Life Span Health Promotion: Adulthood



Life Span Health Promotion


Adulthood



image http://evolve.elsevier.com/Grodner/foundations/ image Nutrition Concepts Online



Role in Wellness


By the time young adults reach their early 20s, growth levels off and the body achieves a state of homeostasis. Mental capacity is fully developed as young people begin to assume their roles in adult society. How this transition is experienced depends on cultural views of growing older. Does growing older confer social privileges of respect and authority? Or does it mean the loss of youth and good times? How we accept new responsibilities within family and intimate relationships may affect our overall health status and level of wellness.


Layered on cultural perceptions of aging is the complexity of today’s world. Through telecommunications we are exposed to and influenced by numerous world and local events in ways unimaginable to previous generations. Similarly, educational and employment opportunities seem endless; yet some adults are caught in cycles of underemployment and unemployment as the marketplace evolves, and others, through economic misfortune, are homeless. Additionally, each stage of adulthood presents particular life stressors. How we cope with these stressors and those of society affects adult nutritional status.


The five dimensions of health affect the health promotion of adulthood. Beginning health-promoting habits early in life and continuing them through older adulthood maintains physical health. Our intellectual health provides the ability to change and adapt as circumstances vary according to age and related responsibilities for our health. The symbolic representation and occasions defined by certain foods are often tied to our emotional well-being. Food provides a means of communication; customs surrounding eating behaviors vary among cultures and ethnic groups; exposure to these differences is rewarding and enhances social health. The support of our religious and charitable communities provides an added dimension to spiritual health promotion and to recovery from disease and illness.


Although previous chapters have addressed nutrition for adults, this section addresses the different influences on nutritional lifestyles through the adulthood stages of the early years (20s and 30s); the middle years (40s and 50s); the older years (60s, 70s, and 80s); and the oldest years (80s and 90s).



Aging and Nutrition


Aging is a gradual process that reflects the influence of genetics, lifestyle, and environment over the course of the life span. The purpose of cell creation begins changing around age 30. No longer supplying new cells for growth and development, cell metabolism slows down and instead creates new cells to replace old cells. At older ages, this process of cell replication slows even more, and the effects of aging on body organs begin to appear. Some body systems are more affected than others, and the changes may begin to affect nutritional status. Other organ functions that may be altered include taste and smell, saliva secretions, swallowing difficulties, liver function, and intestinal function. For example, the gastrointestinal tract functions are diminished by reduced production of gastric juices such as hydrochloric acid, which results in decreased absorption of nutrients. The systems and the effects of aging are listed in Table 13-1.



How an individual body responds to these changes reflects health status across the life span. Consequently, everyone ages differently. The role of nutrition during the life span categories of adolescence through the middle years (40s and 50s) provides a foundation to adequately support body processes to effectively deal with the effects of lifestyle and environmental factors. Nutrient intake and dietary patterns directly influence the risk of developing the chronic disorders of osteoporosis, coronary artery disease, diabetes, hypertension, and obesity. The effect of nutrient intake, though, is mediated by lifestyle behaviors, including physical activity, stress, smoking, alcohol consumption, and exposure to environmental factors. For example, how a young woman eats and the amount of exercise she performs affect the density of her bones and the level of lean body mass of her body. If her nutrient intake is adequate and the exercise is weight bearing, she may reduce her risk of osteoporosis (as well as the risk of the other chronic disorders) decades later when she is in her 60s or 70s.



Productive Aging


The concept of productive aging considers the many psychosocial influences on successful aging. Productive aging refers to an overall process of aging that is dependent on attitudes and skills developed over the course of one’s life. These attitudes and skills prepare an individual to adapt to the transitions of life and maintain a personal sense of experiencing a productive, meaningful life.1 Successful aging considers that different criteria of success apply during the older years compared with those of the earlier life span categories. Box 13-1 is a list of 15 ways to promote successful aging that was developed from suggestions by older adults.1




Stages of Adulthood


The Early Years (20s and 30s)


Students tend to imagine that once they finish high school or college and enter the working world, they will then be able to eat better, sleep more, and generally take better care of themselves than they do during their hectic school years. Unfortunately, that is rarely the experience of young adults. Many find that their lifestyles may be even more time restricted, and positive health behaviors such as regular meal patterns and exercise may fall by the wayside.


These years mark a transition from one stage of the life span to another; young adults separate from their family of origin, focus on personal and career goals, and often face reproductive decisions (Figure 13-1). As such, it is a prime time to either refine or establish an eating style that promotes health, possibly preventing future development of diet-related diseases. National surveys, though, continue to report that few adults consume the health-promoting recommended intakes of fruits and vegetables. As of 2007, 76% of American adults reported consuming fewer than 5 servings of fruits and vegetables a day.2 A self-review or assessment by a nutrition professional can assist in creating a personal schedule that allows time for planning and preparation of simple yet high-quality meals.



