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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:
17.1 Describe the role nutrition plays in longevity.
17.2 Summarize how nutrition interacts with the physical, psychological, economic, and social changes involved
17.4 Identify how nutrition might contribute to, or prevent, the development of age-related problems associated
with vision, arthritis, the brain, and alcohol use.
17.6 Explain why certain nutrients and medications interact.
a. Name some medications that increase excretion of, alter requirements of, or interact with nutrients and
the dietary changes recommended.
Assignments and Other Instructional Materials
The following ready-to–use assignments are available in this chapter of the instructor’s manual:
• Case Study 17-1: Malnutrition in an Elderly Male
• New! Case Study 17-2: Avoiding Food-Drug Interactions
• Worksheet 17-1: Eating for Healthy Aging Review (Internet Exercise)
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• New! Worksheet 17-2: Chapter 17 Crossword Puzzle
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• New! Critical thinking questions with answers
Lecture Presentation Outline
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Key to instructor resource annotations (shown to the right of or below outline topics):
TRA = Transparency acetates: 13e = 13th edition, 12e = 12th edition, 11e = 11th edition, 10e = 10th edition
Website = Available for download from book companion website: HN = student handout
IM = Included in this instructor’s manual: CS = case study, WS = worksheet, CA = classroom activity
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Contributed by Daryle Wane.
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Contributed by Carrie King.
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Handouts 17-1 and 17-2 contributed by Sharon Rady Rolfes.
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Contributed by Melissa Langone.
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I. Nutrition and Longevity (Figure 17–1) 10e TRA 163
A. Observation of Older Adults
1. Healthy Habits
a. Eating well-balanced meals
f. Sleeping regularly and adequately
2. Physical Activity (Table 17-1) 12e TRA 22
a. Lower weight, greater flexibility, increased endurance, better balance and health, and a longer life
span
e. Check with physician first
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
II. The Aging Process
A. Physiological Changes IM CA 17
1. Body Weight
a. Two thirds of the older 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
5. Tooth Loss
1. Dry mouth
2. Eating difficulty
d. Ill-fitting dentures
6. Sensory Losses and Other Physical Problems
a. Vision problems can make driving and shopping difficult
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b. Taste and smell sensitivities may diminish
B. Other Changes
1. Psychological Changes
a. Depression and loss of appetite
III. Energy and Nutrient Needs of Older Adults 12e TRA 23; IM WS 17-1
A. Water
1. Dehydration
2. Fluid needs are not recognized
B. Energy and Energy Nutrients
1. Energy needs decrease by around 5% per decade
C. Vitamins and Minerals (Table 17-2)
1. Vitamin B12
2. Vitamin D
3. Folate
IV. Nutrition-Related Concerns of Older Adults
A. Vision
1. Cataracts
2. Macular Degeneration
a. Supplements of the omega-3 fatty acid DHA, folate, vitamin B6, vitamin B12, leutein, zeaxanthin
1. Osteoarthritis
2. Rheumatoid Arthritis
a. Immune system attacks bone coverings
b. Omega-3 fatty acids may reduce joint tenderness and improve mobility
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c. Vitamin C, vitamin E, and carotenoids as antioxidants may help
3. Gout
4. Treatment
a. Relief from discomfort and improve mobility
1. Nutrient Deficiencies and Brain Function
2. Alzheimer’s Disease (Table 17-3, Figure 17-3) 13e TRA 21
a. Abnormal deterioration of the brain
1. Impairs memory and cognition
2. Ask about drinking behaviors
V. Food Choices and Eating Habits of Older Adults
A. Malnutrition (Table 17–5) IM CS 17-1
1. Limits ability to function
B. Food Assistance Programs
1. Congregate meals
2. Meals on Wheels
3. The Senior Farmers Market Nutrition Program
C. Meals for Singles
1. Foodborne Illness
a. Greater risk in older adults
b. If severe, can cause paralysis, meningitis, or death
VI. Highlight: Nutrient-Drug Interactions IM CS 17-2
A. The Actions of Drugs
1. Modifies one or more of the body’s functions
1. Drugs Alter Food Intake
a. Altering appetite
2. Drugs Alter Nutrient Absorption
a. Changing acidity of the digestive tract
b. Damaging mucosal cells
c. Binding nutrients
3. Diets Alter Drug Absorption
a. Stimulating secretion of gastric acid
4. Drugs Alter Nutrient Metabolism (Figure H17–1)
5. Diet Alters Drug Metabolism
5. Drugs Alter Nutrient Excretion
a. Altering reabsorption in the kidneys
b. May result in diarrhea or vomiting
6. Diets Alter Drug Excretion – May cause the liver to release enzymes that metabolize drugs and
influence excretion
1. Sugar, Sorbitol, and Lactose
2. Sodium – Can be found in antibiotics and antacids
Case Studies
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Case Study 17-1: Malnutrition in an Elderly Male
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 to 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
to doctor’s appointments. Although in reasonably good health, he has lost weight over the past year and complains
of feeling more tired than usual. Since his wife’s death, he has stopped going to his exercise class and prefers to eat
his meals in his apartment rather than the community dining facility. He prepares his own meals, which usually
include toast and coffee for breakfast, a meat or cheese sandwich with potato chips and milk for lunch, and canned
soup or chili beans for dinner. He rarely eats between meals. Although usually at a healthy weight for his height,
Roy’s family is concerned that he has lost 12 pounds since his wife’s death.
