Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 342

It is generally recognized that food preference is affected by a variety of factors, including biological (i.e. hunger, sense of taste and smell), economic (i.e. cost, socioeconomic status), structural (i.e. access, education, cooking facilities, skills, and time), social (i.e. culture, family, peers, and meal patterns) and attitudes, beliefs, and knowledge about food. Ageing is associated with a decline in the ability to smell (olfaction) and taste (gustatory) (Figure 12.1). It is estimated that over half of those between ages 65 and 80, and more than 75% of those over 80, have a measurable decline in olfactory sense.²³ The decline in sense of smell lowers quality of life by impairing the sense of flavour in food and beverages and the identification of hazards such as spoiled foods. Deems et al.²⁴ reported that 46% of older adults with olfactory dysfunction have a change in appetite or body weight. Olfactory dysfunction has more recently been reported as an early risk factor for neurodegenerative diseases.²⁵

Figure 12.1 Decline in olfaction with age. University of Pennsylvania Smell Identification Test (UPSIT) scores as a function of subject age and gender. Numerical data points indicate the sample size for each age group. Note that women identify odorants better than men of all ages.

Source: Doty et al.²³ ©1984, The American Association for the Advancement of Science.

Social isolation, loneliness, institutionalization, and lower socioeconomic status in older adults is associated with consuming an unbalanced diet.²⁶ Locher et al.²⁷ found that ethnicity and gender were risk factors for dietary intake disturbances. Older black women were most at risk followed by older black men and older white women. They concluded that what contribute most to nutritional deficiencies are social isolation, low income level, limited support and social capital, including transportation to food shops and congregated meal sites, and also limited independent life span.

Institutionalized elders also tend to have a lower energy intake, mainly due to lower fat and protein intake. Furthermore, nutrient inadequacy is more prevalent in the institutionalized elderly than in community‐dwelling groups. At the same time, no clear differences in food patterns have been observed. Therefore, the main cause of the higher prevalence of nutrient inadequacy in dependent elders may be the low level of total caloric intake. An exception might be the group with a poor state of dentition. In both the NHANES III and SENECA studies, lower diet quality was observed due to avoidance of food groups such as meat, fruit, and vegetables in people with dental issues – a finding consistent with low‐income households in the UK.²⁸ Institutionalized people are often frail and suffer from both functional and cognitive impairment. In addition to overall inadequate food intake, several studies have pointed to more specific nutrients and functional decline.