Life Span Health Promotion: Adulthood

Physical health dimension

Begin health-promoting habits early in life and continue through older adulthood

Intellectual health dimension

Provides ability to change and adapt as health circumstances vary according to age and related responsibilities

Emotional health dimension

Symbolic representation and occasions defined by certain foods often tied to emotional well-being

Role in Wellness

 Social health dimension

Customs surrounding eating behaviors vary among cultures and ethnic groups; exposure to these differences is rewarding and enhances social health

Spiritual health dimension

Support of religious and charitable communities sustains health promotion efforts and recovery from disease and illness

Role in Wellness, contd

 Aging and nutrition

Aging: gradual process that reflects influence of genetics, lifestyle, and environment over life span Some body systems more affected than others
Changes may begin to affect nutritional status

Other organ functions may be altered

Taste and smell Saliva secretions Swallowing difficulties Liver function Intestinal function

Aging and Nutrition

 Productive aging
Overall process of aging depends on attitudes and skills developed over course of ones life Considers many psychosocial influences on successful aging

Aging and Nutrition, contd

 The early years (20s and 30s)

Young adults separate from family of origin, focus on personal and career goals, and often face reproductive decisions
Prime time to either refine or establish eating styles promoting health, possibly preventing development of diet-related diseases

Factors affecting nutritional and health behaviors

Childbearing years Employment/career Family commitments

Stages of Adulthood

 Nutrition requirements
Growth tends to be completed by late teens for women and early 20s for men RDA for energy is 2900 kcal daily for men; 2200 kcal daily for women
Reflects typical differences in body weight and lean body mass

RDA for protein increases from 58 to 63 g daily for men; from 46 to 50 g for women
Ranges reflect lean body mass growth that may occur in men and women through about age 24

Stages of Adulthood, contd

 Vitamin and mineral needs do not significantly change

Calcium and phosphorus needs decline after age 18
Skeletal growth almost complete AI for calcium drops from 1300 mg to 1000 mg from 19 years on RDA for phosphorus drops from 1250 mg to 700 mg from 19 years on

Maintaining calcium and iron intake continues as concern for women because of often-restricted intake of food during dieting

Stages of Adulthood, contd

 The middle years (40s and 50s)

Stage noted by continuation of family demands and career involvement Consistent 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 additional benefit

Stages of Adulthood, contd

 Nutrition requirements
During middle years, cell loss rather than replication occurs Kcal needs decline as lean body mass lost
Replaced by body fat, less metabolically active
Body fat increases may be slowed by exercise and strength training to maintain lean body mass

After age 50, daily energy needs drop from 2900 to 2300 kcal for men; from 2200 to 1920 kcal for women

Stages of Adulthood, contd

 Protein needs remain constant Iron requirements for women drop from 18 to 8 mg
Reflects reduced iron loss because of menopause

Dietary patterns that best meet nutrient needs

Contain nutrient-dense foods with lower-fat protein sources coupled with fiber-containing fruits, vegetables, and grains

Stages of Adulthood, contd

 The older years (60s, 70s, and 80s)

Senescence: older adulthood
Time of continued professional or career advancement Others in transition, adjusting to retirement

Gerontology: study of aging

Provides insights into emotional, physical, and social aspects of later years of life

Stages of Adulthood, contd

 Factors that influence daily experience quality of life for older adults include:
Health status Nutrition well-being Spirituality Living arrangements Physical activity Social interactions Physical, mental, and emotional functioning Disease management Level of independence

Stages of Adulthood, contd

 Physical activity
Physical fitness and good nutrition
Allows older adult to enter these years with more stamina, cardiovascular conditioning, and solid health-promoting habits

Stages of Adulthood, contd

 Physical, mental, and emotional functions

May be affected by:
Struggling with chronic illnesses of and deaths of family members and friends
Isolation and depression; may lead to loss of appetite (anorexia) or other forms of malnutrition

Stages of Adulthood, contd

 Adjusting to retirement (and its economic realities) Alcohol abuse related to depression and lack of coping skills Disorientation or senility often associated with aging
Improper use of medications, marginal nutrient deficiencies (e.g., vitamin B12), or simple dehydration

Stages of Adulthood, contd

 Nutrition well-being
Nutrition status may be affected by restricted access to food and ability to prepare meals Dietary management for older adults may be more complicated than for other stages of adulthood

Stages of Adulthood, contd

 Protein adequacy
Total body protein decreases as aging progresses Body protein affected consists of:
Skeletal muscle (most noticeable), organ tissue, blood components, and immune bodies Includes compromised wound healing, loss of skin elasticity, reduced ability to battle infection, and longer recuperation from illness and surgeries

Stages of Adulthood, contd

Stages of Adulthood, contd

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
Can lead to deficiencies of B12, A, C, D, calcium, iron, zinc, and others

Increase 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)

 Living arrangements
Older adults may be at nutritional risk because of demographic and lifestyle characteristics; factors may include:
Gender Smoking Alcohol abuse Dietary patterns Educational level Dental health Chronic illnesses Living situations

Stages of Adulthood, contd

 Continuum of care provides continuity of care

Through different living situations and services as health, medical, and supportive services 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

Stages of Adulthood, contd

 Nutrition requirements
DRIs remain constant from age 51 and older for men and women
Except for vitamin D
AI vitamin D 10 mcg a day ages 51 to 70 years AI vitamin D 15 mcg a day older than age 70 Synthesis of vitamin D reduced in older adult Need more exposure to sunlight to produce more vitamin D or require supplement

Stages of Adulthood, contd

 Vitamin B12
Production of intrinsic factor required for vitamin B12 absorption may be reduced Increases risk of pernicious anemia New recommendations suggest use of B12 supplements or consumption of foods fortified with vitamin B12 to meet RDA 2.4 mcg a day

