SECTION 1: NUTRITIONAL STATUS

Proper Nutrition

Proper nutrition depends upon an adequate intake of foods and fluids that provide the body with the essential vitamins, minerals, water, electrolytes, calories, proteins, and fats. These elements provide the necessary energy for function and the maintenance of healthy function. As people age, the requirements for proper nutrition do not change. Due to the physical changes in the aging body and decreased physical activity, the only nutritional change may be a need to decrease the number of calories.

Vitamins and minerals are needed to manufacture enzymes for cell growth and maintenance. Specific vitamins are required for normal physiologic processes such as nerve function, red blood cell formation, and tissue repair. Current research looking at the relationship of vitamins and immune function suggest that some vitamins play a role in preventing diseases frequently seen in aging. Examples include coronary disease, cancer, osteoporosis, and cataracts. Research is also suggesting that degenerative changes accompanying aging affecting bone metabolism, glucose tolerance, and immune function are related to mineral requirement and metabolism. Improper levels of minerals such as selenium, calcium, potassium, and sodium have been associated with the development of hypertension and cardiovascular disease (Schlenker, 1993).

Deficiencies of certain minerals such as magnesium, calcium, zinc, and potassium demonstrate symptoms such as weakness, pain, and impaired wound healing. These symptoms in elders could easily be attributed to aging. The important factor is not to overlook the area of nutrition when assessing an elder for a medical problem.

Water, the most essential element in the body, accounts for about fifty percent of the body weight of older adults. Any losses must be replenished daily through fluid and food intake and water produced through the chemical process of oxidation occurring within the body. Essential electrolytes (potassium, sodium, and chloride), found in balanced amounts in body water, are also replenished by the diet. Specific levels of the electrolytes have to be maintained, and play a role in maintaining adequate fluid levels. The body has mechanisms that help maintain appropriate fluid and electrolyte balances. One such mechanism is thirst; another would be a craving for salt suggesting a low sodium level.

Carbohydrates provide the major source of energy for body processes. Studies have suggested that carbohydrates form the foundation of the diet of elders because of lowered expense, ease of preparation, and the trend among elders to include more fiber and lower the fat intake in their diet.

Fats are necessary for body energy requirements (Triglycerides) and for the manufacture of cell components (Cholesterol). Fats are receiving increasing negative attention due to their suggested relationship to the development of certain cancers and cardiovascular disease. There does not appear to be any decreased ability to absorb dietary fats with aging. In fact, with aging most elders will need to monitor blood levels of fat components and alter their diet to decrease dangerous elevations. Exercise and stress reduction techniques have also been shown to have a positive impact on abnormal blood levels of fat. The only impact of aging is slowed fat absorption, and therefore a possibility of reduced absorption of fat-soluble vitamins A, D, E, and K.

Proteins provide the basic building blocks for growth and repair of body cells, and for the formation of antibodies to help the body resist disease. Older people may not be getting adequate amounts of protein in their diet. Protein intake is compromised in older persons with renal disease. Cost is also a factor in limiting adequate protein intake. Elders with restricted funds may opt for cheaper foods traditionally lower in protein.

Malnutrition In Older Adults

Malnutrition occurs when there is an inadequate intake of food necessary to maintain proper energy levels and function in the body. Short-term malnutrition in older adults results in a protein-calorie malnutrition, a combination of Kwashiorkor and Marasmus found in younger people. In this condition the body feeds on itself to meet it's energy requirements. Over time, malnutrition results in a decreased metabolic rate, decreased immune system function, and impaired healing ability. The malnourished individual can even experience the symptoms of mental illness such as chronic irritability, labile moods, feelings of insecurity, and depression. Malnutrition over time can impair physical health immediately and increase the possibility of chronic illness later on.

