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talking\tlouder\tnot\tonly\tdoesn’t\thelp,\tbut\tcan\tmake\tmatters\tworse).\n•\t\nLook\tdirectly\tat\tthe\tpatient\t(don’t\tlook\tdown,\tat\ta\tcomputer\tscreen,\tetc.).\n•\t\nChoose\tyour\twords\tmore\tcarefully\t(esoteric\twords\twill\tbe\tharder\tfor\tthe\tpatient\tto\nunderstand).\n•\t\nBe\tpatient—you\tmay\n\tbe\tasked\tto\trepeat\tyourself\t(you\tmay\tbe\tasked\tto\tdo\tso\trepeatedly). | [
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be\tasked\tto\trepeat\tyourself\t(you\tmay\tbe\tasked\tto\tdo\tso\trepeatedly).\nWhile\tit\tis\ttempting\tto\tyell\tto\tbe\theard,\tit\tis\tusually\tnot\ta\tgood\tidea.\tYelling\tcan\tbe\tirritating\tand\nraises\tconcerns\tabout\tpatient\tprivacy\tand\toften\tdoes\tnot\tmake\tspeech\tany\teasier\tto\tunderstand.\tIf | [
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only\tsolution.\nAge-related\tmacular\tdegeneration\t(AMD)\n\tis\ta\tdisease\tof\tthe\tretina\tthat\taffects\tcentral\tvision\nand\tcan\tlead\tto\tblindness\tin\tolder\tpeople.\tAMD\tis\tthe\tleading\tcause\tof\tlegal\tblindness\tin\tAmericans\nage\t65\tand\tolder.\tIt\taffects\n\tmore\tthan\t1.75\tmillion\tindividuals\tin\tthe\tUnited\tStates.\tIt\tis\texpected\tto | [
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increase\tto\tmore\tthan\t5\tmillion\tby\t2050\t(\nAmerican\tOptometric\tAssociation\t[AOA],\t2014\n).\tSmoking,\nrace\t(it\tis\tmore\tcommon\tin\tCaucasians),\tand\tfamily\thistory\tare\tknown\trisk\tfactors\t(\nChew\tet\tal,\t2014\n;\nNational\tEye\tInstitute,\t2014\n).\tAs\tthe\tpopulation\tages,\tAMD\tis\tbecoming\ta\tmore\tsignificant\tpublic\nhealth\tproblem.\tAMD\toccurs | [
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health\tproblem.\tAMD\toccurs\n\twhen\tthe\tmacula,\tthe\tcenter\tpart\tof\tthe\tretina,\tdegrades.\tThe\tresult\tis\ncentral\tvision\tloss.\tThe\tmacular\tpigment\tis\tcomposed\tof\ttwo\tchemicals,\tlutein\tand\tzeaxanthin.\tA\tdiet\nrich\tin\tfruits\tand\tvegetables\tmay\thelp\tdelay\tor\tprevent\tthe\tdevelopment\tof\tAMD.\tMicronutrition | [
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supplementation\toften\tis\tused\tin\tthe\ttreatment\tof\tAMD\t(\nAslam\tet\tal,\t2014\n;\t\nKorobelnik,\t2017\n).\nPresbyopia\n\tis\ta\tloss\tof\telasticity\n\tin\tthe\tcrystalline\tlens\tthat\tcauses\tan\tinability\tto\tfocus\tclearly\tat\nclose\tdistances\tand\tresults\tin\tthe\tneed\tfor\treading\tglasses.\tThis\tbecomes\tapparent\taround\tthe\tfourth\ndecade\tof\tlife\t(\nAOA,\t2014 | [
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decade\tof\tlife\t(\nAOA,\t2014\n).\tAs\tit\tworsens,\tpoor\tvision\tinterferes\twith\tshopping,\tcooking,\tand\teating.\nGlaucoma\n\tis\tdamage\tto\tthe\toptic\tnerve\tresulting\tfrom\thigh\tpressure\tin\tthe\teye.\tIt\tis\tthe\tsecond\nmost\tcommon\tcause\tof\tvision\n\tloss,\taffecting\tapproximately\t3\tmillion\tAmericans.\tHypertension, | [
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loss,\taffecting\tapproximately\t3\tmillion\tAmericans.\tHypertension,\ndiabetes,\tand\tcardiovascular\tdisease\t(CVD)\tincrease\tthe\trisk\tof\tglaucoma.\nA\t\ncataract\n\tis\ta\tclouding\tof\tthe\tlens\tof\tthe\teye.\tApproximately\thalf\tof\tAmericans\t65\tand\tolder\thave\nsome\tdegree\tof\tclouding\tof\tthe\tlens.\tThe\tmost\tcommon\ttreatment\tis\tsurgery;\tthe\tclouded\tlens\tis | [
