Special Considerations for the Chronically Ill Older Adult

SPECIAL CONSIDERATIONS FOR THE CHRONICALLY ILL OLDER ADULT

It is estimated that 85% of people over 65 have one or more chronic diseases or physical problems. Examples include osteoporosis, arthritis, cataracts, cancer, diabetes mellitus, hypertension, heart disease, and periodontal disease. The branch of medicine that is involved with diseases of older adults is called geriatrics.

Osteoporosis

Osteoporosis is a condition in which the amount of calcium in bones is reduced, making them porous. It is estimated that 28 million older adults have osteo-porosis, and 80% of these are women. A bone density scan can be done with a special X-ray to determine if one has osteoporosis. It is typically unnoticed at its onset, which occurs at approximately age 45, and it may not be noticed at all until a fracture occurs. One of its symptoms is a gradual reduction in height.

Doctors are not certain of its cause. It is thought that years of a sedentary life coupled with a diet deficient in calcium, vitamin D, and fluoride contribute to it, as does estrogen loss, which occurs after menopause. Physicians are recommending estrogen replacement therapy (ERT) to help prevent osteopo-rosis. Some doctors are also advising clients to consume 1,500 mg of calcium, which would require the daily consumption of over 1 quart of milk or its equiv-alent. Calcium tablets, preferably calcium carbonate, could be used instead, but the client would also require supplementary vitamin D if sunshine were unavailable year-round or if the client were homebound. A diet with sufficient calcium and vitamin D plus an appropriate exercise program begun early in the adult years is thought to help prevent this disease.

Another possible cause of osteoporosis may be a diet containing excessive amounts of phosphorus, which can speed bone loss. It is known that Americans are ingesting increasing amounts of phosphorus. Sodas and processed foods contain phosphorus, and their consumption is increasing as milk consumption is decreasing in the United States. Some believe that periodontal disease may be a harbinger of osteoporosis. Periodontal disease is characterized by bone loss in the jaw, which can lead to loosened teeth and infection in the gums.

Arthritis

Arthritis is a disease that causes the joints to become painful and stiff. It results in structural changes in the cartilage of the joints. A client with arthritis should be especially careful to avoid overweight because the extra weight adds stress to joints that are already painful. If the client is overweight, a weight reduction program should be instituted.

The regular use of aspirin by these clients may cause slight bleeding in the stomach lining and subsequent anemia, so their diets may require additional iron. Arthritis can greatly complicate a client’s life because it may partially or completely immobilize the client so much that shopping, moving around, and cooking become difficult.

Aspirin and other anti-inflammatory drugs do help relieve the pain of arthritis, but there is as yet no cure. Clients should be well informed of this to prevent them from wasting their money on so-called miracle cures recommended by health food faddists or quacks.

Cancer

Research about the role of nutrition in cancer development continues. The American Cancer Society has indicated that diets consistently high in fat or low in fiber and vitamin A may contribute to cancer.

Diabetes Mellitus

Diabetes mellitus is a chronic disease. It develops when the body does not produce sufficient amounts of insulin or does not use it effectively for normal carbohydrate metabolism. Diet is very important in the treatment of diabetes.

Hypertension

Hypertension, or high blood pressure, can lead to strokes. It is associated with diets high in salt or possibly low in calcium. Most Americans ingest from two to six times the amount of salt needed each day. It is thought that the earlier a person reduces salt intake, the better that person’s chances of avoiding hyper-tension, particularly if there is a family history of it.

Heart Disease

Heart attack and stroke are the major causes of death in the United States.They occur when arteries become blocked (occluded), preventing the normal passage of blood. These occlusions (blockages) are caused by blood clots that form and are unable to pass through an unnaturally narrowed artery. Arteries are narrowed by plaque, a fatty substance containing cholesterol that accumulates in the walls of the artery. This condition is called atherosclerosis. It is believed that excessive cholesterol and saturated fats in the diet over many years contribute to this condition. 

Effects of Nutrition 

Current research about the role of nutrition in preventing or relieving these chronic diseases continues. The effects of nutrition are cumulative over many years. The effects of a lifetime of poor eating habits cannot be cured overnight. When diets have been poor for a long time, prevention of these chronic diseases may not be possible. It may be possible, however, to use nutrition to help stabi-lize the condition of a client who has one of these diseases. The prevention of many of the diseases of the elderly should begin in one’s youth (Figure 15-2).