Nutritional Supplements

In general, elders are tending to take more supplements than in years past. The need for nutritional supplements is still being debated specifically over necessity, amounts, and toxicity levels. More education and guidance is needed about food sources and safety in nutritional supplementation. Vitamins and minerals, like any medicines, need to be taken only after thorough assessment of the problem and information gathering about potential solutions. One example is all the excitement over the ability of Vitamin E to rid the body of cancer causing free radicals. Recent research findings by Mariette Gerber of the Inserm Cancer Center in Montpellier, France suggests that certain latent cancers when exposed to antioxidants are developing antioxidant protection as an adaptive response. This response protects the malignancy and even assists in its spread (Science News, 1995).

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SECTION 2: LIFESTYLE & LONGEVITY

The average age we can expect to live is 78 years for women and 72 years for men, and the older age we reach the higher the expectation. For example, if a man reaches the age of 60, he can expect to live another eighteen years. Just because we are living longer than generations before us is no guarantee that the extra time will be of higher quality. Women have higher rates of survival from major causes of death than men. Men are more likely than women to die from all the major diseases. This includes heart attacks, strokes, cancer, respiratory disease, accidents, liver disease, suicide, homicide, and AIDS; the only exception is cancer of the female sex organs. Longevity for women means living with a higher probability of having arthritis, depression, osteoporosis, and heart disease. Longevity for men means living with one or more of the diseases for which they are vulnerable and will eventually succumb.

Occupation and Longevity

Suggestions to explain longevity include work fulfillment, the development of successful ways of coping with stress, and higher economic resources allowing for better health care, diet, and behaviors. Studies have looked at specific groups of people such as Popes, orchestra conductors, presidents, and corporate executives. They were looking for the role that stress played in longevity. The corporate executives outlived all of the other professions. However, the studies had major flaws. One common flaw is the lack of women in these groups. The study of presidents included President John F. Kennedy. To date, no definitive answers have been found relating specific occupations to a longer life.

Theories: Food vs. Longevity

The majority of studies looking at the relationship of caloric intake to disease and longevity have been animal studies with inferences made to humans. Some examples of theories suggested appear below:

1. High levels of food intake lead to sustained high levels of glucocorticoid hormones being secreted by the adrenal cortex. Excessive levels of glucocorticoid hormones results in age-related changes. One example is the impairment of the immune system, thereby increasing vulnerability to infections. Another example is the increased loss of calcium through urinary excretion over time, thus promoting the development of osteoporosis (Masoro & McCarter, 1990).

2. High levels of food intake results in high serum glucose levels, which over time reduces insulin sensitivity. The resultant insufficient control of blood sugar levels leads to the degenerative changes associated with diabetes (Masoro & McCarter, 1990).

3. Caloric restrictions started early on in life or during later mature years leads to increased life span. Lower caloric intake leads to an increase in metabolic efficiency. Unfortunately, these results were found in animal studies. So far in humans we know that greater metabolic efficiency from lower caloric intake leads to higher levels of body fat and therefore more vulnerable to disease (Masoro & Shimokawa, 1991).

Lifestyle and Longevity

"The genetic program directs development toward reproductive success and determines longevity only indirectly after sexual maturation. Longevity, then, is a measure of how far we are able to "coast" on the excess physiological capacity or redundancy remaining after reproductive maturity. The age changes that occur during the "coasting" period are random events, attributable to the increasing likelihood of molecular disorder" (Hayflick, 1994, p. 320). It has been suggested that during this "coasting" period we become physically affected by our lifestyle. Lifestyle includes the way we have chosen to live our life and the effects of those choices on our emotions and physiology.

Some examples of the choices we make that affect our longevity might include diet, exercise, drugs, smoking, emotional stressors such as an unhappy marriage or dislike of a job, living in a polluted city, or driving without a seatbelt or motorcycle helmet. These factors do not stand alone and are not totally understood. For example, exercise is good for you if done correctly. Overdoing exercise, specifically types that are hard on joints may lead to bone and joint disorders later on in life. Many former football players will attest to this comment. Another example would demonstrate a person living a long happy life in a large city with high air pollution without any after effects.

Important to remember is that many factors are within our control. It is up to us to take that control and assist ourselves in being healthier and happier especially if we end up living a longer life.

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