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Chapter\t33\n).\tThickened\tliquids\tand\ttexture-\nmodified\tfoods\tcan\thelp\tpeople\twith\tdysphagia\teat\tsafely\t(see\t\nAppendix\t20\n).\nGastric\tchanges\talso\tcan\toccur.\tEarly\tsatiety\tdue\tto\tage-related\tchanges\tin\n\tthe\tstomach\tin\ncombination\twith\timpaired\tgastric\tmucosal\tfunction\tleads\tto\tan\tinability\tto\tresist\tdamage\tand\tcan
|
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result\tin\tulcers,\tcancer,\tand\tinfections.\tGastritis\tcauses\tinflammation\tand\tpain,\tdelayed\tgastric\nemptying,\tand\tdiscomfort.\tThese\taffect\tthe\tbioavailability\tof\tnutrients\tsuch\tas\tcalcium,\tB\n12,\n\tand\tzinc\nand\tincrease\tthe\trisk\tof\tdeveloping\ta\tchronic\tdeficiency\tdisease.\nAchlorhydria\n\tis
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] |
Achlorhydria\n\tis\n\tthe\tinsufficient\tproduction\tof\tstomach\tacid.\tSufficient\tstomach\tacid\tand\tintrinsic\nfactor\tare\trequired\tfor\tthe\tabsorption\tof\tvitamin\tB\n12\n.\tAlthough\tsubstantial\tamounts\tare\tstored\tin\tthe\nliver,\tB\n12\n\tdeficiency\tdoes\toccur.\tSymptoms\tcan\toften\tbe\tmisdiagnosed\tbecause\tthey\tmimic
|
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] |
Alzheimer’s\tdisease\tor\tother\tchronic\tconditions\tand\tinclude\textreme\tfatigue,\tdementia,\tconfusion,\nand\ttingling\tand\tweakness\n\tin\tthe\tarms\tand\tlegs\t(see\t\nChapter\t39\n).\tIt\thas\tbecome\tcommon\tpractice\tto\nuse\tcalcium\tcarbonate\tantacids\tas\ta\tway\tto\tsupplement\tcalcium\tintake,\tthough\tthis\tis
|
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contraindicated\tin\tthe\telderly\twho\tare\talready\tat\trisk\tfor\tinadequate\tgastric\tacid.\nConstipation\n\tis\tdefined\tas\thaving\tfewer\tbowel\tmovements\tthan\tusual,\thaving\tdifficulty\tor\nexcessive\tstraining\tat\tstool,\tpainful\tbowel\tmovements,\thard\tstool,\n\tor\tincomplete\temptying\tof\tthe
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] |
or\tincomplete\temptying\tof\tthe\nbowel.\tIt\tis\tone\tof\tthe\tmost\tcommon\tdisorders\tin\tthe\tU.S.\tpopulation,\tand\tits\tprevalence\tincreases\nwith\tage.\tPrimary\tcauses\tinclude\tinsufficient\tfluids,\tlack\tof\tphysical\tactivity,\tand\tlow\tintake\tof\ndietary\tfiber.\tStudies\thave\talso\tshown\tthat\tdistinct\tphysiologic\tchanges\taffecting\tcolonic\tmotility
|
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] |
occur\tin\tolder\tpeople.\tThey\tinclude\tmyenteric\tdysfunction,\tincreased\tcollagen\n\tdeposits\tin\tthe\tleft\ncolon,\treduced\tinhibitory\tnerve\tinput\tto\tthe\tcolon’s\tmuscle\tlayer,\tand\tincreased\tbinding\tof\tplasma\nendorphins\tto\tintestinal\treceptors\t(see\t\nChapter\t27\n).\nDiminished\tanal\tsphincter\tpressure\tor\tdegeneration\tof\tthe\tinternal\tanal\tsphincter\tand\tloss\tof
|
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rectal\twall\telasticity\tare\tage-related\tchanges.\tConstipation\talso\tis\tcaused\tby\tsome\tmedications\ncommonly\tused\tin\tolder\tpeople\tsuch\n\tas\tnarcotics\tand\tantidepressants\tthat\tactually\tslow\tintestinal\ntransit.\tDiuretics\tcan\tcause\tdecreased\tstool\tmoisture,\tanother\tcontributing\tfactor\tin\tconstipation.
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0.05340529605746269,
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0.02604353427886963,
0.1300937384366989,
0.06647194176912308,
-0.018237674608826637
] |
The\tincidence\tof\tdiverticulosis\tincreases\twith\tage.\tHalf\tof\tthe\tpopulation\tolder\tthan\tage\t60\tdevelop\nit,\tbut\tonly\t20%\tof\tthem\thave\tclinical\tmanifestations.\tThe\tmost\tcommon\tproblems\twith\tdiverticular\ndisease\tare\tlower\tabdominal\tpain\n\tand\tdiarrhea\t(see\t\nChapter\t27\n).