1. According to Table 17-5, what risk factors for malnutrition apply to Roy?
2. Explain how the recent death of Roy’s wife may have contributed to his risk for malnutrition. What are some
ways his friends and family may help him through this time?
3. Explain how Roy’s change in eating and exercise 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.
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5. What are some creative suggestions from this chapter that may help Roy and his family improve his intake of
key nutrients?
6. From what you have learned in this chapter, what would you suggest to be the best nutritional approach to
reduce Roy’s symptoms of depression and improve his quality of life?
Answer Key
1. Roy is elderly (over 80 years old) and eats alone most of the time—he has reduced social contact. His diet is
poor (few fruits and vegetables) and he has involuntarily lost more than 10 pounds in the past 6 months. He
needs assistance with shopping and cooking for himself.
Case Study 17-2: Avoiding Food-Drug Interactions
Betsy A. is a 72-year-old woman who was recently hospitalized after having a mild stroke. She has been discharged
from the hospital on warfarin—a blood thinning medication—and has been advised to continue her usual diet at
home. Betsy’s doctor also wants her to continue her other medications, which include a diuretic medication, a low–
dose daily aspirin, and pravastatin—her cholesterol medication.
Betsy and her husband consume a varied diet. Betsy’s husband often barbecues fish, poultry, and meat on their
outdoor grill. They eat fresh oranges or grapefruit most mornings and have a mixed green salad with dinner several
nights a week. Betsy begins to wonder if her new medication will require her to make any changes in her diet.
1. Based on information in Highlight 17, what are some potential drug-drug or drug-nutrient interactions Betsy
may encounter with the addition of warfarin to her medication regimen?
2. Which foods in Betsy’s usual diet have the greatest potential to interfere with the therapeutic effect of her new
medication? Explain why this is important for Betsy to understand.
3. Why is it important for Betsy to adhere to her doctor’s advice to maintain her current diet in regards to taking
warfarin?
4. What information about cooking meat and its effect on warfarin activity would be helpful for Betsy and her
husband to understand? How might this change their cooking methods?
5. How might Betsy’s nutritional status be affected by her diuretic medication? Explain how she can use this
information to make daily food choices.
6. Based on her current medication regimen, should Betsy stop eating grapefruit? Why or why not?
7. What is a good course of action for Betsy to follow if she has any questions about the potential interactions of
her medications?
Answer Key
1. Answers may include anti-clotting effect of aspirin that may enhance the effect of warfarin; and the effect of
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2. Betsy’s diet is high in dark-green leafy vegetables, which are the highest sources of vitamin K, a nutrient that is
3. If vitamin K consumption from foods or supplements changes substantially, it can interfere with the action of
4. Components of charcoal-broiled meats increase metabolism of warfarin. Answers will vary but it may be
helpful for Betsy’s husband to charcoal-broil meats less often.
5. Drugs that enhance urine excretion may accelerate the excretion of potassium, calcium, and magnesium. Betsy
7. Betsy can ask her physician about potential interactions and check with her pharmacist for instructions on
taking drugs with foods. If she has any problems with the medications, she should seek professional care
without delay.
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: 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;
• Station 2—sewing needles, thread, fabric, scissors, reading glasses with Vaseline on lenses, plastic or rubber
gloves;
• Station 3—newspaper, scissors, plastic or rubber gloves, reading glasses with Vaseline on lenses, cotton balls.
Assign the following tasks to each student:
• Wrap the knee wraps around one knee to simulate joint stiffness and walk around for 3 to 5 minutes; walk up
and down stairs if available.
