Heart Disease &Stroke Prevention:Nutritional Needs and theABCS Approach
Class ObjectivesUpon completion of the workshop,participants will be able to understand:the basicnutrition andhydrationneeds of ouragingpopulationtherelationshipbetweennutrition andphysical/cognitivefunctioning inolder adultsthe role ofnutrition inchronicdisease careof older adultstheimplications offood and druginteractions inolder adults
3… and to:describemedication-relatedproblemsincluding druginteractions,adverse drugevents,overuse,under use andinappropriateprescribingand non-adherence inolder adultsdescribesymptomsthat mayindicate thatan olderadult isexperiencinga medication-relatedproblemexplain whyolder adultsare at risk formedication-relatedproblemsidentify theABCS ofheart diseaseand strokepreventionandadditionaleducationalresourcesClass Objectives
Registration Question• Which of the following five do you think is the leading cause ofdeath in the US?• Cancer• Alzheimer’s Disease• Heart Disease• Accidents• Stroke4Stroke3%Heart Disease94%Cancer1%Alzheimers Disease0%Accidents2%YOUR ANSWERS
Physical Aging Issues• Loss of bone mass• Weight-bearing joints erode• Oral cavity changes:• Brittle teeth• Tooth Decay• Poor fitting dentures• Decreased salivary production• Esophageal & oropharyngeal changes (swallowing)• Lingual pressure change (tongue)• Decreased kidney function• Loss of taste buds• Poor vision• Others?
7MalnutritionDefinition• a lack of necessary orproper food substancesin the body or improperabsorption anddistribution of them.Contributingriskfactors:• Inadequate food intake• Social isolation• Depression• Oral health• Polypharmacy (multipledrugs)• Cognitive and physicalimpairments• Low income• IncontinenceSignsandSymptoms• Dull, dry or de-pigmentation of hair• Redness, swelling ofmouth, angular fissuresat corner of mouth• Tongue swollen,scarlet, raw• Skin with lack of fat,scaliness, dryness(sandpaper feel) orpallor• Bilateral edema• Muscle wasting,weakness, muscle pain• Nail beds curved andbrittle• Listlessness, memoryimpairment• Change in body weight
Definition• Dehydrationoccurs when youlose more fluidthan you take in,and your bodydoes not haveenough water andother fluids tocarry out itsnormal functions.Contributingriskfactors:• Decreased thirstperception• Lack of access tofluids• Difficultyswallowing• Fears ofincontinence• Diarrhea• Vomiting• FeverSignsandSymptoms• Dry mucousmembranes• Poor skinelasticity• Change in mentalstatus• Increasedweakness• Constipation• Dark, strong-smelling urine• Dry, cracked lips• Sunken eyes• Increased bodytemperature• Decreased bloodpressureDehydration
Signs & symptoms of mild dehydration include:•Thirst, dry mouth•Loss of appetite•Dry skin•Skin flushing•Dark colored urine•Fatigue or weakness•ChillsMild Dehydration
Quick Recap• Physical aging issues• Malnutrition risks• Signs & symptoms of malnutrition• Dehydration risks• Signs & symptoms of dehydration
Poll:Which of the following is NOT a physicalaging issue?A. Loss of taste budsB. Urinary incontinenceC. Decreased kidney functionD. Loss of bone mass
CareArrangementsLive with orattended to bycaregiverAssisted LivingFacilitiesAdult Day CareCentersNursing HomesLivingalone/IndependentLivingHow do differentcare arrangementsimpact nutrition?
• General Observations• Caloric Needs• Fluid Needs• Protein Requirements• Vitamin/Mineral NeedsNutritional Needsof our Aging Population
General ObservationsCaloric needs tend to decrease with agewhile nutrient needs may increase.Caloric needs may increase relative tochronic disease(e.g., cancer) orhyperactivity(e.g., excessive walking, pacing, involuntarymovements, wounds).Daily consumption of 1500-2000 calories willmaintain weight for most older adults,500 calories a day either as addition or adeduction will usually promote a change inthe weight pattern of an individual.