|
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] |
disease\tare\tlower\tabdominal\tpain\n\tand\tdiarrhea\t(see\t\nChapter\t27\n).\nEach\tof\tthese\tchanges\tin\tthe\tGI\tcould\thave\tsubstantial\timpact\ton\tthe\toverall\tnutrition\tof\tthe\tolder\nadult\tas\tlimitations\tin\tability\tto\tconsume\tadequate\tfood\tquantity\tcoupled\twith\tdecreased\tnutrient\nabsorption\tcan\tresult\tin\tundernutrition.\nCardiovascular
|
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absorption\tcan\tresult\tin\tundernutrition.\nCardiovascular\nCVD,\tincluding\theart\tdisease\tand\tstroke,\tis\tthe\tleading\tcause\tof\tdeath\tin\tall\tgenders\tin\tall\tracial\tand\nethnic\n\tgroups\tand\tis\tnot\tnecessarily\ta\tdisease\tof\taging.\tCVD\tage-related\tchanges\tare\textremely
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variable\tand\tare\taffected\tby\tenvironmental\tinfluences\tsuch\tas\tsmoking,\texercise,\tand\tdiet.\tChanges\ncan\tinclude\tdecreased\tarterial\twall\tcompliance,\tdecreased\tmaximum\theart\trate,\tdecreased\nresponsiveness\tto\tbeta-adrenergic\tstimuli,\tincreased\tleft\tventricle\tmuscle\tmass,\tand\tslowed\nventricular\trelaxation.\tOften
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] |
failure.\tOne\tin\tnine\thospital\tadmissions\tin\tthe\tUnited\tStates\tinclude\tthe\tdiagnosis\tof\theart\tfailure.\tA\nlow-sodium\tdiet\tand\tfluid\trestriction\tare\tcommonly\tprescribed\tfor\tthis\tcondition.\tThese\tdiet\nrestrictions\tin\tconjunction\twith\tother\tside\teffects\tof\theart\tfailure\toften\tlead\tto\tdecreased\tnutrient\nconsumption.\tSee\t\nChapter\t32\n\tfor
|
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] |
consumption.\tSee\t\nChapter\t32\n\tfor\n\tdiscussion\tof\tthe\tmultifaceted\tapproach\trequired\tto\tmanage\tCVD\nin\tolder\tadults.\nRenal\nAge-related\tchanges\tin\trenal\tfunction\tvary\ttremendously.\tSome\tolder\tadults\texperience\tlittle\tchange,\nwhereas\tothers\tcan\thave\tdevastating,\tlife-threatening\tchange.\tOn\taverage\tglomerular\tfiltration\trate,
|
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measured\tin\tcreatinine\tclearance\trates,\tdeclines\tby\tapproximately\t8\tto\t10\tmL/min/1.73m\n2\n\tper\ndecade\tafter\n\tage\t30\tto\t35.\tThe\tresulting\tincrease\tin\tserum\tcreatinine\tconcentrations\tshould\tbe\nconsidered\twhen\tdetermining\tmedication\tdosages.\tThe\tprogressive\tdecline\tin\trenal\tfunction\tcan\tlead
|
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0.05876718461513519,
0.01922006718814373,
-0.030633889138698578
] |
to\tan\tinability\tto\texcrete\tconcentrated\tor\tdilute\turine,\ta\tdelayed\tresponse\tto\tsodium\tdeprivation\tor\ta\nsodium\tload,\tand\tdelayed\tresponse\tto\tan\tacid\tload.\tRenal\tfunction\tis\talso\taffected\tby\tdehydration,\ndiuretic\tuse,\tand\n\tmedications,\tespecially\tantibiotics\t(see\t\nChapter\t34\n).\nNeurologic
|
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] |
medications,\tespecially\tantibiotics\t(see\t\nChapter\t34\n).\nNeurologic\nThere\tcan\tbe\tsignificant\tage-related\tdeclines\tin\tneurologic\tprocesses.\tCognition,\tsteadiness,\treaction\ntime,\tcoordination,\tgait,\tsensations,\tand\t\nactivities\tof\tdaily\tliving\t(ADLs)\n\t(toileting,\tbathing,\teating,
|
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activities\tof\tdaily\tliving\t(ADLs)\n\t(toileting,\tbathing,\teating,\ndressing)\toften\tdecline\twith\tage,\tbut\tthe\tvelocity\tof\tthe\tdecline\tvaries\tgreatly\tfrom\tone\tindividual\tto\nanother\tand\tis\n\tdependent\ton\tdisease\tas\tmuch\tas\ton\taging.\tOn\taverage,\tthe\tbrain\tloses\t5%\tto\t10%\tof
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] |
conditions\tsuch\tas\tdementia,\ta\tdisease\n\tprocess\t(\nGalvin\tand\tSadowsky,\t2012\n).\tMemory\tdifficulties\tdo\nnot\tnecessarily\tindicate\tdementia,\tAlzheimer’s\tdisease,\tParkinson’s\tdisease,\tor\tany\tmental\tdisorder\n(see\t\nChapters\t39\n\tand\t\n40\n).\tMany\tchanges\tin\tmemory\tcan\tbe\tattributed\tto\tenvironmental\tfactors,
|
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] |
).\tMany\tchanges\tin\tmemory\tcan\tbe\tattributed\tto\tenvironmental\tfactors,\nincluding\tstress,\tchemical\texposure,\tand\tinadequate\tfood\tand\tfluid,\trather\tthan\tto\tphysiologic\nprocesses.\tUrinary\ttract\tinfections\tare\tassociated\n\twith\tchanges\tin\tcognition\tthat\tmimic\tdementia\tbut\nare\treversible\twith\ttreatment\t(\nBeveridge\tet\tal,\t2011
|
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] |
are\treversible\twith\ttreatment\t(\nBeveridge\tet\tal,\t2011\n).\tHowever,\teven\tmild\tcognitive\timpairment\tmay\naffect\teating,\tchewing,\tand\tswallowing,\tthus\tincreasing\tthe\trisk\tof\tmalnutrition\t(\nLopes\tda\tSilva\tet\tal,\n2014\n).\tThe\tgreatest\trisk\tfactor\tfor\tdeveloping\tdementia\tis\tin\tfact\tadvanced\tage.\nPressure\tinjuries\nPressure\tinjuries
|
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] |
