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Part I Introduction to Nutrition Care in Older Adults

TABLE 1.2 Aging Effects on Organ Systems Other Than the Gastrointestinal Tract Organ System Skin

Aging Effect

Head and neck Cardiovascular

Pulmonary Renal

Endocrine Nervous

Musculoskeletal

Dryness, wrinkling, mottled pigmentation, loss of elasticity, dilation of capillaries Macular degeneration, hearing loss

Thickening heart wall and valves, increased collagen, increased collagen rigidity, alterations in heart size, decreased elasticity of blood vessels with calcification

Stiffening of tissue, decreased vital capacity, decreased maximum oxygen consumption, decreased breathing capacity, decreased propulsive effectiveness of cough reflex

Decreased size, decreased glomerular filtration rate, decreased renal blood flow, decreased active tubular secretion and reabsorption, decreased renal concentrating ability

Altered circulating hormone levels and actions

Decreased sensory perception, decreased muscle response to stimuli, decreased cognition and memory, loss of brain cells

Progressive loss of skeletal muscle, degeneration of joints, decalcification of bone

Source: Reprinted from Jensen GL, McGee M, Binkley J. Nutrition in the elderly. Gastroenterol Clin North Am. 2001;30:314, with permission from Elsevier.

TABLE 1.3 Recommended Levels of Supplementation

Supplement Vitamin C Vitamin E Lutein

Zeaxanthin Zinc oxide

Copper (as cupric oxide)a

Recommended Level 500 mg 400 IU 10 mg 2 mg

80 mg 2 mg

aTo prevent copper deficiency, which may be associated with

high amounts of zinc. Source: Data are from references 27-29.

“Changes in how the taste and smell of foods are perceived typically contribute to poor dietary choices, decreased appetite, and low nutrient intake” (4). Taste sensitivity seems to diminish with age, with men experiencing greater declines in taste sensitivity thresholds than women (32). Greatest changes in taste sensitivity appear to occur with salty and umami tastes. Peptides, catechins, polyphenols, and caffeine seem to activate bitter taste receptors (33). Alterations in saliva content and consistency, xerosto- mia, poor oral hygiene, periodontal disease, medica- tions, and cigarette smoking may play a greater role in altered taste perception than aging (17). The signifi- cance of how changes in olfaction and taste perception impact food intake and the nutritional status of older Americans has yet to be determined.

Gastrointestinal Conditions Constipation is a common complaint of older adults. The definition of constipation is poorly understood and often ignored by older adults, leading to demand for treatment of a problem that may not, in fact, exist. “It has a major impact on health care costs in the United States because it results in several office visits, spe- cialty referrals, hospital admissions, and surgical pro- cedures. It also affects health-related quality of life”