Helping Relationships With Older Adults. Adelle M. Williams

Her PCP recommended strength training 3 times per week for 6 weeks. She complied, and upon examination, her PCP reported that she exhibited no signs of osteopenia. She was delighted and continued with her regular strength training sessions. Research other older persons with health conditions and examine how they used exercise to improve their health challenges.

      Aerobic capacity (also called maximal oxygen intake or work capacity) is a fundamental measure of the cardiopulmonary system, made up of the heart, lungs, and circulatory mechanisms. Simply put, aerobic capacity is the body’s ability to process oxygen. It includes the ability to breathe air into the lungs for aeration of the blood and the ability to transport oxygen effectively to all parts of the body through the bloodstream. By age 65, the average American has lost 30 to 40% of his or her aerobic capacity—and the health of his or her entire cardiovascular system.

      Another biomarker for physiological aging that can be reversed by regular exercise is glucose tolerance and insulin sensitivity. For most people, the body’s ability to use glucose in the bloodstream declines with age. As people develop more body fat and less muscle, their muscle tissue becomes less and less sensitive to insulin. As a consequence, it takes more and more insulin to have the desired effect. Increasing the muscle-to-fat ratio can reverse this deterioration, improve the blood-sugar tolerance, keep the insulin sensitivity high, and greatly reduce the chances of developing diabetes.

      Improving fitness level, especially if one is sedentary, can enhance functional years. As the body ages, it loses muscle mass. The less muscle it has, the less energy it will burn even while resting. The lower a person’s metabolic rate, the more likely he or she will gain weight. Regular strength training can increase muscle mass, boost metabolism, strengthen bones, prevent osteoporosis, and in general, make one feel better and function more efficiently (Nelson, Rejeski, Blair, Duncan, & Judge, 2007). Both aerobic and muscle strengthening activities are critical for healthy aging. Basic recommendations for aerobic and strength training exercises in older adults include moderately intense aerobic exercise for 30 minutes 5 days a week or vigorous intense aerobic exercise for 20 minutes 3 days a week as well as 8 to 10 strength training exercises with 10 to 15 repetitions of each exercise 2 to 3 times per week (Nelson et al., 2007). In addition, the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) recommend that older adults or adults with chronic conditions develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure safety. Case Illustration 3.2 identifies the significance of exercise for an elderly woman with major health problems.

      Case Illustration 3.2

      Mrs. Morris is a happily married 67-year-old female who lives in a four-story home with her spouse. She has suffered from various forms of cancer, received treatment, and has been considered in remission. Her outlook is usually positive; however, she worries a great deal about her daughter, who has developed a rare disease of unknown etiology. She frequently accompanies her to her physician appointments and also assists with paying for these medical services.

      Unfortunately, she has been unable to attend the “Silver Sneakers” classes that she enjoyed, and she is not taking adequate care of herself. Her cancer has re-emerged, and she is receiving chemotherapy treatment, which she is optimistic will help, as it has in the past. When she exercised, her mood improved, her body was toned, and she completed all activities of daily living with ease. Despite her recent recurrence of cancer, she appears to be more concerned with getting back to the health club. She reported that she developed relationships there, had something to look forward to, and felt good because she was able to stay mentally sharp. Exercise had become an integral component of her life.

      Nutrition

      Nutrition is an essential element not only in weight management and disease prevention, but additional considerations that are critical to older adults. Adequate calcium consumption is necessary to prevent bone loss. During perimenopause and menopause, bone loss accelerates rapidly, with an average of about 3% skeletal mass lost per year over a 5-year period. Vitamin D is necessary for adequate calcium absorption, yet as people age, particularly in their 50s and 60s, they do not absorb vitamin D from foods as readily as they did in their younger years. If vitamin D is unavailable, calcium levels are also likely to be lower. As older adults become more concerned about cholesterol and fatty foods, and as their budgets shrink, they often cut back on protein. Because protein is necessary for muscle mass, protein insufficiencies can spell trouble. Other nutrients, including folic acid (folate), vitamin E, iron, potassium, and vitamin B_12, are important to the aging process, and most of these are available in any diet that follows the nutrition guidelines for older adults (U.S. Department of Agriculture & U.S. Department of Health and Human Services, 2015).

      The U.S. government’s Dietary Guidelines for Americans 2015 includes the following recommendations for a healthy lifestyle and diet (U.S. Department of Agriculture & U.S. Department of Health and Human Services, 2015). Individuals are encouraged to adhere to dietary patterns that emphasize the following items.

       Consume a variety of foods within and among the basic food groups while staying within energy needs.

       Consume dietary patterns that are higher in vegetables, fruits, and whole grains.

       Include seafood and legumes.

       Moderate intake of dairy products (with an emphasis on low and non-fat dairy).

       Moderate consumption of alcohol.

       Lower intake of meats (including red and processed meats).

       Lower intake of sugar-sweetened foods, beverages, and refined grains.

       Limit sodium and saturated fat.

       Tailor dietary patterns to individuals’ biological, cultural, and individual food preferences.

       Control caloric intake to manage body weight.

       Be physically active every day.

       Keep food safe to eat.

      The Older Americans 2012 report (Federal Interagency Forum on Aging-Related Statistics, 2012) identifies guidelines to improve the nutritional health of older Americans. Major improvements in the nutritional health of older Americans could be made by increasing intakes of whole grains, dark green and orange vegetables and legumes, and fat-free or low-fat milk products. Additionally, incorporating foods and beverages that are lower in sodium and have fewer calories from solid fats, alcoholic beverages, and added sugars is also recommended (Federal Interagency Forum on Aging-Related Statistics, 2012). A healthy diet for an older person must take into account the slowing of the system with age, the body’s increased sensitivity to extremes (like hot, spicy, and rich foods), and the body’s need for high-quality nutrients with minimal calories. Guided Practice Exercise 3.5 provides the opportunity to conduct a nutritional assessment of an elderly client and determine ways to enhance his or her nutritional intake to prevent and/or decrease health conditions.

      Guided Practice Exercise 3.5

      Identify an elderly man or woman and have him or her complete a 3-day nutritional intake diary. Take this data and give them to a nutritionist for a dietary analysis. Once analyzed, discuss with the nutritionist how you should relay this information to your client and any medical conditions associated with inadequate nutritional habits.

      Calorie needs decline with age due to a slow-down in metabolism and physical activity, nutritional requirements may remain the same or in some cases increase. My Plate for Older Adults provides examples of foods that contain high levels of vitamins and minerals per serving and is consistent with the federal dietary guidelines (USDA Human Nutrition Research Center on Aging, 2011). These calories should be gained through a healthy diet, such as that shown in Table 3.2.

      A healthy diet is essential to everyday life and prevention and controlling chronic disease. As people age, they need to obtain maximum nutrition with the fewest calories. Guided Practice Exercise 3.6 addresses how a person’s diet plays a role in controlling the chronic medical condition, diabetes. If