Pressure\tinjuries\nPressure\tinjuries\n,\tformerly\tcalled\tpressure\n\tsores\tand\tbefore\tthat,\tbedsores\tor\tdecubitus\tulcers,\ndevelop\tfrom\tcontinuous\tpressure\tthat\timpedes\tcapillary\tblood\tflow\tto\tskin\tand\tunderlying\ttissue.\nSeveral\tfactors\tcontribute\tto\tthe\tformation\tof\tpressure\tinjuries,\tbut\timpaired\tmobility,\tpoor
|
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0.014818497002124786,
0.08517897129058838,
0.07978220283985138,
-0.026741204783320427
] |
circulation,\tobesity,\tand\turinary\tincontinence\tare\tkey.\tOlder\tadults\twith\tneurologic\tproblems,\tthose\nheavily\tsedated,\tand\tthose\twith\tdementia\tare\toften\n\tunable\tto\tshift\tpositions\tto\talleviate\tpressure.\nParalysis,\tincontinence,\tsensory\tlosses,\tand\trigidity\tcan\tcontribute\tto\tthe\tproblem.\tNotably
|
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] |
malnutrition\tand\tundernutrition\t(inadequate\tenergy\tintake)\tset\tthe\tstage\tfor\tits\tdevelopment\tand\ncan\tdelay\twound\thealing.\tThe\tescalating\tchronic\tnature\tof\tpressure\tinjury\tin\tnonambulatory\tor\nsedentary\tindividuals\trequires\tvigilant\tattention\tto\tnutrition.\nThe\tNational\tPressure\tInjury\tAdvisory\tPanel\t(NPIAP),\tformerly
|
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The\tNational\tPressure\tInjury\tAdvisory\tPanel\t(NPIAP),\tformerly\t\nNational\tPressure\tUlcer\tAdvisory\nPanel\t(NPUAP)\n,\tis\tan\tindependent\tnot-for-profit\tprofessional\torganization\tdedicated\tto\tthe\nprevention\tand\tmanagement\tof\tpressure\tinjuries.\tThe\tNPIAP\tBoard\tof\tDirectors\tis\tcomposed\tof
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education,\tpublic\tpolicy\tand\tresearch.\tNPIAP\tprovides\tvital\tpublications\tfor\tmedical,\tnursing\tand\nnutrition\tprofessionals\tworking\tin\tall\thealthcare\tsettings.\nThe\t2019\t\nInternational\tClinical\tPractice\tGuideline\tfor\tthe\n\tPrevention\tand\tTreatment\tof\tPressure\nInjuries\t(CPG)\n\tpresents\trecommendations\tand\tsummarizes\tthe\tsupporting\tevidence\tfor\tpressure
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] |
injury\tprevention\tand\ttreatment.\tThe\tnew\tedition\twas\tdeveloped\tas\ta\tfour-year\tcollaboration\nbetween\tthe\tNational\tPressure\tInjury\tAdvisory\tPanel\t(NPIAP),\tthe\tEuropean\tPressure\tUlcer\tAdvisory\nPanel\t(EPUAP)\tand\tthe\tPan\tPacific\tPressure\tInjury\tAlliance\t(PPPIA).\tIt\tprovides\n\ta\tdetailed\tanalysis
|
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] |
a\tdetailed\tanalysis\nand\tdiscussion\tof\tavailable\tresearch,\tcritical\tevaluation\tof\tthe\tassumptions\tand\tknowledge\tin\tthe\nfield,\trecommendations\tfor\tclinical\tpractice,\timportant\timplementation\tconsiderations,\ta\tdescription\nof\tthe\tmethodology\tused\tto\tdevelop\tthe\tguideline,\tand\tacknowledgment\tof\tthe\tmany\texperts\tformally
|
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] |
involved\tin\tthe\tdevelopment\tprocess.\tThe\tguideline\tmay\tbe\tpurchased\tat\t\nwww.guidelinesales.com\n.\nSeveral\tclassification\tsystems\tdescribe\tpressure\tinjuries.\tThe\tsix\tstages\tof\tinjury,\tbased\ton\tthe\ndepth\tof\tthe\tsore\tand\tlevel\tof\ttissue\tinvolvement,\tare\tdescribed\tin\t\nTable\t19.2\n.\tAs\twound\tnutrition
|
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] |
Table\t19.2\n.\tAs\twound\tnutrition\ntends\tto\tequal\twhole-body\tnutrition,\tcoordinated\tefforts\tof\ta\tmultidisciplinary\ttreatment\tteam\tare\nimportant.\tThe\tbenefits\tof\tspecific\tlevels\tof\tenergy\t(30-35\tkcal/kg)\tand\tprotein\t(1.25-1.5\tg/kg)\tfor\nprevention\tof\tpressure\tinjuries\tin\tpatients\tat\trisk\tof\tmalnutrition\trecommended\tin\tthe\tprevious
|
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] |
guidelines\tare\tnow\tconsidered\tinconclusive.\tThe\t2019\tguidelines\tfocus\ton\tindividualized\tassessment\nby\tthe\tRDN\trather\tthan\tstandardized\tprescriptions.\tHowever\tthe\trecommendation\tabove\tfor\tcalories\nand\tprotein\tremain\tfor\tindividuals\twith\texisting\tpressure\tinjuries.\tAdditionally,\ta\thigh\tcalorie,\thigh\nprotein
|
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] |
protein\n\tsupplement\tis\trecommended\tfor\tthose\twith\ta\tpressure\tinjury\twho\tare\tmalnourished\tand\nunable\tto\tmeet\ttheir\tneeds\tthrough\tdiet\talone.\tRecommendations\tfor\ta\tprotein\tsupplement\thigh\tin\narginine,\tzinc\tand\tantioxidants\twas\tincluded\tfor\tstage\tII,\tIII\tand\tIV\tpressure\tinjuries\t(\nEuropean
|
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] |
European\nPressure\tUlcer\tAdvisory\tPanel,\tNational\tPressure\tInjury\tAdvisory\tPanel\tand\tPan\tPacific\tPressure
|
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] |
Injury\tAlliance,\t2019\n).\nTABLE\t19.2\nPressure\tInjury\tStages\nDeep\tTissue\tInjury\nDeep\tTissue\tPressure\tInjury:\tPersistent\tnonblanchable\tdeep\tred,\tmaroon,\tor\tpurple\tdiscoloration\nIntact\tor\tnonintact\tskin\twith\tlocalized\tarea\tof\tpersistent\tnonblanchable\tdeep\tred,\tmaroon,\tor\tpurple
|
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discoloration\tor\tepidermal\tseparation\trevealing\ta\tdark\twound\tbed\tor\tblood-filled\tblister.\tPain\tand\ntemperature\tchange\toften\tprecede\tskin\n\tcolor\tchanges.\tDiscoloration\tmay\tappear\tdifferently\tin\ndarkly\tpigmented\tskin.\tThis\tinjury\tresults\tfrom\tintense\tand/or\tprolonged\tpressure\tand\tshear\tforces