• Wearing the reading glasses and plastic or rubber gloves, thread a needle and sew a row of stitches.
• Wearing the reading glasses and plastic or rubber gloves, with cotton balls placed in the ears, cut an article out
of the paper and talk about it to another student.
After the activity is complete, discuss the challenges of the aging process.
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,
gender, and activity level as listed in Appendix F. If she/he is a different age, she/he will need to subtract kcal for
each year over 30 or add kcal for each year under 30 (7 kcal/year for women or 10 kcal/year for men). For example,
a 38-year-old female who is 59” tall, weighs 107 lb., and is low active would estimate energy needs at 1874 – (7
8) or 1818 kcal/day. To determine her/his requirement in 20 years, the student should subtract an additional 140 kcal
(for women) or 200 kcal (for men) from the current estimation.
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Study Card 17 Answer Key
7. On average, energy needs decline an estimated 5 percent per decade. One reason is that people usually reduce
their physical activity as they age, although they need not do so. Another reason is that basal metabolic rate
declines 1 to 2 percent per decade in part because lean body mass and thyroid hormones diminish.
Critical Thinking Questions
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1. What nutritional factors contribute to longevity?
2. Describe how differences in body weight and body composition affect older adults in terms of health outcomes.
3. Explain how dentition factors affect nutrition for the older adult.
4. Describe how decreased fluid intake for the older adult leads to poor health outcomes.
5. What dietary measures will help to alleviate clinical symptoms of gout?
6. Compare and contrast the nutritional benefits of congregate meals versus Meals on Wheels for the older adult.
Answer Key
1. Eating a well-balanced diet that is low in unhealthy fats and rich in fruits, whole grains, and vegetables is
associated with increased longevity. Limited alcohol intake and/or avoidance of alcohol is also associated with
2. With aging, older adults tend to lose bone and muscle mass but at the same time are prone to gain body fat. This
is considered to be a normal part of the aging process due to hormonal effects. In the older adult, it is better to
be normal weight or slightly overweight as compared to being underweight or obese. If underweight, the older
3. Due to the effects of aging, older adults are likely to experience a dry mouth. Dryness in the mouth can lead to
the occurrence of dental disease that can affect both teeth and gums. Gum or periodontal disease can lead to
significant impairments such as pain, inability to chew foods, and alterations in taste. If there are any lesions or
4. Older adults experience a larger proportional fluid loss than younger adults as their total body water decreases
with age. Older adults are therefore at a greater risk to suffer from the effects of dehydration. Older adults also
5. Since gout is associated with an increase in uric acid levels, avoidance and/or limitation of foods that are
considered to be high in uric acid should be practiced. Purine–based foods are associated with high uric acid
6. Congregate meals are meals that are served in a group setting. Meals on Wheels are those that are served to an
individual person in her/his own home. In terms of nutritional benefits, both of these methods offer similar
nutritional value because they are based on daily food group nutritional standards. Each of these meal options
provides nutritional benefits based on meeting established economic guidelines for distribution. They differ in
IM Worksheet Answer Key
Worksheet 17-1: Eating for Healthy Aging Review (Internet Exercise)
Worksheet 17-2: Chapter 17 Crossword Puzzle
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Worksheet 17-1: Eating for Healthy Aging Review (Internet Exercise)
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
caloric intake.
a. True
b. False
4. Refined grain food sources are equivalent in nutritional content to whole-grain food sources.
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
terms of physical activity.
a. True
b. False
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Worksheet 17-2: Chapter 17 Crossword Puzzle
1
2
3
4
5
6
7
8
9
10
11
12
Across:
Down:
1. Regular physical activity and achieving a healthy
8. Influenced by regular physical activity and good
nutritional intake
12. _____ are an important option for socialization at
2. Dietary intake of _____ is essential for minimizing
with the metabolism of _____.
6. Intake of _____ needs to be carefully maintained
this process
11. _____ restriction of 10-20% may be associated with
increased longevity in humans.
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Handout 17-1: More about the Brain
Summary of Nutrient-Brain Relationships
Brain Function
Adequate Intake of
Short-term memory
Vitamin B12, vitamin C, vitamin E
Performance in problem-solving tests
Riboflavin, folate, vitamin B12, vitamin C
Common Signs of Dementia
• Agitated behavior
• Becoming lost in familiar surroundings or circumstances
• Confusion
Mental health
Thiamin, niacin, zinc, folate
Cognition
Folate, vitamin B6, vitamin B12, iron, vitamin E, iodine
Neurotransmitter synthesis
Tyrosine, tryptophan, choline