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removed\tand\treplaced\twith\ta\tpermanent\tprosthetic\tlens.\tA\tdiet\n\thigh\tin\tbeta\tcarotene,\tselenium,\nlutein,\tomega-3\tfat,\tand\tvitamins\tC\tand\tE\tmay\tdelay\tcataract\tdevelopment\t(\nAOA,\t2014\n).\tStudies\nshow\tthat\ta\thigh\tsodium\tintake\tmay\tincrease\trisk\tof\tcataract\tdevelopment.\tUltraviolet\t(UV)\tradiation | [
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exposure\tis\trelated\tdirectly\tto\t5%\tof\tworldwide\tcataracts.\tWhen\tthe\tUV\tindex\tis\t3\tand\tabove,\nprotective\tsunglasses\tare\trecommended.\nImmunocompetence\nAge-related\n\talterations\tin\tthe\timmune\tsystem\tinclude\tboth\tcellular\tand\tserologic\tchanges\tthat\tcause\ndysfunction\tin\tthe\tresponse\tto\tforeign\tand\tself-antigens.\tImmune\tresponse\tis\tslower\tand\tless | [
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efficient.\tThe\tmechanisms\tof\tage-related\tchanges\tin\timmune\tfunction\tare\tnot\tfully\tunderstood\tbut\nlikely\tdepend\ton\tgenetics,\tenvironmental\tfactors,\tand\tlifestyle\tchoices\t(\nKeenan,\t2018\n).\tMaintaining\ngood\tnutritional\tstatus\n\tpromotes\tgood\timmune\tfunction.\nOral\nDiet\tand\tnutrition\tcan\tbe\tcompromised\tby\tpoor\toral\thealth\t(see\t\nChapter\t24 | [
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] |
Chapter\t24\n).\tTooth\tloss,\tuse\tof\ndentures,\tand\t\nxerostomia\n\t(dry\tmouth)\tcan\tlead\tto\tdifficulties\tin\tchewing\tand\tswallowing.\tDecreases\nin\ttaste\tsensation\tand\tsaliva\tproduction\tmake\teating\tless\tpleasurable\tand\tmore\tdifficult.\tOral\ndiseases\tand\tconditions\tare\tcommon\tamong\tpeople\twho\tgrew\tup\twithout\n\tthe\tbenefit\tof\tcommunity | [
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mouth.\tPreparing\tfoods\tthat\tare\tmoisture-rich\tsuch\tas\thearty\tsoups\tand\tstews,\tadding\tsauces,\tand\npureeing\n\tand\tchopping\tfoods\tcan\tmake\tmeals\teasier\tto\teat.\tIn\taddition,\tthose\twith\tpoor\toral\thealth\nmay\tbenefit\tfrom\tfortified\tfoods\twith\tincreased\tnutrient\tdensity\t(see\t\nFocus\tOn:\n\tFood\tFirst!\n).\nGastrointestinal | [
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] |
Focus\tOn:\n\tFood\tFirst!\n).\nGastrointestinal\nSome\tgastrointestinal\t(GI)\tchanges\tare\tconsidered\tto\tbe\tnormal\tconsequences\tof\taging\tthough\tsome\nchanges\tcan\tbe\tattributed\tto\tother\tclinical\tcauses\tand\tshould\tbe\tevaluated\t(\nBox\t19.2\n).\tGI\tchanges\ncan\tnegatively\taffect\ta\tperson’s\tnutrient\tintake,\tstarting\tin\tthe\tmouth.\tAs\ta\tnormal\tconsequence\tof | [
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] |
aging,\ttaste\tand\tsmell\tchanges\toccur\tin\tthe\tolder\tadult\tincluding\tdecreased\tability\tto\ttaste\tsalt,\nbitter,\tsweet,\tand\tsour.\tAdditionally,\tchanges\tin\tsalivation\tdue\tto\tnatural\taging\tor\tmedication\tside\neffects\tcan\tfurther\talter\ttaste\tsensations\tand\tcause\tchallenges\tfor\tolder\tadults.\nBOX\t19.2\nGastrointestinal\n\t\n(GI)\tChanges\twith\tAging\nHead: | [