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are\tvisible,\tthis\tindicates\ta\tfull\tthickness\tpressure\ninjury\t(unstageable,\tstage\t3\tor\tstage\t4).\tDo\tnot\tuse\tDeep\tTissue\tPressure\tInjury\t(DTPI)\tto\tdescribe\nvascular,\ttraumatic,\tneuropathic,\tor\tdermatologic\tconditions.\nStage\t1\nStage\t1\tPressure\tInjury:\tNonblanchable\terythema\tof\tintact\tskin
|
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Stage\t1\tPressure\tInjury:\tNonblanchable\terythema\tof\tintact\tskin\nIntact\tskin\twith\ta\tlocalized\tarea\tof\tnonblanchable\terythema,\twhich\tmay\tappear\tdifferently\tin\tdarkly\npigmented\n\tskin.\tPresence\tof\tblanchable\terythema\tor\tchanges\tin\tsensation,\ttemperature,\tor\tfirmness
|
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may\tprecede\tvisual\tchanges.\tColor\tchanges\tdo\tnot\tinclude\tpurple\tor\tmaroon\tdiscoloration;\tthese\nmay\tindicate\tdeep\ttissue\tpressure\tinjury,\theralding\tsign\tof\trisk.\nStage\t2\nStage\t2\tPressure\tInjury:\tPartial-thickness\tskin\tloss\twith\texposed\tdermis\nPartial-thickness\tloss\tof\tskin\twith\texposed\tdermis.\tThe\twound\n\tbed\tis\tviable,\tpink\tor\tred,\tmoist,\tand\tmay
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] |
bed\tis\tviable,\tpink\tor\tred,\tmoist,\tand\tmay\nalso\tpresent\tas\tan\tintact\tor\truptured\tserum-filled\tblister.\tAdipose\t(fat)\tis\tnot\tvisible\tand\tdeeper\ntissues\tare\tnot\tvisible.\tGranulation\ttissue,\tslough,\tand\teschar\tare\tnot\tpresent.\tThese\tinjuries\ncommonly\tresult\tfrom\tadverse\tmicroclimate\tand\tshear\tin\tthe\tskin\tover\tthe\tpelvis\tand\tshear\tin\tthe
|
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] |
heel.\tThis\tstage\tshould\tnot\tbe\tused\tto\tdescribe\tmoisture\tassociated\n\tskin\tdamage\t(MASD)\tincluding\nincontinence\tassociated\tdermatitis\t(IAD),\tintertriginous\tdermatitis\t(ITD),\tmedical\tadhesive\trelated\nskin\tinjury\t(MARSI),\tor\ttraumatic\twounds\t(skin\ttears,\tburns,\tabrasions).\nStage\t3\nStage\t3\tPressure\tInjury:\tFull-thickness\tskin\tloss
|
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Stage\t3\nStage\t3\tPressure\tInjury:\tFull-thickness\tskin\tloss\nFull-thickness\tloss\tof\tskin,\tin\twhich\tadipose\t(fat)\tis\tvisible\tin\tthe\tulcer\tand\tgranulation\ttissue\tand\nepibole\t(rolled\twound\tedges)\n\tare\toften\tpresent.\tSlough\tand/or\teschar\tmay\tbe\tvisible.\tThe\tdepth\tof
|
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] |
are\toften\tpresent.\tSlough\tand/or\teschar\tmay\tbe\tvisible.\tThe\tdepth\tof\ntissue\tdamage\tvaries\tby\tanatomic\tlocation;\tareas\tof\tsignificant\tadiposity\tcan\tdevelop\tdeep\twounds.\nUndermining\tand\ttunneling\tmay\toccur.\tFascia,\tmuscle,\ttendon,\tligament,\tcartilage,\tand/or\tbone\tare
|
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] |
not\texposed.\tIf\tslough\tor\teschar\tobscures\tthe\textent\tof\ttissue\tloss,\tthis\tis\tan\tunstageable\tpressure\ninjury.\nStage\t4\nStage\t4\n\tPressure\tInjury:\tFull-thickness\tskin\tand\ttissue\tloss\nFull-thickness\tskin\tand\ttissue\tloss\twith\texposed\tor\tdirectly\tpalpable\tfascia,\tmuscle,\ttendon,\tligament,
|
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] |
cartilage,\tor\tbone\tin\tthe\tulcer.\tSlough\tand/or\teschar\tmay\tbe\tvisible.\tEpibole\t(rolled\tedges),\nundermining,\tand/or\ttunneling\toften\toccur.\tDepth\tvaries\tby\tanatomic\tlocation.\tIf\tslough\tor\teschar\nobscures\tthe\textent\tof\ttissue\tloss\tthis\tis\tan\tunstageable\n\tpressure\tinjury.\nUnstageable
|
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0.035613398998975754,
0.01451182458549738,
0.08274946361780167,
-0.0034342536237090826
] |
pressure\tinjury.\nUnstageable\nUnstageable\tPressure\tInjury:\tObscured\tfull-thickness\tskin\tand\ttissue\tloss\nFull-thickness\tskin\tand\ttissue\tloss\tin\twhich\tthe\textent\tof\ttissue\tdamage\twithin\tthe\tulcer\tcannot\tbe\nconfirmed\tbecause\tit\tis\tobscured\tby\tslough\tor\teschar.\tIf\tslough\tor\teschar\tis\tremoved,\ta\tstage\t3\tor
|
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] |
stage\t4\tpressure\tinjury\twill\tbe\trevealed.\tStable\teschar\t(i.e.,\tdry,\tadherent,\tintact\twithout\n\terythema,\nor\tfluctuance)\ton\tthe\theel\tor\tischemic\tlimb\tshould\tnot\tbe\tsoftened\tor\tremoved.\nNational\tPressure\tUlcer\tAdvisory\tPanel\t(NPUAP)\tannounces\ta\tchange\tin\tterminology\tfrom\tpressure\tulcer\tto\tpressure\tinjury\tand\tupdates\tthe\tstages
|
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of\tpressure\tinjury.\tApril\t2016.\nQuality\tof\tlife\nQuality\tof\tlife\n\tis\ta\tgeneral\tsense\tof\thappiness\tand\tsatisfaction\twith\tone’s\tlife\tand\tenvironment.\nHealth-related\n\tquality\tof\tlife\tis\tthe\tpersonal\tsense\tof\tphysical\tand\tmental\thealth\tand\tthe\tability\tto\nreact\tto\tfactors\tin\tthe\tphysical\tand\tsocial\tenvironments.\tTo\tassess\thealth-related\tquality\tof\tlife,
