Ch. 13 Healthy Aging: Nutrition Assessment, Services, and Programs

DEMOGRAPHICS & AGING

a) Rapidly aging population (>65 yo) of baby boomers. What was the size of the population in 2013 and what is it projected to be in 2040?

b) What other population is rapidly increasing? What percent of the population will they represent in 2030?

a) 2013 = 44.7 million

2040 = 82 million

b) Increase in minority groups >65 = Hispanics & Asians. Will be 26.4% of the population 2030.

LIFE EXPECTANCY

a) What is the life expectancy of children born in 2013?

b) What is the life expectancy for white women? for black women?

c) What is the life expectancy for white men? for black men?

a) 78.8 years

b) white women = 81.4

black women = 78.4

c) white men = 76.7

black men = 72.3

HEALTH CARE COSTS (2008)~

The >65 year old populations represented what percentage of the:

a) total population

b) country's health care costs

c) all prescription drugs

a) 12% of total population

b) 30% of country's healthcare costs

c) 40% of all prescription drugs

HEALTHY ADULTS

a) What is the most important goal of health promotion & disease prevention for adults as they age?

b) What are the 5 Behavioral Factors that affect the above goal?

c) It is important that healthy adults have supportive social environments at _______ and _______

d) Worksite health promotion efforts can be classified under what four main areas?

a) Maintaining health & Functional Independence

b) 1. Cigarette smoking

2. Physical Activity

3. Fruits/Vegetables/Whole grains

4. Saturated Fat

5. Sodium Intake (target 2300 mg/d)

c) Home & Worksite

d) 1. Policies

2. Screenings

3. Information or Activities

4. Facilities or Services

MYPLATE FOR OLDER ADULTS

a) What do many older adults face challenges with concerning their diet?

b) What should older adults try utilize since it is more affordable & convenient?

c) What is included on the Older adult MYPLATE that is not on the traditional one?

d) Older Adults should consumer more ______ and _________, & less ________

a) choosing a NUTRIENT-DENSE diet

b) Canned options

c) Icons for common daily activities such as running errands, walking, cleaning, and cooking, & modified exercises

d) More vitamins & minerals, and less saturated fat

AGING & NUTRITION STATUS

a) Define Disabilities

b) In the aging population, their declining functional capacity includes:

c) The 1/3 of those 65 years or older utilize Polypharmacy. What is polypharmacy?

d) Older adults need a nutrient dense diet with more of what 3 vitamins/minerals?

a) Any restriction/impairment in performing an activity in the manner/within the range that is normal for a human being

b) - Sensory impairment

- Altered endocrine, gastrointestinal, & cardiovascular functions

- Changes in renal & musculoskeletal systems

c) taking of 3 or more medications regularly. Cardiac drugs are the most used. occurs in 1/3 of those 65+

d) calcium, vitamin D, and vitamin B12

- because absorption of vitamin B12 decreases with age the prevalence of ATROPHIC gastritis is high = low acid-pepsin secretion & bacterial overgrowth

OLDER ADULT POOR NUTRITION

What are the 7 Risk factors for poor nutrition in older adults?

(See Table 13-5 for more details)

1. Inappropriate food intake

2. Poverty

3. Social isolation

4. Dependence/disability

5. Acute/chronic disease

6. Chronic medication use

7. Advanced age (80+)

MALNUTRITION 2nd TO DISEASE

In what 12 diseases can malnutrition come secondary?

1. Atherosclerosis

2. Cancer

3. Dental and oral disease

4. Depression & Dementia

5. Diabetes mellitus

6. Emphysema & COPD

7. End-stage renal disease

8. GI disorders

9. High Blood Pressure

10. Osteoarthritis

11. Osteoporosis

12. Stroke

NUTRITION POLICY

a) What activities are considered Activities of Daily Living (ADLs)?

b) What ac activities are considered Instrumental activities of daily living (IADLs)?

c) What two things can be used to Identify adults at nutritional risk?

d) What does each letter of "DETERMINE" mean when assessing the warning signs of poor nutrition?

a) Bathing, dressing, grooming, transferring from bed or chair, going to the bathroom, feeding oneself

b) Food preparation, use of Telephone, Housekeeping, Laundry, use of Transportation, responsibility for Medication, managing Money, & Shopping.

c) 1. Screening - Mini Nutritional Assessment (MNA): assesses early malnutrition in older adults

2. Nutrition Assessment: anthropometrics, biochemical, clinical, dietary, chronic med use, living environment, cognitive, emotional, and functional status.

d)

D - Disease

E - Eating poorly

T - Tooth loss/Mouth pain

E - Economic hardship

R - Reduced social contact

M - Many medications

I - Involuntary weight loss/gain

N - Needs assistance in self-care

E - Elder years above age 80

EVAL OF NUTRITION STATUS

Describe the seven components of a Nutrition Assessment thoroughly

1. Anthropometrics - ht, wt, skin fold

2. Clinical - look at hair, skin, nails, musculature, eyes, mucosa, mouth teeth, dentures, oral lesions, ability to chew, swallow, and self-feed

3. Biochemical - polypharmacy, chronic disease, hydration status, blood labs

4. Dietary - detailed record of food consumption

5. Functional - measures changes in the basic fxns necessary to maintain independent living (ADLs & IDLs)

6. Medication - drug nutrient interactions & identify drugs that may depress appetite/alter taste

7. Social - Financial resources, living arrangements, social support networks, poverty & social isolation

What are the TEN NUTRITIONAL RISK FACTORS diagnostic for the need for assistance among older adults?