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] |
BOX\t19.2\nGastrointestinal\n\t\n(GI)\tChanges\twith\tAging\nHead:\n\tDecreased\tvelocity\tof\tneuronal\tconduction\tto\tGI\ttract,\tdecreased\thunger\tsensations\nNose/Mouth:\n\tDecreased\ttaste,\tsmell,\tchanges\tin\tdentition,\tdecreased\tsaliva\nNeck:\n\tIncreased\toropharyngeal\tphase,\tdelayed\topening\tof\tesophageal\tsphincter,\tdecreased\nperistaltic\tpressure\tin\tesophagus\nStomach: | [
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peristaltic\tpressure\tin\tesophagus\nStomach:\n\tIncreased\tand\tmore\trapid\tsatiety,\treduced\tperistalsis\tand\tgastric\tcontractile\n\tforce\nincrease\tin\tgastric\tpH\nIntestines:\n\tDecreased\tabsorption\tof\tcarbohydrate,\tprotein,\ttriglyceride,\tfolate,\tB\n12\n,\tD,\tcalcium;\nincreased\tabsorption\tof\tvitamins\tA\tand\tC,\tcholesterol\nLower\tintestines: | [
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Lower\tintestines:\n\tDecreased\trectal\twall\telasticity,\tdecreased\tcolonic\tmotility,\tconstipation\nAge-\tand\tdisease-related\tchanges\tin\tswallow\tfunction,\tincluding\treduction\tof\toral\tand\tesophageal\nmuscle\tmass\tand\tconnective\n\ttissue\telasticity,\tcan\tcause\tdelay\tin\tthe\tswallow\tprocesses\tof\tolder\nadults.\tIncreased\toropharyngeal\tphase\tof\tswallowing\t(see | [
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adults.\tIncreased\toropharyngeal\tphase\tof\tswallowing\t(see\t\nChapter\t39\n),\tdelayed\topening\tof\tthe\nesophageal\tsphincter,\tand\tdecreased\tperistaltic\tpressure\tin\tthe\tesophagus\tcan\tall\tcontribute\tto\nchallenges\tin\tfunctional\tswallow,\twhich\tmay\tthreaten\tadequate\tnutrition\tand\tmake\tone\tmore\nsusceptible\tto\tchoking\tor\taspiration.\t\nDysphagia | [
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susceptible\tto\tchoking\tor\taspiration.\t\nDysphagia\n,\ta\tdysfunction\tin\tswallowing,\tcommonly\tis\nassociated\twith\tneurologic\tdiseases\tand\tdementia.\tIt\tincreases\tthe\trisk\tfor\taspiration\tpneumonia,\tan\ninfection\tcaused\tby\tfood\tor\tfluids\tentering\tthe\tlungs\t(see\t\nChapter\t33\n).\tThickened\tliquids\tand\ttexture- | [
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] |
Chapter\t33\n).\tThickened\tliquids\tand\ttexture-\nmodified\tfoods\tcan\thelp\tpeople\twith\tdysphagia\teat\tsafely\t(see\t\nAppendix\t20\n).\nGastric\tchanges\talso\tcan\toccur.\tEarly\tsatiety\tdue\tto\tage-related\tchanges\tin\n\tthe\tstomach\tin\ncombination\twith\timpaired\tgastric\tmucosal\tfunction\tleads\tto\tan\tinability\tto\tresist\tdamage\tand\tcan | [
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result\tin\tulcers,\tcancer,\tand\tinfections.\tGastritis\tcauses\tinflammation\tand\tpain,\tdelayed\tgastric\nemptying,\tand\tdiscomfort.\tThese\taffect\tthe\tbioavailability\tof\tnutrients\tsuch\tas\tcalcium,\tB\n12,\n\tand\tzinc\nand\tincrease\tthe\trisk\tof\tdeveloping\ta\tchronic\tdeficiency\tdisease.\nAchlorhydria\n\tis | [