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common\tmeasures\tand\tscales,\teither\tgeneral\tor\tdisease-specific,\tcan\tbe\tused.\tBecause\tolder\tage\noften\tis\tassociated\twith\thealth\tproblems\tand\tdecrease\tin\tfunctionality,\tquality-of-life\tissues\tbecome\nrelevant.\nDepression\nPsychological\tchanges\toften\tmanifest\tas\tdepression,\tand\tits\textent\tcan\tvary\twidely\tfrom\tperson\tto
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person.\tAmong\tolder\tpersons\tdepression\toften\tis\tcaused\tby\tother\tconditions\tsuch\tas\theart\tdisease,\nstroke,\tdiabetes,\tcancer,\tgrief,\tor\tstress.\tDepression\tin\tolder\tpeople\tfrequently\tis\tundiagnosed\tor\nmisdiagnosed\tbecause\tsymptoms\tare\tconfused\twith\tother\tmedical\tillnesses.\tUntreated\tdepression
|
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can\thave\tserious\tside\teffects\tfor\tolder\tadults.\tIt\tdiminishes\tthe\tpleasures\tof\tliving,\tincluding\teating;\nit\tcan\texacerbate\tother\tmedical\tconditions;\tand\tit\tcan\tcompromise\timmune\tfunction.\tDepression\tis\nassociated\twith\tdecreased\tappetite,\tweight\tloss,\tand\tfatigue.\tNutritional\tcare\tplays\tan\timportant\trole
|
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] |
in\taddressing\tthis\tcondition\t(see\t\nChapter\t40\n).\tProviding\tnutrient-\tand\tcalorie-dense\tfoods,\n\tadditional\nbeverages,\ttexture-modified\tfoods,\tand\tfavorite\tfoods\tat\ttimes\twhen\tpeople\tare\tmost\tlikely\tto\teat\tthe\ngreatest\tquantity\tcan\tbe\tvery\teffective.\tIn\tthat\tcomorbidities\tlead\tto\tpolypharmacy\tand\tconcern
|
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regarding\tdrug-drug\tinteractions,\tproviders\tmay\tchoose\tto\tomit\tantidepressants,\twhich\tleaves\tthe\ndepression\tuntreated.\nGiven\tthe\tuntoward\tconsequences\tof\tunintentional\tweight\tloss\twith\taging\n\tand\tthe\tlack\tof\tFood\tand\nDrug\tAdministration–approved\tmedications\tfor\tappetite\tstimulation\tin\tolder\tadults,\tfood\tand
|
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0.12116844952106476,
0.006037693936377764
] |
nutritional\tinterventions\talong\twith\tthe\ttreatment\tof\tunderlying\tconditions\tthat\tcontribute\tto\tweight\nloss,\tsuch\tas\tpoor\tdentition,\tdeserve\tgreater\tattention.\tOne\tantidepressant,\tmirtazapine\t(Remeron),\nhas\thelped\tincrease\tappetite\tand\tweight\tgain\tin\tdepressed\telderly\tpatients.\n\tWith\tappropriate
|
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With\tappropriate\nmonitoring\tfor\tside\teffects,\tmirtazapine\tmay\tbe\ta\tdrug\tof\tchoice\tfor\tolder\tpersons\texperiencing\nweight\tloss\tand\tdepression\t(\nRudolph,\t2009\n)\tand\tcould\tpotentially\tdecrease\tgastroparesis,\tnausea,\nand\tvomiting\t(\nMalamood\tet\tal,\t2017\n).\nFood\tand\tnutrition\tcontribute\tto\tone’s\tphysiologic,\tpsychological,\tand\tsocial\tquality\tof\tlife\n(
|
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] |
(\nRaymond,\t2019\n).\tA\tmeasure\tof\tnutrition-related\tquality\n\tof\tlife\thas\tbeen\tproposed\tto\tdocument\nquality-of-life\toutcomes\tfor\tindividuals\treceiving\tmedical\tnutrition\ttherapy.\tEffective\tstrategies\tto\nimprove\teating\tand\tthereby\timprove\tnursing\thome\tresidents’\tquality\tof\tlife\tare\twell\testablished\tbut\ncould\tbe\tmore\twidely\timplemented\t(
|
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could\tbe\tmore\twidely\timplemented\t(\nBernstein\tand\tMunoz,\t2012\n)\t(see\t\nNew\tDirections:\n\tCulture\nChange\n).\n\t\nNew\tDirections\nCulture\tChange\nCulture\tchange\tin\tlong-term\tcare\nThe\tPioneer\tNetwork\twas\tformed\tin\t1997\tby\ta\tsmall\tgroup\tof\tprominent\tprofessionals\t(including
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dietitians)\tworking\tin\tlong-term\tcare\tto\tadvocate\tfor\tperson-directed\tcare.\tThis\tgroup\tcalled\tfor\ta\nradical\tchange\tin\tthe\tculture\tof\taging\tso\tthat\twhen\tour\tgrandparents,\tparents—and\tultimately\twe\n—go\tto\ta\tnursing\thome\tor\tother\tcommunity-based\n\tsetting,\tit\tis\tto\tthrive,\tnot\tto\tdecline.\tThis
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setting,\tit\tis\tto\tthrive,\tnot\tto\tdecline.\tThis\nmovement,\taway\tfrom\tinstitutional\tprovider-driven\tmodels\tto\tmore\thumane\tconsumer-driven\nmodels\tthat\tembrace\tflexibility\tand\tself-determination,\thas\tcome\tto\tbe\tknown\tas\tthe\t\nculture\nchange\tmovement\n.\tThe\tbelief\tis\tthat\tthe\tquality\tof\tlife\tand\tliving\tfor\tolder\tAmericans\tis\trooted\tin
|
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a\tsupportive\tcommunity\tand\tcemented\tby\trelationships\tthat\trespect\teach\n\tindividual\tregardless\tof\nage,\tmedical\tcondition,\tor\tlimitations.\nThe\tmission\tof\tthe\tPioneer\tNetwork\tis\tto:\n•\t\nCreate\tcommunication,\tnetworking,\tand\tlearning\topportunities\n•\t\nBuild\tand\tsupport\trelationships\tand\tcommunity\n•
|