1. Consumption of fewer than 8 main meals (hot or cold) a week

2. Drinking very little/less than half a pint a day of milk or milk alternatives

3. Little or no intake of fruits or veggies

4. Wastage of food, even if supplied hot and ready-to-eat

5. Long Periods of the day w/out food or beverages

6. Depression & Loneliness

7. Unexpected weight change (gain or loss)

8. Shopping difficulties

9. Low income

10. Presence of disabilities (including alcoholism)

HOME & COMMUNITY PROGRAMS (Figure 13-10)

An individuals's need for nutrition services depends on their level of independence, which can be depicted as a continuum:

a) Independent - Healthy Older Adults can utilize what kind of care/programs?

b) Sem-independent adults that maintain ability to live at home BUT WITH HELP or live at relative's home can utilize what kind of care/programs?

c) Fully Dependent Frail Older Adults need what kind of care?

a) Support selfcare in own home:

- SNAP/commodity foods

- Senior Farmers' Market Nutr Prog

- Dining-out programs

- Congregate meal programs

- Nutrition education: Mass media, Senior centers, Cooperative extension, EFNEP, SNAP-Ed, Local food banks, food pantries, & community gardens

- Nutrition Counseling from Community Nutritionists or Dietitians in private practice

b) - Home health services w/nutrition counseling

- Homemaker services (help with meal prep)

- Home-delivered meal programs

- Food shopping assistance

- Chore services

- Adult daycare

- Transportation services

c) Institutional care - Food service & nutritional care in:

- Apartments in congregate housing

- Continuing-care retirement community

- Assisted living housing

- Nursing homes (Intermediate care facilities or Skilled nursing care facilities)

- Hospices

OLDER ADULT NUTRITION PROGRAMS

What are the 6 main Nutrition Programs for Older Adults?

(See Table 13-7 on Slide 17 for more information)

1. Older Americans Nutrition Program (DHHS & AoA): congregate & home-delivered meals; special diets

2. SNAP (USDA): Income subsidy - EBT for food purchases

3. SNAP Nutrition Education (USDA & NIFA): Provide info about making healthy food choices

4. Adult Day Care Food Program (USDA):

Meal program, supervised daycare

- provides meals and snacks

5. Senior Farmers' Market Nutrition Program (USDA): Income subsidy - provides coupons for farmers markets, roadside stands, & community supported agri programs

6. Medicare/Medicaid(DHHS, CMS, & SSA): third-party payment system - covers medical & related services

DHHS NUTRITION PROGRAMS

a) What act was administered by the Administration on Aging (AoA) in the DHHS in 1965?

b) The Older Americans Nutrition Program includes what three programs?

a) The Older Americans Act (OAA) of 1965 (Title III)

b) 1. Congregate Nutrition Services Program

2. Home-Delivered Nutrition Services

3. Nutrition Services Incentive Program (NSIP)

OLDER AMERICANS NUTRITION PROGRAM

What are the 8 goals of the Older Americans Nutrition Program?

1. Reduce hunger & food insecurity by providing low cost, nutritious meals

2. Provide Social interaction

3. Promote health & well-being. Delay adverse health conditions through nutrition screenings, assessment & education, shopping assistance, Counseling, Referrals, and Transportation

4. Congregate Meals Program - provides One hot meal a day 5 days a week providing 1/3 of DRI.

5. Menu planning

6. No cost for meals, but participants sometimes make voluntary contributions

7. Home-Delivered Meals Program

8. 60 years and older & SPOUSES can participate

Income not apart of eligibility but priority given to low-income & extremely old

What programs are under the USDA?~

1. SNAP PROGRAM

2. Adult Daycare Center

3. USDA Commodity Food Supplemental food program

PRIVATE-SECTOR

What are 2 Private-Sector Nutrition Assistance Programs?

1. Food Banks

2. Meals on Wheels --> Home delivered meals to help reach older adults in communities not fully serviced by Older Americans Nutrition Program

SUCCESSFUL AGING

The ability of older adults to function well depends on what factors?

1. Genetic potential for extended longevity

2. Continued desired or new knowledge & new experiences

3. Socialization

4. Adherence to a nutritious diet

5. Regular physical activity

6. Financial independence

7. Access to health services

SUCCESSFUL AGING (See Pyramid on Powerpoint)

"Aging Well Pyramid" From Top to Bottom:

a) Stress Busters:

b) Emotional Well Being:

c) Social Health:

d) Nutritional Health:

e) Physical Health:

f) Lifelong Habits for Successful Aging:

a) Relax, Go for a Walk, Breathe deeply, Think positively

b) Reduce stress, Learn relaxation techniques, Cultivate a garden, Seek out laughter, Take time for spiritual growth, Adopt a pet, Take time off

c) Socially active, Volunteer, Make new friend, Enroll in lifelong learning, Be active in community

d) Nutrient dense foods, 5-9 fruits & veggies, Water, Keep fat intake at healthful level, Fiber

e) Physically active, adequate sleep, challenge mental skills, aerobic & strength training 3x a week, Stretch

f) Cherish your personal values & goals, Communication skills, Balance diet & exercise for weight, Preventive healthcare, Skills & hobbies, Manage time,

Learn from mistakes, Family & friends, Accept change as inevitable, plan ahead for Financial security