Ch. 19

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Author:
Kymberli
ID:
84285
Filename:
Ch. 19
Updated:
2011-05-07 21:58:37
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Nutrition
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Description:
The Older Dental Patient
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  1. T/F: Improvements in health & subsequent longevity throughout the 20th Century have resulted in TREMENDOUS growth in the size of the elderly population.
    TRUE!
  2. T/F: MANY changes that accompany aging can AFFECT nutritional status & nutritional requirements.
    TRUE!
  3. 7 Aging & Nutrition Facts:
    • 1.) Nutrient-dense foods are IMPORTANT
    • 2.) Taste & smell are LESS sensitive
    • 3.) LOW-sodium & LOW-fat diets are COMMON
    • 4.) VARIOUS physical & mental challenges may LIMIT ability to purchase & prepare foods
    • 5.) Elderly people who live alone have a HARDER time eating a VARIETY of nutritious foods; so malnutrition is a CONCERN
    • 6.) MANY health concerns & diseases from to aging AFFECT eating habits & food choices
    • 7.) Food assistance programs are available to HELP feed the elderly
  4. Successful aging is defined as the ABILITY to MAINTAIN 3 KEY behaviors:
    • 1.) LOW RISK of disease-related disability
    • 2.) HIGH mental & physical function
    • 3.) ACTIVE engagement of life
  5. T/F: Nutrition is MAJOR determinant of Successful Aging.
    TRUE!
  6. What is the MOST COMMON nutritional disorder in older persons?
    Obesity
  7. Obesity & Older Patients:
    • Obesity affects 2 out of 4 Americans > 65 years old
    • Overweight people can STILL be malnourished if their diet is HIGH in calories, but LOW in essential nutrients
  8. T/F: Undernutrition is a pervasive PROBLEM in older patients too.
    TRUE
  9. T/F: A person's diet quality DECREASES substantially with age.
    TRUE
  10. Average Energy Intakes DECLINE by _______ Calories in Men & Women ages 20-80.
    • Men: 1,000-1,200 calories
    • Women: 600-800 calories
  11. DECLINES in nutrient intakes accompanies the DECLINE in energy intake, ESPECIALLY in these 4 Nutrients:
    • 1.) B Vitamins
    • 2.) Calcium
    • 3.) Iron
    • 4.) Zinc
  12. With INCREASING age, there is an INCREASE in the PREVALENCE of _________.
    Anemia
  13. An INCREASE in the PREVALENCE of anemia with INCREASING age is MAINLY DUE to a LACK of 2 nutrients:
    • 1.) Vitamin B6
    • 2.) Vitamin B12
  14. T/F: General health, oral health, nutrition, & aging are ALL RELATED.
    TRUE!
  15. 3 MAIN age-related changes that AFFECT nutritional status:
    • 1.) Physiological Changes: sensory, cognitive, functional
    • 2.) Social & Psychological Changes: poverty, food insecurity, loneliness, depression, changes in living situation, medications, alcohol
    • 3.) Oral Changes: root caries, periodontal disease & diabetes mellitus, oral cancers, tooth loss & osteoporosis, dentition status (dentures), xerostomia
  16. 7 Physiological changes in Older Patients:
    • 1.) Body composition changes: DECREASED lean body mass; Sarcopenia (loss of muscle mass)
    • 2.) LOWER energy requirement: LOWER physical activity & LOWER basal metabolic rate
    • 3.) GI tract function DECLINES: DELAYED gastric emptying, SLOWED digestion & absorption, constipation, DECREASED appetite, Atrophic Gastritis which leads to REDUCED secretion of Hydrochloric Acid & INADEQUATE absorption of Iron, Calcium, Vitamin B6, B12, & Folate
    • 4.) Kidney function DECLINES
    • 5.) Dehydration
    • 6.) Chewing difficulties/Use of Dentures: soft, easy-to-chew diets
    • 7.) Constipation
  17. 4 Sensory changes of Older Patients:
    • 1.) Smell & taste DECLINE with age
    • 2.) DECREASED # of taste buds on the tongue
    • 3.) DECREASE in nerve ending response to taste & smell
    • 4.) Medical conditions, drugs, & dentures can be CONTRIBUTING FACTORS to sensory changes
  18. 6 Cognitive Changes in Older Patients:
    • 1.) Dementia
    • 2.) Alzheimer's disease
    • 3.) Memory loss
    • 4.) Disorientation
    • 5.) Anxiety
    • 6.) Biochemical & metabolic disturbances

    * ALL of these may RESULT in DECREASED food intake
  19. 5 Functional Changes in older patients:
    • 1.) Physical Disabilities: Arthritis, Stroke, Vision/Hearing impairment
    • 2.) DIFFICULTY transporting to the grocery store
    • 3.) INABILITY to handle eating utensils
    • 4.) INABILITY to see food clearly
    • 5.) Social isolation due to hearing difficulties

