1. Theories of Aging

2. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. TabloskiObjectives This presentation will describe aging from both a biological/physiological and a psychosocial perspective. Biological/physiological theories will be presented in two main categories, program theories and error theories. Psychosocial theories will be discussed in two main categories, full-life theories and mature-life theories.

3. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski What is Aging? The gradual and spontaneous changes that occur in maturation from infant to young adult. These changes create a normal physiologic decline seen in middle and late adulthood. Changes during puberty Graying of hair

4. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. TabloskiSenescence The process by which a cell looses its ability to divide, grow, and function. This loss of function ultimately ends in death. A degenerative process, only. Has no positive features.

5. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Theories of Aging “The link between genes and lifespan is unquestioned. The simple observation that some species live longer than others -- humans longer than dogs, tortoises longer than mice -- is one convincing piece of evidence.” The National Institute on Aging

6. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Theories of Aging All aging begins with genetics Aging changes the biochemical and physiological processes in the body Cell and molecular biologists examine and propose theories to explain the aging process –What causes aging? –How can you influence aging …prolong life?

7. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski The Two Main Aging Theory Categories Programmed Theories Aging has a biological timetable or internal biological clock. Error Theories Aging is a result of internal or external assaults that damage cells or organs so they can no longer function properly. Many theories are a combination of programmed and error theories.

8. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Programmed vs. Error Theories Programmed Theories Programmed Senescence Theory Endocrine Theory Immunology Theory Error Theories Wear and Tear Theory Rate-of-Living Theory Cross-linking Theory Free Radical Theory Error CatastropheTheory Somatic Mutation Theory

9. Programmed Theories Programmed Senescence Theory Endocrine Theory Immunology Theory

10. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Programmed Senescence Theory The result of sequential switching “off” or “on” of specific genes.

11. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Telomeric Theory Telomeres are specialized DNA sequences at the end of chromosomes. –They shorten with each cell division. –When the telomeres become too short, the cell enters the senescence stage. In the normal process of DNA replication, the end of the chromosome is not copied exactly, which leaves an unreplicated gap.

12. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski

13. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Telomeric Theory The enzyme, telomerase, fills the gap by attaching bases to the end of the chromosomes. As long as the cells have enough telomerase to do the job, they keep the telomeres long enough to prevent any important information from being lost as they go through each replication. –With time, telomerase levels decrease. –With decreasing telomerase levels, the telomeres become shorter and shorter.

14. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski

15. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Telomeric Theory Shortened telomeres are found in: –Atherosclerosis –Heart disease –Hepatitis –Cirrhosis

16. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Telomeric Theory and Cancer 90% of cancer cells have been found to possess telomerase. –Telomerase prevents the telomere from shortening. –This allows the cancer cells to reproduce, resulting in tumor growth. Research areas –Measuring telomerase may help detect cancer. –Stopping telomerase may fight cancer by causing death of cancer cells. –Telomerase may be used to help with wound healing or the immune response.

17. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Endocrine Theory Biological clocks act through hormones to control the pace of aging. Hormones effects growth, metabolism, temperature, inflammation and stress. Examples- Menopause –Decreased level of estrogen & progesterone –Hot flashes, insomnia

18. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Immunologic Theory A programmed decline in the immune system leads to an increased vulnerability to disease, aging and death Example- Decreased T cells (helper cells) in adults –Increased diseases in older adults –Increased autoimmune diseases in adults

19. Error Theories Wear and Tear Theory Error Free Radical Theory Rate-of-Living Theory CatastropheTheory Cross-linking Theory Somatic Mutation Theory

20. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Wear and Tear Theory Years of damage to cells, tissues and organs eventually wears them out, killing both them and the body Example- Wearing out of the skeletal system such as in osteoarthritis Wear and tear can be viewed as a result of aging and not the cause of it.

21. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Rate-of-Living Theory The greater an organism’s basal metabolic rate, the shorter the life span. Free radicals or other metabolic by- products play a role in senesce. Example Animals with the most rapid metabolisms tend to have the shortest lifespans, i.e, birds have a shorter lifespan than humans. Studies examining the relationship between metabolic rates and longevity have produced inconsistent results, limiting the usefulness of this theory.

22. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Cross-Linking Theory The accumulation of cross-linked proteins damages cells and tissue, slowing down bodily processes. Example Non-enzymatic glycosylation reactions occur when glucose molecules attach to proteins causing a chain of chemical reactions resulting in a structural change to the proteins. –Loss of flexibility of connective tissue –Microvascular changes in arteries

23. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Free Radical Theory During aging, damage produced by free radicals cause cells and organs to stop functioning. A free radical is a molecule with an unpaired, highly reactive electron. One type of very reactive free radical is the oxygen free radical, which may be produced during metabolism or as a result of environmental pollution. Oxygen free radicals are formed in your cells, naturally, during the oxidation of food to water and carbon dioxide.

24. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Free Radical Theory The free radical “grabs” a electron from any molecule in its vicinity. It does this because electrons like to exist in pairs. When it “grabs” an electron from another molecule, it damages the other molecule.

25. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Free Radical Theory Some of the molecules that may be damaged by free radicals are fats, proteins, and DNA (both in the nucleus and in mitochondria). If membrane fats are attacked, then you get the breakdown of the cell membrane. If it is a red blood cell membrane, you get hemolysis. If proteins are attacked, you get the breakdown of proteins, which may result in the loss of biological function and the accumulation of “catastrophic” compounds. If DNA is attacked, you will get a mutation that may cause aging or cancer.

26. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Free Radical Theory Under normal conditions, your natural defense mechanisms prevent most of the oxidative damage from occurring. The free radical theory of aging proposes that, little-by-little, small amounts of damage accumulate and contribute to deterioration of tissues and organs.

27. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Free Radical Theory For example, when Vitamin E “scavenges” free radicals, it becomes a free radical and may be more carcinogenic than the original free radical. This is the reason why taking high doses of vitamin E SUPPLEMENTS appears to INCREASE cancer risk in a person, not decrease cancer risk.

28. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Catastrophe Theory Any damage to the enzyme systems that synthesize proteins in the body results in faulty protein synthesis. The faulty proteins continue to accumulate in the cell until they reach a level that damages the cells, tissues, and organ When enough damage accumulates, this may result in cell malfunctioning ( aging) leading to death.

29. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Somatic Mutation Genetic mutations occur and accumulate with age in the somatic cell causing the cell to: –Deteriorate –Malfunction Accumulation of mutations result in : –Damage to the DNA The theory states that aging is an imbalance between DNA’s ability to repair itself and accumulating DNA damage. –When the damage exceeds the repair, the cell malfunctions and this can lead to senesence.

30. Psychological Theories of Aging

31. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Psychological Theories of Aging 1.Full-Life Development Theories ( Erikson’s Theory will be the only one discussed.) 2.Mature-Life Theories 1.Robert Peck’s Theory 2.The Activity Theory (Neugarten’s Theory will be the only one discussed.) 3.The General Theory of Disengagement

32. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Full-Life Development Theory Eric Erickson was one of the first psychological theorists to develop a personality theory that extends to old age.

33. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Full-Life Development Theory Major Concepts The ego is a positive driving force for development. –The ego’s job is to establish and maintain identity. –A lack of identify leads to lack of direction and non-productivity. There are stages of personality and ego development.

34. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Full-Life Development Theory Major Concepts The last stages are “Adulthood” & “Late Life Stage.” “Adulthood” is characterized by a struggle between “Generativitiy” and Stagnation. “Generativity” –Giving back to society by raising children –Being productive at work –Being involved in the community –Guiding, parenting, and monitoring the next generation

35. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Full-Life Development Theory Major Concepts Stagnation –Being unproductive –Feeling anger, hurt and self absorption As one becomes mature, there is a struggle between “Ego Integrity” & despair “Ego Integrity” –Exploring life as a retired person who is not identified with an occupation –Contemplating accomplishment –Feeling life is successful

36. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Full-Life Development Theory Despair –Feeling guilt about the past –Not accomplishing life goals –The final pathway: dissatisfied despair depression hopelessness

37. Mature-Life Theories

38. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Mature-Life Theories Neugarten Bernice Neugarten describes tasks that must be accomplished for successful aging. Some of these tasks include: Accepting reality and the imminence of death. Coping with physical illness. Accepting the necessity of being dependent on outside support while still making independent choices that can give satisfaction.

39. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Mature-Life Theories Neugarten A person must remain as active as possible. This falls under the category of “activity theory.”

40. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Mature-Life Theories General Theory of Disengagement This theory is controversial and has these features: Both older people and society mutually withdraw from each other. A person gradually disconnects from other people in anticipation of death. Intrinsic changes in personality occur which allow a person to psychologically withdraw from society’s expectations. Note: This is the opposite of “Activity Theory.”

41. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. TabloskiSummary This presentation has described aging from both a biological/physiological and a psychosocial perspective. Biological/physiological theories are divided into two main categories, program theories and error theories. Psychosocial theories are divided into two main categories, full life theories and mature life theories.

42. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski The End

43. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. CHAPTER Gerontological Nursing, Second Edition Patricia A. Tabloski Nutrition and Aging 5 Lecture Note PowerPoint Presentation

44. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 1 Describe the normal changes of aging in body composition and digestion, absorption, and metabolism of nutrients.

45. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Causes of Sarcopenia (Excessive Loss of Lean Muscle Mass) Disability or disease Sedentary (inactive) lifestyle Decreased anabolic hormone production Increased cytokine activity Decreased nutrition Cytokine: Any of several regulatory proteins, such as the interleukins and lymphokines, that are released by cells of the immune system and act as intercellular mediators in the generation of an immune response.

46. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Effects of Loss of Muscle Function Functional decline in strength and endurance Predisposition to falls Lower total body water (TBW)

47. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski having lost teeth) At Age 65, 33.1% of Adults are Edentulous (having lost teeth) Effects amounts and types of foods consumed

48. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Saliva Production Declines (Xerostomia) Hindered taste and swallowing

49. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Atrophic Gastritis Reduction in stomach size Reduction in size and number of glands and mucous membranes

50. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Achlorhydria (Lack of Hydrochloric Acid) Impaired absorption of B12 and iron –Reduced gastric production of intrinsic factor can also impair B12 absorption

51. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Constipation Reduces Intake and Can Be Caused by Slowed intestinal peristalsis Inadequate intake of fluid and fiber Illness or medications Sedentary lifestyle

52. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Causes of Increased Risk of Uncompensated Dehydration Altered thirst mechanism Impaired angiotensin

53. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Dehydration Risks Increase as a Result of Voluntary Fluid Restriction Due to Incontinence Nocturia Need for assistance with toileting Cognitive or physical limitations –Inadequate access to free fluids –Thirst dysregulation

54. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Sensory Changes Impact the ability to obtain, prepare, and enjoy food

55. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Causes of Altered Nutritional Adequacy More sedentary lifestyle Social isolation Changes in economic status

56. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 2 Differentiate between normal and disease- related changes in risk factors for undernutrition in the older person.

57. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski How Chronic Disease Impacts Nutritional Status Changes in nutritional needs Therapeutic diets Changes in nutrient utilization and absorption Medication side effects –Impact on appetite and taste –Decreased saliva –Gastrointestinal side effects

58. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 3 Identify normal nutrition requirements of the older person.

59. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nutritional Dietary Standards Provide nutritional recommendations Work well as an assessment tool Types –Dietary reference intakes  Provide specific nutrient recommendations  Recommended dietary allowances (RDAs)  Adequate intakes (AIs)  Tolerable upper limits (TULs) –Food Guide Pyramid

60. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Differences in Dietary Reference Intake (DRI) for the Older Adult Versus General Adult Population Vitamin D Calcium Vitamin B12 Vitamin B6 Energy

61. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Recommended Dietary Allowance for the Older Person Protein 0.8 g/kg body weight

62. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski DRI for Energy, or Estimated Energy Requirements (EER), Based On Gender Age Body mass index (BMI) Activity level

63. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski EER Adjusts for Age to Account for Losses in Lean Muscle Mass and Diminished Physical Activity Following the lowest daily recommended values for all the food groups will result in approximately 1,600 kcal of energy

64. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Figure 5-1 Modified MyPyramid for the older adult. Source: Copyright 2007 Tufts University. Reprinted with permission from Lichtenstein, A. H., Rasmussen, H., Yu, W. W., Epstein, S. R., and Russell, R. M. (2008). Modified MyPyramid for Older Adult. J Nutr. 2008, 138, 78–82.

65. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Vitamin D The Adequate Intake (AI) for vitamin D triples from young adulthood to age 71 Adults over age 70 require 600 IU of vitamin D AI for adults aged 51 to 70 is 400 IU Tolerable Upper Limit (TUL) of vitamin D is 2,000 IU The Modified Food Guide Pyramid recommends a supplement of vitamin D and three dairy servings per day

66. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Calcium AI for in adults over 50 years of age is 1,200 mg Modified Food Guide Pyramid recommends three dairy servings daily plus a calcium supplement TUL is 2,500 mg

67. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Vitamin B12 Recommended Dietary Allowance (RDA) is 2.4 mcg Dietary Reference Intakes (DRI), Modified Food Guide Pyramid, and U.S. Dietary Guidelines recommend B12-fortified foods or a vitamin B12 supplement

68. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Vitamin B6 DRI for adults over age 50 is 1.5 mg per day for women and 1.7 mg per day for men TUL is 100 mg

69. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Fluid Needs Total daily water recommendation for adults over age 51 is 3.7 L for men and 2.7 L for women RDA based on a general water requirement of 1.0–1.5 ml/cal of energy intake

70. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Fluid Needs Modified Food Guide Pyramid recommends 8 cups of water as pyramid foundation Do not include alcohol and caffeinated beverages in fluid calculations

71. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 4 Outline the causes and consequences of undernutrition in the older person.

72. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Physical and Psychological Causes for Insufficient Intake Reduced access Rear of incontinence Dependence for toileting or feeding Depression or cognitive impairment Polypharmacy Pain Chronic diseases Dysphagia

73. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Physical and Psychological Causes for Insufficient Intake Sensory changes Diet –Preferences –Unfamiliarity –Medically restricted diets Finances –Quality –Quantity

74. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Box 5-5 Causes of Unintentional Weight Loss

75. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Hypermetabolism Chronic illnesses Fever Wounds Infection Fractures

76. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nutrient Losses Malabsorption or high output from diseases or treatments

77. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Consequences of Undernutrition Impact quality and quantity of life, and morbidity and mortality –Poor wound healing –Skeletal muscle loss –Functional decline –Altered immune response –Altered pharmacokinetics –Increased risk of institutionalization

78. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 5 Identify tools and parameters used to assess nutritional status.

79. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Comprehensive Nutritional Assessment Reviews Anthropometric measurements Laboratory values Clinical findings from the physical examination Patient history

80. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Anthropometric Measurements Include Scientific Measurement of Height Weight Weight history Body mass index (BMI) Muscle mass Fat mass

81. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Laboratory Parameters Used to Assess Nutritional Status Albumin Transferrin Complete blood count (CBC) –Mean cell volume (MCV) –Hemoglobin –Hematocrit Serum folate B12 assays

82. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Assessment Findings May Indicate Existing nutritional problems Risk factors for undernutrition

83. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nutritional History Assessment 24-hour diet recall Food frequency assessment 3-day food record (2 weekdays and 1 weekend day)

84. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Screening Tools Nutritional Screening Initiative (NSI) DETERMINE checklist Mini Nutritional Assessment Minimum Data Set (MDS)

85. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 6 Define appropriate nursing interventions and treatment for nutrition-related problems of the older person.

86. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Skin Assessment Turgor Lesions Wound healing Color variations Dryness and cracking Oral mucous membranes for hygiene, coatings, and fissures

87. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Hair Assessment Distribution and condition

88. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Abdominal Assessment Firmness Tenderness Bowel patterns

89. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Pain Assessment Levels of pain PRN medications prior to dining

90. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Eating or Drinking Assessment Dysphagia Positioning Need for adaptive equipment

91. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Dining Environment Assessment Small, frequent meals Avoid distractions and delays Pay attention to sights, sounds, and smells Include family members

92. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Review of Medications Potentially Causing Anorexia Depression Early satiety Taste alterations Lethargy Appetite suppression

93. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Common Offending Medications Digoxin Diuretics Chemotherapy Antibiotics Antidepressants

94. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Nursing Interventions Individualized nutritional care plans Feeding assistance Altering the physical environment Liberalizing restrictive diets Collaborating with registered dieticians Making appropriate referrals

95. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski LEARNING OUTCOME 7 Identify current dietary approaches to chronic disease in the older person.

96. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Weight Loss and Sodium Restriction May Benefit Sleep apnea Osteoarthritis Hypertension

97. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Taste Deficits Provide saltier or sweeter foods

98. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gerontological Nursing, Second Edition Patricia A. Tabloski Visual Deficits Use the face of a clock for plate food locations