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•\t\nBuild\tand\tsupport\trelationships\tand\tcommunity\n•\t\nIdentify\tand\tpromote\ttransformations\tin\tpractice,\tservices,\tpublic\tpolicy,\tand\tresearch\n•\t\nDevelop\tand\tprovide\taccess\tto\tresources\tand\tleadership\nValues\tand\tprinciples\n•\t\nKnow\teach\tperson.\n•\t\nEach\tperson\tcan\tand\tdoes\tmake\ta\tdifference.\n•
|
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0.06796207278966904,
0.000250283774221316
] |
Know\teach\tperson.\n•\t\nEach\tperson\tcan\tand\tdoes\tmake\ta\tdifference.\n•\t\nRelationship\tis\tthe\tfundamental\tbuilding\tblock\tof\ta\ttransformed\tculture.\n•\t\nRespond\tto\tspirit,\tas\twell\tas\tmind\tand\tbody.\n•\t\nRisk-taking\tis\ta\tnormal\tpart\tof\tlife.\n•\t\nPut\tperson\tbefore\ttask.\n•\t\nAll\telders\tare\tentitled\tto\tself-determination\twherever\tthey\tlive.\n•
|
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] |
All\telders\tare\tentitled\tto\tself-determination\twherever\tthey\tlive.\n•\t\nCommunity\tis\tthe\tantidote\tto\tinstitutionalization.\n•\t\nDo\tunto\n\tothers\tas\tyou\twould\thave\tthem\tdo\tunto\tyou.\n•\t\nPromote\tthe\tgrowth\tand\tdevelopment\tof\tall.\n•\t\nShape\tand\tuse\tthe\tpotential\tof\tthe\tenvironment\tin\tall\tits\taspects:\tphysical,\torganizational,\npsycho/social/spiritual.\n•
|
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psycho/social/spiritual.\n•\t\nPractice\tself-examination,\tsearching\tfor\tnew\tcreativity\tand\topportunities\tfor\tdoing\tbetter.\n•\t\nRecognize\tthat\tculture\tchange\tand\ttransformation\tare\tnot\tdestinations\tbut\ta\tjourney,\talways\na\twork\tin\tprogress.\nFunctionality
|
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a\twork\tin\tprogress.\nFunctionality\nFunctionality\tand\tfunctional\tstatus\tare\tterms\tused\tto\tdescribe\tphysical\tabilities\tand\tlimitations\tin,\nfor\texample,\tambulation.\t\nFunctionality\n,\tthe\tability\tto\tperform\tself-care,\tself-maintenance,\tand\nphysical\tactivities,\tcorrelates\twith\tindependence\tand\tquality\tof\tlife.\tDisability\trates\tamong\tolder
|
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adults\tare\tdeclining,\tbut\tthe\tactual\tnumber\tconsidered\n\tdisabled\tis\tincreasing\tas\tthe\tsize\tof\tthe\taging\npopulation\tgrows.\tLimitations\tin\tADLs\t(toileting,\tbathing,\teating,\tdressing)\tand\t\ninstrumental\nactivities\tof\tdaily\tliving\t(IADLs)\n\tsuch\tas\tmanaging\tmoney,\tshopping,\ttelephone\tuse,\ttravel\tand
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] |
such\tas\tmanaging\tmoney,\tshopping,\ttelephone\tuse,\ttravel\tand\ntransportation,\thousekeeping,\tpreparing\tmeals,\ttaking\tmedications\tcorrectly,\tand\tother\tindividual\nself-performance\tskills\tneeded\tin\teveryday\tlife,\tare\tused\tto\n\tmonitor\tphysical\tfunction\t(\nFederal\nInteragency\tForum\ton\tAging-Related\tStatistics,\t2012\n).
|
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] |
Federal\nInteragency\tForum\ton\tAging-Related\tStatistics,\t2012\n).\nMany\tnutrition-related\tdiseases\taffect\tfunctional\tstatus\tin\tolder\tindividuals.\tInadequate\tnutrient
|
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intake\tmay\thasten\tloss\tof\tmuscle\tmass\tand\tstrength,\twhich\tcan\thave\ta\tnegative\teffect\ton\tperforming\nADLs.\tAmong\tthe\tolder\tadults\twho\thave\tone\tor\tmore\tnutrition-related\tchronic\tdiseases,\timpaired\nphysical\tfunction\n\tmay\tcause\tgreater\tdisability,\twith\tincreased\tmorbidity,\tnursing\thome\tadmissions,\nor\tdeath.\nFrailty\tand\tfailure\tto\tthrive
|
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or\tdeath.\nFrailty\tand\tfailure\tto\tthrive\nThe\tfour\tsyndromes\tknown\tto\tbe\tpredictive\tof\tadverse\toutcomes\tin\tolder\tadults\tthat\tare\tprevalent\tin\npatients\twith\tfrailty\tor\t“geriatric\tfailure\tto\tthrive”\tinclude\timpaired\tphysical\tfunctioning,\nmalnutrition,\tdepression,\tand\tcognitive\timpairment.\tSymptoms\tinclude\tweight\tloss,\n\tdecreased
|
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] |
decreased\nappetite,\tpoor\tnutrition,\tdehydration,\tinactivity,\tand\timpaired\timmune\tfunction.\tInterventions\tshould\nbe\tdirected\tat\teasily\tremediable\tcontributors\tin\tthe\thope\tof\timproving\toverall\tfunctional\tstatus.\nOptimal\tmanagement\trequires\ta\tmultidisciplinary,\tmultifaceted\tapproach.\tOccupational\ttherapists
|
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and\tspeech\ttherapists\tare\tessential\tto\tcomprehensive\tcare\tmanagement.\tNutrition\tinterventions,\nespecially\tthose\trectifying\tprotein-energy\tmalnutrition,\tare\tessential\tbut\toften\tdifficult\tto\timplement\nin\tan\tolder\tperson\twho\tis\tdisinterested\tin\teating.\tBecause\toverall\tdiet\tquality\thas\tbeen\tshown\tto\tbe
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associated\tinversely\twith\tprevalent\tand\tfuture\tfrailty\tstatus\tin\ta\tlarge\tcohort\tof\tcommunity-living\nolder\tmen,\tmore\tattention\tto\tthe\ttotal\tdietary\tintakes\twhen\tadvancing\tage\tis\tcritical\t(\nGalvin\tand\nSadowsky,\t2012\n).\tLiberalization\tof\toverly\trestrictive\tdiet\tprescriptions\tis\toften\tkey\tto\timproving\ncalorie\tintake\tand\tdietary\tquality\t(\nRaymond,\t2019
|
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] |