Many women bear children during these years. The nutrition and health requirements of pregnancy are detailed in Chapter 11. Layered on these needs during this life span stage are often employment and other family commitments, all of which affect nutritional and health behaviors. Physically caring for young children, although eminently rewarding, may be exhausting. Throughout the mother’s pregnancy and during childbearing, the father’s role in terms of health issues is often ignored. Although the woman’s body is nourishing fetal development, the father is under stress as he prepares to support additional responsibilities. Fathers also need to be at optimum health, especially during the first few years of childrearing when physical stamina is put to the test.



Nutrition Requirements


Growth tends to be completed by the late teens for women and early 20s for men, as reflected by the Dietary Reference Intake (DRI) (see the inside front cover). For women, the Recommended Dietary Allowance (RDA) for energy is 2200 kcal daily; for men, it is 2900 kcal. This reflects the typical differences in body weight and lean body mass of men and women. When this stage includes a departure from high school or college sports training, energy intake should be reduced to meet actual need, or weight gain could occur. A teenage boy’s serious athletic training may require as much as 5000 to 6000 kcal a day to maintain weight. Switching to a desk job and exercising for 1 hour per day does not equal previous energy requirements.


The RDA for protein increases for women from 46 to 50 g and for men from 58 to 63 g daily; these ranges reflect lean body mass growth that may occur in both men and women through about age 24. Vitamin and mineral needs do not significantly change. Calcium and phosphorus needs for men and women decline after age 18 because skeletal growth is almost complete. Daily Adequate Intake (AI) recommended calcium levels up to age 18 are 1300 mg, dropping to 1000 mg from 19 years on. For phosphorus, RDA levels up to age 18 are 1250 mg a day, dropping to 700 mg from 19 years on. Maintaining calcium and iron intake continues to be a concern for women because of their often-restricted intake of food during dieting. (See also Box 7-1 or Box 8-3 regarding nutrients and their functions.)



The Middle Years (40s and 50s)


The years from 40 to 50 are marked by a continuation of family demands and career involvement. Some middle-year adults may be faced with caring for aging parents (Figure 13-2); this increased stress and responsibility may be offset by the seemingly reduced parenting of their own children. As older children leave for college or move into their own residences, the resultant “empty nest” necessitates rediscovering preparation of dinners for two or, for single parents, dinners for one. With family meals no longer a requirement, many middle-year adults often have the finances and time for restaurant dining. However, making the transition to food preparation styles and dietary patterns that maintain healthful dietary patterns is crucial.



The impact of continued positive dietary patterns coupled with regular exercise provides continued prevention or delay of diet-related diseases such as type 2 diabetes mellitus (type 2 DM) and coronary artery disease. Increased stamina is an additional benefit from such behaviors.



Nutrition Requirements


During the middle years, cell loss rather than replication occurs. Kcal needs decline as lean body mass is lost and replaced by body fat that is less metabolically active. Women in particular experience an increase in body fat composition. Body fat increases can be slowed by exercise and strength training to continue maintenance of lean body mass. After age 50, daily energy needs drop from 2200 to 1920 kcal for women and from 2900 to 2300 kcal for men. It is a challenge to meet the same nutrient needs with reduced kcal intake. Protein needs remain constant for both genders. Iron requirements for women drop from 18 to 8 mg, which reflects reduced iron loss because of menopause. (See also Box 7-1 or Box 8-3 regarding nutrients and their functions.)


Overall, dietary patterns that are nutrient dense and feature lower-fat protein foods coupled with fiber-containing fruits, vegetables, and grains best meet the nutrient needs of middle-year adults.



The Older Years (60s, 70s, and 80s)


The United States has never had a population with as high a percentage of older adults as it will have soon. As our life span increases in years, senescence (older adulthood) is for many a time of life for continued professional or career advancement and recreational enjoyment. Others are in transition, adjusting to retirement and settling into new patterns of activities. Gerontology, the study of aging, has provided insights into the emotional, physical, and social aspects of the later years of life. Preparation for the social and physical transitions of aging actually begins many years earlier, as individual approaches to lifestyle health behaviors, career fulfillment, and leisurely pursuits evolve.


Overall, quality of life for older adults depends on factors that influence daily experiences. These factors include health status; nutrition well-being; spirituality; living arrangements; physical activity; social interactions; physical, mental, and emotional functioning; disease management; and level of independence (Figure 13-3). The level of wellness experienced during this stage of life often reflects the quality of life resulting from health behaviors through the several life span stages.