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or\tincomplete\temptying\tof\tthe\nbowel.\tIt\tis\tone\tof\tthe\tmost\tcommon\tdisorders\tin\tthe\tU.S.\tpopulation,\tand\tits\tprevalence\tincreases\nwith\tage.\tPrimary\tcauses\tinclude\tinsufficient\tfluids,\tlack\tof\tphysical\tactivity,\tand\tlow\tintake\tof\ndietary\tfiber.\tStudies\thave\talso\tshown\tthat\tdistinct\tphysiologic\tchanges\taffecting\tcolonic\tmotility | [
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occur\tin\tolder\tpeople.\tThey\tinclude\tmyenteric\tdysfunction,\tincreased\tcollagen\n\tdeposits\tin\tthe\tleft\ncolon,\treduced\tinhibitory\tnerve\tinput\tto\tthe\tcolon’s\tmuscle\tlayer,\tand\tincreased\tbinding\tof\tplasma\nendorphins\tto\tintestinal\treceptors\t(see\t\nChapter\t27\n).\nDiminished\tanal\tsphincter\tpressure\tor\tdegeneration\tof\tthe\tinternal\tanal\tsphincter\tand\tloss\tof | [
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The\tincidence\tof\tdiverticulosis\tincreases\twith\tage.\tHalf\tof\tthe\tpopulation\tolder\tthan\tage\t60\tdevelop\nit,\tbut\tonly\t20%\tof\tthem\thave\tclinical\tmanifestations.\tThe\tmost\tcommon\tproblems\twith\tdiverticular\ndisease\tare\tlower\tabdominal\tpain\n\tand\tdiarrhea\t(see\t\nChapter\t27\n). | [
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disease\tare\tlower\tabdominal\tpain\n\tand\tdiarrhea\t(see\t\nChapter\t27\n).\nEach\tof\tthese\tchanges\tin\tthe\tGI\tcould\thave\tsubstantial\timpact\ton\tthe\toverall\tnutrition\tof\tthe\tolder\nadult\tas\tlimitations\tin\tability\tto\tconsume\tadequate\tfood\tquantity\tcoupled\twith\tdecreased\tnutrient\nabsorption\tcan\tresult\tin\tundernutrition.\nCardiovascular | [
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] |
failure.\tOne\tin\tnine\thospital\tadmissions\tin\tthe\tUnited\tStates\tinclude\tthe\tdiagnosis\tof\theart\tfailure.\tA\nlow-sodium\tdiet\tand\tfluid\trestriction\tare\tcommonly\tprescribed\tfor\tthis\tcondition.\tThese\tdiet\nrestrictions\tin\tconjunction\twith\tother\tside\teffects\tof\theart\tfailure\toften\tlead\tto\tdecreased\tnutrient\nconsumption.\tSee\t\nChapter\t32\n\tfor | [
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] |
consumption.\tSee\t\nChapter\t32\n\tfor\n\tdiscussion\tof\tthe\tmultifaceted\tapproach\trequired\tto\tmanage\tCVD\nin\tolder\tadults.\nRenal\nAge-related\tchanges\tin\trenal\tfunction\tvary\ttremendously.\tSome\tolder\tadults\texperience\tlittle\tchange,\nwhereas\tothers\tcan\thave\tdevastating,\tlife-threatening\tchange.\tOn\taverage\tglomerular\tfiltration\trate, | [
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] |
to\tan\tinability\tto\texcrete\tconcentrated\tor\tdilute\turine,\ta\tdelayed\tresponse\tto\tsodium\tdeprivation\tor\ta\nsodium\tload,\tand\tdelayed\tresponse\tto\tan\tacid\tload.\tRenal\tfunction\tis\talso\taffected\tby\tdehydration,\ndiuretic\tuse,\tand\n\tmedications,\tespecially\tantibiotics\t(see\t\nChapter\t34\n).\nNeurologic | [
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] |
medications,\tespecially\tantibiotics\t(see\t\nChapter\t34\n).\nNeurologic\nThere\tcan\tbe\tsignificant\tage-related\tdeclines\tin\tneurologic\tprocesses.\tCognition,\tsteadiness,\treaction\ntime,\tcoordination,\tgait,\tsensations,\tand\t\nactivities\tof\tdaily\tliving\t(ADLs)\n\t(toileting,\tbathing,\teating, | [
