older adults老年人

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1、OlderAdultsI.PhysiologicChangesA.òBMRB.òLeanbodymassC.òGastricacidsecretionD.òLactaseActivityE.òTastebudsF.òOlfactorynerveendingsII.RiskFactorsA.AcuteandChronicDiseasesB.OralHealthProblemsC.CognitiveoremotionalimpairmentD.IsolationE.Alcohol/druguseF.So

2、cioeconomicstatusG.FunctionalstatusIII.MedicationsA.AntacidsB.LaxativesC.AnticoagulantsD.SeeMorrison,page141-142IV.NutritionalNeedsA.CalciumA.VitaminDB.FolateC.VitaminB12D.VitaminB6II.ExerciseIII.GastricAcidityA.òAbsorptionofcalcium,iron,zincB.òSecreti

3、onofintrinsicfactor--òB12absorptionIV.LactaseDeficiencyV.DietaryFiber:PlantmaterialnotdigestedbymammalianenzymesA.FoodSources1.Wholegrainproducts2.Legumes3.LeafyVegetables4.FruitsB.RecommendedIntake1.Children<2years--(ageinyears+5)g/day2.Adults24-30g/d

4、ayC.Physiologicalcategories1.Solublevs.insoluble2.Viscousvs.nonviscous3.Fermentablevs.nonfermentableD.UpperGIeffects1.Satiety2.Delayedcarbohydrateabsorption3.Decreasesinserumcholesterol4.òinsulinresponse,òHMGCoAreductase5.òreabsorptionofbileacids6.Prop

5、ionateinhibitionofHMGCoAreductase7.DecreasedmineralabsorptionB.LowerGIeffects1.Fermentationtoshortchainfattyacids2.Propionate3.Butyrate4.Acetate5.Dilution--nonfermentingfibers6.Increasefecalbulk7.DecreasetransittimeII.Case994:LilyA.LossofstrengthB.Cons

6、tipationC.MedicalHistory1.Osteoporosis2.UrinaryurgencyD.Medications1.Fosamax1.Amitriptyline2.GeritolB.SocialHistory1.Livesathomeinruraltown2.Personalcareattendant-daily9:00AM-2:00PM3.Occasionallydisorientedandforgetful4.Needshelpwithinstrumentalactivit

7、iesofdailyliving5.SeemstoberequiringmorehelpwithactivitiesofdailylivingC.DietHistory-24Hourrecall1.1233Kcal56%RDA2.71gprotein141%RDAD.OtherNutrientsE.AnthropometricsF.Lily'sEnergyExpenditure1.REE=960kcal/day2.Assumeabout20%ofREEforotheractivities:960x0

8、.2=192kcal3.960+192=1152kcal/day G.LaboratoryTestsH.ComparisontoFoodPyramidI.Treatment1.Medications2.Calories3.Morefood-Breads,milk4.Nutritionalsupplement(energyandprotein)5.Constipationa.Fiberb.Water6.Vitamin/MineralSupplementII.Case01