calorie\tintake\tand\tdietary\tquality\t(\nRaymond,\t2019\n).\tIt\tis\timportant\tto\trecognize\twhen\tfailure\tto\nthrive\tis\tactually\tnormal\tend\tof\tlife.\tSpiritual\tsupport\tis\tan\timportant\tcomponent\tof\tthe\tcare.\nWeight\tmaintenance\nObesity\nThe\tprevalence\tof\tobesity\tin\tall\tages\thas\tincreased\tduring\tthe\tpast\t25\tyears\tin\tthe\tUnited\n\tStates;
|
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States;\nolder\tadults\tare\tno\texception.\tObesity\trates\tare\tgreater\tamong\tthose\tages\t65\tto\t74\tthan\tamong\nthose\tage\t75\tand\tolder.\tObesity\tis\ta\tmajor\tcause\tof\tpreventable\tdisease\tand\tpremature\tdeath.\tBoth\nare\tlinked\tto\tincreased\trisk\tof\tcoronary\theart\tdisease,\ttype\t2\tdiabetes,\tendometrial,\tcolon,
|
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] |
postmenopausal\tbreast,\tand\tother\tcancers,\tasthma\tand\tother\trespiratory\tproblems,\tosteoarthritis,\nand\tdisability.\n\tObesity\tcauses\ta\tprogressive\tdecline\tin\tphysical\tfunction,\twhich\tmay\tlead\tto\tincreased\nfrailty.\tOverweight\tand\tobesity\tcan\tlead\tto\ta\tdecline\tin\tIADLs.
|
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frailty.\tOverweight\tand\tobesity\tcan\tlead\tto\ta\tdecline\tin\tIADLs.\nWeight\tloss\ttherapy\tthat\tmaintains\tmuscle\tand\tbone\tmass\tis\trecommended\tfor\tobese\tolder\tadults\nbecause\tit\timproves\tphysical\tfunction\tand\tquality\tof\tlife\tand\treduces\tthe\tmultiple\tmedical\ncomplications\tassociated\twith\tobesity.\tWeight\tmaintenance,
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0.11708027869462967,
0.08647973835468292,
0.05493185296654701,
-0.012066150084137917
] |
complications\tassociated\twith\tobesity.\tWeight\tmaintenance,\n\tnot\tweight\tloss,\tshould\tbe\tthe\tgoal\tin\tthe\nvery\told\tbecause\textra\tweight\tis\tactually\ta\tbenefit.\tNormal\tBMI\tstandards\tare\tnot\tappropriate\tfor\nthe\tvery\told\tsince\tthey\thave\tnot\tbeen\tvalidated\tin\tthis\tpopulation.
|
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0.05875322222709656,
0.013781758956611156
] |
the\tvery\told\tsince\tthey\thave\tnot\tbeen\tvalidated\tin\tthis\tpopulation.\nWeight\tloss\tof\tno\tmore\tthan\t10%\tof\ttotal\tbody\tweight\tover\t6\tmonths\tshould\tbe\tthe\tinitial\tgoal\tin\nthose\twho\tare\tappropriate\tfor\tweight\tintervention.\tMild\tcalorie\trestriction\tand\tincreased\n\tactivity\nshould\tbe\tencouraged\t(see\t\nChapter\t20\n).
|
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] |
activity\nshould\tbe\tencouraged\t(see\t\nChapter\t20\n).\nHaving\ta\thigher\tbody\tweight\tafter\tage\t70\tmay\tbe\thealth\tprotective.\tA\tstudy\treviewed\tdata\tfrom\ntwo\tlong-term\tstudies\tand\tfound\tthat\tadults\twho\twere\toverweight\taveraged\ta\t13%\tlower\trisk\tof\ndeath\tfrom\tany\tcause\tover\t10\tyears,\tcompared\twith\tthose\twho\twere\tin\tthe\toptimal\tBMI\trange\n(\nFlicker\tet\tal,\t2010
|
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] |
(\nFlicker\tet\tal,\t2010\n).\tThose\twho\twere\tunderweight\twere\t76%\tmore\tlikely\n\tto\tdie,\talthough\tthe\tobese\nhad\tthe\tsame\tmortality\trisk\tas\tthose\tof\twithin\tthe\toptimal\tBMI\trange.\tThe\tresearchers\tconcluded\nthat\tthe\tbody\tmass\tindex\t(BMI)\tthresholds\tfor\toverweight\tand\tobese\tmay\tbe\toverly\trestrictive\tfor
|
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older\tadults.\tNotably,\tthe\tresearchers\talso\tfound\tthat\tbeing\tsedentary\tincreased\tthe\trisk\tof\tdeath\tin\nmen\tby\t28%;\tin\twomen,\tthe\trisk\twas\tdoubled.\nUnderweight\tand\tmalnutrition\nThe\tactual\tprevalence\tof\tunderweight\tamong\tolder\tadults\tis\tlow;\twomen\tolder\tthan\tage\t65\tare\tthree\ntimes\tas\tlikely\tas\ttheir\tmale\tcounterparts\tto\tbe\tunderweight\t(
|
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0.11142628639936447,
0.06425085663795471,
0.015991782769560814,
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] |
times\tas\tlikely\tas\ttheir\tmale\tcounterparts\tto\tbe\tunderweight\t(\nWinter\tet\tal,\t2014\n).\tHowever,\tmany\nolder\tadults\tare\tat\trisk\tfor\tundernutrition\tand\tmalnutrition\t(\nFederal\tInteragency\tForum\ton\tAging-\nRelated\tStatistics,\t2012\n).\tAmong\tthose\thospitalized,\t40%\tto\t60%\tare\tmalnourished\tor\tat\trisk\tfor\nmalnutrition,
|
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] |
malnutrition,\n\t40%\tto\t85%\tof\tnursing\thome\tresidents\thave\tmalnutrition,\tand\t20%\tto\t60%\tof\thome\ncare\tpatients\tare\tmalnourished.\tMany\tcommunity-residing\tolder\tpersons\tconsume\tfewer\tthan\t1000\nkcal/day,\tan\tamount\tnot\tadequate\tto\tmaintain\tgood\tnutrition.\tSome\tcauses\tof\tundernutrition\tinclude
|
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medications,\tdepression,\tdecreased\tsense\tof\ttaste\tor\tsmell,\tpoor\toral\thealth,\tchronic\tdiseases,\ndysphagia,\tand\tother\tphysical\n\tproblems\tthat\tmake\teating\tdifficult.\tSocial\tcauses\tmay\tinclude\tliving\nalone,\tinadequate\tincome,\tlack\tof\ttransportation,\tand\tlimitations\tin\tshopping\tfor\tand\tpreparing\tfood.