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conditions\tsuch\tas\tdementia,\ta\tdisease\n\tprocess\t(\nGalvin\tand\tSadowsky,\t2012\n).\tMemory\tdifficulties\tdo\nnot\tnecessarily\tindicate\tdementia,\tAlzheimer’s\tdisease,\tParkinson’s\tdisease,\tor\tany\tmental\tdisorder\n(see\t\nChapters\t39\n\tand\t\n40\n).\tMany\tchanges\tin\tmemory\tcan\tbe\tattributed\tto\tenvironmental\tfactors, | [
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).\tMany\tchanges\tin\tmemory\tcan\tbe\tattributed\tto\tenvironmental\tfactors,\nincluding\tstress,\tchemical\texposure,\tand\tinadequate\tfood\tand\tfluid,\trather\tthan\tto\tphysiologic\nprocesses.\tUrinary\ttract\tinfections\tare\tassociated\n\twith\tchanges\tin\tcognition\tthat\tmimic\tdementia\tbut\nare\treversible\twith\ttreatment\t(\nBeveridge\tet\tal,\t2011 | [
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are\treversible\twith\ttreatment\t(\nBeveridge\tet\tal,\t2011\n).\tHowever,\teven\tmild\tcognitive\timpairment\tmay\naffect\teating,\tchewing,\tand\tswallowing,\tthus\tincreasing\tthe\trisk\tof\tmalnutrition\t(\nLopes\tda\tSilva\tet\tal,\n2014\n).\tThe\tgreatest\trisk\tfactor\tfor\tdeveloping\tdementia\tis\tin\tfact\tadvanced\tage.\nPressure\tinjuries\nPressure\tinjuries | [
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Pressure\tinjuries\nPressure\tinjuries\n,\tformerly\tcalled\tpressure\n\tsores\tand\tbefore\tthat,\tbedsores\tor\tdecubitus\tulcers,\ndevelop\tfrom\tcontinuous\tpressure\tthat\timpedes\tcapillary\tblood\tflow\tto\tskin\tand\tunderlying\ttissue.\nSeveral\tfactors\tcontribute\tto\tthe\tformation\tof\tpressure\tinjuries,\tbut\timpaired\tmobility,\tpoor | [
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circulation,\tobesity,\tand\turinary\tincontinence\tare\tkey.\tOlder\tadults\twith\tneurologic\tproblems,\tthose\nheavily\tsedated,\tand\tthose\twith\tdementia\tare\toften\n\tunable\tto\tshift\tpositions\tto\talleviate\tpressure.\nParalysis,\tincontinence,\tsensory\tlosses,\tand\trigidity\tcan\tcontribute\tto\tthe\tproblem.\tNotably | [
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] |
malnutrition\tand\tundernutrition\t(inadequate\tenergy\tintake)\tset\tthe\tstage\tfor\tits\tdevelopment\tand\ncan\tdelay\twound\thealing.\tThe\tescalating\tchronic\tnature\tof\tpressure\tinjury\tin\tnonambulatory\tor\nsedentary\tindividuals\trequires\tvigilant\tattention\tto\tnutrition.\nThe\tNational\tPressure\tInjury\tAdvisory\tPanel\t(NPIAP),\tformerly | [
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education,\tpublic\tpolicy\tand\tresearch.\tNPIAP\tprovides\tvital\tpublications\tfor\tmedical,\tnursing\tand\nnutrition\tprofessionals\tworking\tin\tall\thealthcare\tsettings.\nThe\t2019\t\nInternational\tClinical\tPractice\tGuideline\tfor\tthe\n\tPrevention\tand\tTreatment\tof\tPressure\nInjuries\t(CPG)\n\tpresents\trecommendations\tand\tsummarizes\tthe\tsupporting\tevidence\tfor\tpressure | [
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injury\tprevention\tand\ttreatment.\tThe\tnew\tedition\twas\tdeveloped\tas\ta\tfour-year\tcollaboration\nbetween\tthe\tNational\tPressure\tInjury\tAdvisory\tPanel\t(NPIAP),\tthe\tEuropean\tPressure\tUlcer\tAdvisory\nPanel\t(EPUAP)\tand\tthe\tPan\tPacific\tPressure\tInjury\tAlliance\t(PPPIA).\tIt\tprovides\n\ta\tdetailed\tanalysis | [
