping an eye
on the complex medical, physiological, and nutritional needs of the patient as well as the family caring for
them. If there is no family available, the RD must be very cognizant of all state and federal programs of
assistance for the patient to optimize their care process. The social worker can help in this process.
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Ask the patient about their past weeks with the present diet and any problems. Also ask the family members to
correlate the information. Never assume anything, as changes can happen quickly in the elderly population.
Therefore, a thorough and complete assessment is required for each patient and their family to be most
effective.
The elderly client suffers many losses. Not only do they lose friends but they lose their independence, and they
may lose their ability to walk, feel, and remember people. Consider one of your family members or a friend.
Aging is not for the weak! Those that have taken the best care of themselves may live longer but are often left
alone with no one their age to talk to and many aliments to deal with as well as isolation, etc.
5. What other health challenges do older Americans face in an often volatile economy? How can they protect
themselves nutritionally and with regard to their health status?
Answer: While older Americans face many challenges, all Americans face incredible challenges. Many older
adults are living with their younger children and facing the challenges of trying to survive and provide for their
children, given this poor economy.
6. Nutrient-drug interactions can negatively influence the overall effect of a drug and in some cases they can be
fatal. After reading Highlight 17, select a member of your family that is in the older adult category and takes
more than 4–5 medications. Thinking about what you know of this person’s overall health and nutritional status,
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assess the nutrient-drug interactions that may occur with these drugs. Your family member will remain
confidential. Make dietary recommendations given your family member’s medical history, rationale for taking
medications, and potential or nutrient-drug interactions.
Answer: This is a great opportunity for each student to observe drug-nutrient interactions, plus observe all the
complex interactions that are required to be assessed and counseled in the elderly client. Students often love this
IM Worksheet Answer Key
Worksheet 17-1: Chapter 17 Crossword Puzzle
Worksheet 17-2: Eating for Healthy Aging Review (Internet Exercise)
17.1 Eating Well with Canada’s Food Guide
Health Canada encourages healthy eating for seniors through Eating Well with Canada’s Food Guide. In addition to
recommending servings from each food group for Canadians over the age of 50 years, the food guide also
recommends all Canadians in this age range take a daily supplement that contains 10 micrograms (400 IU) of
vitamin D, due to an increased need during this life-stage.
17.2 Canadian Programs and Resources for Seniors
Although there are no Canadian national programs focused on nutrition for seniors, many provinces and
municipalities offer meals-on-wheels and congregate dining programs, as well as other services to support the aging
population. Instructors can check with nutritionists at local health units to become informed of nutrition services
available to seniors living in their area.
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funding for the New Horizons for Seniors program that encourages seniors to contribute to their communities
through active living and social participation, helping others in need, providing leadership, and sharing their
knowledge and skills.
10
Seniors who are involved with nutrition education programs and enjoy talking about food
make excellent guest speakers for class lectures.
One example of a community-based nutrition education program for seniors is Evergreen Action Nutrition provided
by the Guelph/Wellington Seniors Association at the Evergreen Seniors Centre.
11
,
12
This program includes cooking
workshops, men’s cooking groups, monthly displays with recipes and pamphlets, and individual counselling by a
registered dietitian based on suggestions from community seniors.
17.3 Nutrition Screening Tool for Canadian Seniors
Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN) was developed and validated
among seniors of varying health status living in the community in southern Ontario.
13
,
14
,
15
,
16
,
17
This screening tool is
Canadian Readings
Payette H. 2005. Nutrition as a determinant of functional autonomy and quality of life in aging: a research program.
Canadian Journal of Physiology & Pharmacology, 83(11):1061-1070.
Payette H, Shatenstein B. 2005. Determinants of healthy eating in community-dwelling elderly people. Canadian
Journal of Public Health, 96(S3):S27-S31.
Shatenstein B, Nadon S, Ferland G. 2003. Diet quality among older Quebecers as assessed by simple indicators.
Canadian Journal of Dietetic Practice and Research, 64(4):174–180.
Keller HH, McKenzie JD. 2003. Nutritional risk in vulnerable community-living seniors. Canadian Journal of
Dietetic Practice and Research, 64(4):195–201.
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Canadian Web-Based Resources
The Government of Canada has a web site, Seniors Canada, which outlines the government’s actions on seniors’
educational association that provides leadership in matters related to the aging population, and seeks to improve the
lives of older Canadians by creating and disseminating knowledge in gerontological policy, practice, research, and
education.
extensive list of online resources, many of which are associated with active living in the senior years. The Centre is
based in the Faculty of Health Sciences at the University of Western Ontario.
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Worksheet 17-1: Chapter 17 Crossword Puzzle
Across:
Down:
2. arthritic disease of the immune system involving
painful inflammation of the joints and related
structures
7. a person’s perceived physical and mental well being
8. thickenings of the eye lenses that impair vision and
can lead to blindness
1. a painful, chronic disease of the joints that occurs
when the cushioning cartilage in a joint breaks
down
3. inflammation of a joint usually accompanied by
pain, swelling, and structural changes
4. a degenerative disease of the brain involving
1 2 3
4
5
6
7
8
9
10
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Worksheet 17-2: Eating for Healthy Aging Review (Internet Exercise)
Click on Benefits of Eating Well and proceed through all of the information provided. Click on the Next
Page button to proceed through the content. Take the quizzes as you go through the content areas to make
sure that you understand the presented information. Do not close the window until you have answered all
of the questions.
1. Eating well can reduce the risk of developing type 2 diabetes.
a. True
b. False
2. The number of calories you need each day only depends on your age.
3. Including nutrient-dense foods in your diet can provide you with needed nutrients while limiting
4. Refined grain food sources are equivalent in nutritional content to whole-grain food sources.
a. True
b. False
5. Walnuts are an example of a food that contains polyunsaturated fat.
6. Women over age 50 should consume 2,000 calories (kcal) per day if they are moderately active in