Physical, Mental, and Emotional Functioning


During these later years, individuals may struggle with the deaths of family members and friends and adjustment to retirement. Although some delight in retirement, others view retirement as a loss of social status. This combination of death and loss of status may lead to isolation and depression, leading to loss of appetite (anorexia) or other forms of malnutrition. The economic realities of retirement without a solid financial base may thrust some older adults into unexpected poverty, because Social Security and Medicare payments may not be sufficient to adequately cover living and medical expenses. Resources for food purchases may be limited and negatively affect nutritional status. Unless social networking and family supports are strong, these conditions may persist. Older adults may abuse alcohol as a way to deal with these perceived difficult events.


Disorientation or senility often associated with aging may be caused by improper use of medications, marginal nutrient deficiencies (e.g., vitamin B12), or simple dehydration. Older clients may intentionally restrict fluids because of incontinence, nocturia (excessive urination at night), or the inability to get to the toilet on their own. Some older adults lose their sense of thirst and forget to consume enough fluids. Fluid requirements in older adults remain the same as in younger adults (about 8 cups daily is sufficient) unless a medical condition or medication prescribes otherwise. The signs of dehydration are listed in Box 13-2. Medical diagnosis should be sought to determine the specific etiology of these signs.




Nutrition Well-Being


Nutrition status may be affected by restricted access to food and ability to prepare meals. Shopping may be difficult without transportation, and mobility to walk through stores may be limited. Funds for food may be constrained, and often food quantities available are beyond the amounts that can be used by individuals living alone. Once foods are purchased, preparation may be affected by physical limitations caused by progressive chronic illnesses such as arthritis. Some older adults may no longer have an interest in cooking. Others have become so frightened about foods containing too much fat or cholesterol that they become malnourished. For individuals in this age bracket, there is not sufficient evidence to warrant restrictive dietary intake; in actuality, malnutrition and underweight are more detrimental than excess dietary fat and cholesterol intake. Box 13-3 lists risks factors for malnutrition of older adults.



Dietary management for older adults may be more complicated than for other stages of adulthood. For example, obesity is viewed as a form of malnutrition of an older adult.4 For younger adults, reducing body mass index (BMI) decreases health risks. For older adults, decreased BMI may be associated with increased risk of strokes. Having an average BMI provides healthful weight reserves during times of illness.4 Studies of weight reduction strategies seldom include older participants, so their complex physiologic, behavioral, and social needs are not considered. Additionally such strategies may overly limit intake of essential nutrients, further increasing malnutrition.4


Another aspect of older adult dietary management is protein adequacy. Total body protein decreases as aging progresses. Although the loss of skeletal muscle is the most noticeable body protein lost, organ tissue, blood components, and immune bodies are also affected, including compromised wound healing, loss of skin elasticity, reduced ability to battle infection, and longer recuperation from illness and surgeries.5 Dietary intake may be further altered when these physical factors combine with social factors, leading to reduced protein intake. Consumption of micronutrients found in protein foods also may be limited, leading to deficiencies of B12, A, C, D, calcium, iron, zinc, and others.6 This need, combined with the greater turnover of whole-body protein of aging bodies, results in older adults needing greater dietary protein intake (1 g/kg body weight) compared with younger adults (0.8 g/kg body weight).5 Frail elderly women are most at risk for these micronutrient deficiencies.



Living Arrangements


Living arrangements also affect nutritional status. A variety of living arrangements exists for older adults. Although many continue to live in their own homes or with family members, some opt for retirement communities, and others, because of health conditions, may reside in long-term care facilities or nursing homes. Living in one’s own home provides the freedom to prepare and eat foods whenever desired; illness, however, may make shopping for food and preparing it difficult. Retirement communities may provide transportation to food stores and more social events involving meals (Figure 13-5), although residents still are responsible for their own food preparation. Long-term care facilities usually provide prepared meals, but the style of cooking may not be as appealing or comforting as home-prepared meals.



A challenge for meeting the nutritional needs of institutionalized older adults is that the DRIs used to guide nutrient levels are intended to meet the needs of healthy older adults. Adjustments are necessary for individual circumstances of acute or chronic illness to achieve rehabilitation, recuperation, or maintenance to reduce the risk of further complications.7 Consequently, it is now recommended that diets in long-term care facilities be liberalized to improve dietary intake of this age group.8


Dietary patterns and preferences of older adults are the result of long-established habits. When they are ill, lonely, or under stress, older adults may strongly prefer foods they associate with pleasant memories. Ethnic favorites may provide security and comfort. The psychologic and social meanings of foods can play an important part in helping an older client recover from illness or adjust to changed circumstances.