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0.019650256261229515,
0.04340619966387749,
0.06082552671432495,
0.037760864943265915
] |
Health\tcare\tprofessionals\tfrequently\toverlook\tprotein-energy\tmalnutrition\t(PEM).\tThe\tphysiologic\nchanges\tof\taging,\tas\twell\tas\tchanges\tin\tliving\tconditions\tand\tincome,\tcontribute\tto\tthe\tproblem.\nSymptoms\tof\tPEM\toften\tare\tattributed\n\tto\tother\tconditions,\tleading\tto\tmisdiagnosis.\tSome\tcommon
|
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] |
to\tother\tconditions,\tleading\tto\tmisdiagnosis.\tSome\tcommon\nsymptoms\tare\tconfusion,\tfatigue,\tand\tweakness.\tOlder\tadults\twith\tlow\tincomes,\twho\thave\tdifficulty\nchewing\tand\tswallowing\tmeat,\twho\tsmoke,\tor\twho\tengage\tin\tlittle\tor\tno\tphysical\tactivity\tare\tat\nincreased\trisk\tof\tdeveloping\tPEM.
|
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] |
increased\trisk\tof\tdeveloping\tPEM.\nStrategies\tto\tdecrease\tPEM\tinclude\tincreased\tcaloric\tand\tprotein\tintake.\tStrategies\tto\timprove\nintake\tin\ta\tlong-term\n\tcare\tcommunity\tshould\tbe\tindividualized\tbased\ton\tthe\tspecific\tsituation.\nNutrition\trisk\tscreening\tis\tan\timportant\tfirst\tstep\t(see\t\nChapter\t4\n).
|
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] |
Chapter\t4\n).\nIn\tcommunity\tsettings\tolder\tadults\tshould\tbe\tencouraged\tto\teat\tenergy-dense\tand\thigh-protein\nfoods.\tFederal\tfood\tand\tnutrition\tservices\tare\talso\tavailable\tfor\tthe\tmany\twho\treside\tat\thome\t(see\nsections\tbelow\tand\t\nFocus\tOn:\n\tFood\tFirst!\n).\tDiets\tshould\tbe\tindividualized\n\trather\tthan\trestricted\tto
|
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).\tDiets\tshould\tbe\tindividualized\n\trather\tthan\trestricted\tto\noffer\tmore\tchoices\tand\thonor\tpersonal\tpreference\t(\nDorner\tand\tFriedrich,\t2018\n).\tSimple,\tpractical\napproaches,\tsuch\tas\tadding\tgravies\tand\tcreams,\tcan\tincrease\tcalories\tand\tsoften\tfoods\tfor\teasier\nchewing.
|
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tube-related\ncomplications\tincluding\thospital\tvisits,\trisk\tof\taspiration,\tand\tgreater\tlikelihood\tof\tnew\tpressure\ninjury\tdevelopment.\tFor\tthose\twith\tadvanced\tdementia,\tit\tis\trecommended\tthat\tclose\tattention\tbe\npaid\tto\tassistance\tat\tmeals,\tindividual-centered\tapproaches\tto\teating\tand\tshould\tinclude\ta\tfocus\ton
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altering\tthe\tenvironment\tto\tmaximize\toral\tintake\tfor\tthe\tolder\tadult\twith\tadvanced\n\tdementia.\n\t\nFocus\tOn\nFood\tFirst!\nThere\tare\tmany\treasons\tfor\tpractitioners\tto\tconsider\tchanging\tfrom\tthe\tuse\tof\tcommercially\nmanufactured\tnutritional\tsupplements\tto\tnutrient-dense\treal\tfood.\tAlthough\tcommercial
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tradition,\tand\tpart\tof\tlife\tcelebrations.\tThe\tsmell\tof\tfood\tand\tappearance\ton\ta\tplate\tis\tpart\tof\tthe\noverall\teating\texperience.\nFortified\tfoods\tat\tmeals\tand\tsnack\ttime\tin\tlieu\tof\tcommercially\tprepared\tsupplements\n\tcan\nsatisfy\tthe\tmost\tdemanding\tpalate\tbecause\tthey\tcan\tbe\tflexible\tand\tindividualized.\tVirtually\tany
|
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food\tcan\tbe\tcalorie\tenhanced;\tmany\tcan\tbe\tprotein\tenhanced.\nFortified\tfood\tprograms\thave\tbeen\tknown\tby\ta\tvariety\tof\tnames:\tEvery\tBite\tCounts,\tNutrition\nIntervention\tProgram,\tEnhanced\tFood\tProgram,\tSuper\tFoods,\tor\tFood\tFortification\tProgram.\nToday,\tthanks\tto\tthe\tDining\tPractice\tStandards\tpublished\n\tin\t2011\tand\tadopted\tby\tthe\tCenters\tfor
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