Fluids• Water is the nutrient our body needsthe most.• Water content of the body decreaseswith age.• Decreasing kidney function cancontribute to risk of dehydration.• Body needs are approximately 1500-2000cc fluid a day (6-8 ounce glasses).• Chronic incontinence can lead to lowfluid intake. Why?• Some alternatives to liquids that stillpromote hydration include:• Popsicles, sherbert, ice cream,frozen yogurt bars, fruitVitamins & Minerals• Increased need for calcium(16-24 ounces milk will helpmeet increased need in mostadults)• Potential deficiencies inB12, folate and vitamin Dthat might necessitatesupplementation• Need to monitor sodiumlevels as one agesProtein• Important tomaintain bodytissue, muscle andimmune system• 5-8 ounces of meator other proteinsource daily
Groups with Special Needs•Individuals with disabilities•Individuals with cognitive impairments• Dementia• Intellectual & Developmental Disabilities
Individuals with DisabilitiesPhysicalImpairmentsArthritisAmputationsMuscle Contractures (shortening)Decreased bladder controlHearing lossRecent fracturesVision ImpairmentCognitiveImpairmentsConfusion/DeliriumDementiaDepressionIntellectual and Developmental Disabilities
DrugEffects onNutritionalStatusPoor nutrition caninterfere with drugefficacy or lead to higherrisk of drug toxicity.The intestine is the siteof most drug absorptionand also metabolizessome drugs. Drugabsorption andmetabolism depends ona healthy gut.Cancer chemotherapycan alter taste orappetite, thusdecreasing food intake.Some drugs can causedry mouth, resulting inloss of appetite and ill-fitting dentures. (e.g.Benadryl)Some drugs can causeconstipation, resulting inloss of appetite andnausea. (e.g. Calciumsupplements)
Poll:Which organ is primarily responsible formetabolizing and absorbing drugs?A. LiverB. KidneyC. IntestineD. Pancreas
Drug Effects on Nutritional Status• Updated Beers Criteria:• www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf• Webinar (recording and slides): Strategies to AvoidMedication-Related Problems• www.alzpossible.org/wordpress-3.1.4/wordpress/webinars-2/medication-related-issues/
Drug-Food InteractionsFoods high in VitaminK can interfere withblood thinners(e.g., warfarin).High fiber meals candecrease theabsorption of somedrugs(e.g., digoxin, lovastatin,penicillin, metformin).High protein meals canalso decrease theabsorption of somedrugs(e.g., levodopa,carbidopa).High protein meals mayaccelerate themetabolism of somedrugs(e.g., theophylline- amedication commonlyused to treat COPD).Foods high intyramines can inhibitthe absorption ofantidepressants(MAOIs).Grapefruit juiceimpairs the absorptionof certain drugs(e.g., antiarrythmics,antidepressants, anti-hypertensives,immunosupressants,statins, anti-seizuremedications) byinterfering withenzymes in thedigestive system.
Drug FoodInteractionsMedications are besttaken with water.Acidic fruit juices,vegetable juices,carbonated beveragesand caffeinatedbeverages can inhibitthe absorption ofsome drugs.Not taking enoughfluids withmedications can alsodelay drug dissolutionand absorption.Milk and productscontaining calciumcan complex withsome drugsparticularlyfluoroquinolenes (e.g.ciprofloxacin ornorfloxacin).Medication should betaken 1 hr before or 2hrs after ingestion ofmilk products.Osteoporosismedications (e.g.,Fosomax or Boniva)should be taken withwater only as otherbeverages (e.g., tea,fruit juice, coffee,soda) can decreasethe absorption ofthese drugs into thebody.….
Nutrition and Chronic Disease•How do the following Chronic Diseasesaffect older adults?•What are possible interventions?• Cancer• DRD• Chronic Obstructive Pulmonary Disease (COPD)• Congestive Heart Failure (CHF)• Coronary Heart Disease• HIV/AIDS• Diabetes Mellitus (DM)• Osteoporosis
Nutritional Interventions for Dementia:Provideadequatecalories andprotein• Make sure to snack and use liquidmeal supplements if an individual is notconsuming enough during meal time.Use creativefeedingtechniques• Have finger foods available to snackon as individuals walk aroundthroughout the day.• E.g. Availability of a favorite snackfood of individualAllowadequatetime foreatingBestPracticeSuggestions
Individualsat risk forlowproteinintake:• Build up breakfast – eggs are agreat source of protein• Serve peanut butter or cheese withcrackers and soup to increase theprotein intake• Use low fat/fat-free milk instead ofwater to make soup or gravy• Finger foods, cheese slices withapplesauce, fortified foods are greatadditionsBestPracticeSuggestions
Registration Question• Which risk factors can you control:a) high blood pressure;b) abnormal cholesterol;c) tobacco use;d) diabetes;e) overweight.27a), b), c), d), e)80%a), b), c), e)11%b), c), e)9%a), b), c)0%a), d), e)0%YOUR ANSWERS