    *Functional changes can AFFECT their nutritional status INDIRECTLY*
  20. 7 Social & Psychological Factors of Older Patients that AFFECT Nutrition:
    • 1.) Poverty
    • 2.) Living arrangements
    • 3.) Finances
    • 4.) Transportation
    • 5.) Social interaction
    • 6.) Depression
    • 7.) Living alone
  21. 2 Types of Living Situations of Older Patients:
    • 1.) Free-living homebound elders
    • 2.) Nursing home residents
  22. Medications & Older Patients: (2)
    • Elderly people use MANY prescription & over-the-counter drugs
    • INCREASED RISK of drug-drug & drug-nutrient interaction
  23. Alcohol Abuse & Older Patients: (4)
    • Alcohol abuse is a RISK FACTOR in elders
    • Alcohol abuse may be a RESPONSE to stress, unwanted changes in life situations, depression, & social isolation
    • it PROVIDES calories, but LITTLE nutritional value
    • may SUBSTITUTE alcohol for MORE nutritious foods in the diet
  24. 6 COMMON Oral Conditions that have Nutritional Complications in Older Patients:
    • 1.) Root caries
    • 2.) Periodontal Disease & Diabetes Mellitus
    • 3.) Oral Cancers
    • 4.) Tooth loss & Osteoporosis
    • 5.) Dentition status (Dentures)
    • 6.) Xerostomia
  25. T/F: Vertical dimensions of the jawbone DIMINISH with age.
    TRUE
  26. Screening Older Patients for Nutritional Risk: (2)
    • Dental team members are IMPORTANT allies in screening older patients for health risks, including nutrition issues
    • COMMON oral complications that affect nutritional status such as Xerostomia, impaired taste, or difficulty chewing & swallowing can be QUICKLY identified with the use of oral health screening tools
  27. 2 Ways to IMPROVE the Nutritional Status of Aging Patients:
    • 1.) Dietary guidance
    • 3.) Supplements
  28. Supplements for Elder Patients: (2)
    • Supplements can INTERACT with medicines
    • Elders should be ENCOURAGED to eat a balanced, nutritious diet & may take daily multivitamin/mineral supplements that contain NO MORE THAN 100-200% of the DRI for the nutrients contained
  29. Older adults should eat a diet that EMPHASIZES 3 Things:
    • 1.) Nutrient-dense foods
    • 2.) HIGH-fiber foods
    • 3.) CONTROLS calories
  30. T/F: Dental health professionals are in an IDEAL position to IDENTIFY nutritional problems & counsel elderly patients.
    TRUE!
  31. T/F: Elders may be at GREATER RISK for nutritional problems than younger patients.
    TRUE!
  32. T/F: Dental hygienists should ROUTINELY screen older patients for nutritional risk factors.
    TRUE!
  33. T/F: Oral conditions may CONTRIBUTE to nutritional problems & vice versa.
    TRUE!
  34. Modified Food Pyramid for 70+ Adults:
    • Supplements: Vitamin B12, Vitamin D, & Calcium
    • Fats, Oils, & Sweets: use SPARINGLY
    • Dairy: > or EQUAL TO 3 servings
    • Vegetables: > or EQUAL to 3 servings
    • Meat/Beans/Nuts: > or EQUAL to 2 servings
    • Fruit: > or EQUAL to 2 servings
    • Grains: > or EQUAL to 6 servings
    • Water: > or EQUAL to 8 servings
  35. 7 Tricks to IMPROVE flavor for Elders:
    • 1.) Plan meals that include a WIDE palette of colors & shapes for eye appeal, & a VARIETY of textures & temperatures for tongue appeal
    • 2.) Perk up food flavors with small amounts of intense-flavored ingredients such as sharp cheese, toasted nuts, or fruity olive oil
    • 3.) Try a spoonful of cheese sauce, a shaving of sweet butter, or a drizzle of creamy dressing to add luscious flavor to bitter vegetables & salad greens, & promote absorption of fat-soluble nutrients
    • 4.) Enhance natural flavors of foods with reduced, concentrated stocks, monosodium glutamate (MSG), flavored vinegars, zesty condiments, or an extra dash of herbs or spices
    • 5.) Stave off taste fatigue. Encourage older adults to ALTERNATE between bites of food with DIFFERENT tastes, temperatures & textures
    • 6.) Try shakes made with coffee or chocolate extracts to MASK bitter tastes from medications
    • 7.) Be adventurous! Expand tastes to enjoy a variety of foods.
  36. Dietary Suggestions for Difficulty Chewing or Swallowing:
    • Dairy: eat cottage cheese, yogurt instead of hard cheeses
    • Meat: substitute fish, eggs, peanut butter, tofu for hard-to-chew meats; cut into small pieces
    • Fruits & Vegetables: use cooked, canned fruits & vegetables; cut into small pieces or puree foods
    • Grains: avoid breads with hard crusts; use pasta, rice, cooked cereals
    • Other: avoid seeds & nuts that tend to slip under dentures
  37. Dietary Suggestions for Impaired Taste or Appetite:
    • Dairy: use flavored milk & yogurt; add powdered milk to foods to increase protein & calorie intakes
    • Meat: chew thoroughly; add herbs & spices instead of salts
    • Fruits & Vegetables: choose ripe fruits & raw vegetables with skins
    • Grains: use whole grains such as rye & pumpernickel
    • Other: wine BEFORE a meal may stimulate the appetite when used in moderation
  38. Dietary Suggestions for Xerostomia:
    • Dairy: add milk or yogurt to moisten dry foods
    • Meat: add broths, gravies, & sauces
    • Fruits & Vegetables: use soups & stews with HIGH water content
    • Grains: moisten breads, cereals with milk or broths
    • Other: use candy or gum with non-nutritive sweeteners INSTEAD of sucrose-containing products; drink plenty of fluids
  39. Dietary Suggestions for Food Intolerance:
    • Dairy: use milk in SMALL amounts; use MORE cheese, yogurt, buttermilk, greens
    • Meat: use LESS fatty, fried meat; prepare by broiling, baking, stewing
    • Fruits & Vegetables: use cooked vegetables, fruit, sauces
    • Grains: choose PLAIN breads & cereals; other as tolerated

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