Stages of Adulthood, contd

 Other factors may affect nutritional status

Marginal deficiency of zinc alters taste receptors Overconsumption of simple sugars and sodium
May exacerbate other diet-related disorders such as diabetes and hypertension

Constipation
Muscularity of digestive system weakens, especially after lifetime of low-fiber foods

Dental health
Loss of teeth by periodontal disease limits chewing ability

Stages of Adulthood, contd

 The oldest years (80s and 90s)

Healthiest of oldest develop individual patterns of dietary intake that most meet physical and social needs Nutrition requirements
Malnutrition and underweight concern during this stage Oldest adults may be most at risk for dehydration
Risk increases because decreased ability of kidneys to concentrate urine, limited movement, drug interactions, and malfunctioning thirst sensation

Stages of Adulthood, contd

 Knowledge
Health promotion integrates nutrition education and focuses on three areas of knowledge:
Adequate intake of nutrients found in foods (rather than supplements) Relationship between diet and disease Moderate kcal intake coupled with regular exercise for physical fitness and obesity prevention

Adult Health Promotion

 Techniques
Strategies to apply new knowledge to everyday activities to modify lifestyle behaviors
Numerous strategies suggested to alter behavior to reduce dietrelated disorders and manage body weight

Adult Health Promotion, contd

 Community supports
Government, corporate, and social institutions create environments and structures supporting lifestyle health promotion behaviors
Provide socioeconomic support within community Government programs include Food Stamp Program, Emergency Food Assistance Program, and community food banks and meals Supports specifically for older adults include Child and Adult Care Food Program and Senior Nutrition Program

Adult Health Promotion, contd

 Food asphyxiation
Older adults may be at risk for food asphyxiation
Reduced chewing ability from loss of teeth or poorly fitting dentures Neurologic conditions such as Parkinsons disease and effects of stroke may result in chewing and swallowing difficulties (dysphagia) Referrals to registered dietitians with expertise in these disorders

Overcoming Barriers

 Stress
Affects all aspects of well-being
Nutrient intake may be altered
Inappropriate eating patterns Gastrointestinal tract may produce excessive gastric juices Loss of appetite, further reduces nutrient intake and affects nutrient absorption, including minerals, protein, and vitamin C

Overcoming Barriers, contd

 Emotional stress increases release of some hormones such as adrenaline

Excess adrenaline production in response to repetitive stressors affects bone health and risk for osteoporosis

Overcoming Barriers, contd

 Womens health issues

Diseases for which women are most at risk
Osteoporosis Coronary artery disease Hypertension Cerebrovascular disease Certain cancers, diabetes Weight-related disorders

Overcoming Barriers, contd

 More common among minority women

Access to preventive and medical care may be limited
Greater incidence of poverty and other socioeconomic factors

Overcoming Barriers, contd

 Cancer
A third of cancer mortality may be due to dietary or nutritional factors such as energy intake or weight Risk factors differ among varied forms of cancer General dietary recommendations to reduce cancer risk important
Promote plant-based diets stressing minimally processed foods Recommend corollary lifestyle behaviors including healthy weight and physically active lifestyle

Overcoming Barriers, contd

 Menopause
Perimenopause Menopause
Characterized by decreased production of estrogen and progesterone Results in termination of menses Hormone replacement therapy (HRT)

Overcoming Barriers, contd

 Alternative approach to menopausal symptoms

Consume foods containing phytoestrogens May replicate some functions of estrogen Particularly soy foods or isoflavone extracts Overall, potential benefits, risks, and combination of supplements with food and/or medications remain uncertain

Nutrition approaches to reduce symptoms continue to focus on quality of dietary choices and healthy weight maintenance

Overcoming Barriers, contd

 Mens health issues

Alcohol
Moderate alcohol consumption (defined as 14 drinks per week)
Recognized as beneficial for lower risk of coronary artery disease

National Institute on Alcohol Abuse and Alcoholism guidelines

Recommend older adults limit consumption to one alcoholic drink per day

Overcoming Barriers, contd

 Alcohol most often used and abused drug in U.S.

Death rate from alcohol abuse more than twice as high for men as for women Native Americans most at risk for chronic alcohol ingestion problems Excessive alcohol consumption associated with poverty, violent crimes, birth defects, suicide, and sexual and domestic abuse Pattern of excessive intake often begins during adolescence and continues through adult years

Overcoming Barriers, contd

 Chronic excessive consumption affects nutritional status

Appetite diminishes Associated with limited nutrient absorption, metabolism, excretion; further increases aging effects

Other medical and social problems emerge

Medical conditions: liver cirrhosis and cancer of liver and gastrointestinal tract Social problems: impaired driving while intoxicated

Community resources available

Overcoming Barriers, contd

 Prostate cancer
Second most common cancer among American men (skin cancer first) Multifactorial including genetics, hormones, environment, virus, and diet
Association with fat intake, particularly saturated fat African American men higher incidence rate than other Americans

Overcoming Barriers, contd

 Dietary approaches to prevent prostate cancer being explored

Increased consumption of fruits, vegetables, and whole grains lowers intake of animal-derived saturated fat
May reduce risk; also heart healthy May reduce blood pressure and decrease risk of type 2 DM

Lycopene, antioxidant naturally occurring in tomatoes and other fruits and vegetables, may reduce risk of prostate cancer

Overcoming Barriers, contd

Toward a Positive Nutrition Lifestyle: Rationalizing

Rationalization
To assign reasonable explanations to behaviors when behaviors, feelings, or perceptions irrational or unreasonable Rationalize poor eating habits