ABCS Initiative:Heart Disease & Stroke PreventionHeart disease and stroke are the first and third leading causes ofdeath among men and women.Risk factors are largely controllable and preventable.A• AspirinTherapy (ifappropriate)B• BloodPressureManagementC• CholesterolManagementS• SmokingCessation
Ask your MD about taking aspirin once a day toprevent heart attacks and strokes.General Recommendations:• One baby aspirin (81 mg) every day• One regular aspirin (325 mg) every other dayA• AspirinTherapy (ifappropriate)ABCS Initiative:Heart Disease & Stroke Prevention
Reduce sodium intake!• 1 in 3 U.S. American’s have high BP (Blood Pressure).Half of them do not have it under controlGeneral Recommendations:• BP goal: Less than 120/80 mmHg• Sodium Intake: 1,500 mgCook at home more. Try to eat foods that are low in sodium or have no salt added. Limitsauces, mixes, and "instant" products, like flavored rice and ready-made pasta.B• BloodPressureManagementABCS Initiative:Heart Disease & Stroke Prevention
Triglycerides: Less than 150 mg/dLABCS Initiative:Heart Disease & Stroke PreventionC• CholesterolManagementLimit foods with high amounts of saturated fat, transfat, and cholesterol. This information is on theNutrition Facts labels.Total Cholesterol: Less than 200 mg/dL• Men: 40 mg/dL or higher• Women: 50 mg/dL orhigherHDL (good)Cholesterol:• Low risk: Less than 160mg/dL• Intermediate risk: Lessthan 130 mg/dL• High risk: Less than100mg/dLLDL (bad)Cholesterol:Risk’s For Disease:
Smokers are reported having a 70% greaterchance of dying of heart disease thannon-smokers.General Recommendations:• Do not smoke.• Support smoke-free policies in yourcommunity and try to avoid secondhandsmokeABCS Initiative:Heart Disease & Stroke PreventionS• SmokerCessation
Other risk factors individuals can do somethingabout to prevent strokes:• Atrial Fibrillation (Arrhythmia)• Diabetes• Being Overweight• Excessive Alcohol Consumption• Physical Inactivity• Stress
Poll:What is the ideal combination of the following levels for heart andstroke prevention?A• BP goal: Less than120/80 mmHg• Sodium Intake:1,500 mg• TotalCholesterol: Lessthan 200 mg/dLB• BP goal: Less than140/90 mmHg• Sodium Intake:2,000 mg• TotalCholesterol: Lessthan 250 mg/dLC• BP goal: Less than120/80 mmHg• Sodium Intake:2,000 mgTotal• Cholesterol: Lessthan 200 mg/dL
Discussion Questions• What are barriers to inclusion for proper nutrition for the agingpopulation?• How would you overcome them?• How would you improve medication efficacy in older adults?• Ex: How would you maximize the positives and minimize the sideeffects?
Food for Thought•Social isolation also has negative health outcomes.It can lend itself to:• Nutritional deficits• Poor medication management• Lack of exercise• Depression•Do you think there is a correlation among thesefactors and high blood pressure, high cholesterol,and smoking?
Wrap Up and QuestionsPhone: (804) 828-1565Website: http://www.sahp.vcu.edu/gerontology/Email: firstname.lastname@example.orgBe sure to “like” us on Facebookhttps://www.facebook.com/vcugerontology
Resources:U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.).National Heart Disease & Stroke Prevention Program: Strategies for states to address the “ABCS” ofheart disease and stroke prevention [Program Guide]. Retrieved fromhttp://www.cdc.gov/DHDSP/programs/nhdsp_program/docs/ABCs_Guide.pdfU.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.).Million of Hearts: About heart disease and stroke. Retrieved fromhttp://millionhearts.hhs.gov/abouthds/prevention.html#ABCSThe American Geriatrics Society Updated Beers Criteria (2012). Retrieved fromhttp://www.americangeriatrics.org/files/documents/beers/2012AGSBeersCriteriaCitations.pdfHeart & Stroke Foundation. (n.d.) Healthy Living. Retrieved from http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483949/k.967D/Healthy_Living.htmLeadingAge Wisconsin. (2012). The Normal Aging Process. Retrieved fromhttp://wahsa.org/agingprocess.pdfU.S. Food and Drug Administration. (2013). Smoking cessation products to help you quit. Retrievedfrom http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm
Resources:• American Heart Association• http://www.heart.org/HEARTORG/• The American Stroke Association• http://www.strokeassociation.org/STROKEORG/• National Stroke Association• http://www.stroke.org/site/PageNavigator/HOME• Mayo Clinic• http://www.mayoclinic.com/• Virginia Department of Health• http://www.vdh.virginia.gov/ofhs/prevention/hdsp/• National Institute of Neurological Disorders and Stroke• http://www.ninds.nih.gov/