Demographic and lifestyle characteristics may, as noted, put older adults at nutritional risk. Factors may include gender, smoking, alcohol abuse, dietary patterns, educational level, dental health, chronic illnesses, and living situations. Interventions to assist older adults need to account for these influences and should view support services through a continuum of care. Continuum of care provides continuity of care while the older individual moves through different living situations and services as health, medical, and supportive services are provided in suitable care environments. Care settings may range from acute medical settings to community and daycare, from assisted-living retirement housing to traditional nursing home facilities and hospices.



Nutrition Requirements


The DRIs remain constant from age 51 years and older for men and women, except for vitamin D. What does change is the ability of the body to either process or synthesizes certain nutrients. Synthesis of vitamin D is reduced; the AI for vitamin D for individuals older than age 70 increases to 15 mcg a day compared with 10 mcg a day for ages 51 to 70 years. Older adults either need more exposure to sunlight to produce required amounts of vitamin D or require a supplement if so diagnosed by a physician, qualified nutritionist, or dietitian. Because of decreased production of gastric juices and intestinal enzymes, digestion and absorption may be reduced, further highlighting the need for optimum nutrient intake. The production of the intrinsic factor required for vitamin B12 absorption also may be reduced, increasing the risk of pernicious anemia. New recommendations suggest the use of vitamin B12 supplements or consumption of foods fortified with vitamin B12 to meet the RDA of 2.4 mcg/day (see also Box 7-1 or Box 8-3 regarding functions of nutrients).


Other factors may affect nutritional status. A marginal deficiency of zinc can alter the sensitivity of taste receptors. This deficiency heightens the ability to taste bitter and sour flavors and reduces sweet and salty sensations; excessive use of sugars and salt to make foods taste appealing may result.


Overconsumption of simple sugars and sodium may exacerbate other diet-related disorders such as diabetes and hypertension. As the muscularity of the digestive system weakens, constipation may be a problem, especially after a lifetime of low-fiber foods. Constipation may be alleviated by slowly increasing consumption of whole-wheat products, fruits, vegetables, and fluids, as well as increasing exercise. The Modified MyPyramid for Older Adults, developed by Tufts University, highlights nutrient-dense foods and fluid intake while also suggesting different forms of foods that may be more easily available (Figure 13-6).



Dental health may also affect the ability of older adults to be well nourished. Loss of teeth caused by periodontal disease limits the ability to chew foods such as meats, a prime source of zinc. Chewing ability for some may still be compromised even after dentures have been fitted to replace missing teeth. Dentures may need to be periodically refitted. When dentures do not fit properly, some people do not use them. Instead, they tend to eat foods that can be gummed rather than chewed.



The Oldest Years (80s and 90s)


As life expectancy increases in years, the number of those in the most golden years rises. Although nutrient needs remain basically stable, the effects of aging may continue to reduce the ability of the body to absorb and synthesize nutrients. Optimum nutrition continues to be critical. The healthiest of the oldest develop individual patterns of dietary intake that most meet their physical and social needs.


The Personal Perspectives box, Settling into a New Home, provides some first-person insight into the transition one 80-year-old woman experienced on moving from her home to an adult independent living community.



image Personal Perspectives


Settling into a New Home


When 80-year-old Yetta Kaemmer moved to an adult independent living community after living in her own home, she made some adjustments, including eating meals with others every day in the congregate dining room, no longer needing to even cook for herself.


It’s like living in a hotel. I don’t have to cook, and I always have someone to eat with. Every morning I go to the dining room for breakfast. It’s good to be dressed and have a schedule to follow. By the time breakfast is over, you forget about the aches and pains you woke up with. For lunch I have something in my refrigerator to eat, or I may go out. Before dinner I relax by watching television. Then I always freshen my makeup and go to the dining room to eat at my assigned table with three others. When new people arrive, they sometimes feel awkward until they get to know others, especially when entering the dining room for dinner, since everyone seems to know each other. After dinner, there is often a program to attend.


Although we are served balanced meals, we actually eat more food than before, since we have full dinners every night. There are always choices of appetizers, main dishes, and desserts. You get to choose. And so most of us have put on a few pounds!


I don’t really miss cooking. Sometimes, though, I will feel a twinge in the supermarket when I see the ingredients of favorite meals I used to prepare. I made a real good meatloaf and, for company, Cornish hens each with a pineapple ring and cherry. Oh they would look so nice!


Yetta Kaemmer


Teaneck, N.J.

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Feb 9, 2017 | Posted by in NURSING | Comments Off on Life Span Health Promotion: Adulthood

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