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a\tdetailed\tanalysis\nand\tdiscussion\tof\tavailable\tresearch,\tcritical\tevaluation\tof\tthe\tassumptions\tand\tknowledge\tin\tthe\nfield,\trecommendations\tfor\tclinical\tpractice,\timportant\timplementation\tconsiderations,\ta\tdescription\nof\tthe\tmethodology\tused\tto\tdevelop\tthe\tguideline,\tand\tacknowledgment\tof\tthe\tmany\texperts\tformally | [
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involved\tin\tthe\tdevelopment\tprocess.\tThe\tguideline\tmay\tbe\tpurchased\tat\t\nwww.guidelinesales.com\n.\nSeveral\tclassification\tsystems\tdescribe\tpressure\tinjuries.\tThe\tsix\tstages\tof\tinjury,\tbased\ton\tthe\ndepth\tof\tthe\tsore\tand\tlevel\tof\ttissue\tinvolvement,\tare\tdescribed\tin\t\nTable\t19.2\n.\tAs\twound\tnutrition | [
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0.09470688551664352,
0.00015869823982939124,
0.08445604890584946,
0.045511532574892044
] |
Table\t19.2\n.\tAs\twound\tnutrition\ntends\tto\tequal\twhole-body\tnutrition,\tcoordinated\tefforts\tof\ta\tmultidisciplinary\ttreatment\tteam\tare\nimportant.\tThe\tbenefits\tof\tspecific\tlevels\tof\tenergy\t(30-35\tkcal/kg)\tand\tprotein\t(1.25-1.5\tg/kg)\tfor\nprevention\tof\tpressure\tinjuries\tin\tpatients\tat\trisk\tof\tmalnutrition\trecommended\tin\tthe\tprevious | [
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] |
guidelines\tare\tnow\tconsidered\tinconclusive.\tThe\t2019\tguidelines\tfocus\ton\tindividualized\tassessment\nby\tthe\tRDN\trather\tthan\tstandardized\tprescriptions.\tHowever\tthe\trecommendation\tabove\tfor\tcalories\nand\tprotein\tremain\tfor\tindividuals\twith\texisting\tpressure\tinjuries.\tAdditionally,\ta\thigh\tcalorie,\thigh\nprotein | [
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Injury\tAlliance,\t2019\n).\nTABLE\t19.2\nPressure\tInjury\tStages\nDeep\tTissue\tInjury\nDeep\tTissue\tPressure\tInjury:\tPersistent\tnonblanchable\tdeep\tred,\tmaroon,\tor\tpurple\tdiscoloration\nIntact\tor\tnonintact\tskin\twith\tlocalized\tarea\tof\tpersistent\tnonblanchable\tdeep\tred,\tmaroon,\tor\tpurple | [
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are\tvisible,\tthis\tindicates\ta\tfull\tthickness\tpressure\ninjury\t(unstageable,\tstage\t3\tor\tstage\t4).\tDo\tnot\tuse\tDeep\tTissue\tPressure\tInjury\t(DTPI)\tto\tdescribe\nvascular,\ttraumatic,\tneuropathic,\tor\tdermatologic\tconditions.\nStage\t1\nStage\t1\tPressure\tInjury:\tNonblanchable\terythema\tof\tintact\tskin | [
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bed\tis\tviable,\tpink\tor\tred,\tmoist,\tand\tmay\nalso\tpresent\tas\tan\tintact\tor\truptured\tserum-filled\tblister.\tAdipose\t(fat)\tis\tnot\tvisible\tand\tdeeper\ntissues\tare\tnot\tvisible.\tGranulation\ttissue,\tslough,\tand\teschar\tare\tnot\tpresent.\tThese\tinjuries\ncommonly\tresult\tfrom\tadverse\tmicroclimate\tand\tshear\tin\tthe\tskin\tover\tthe\tpelvis\tand\tshear\tin\tthe | [
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heel.\tThis\tstage\tshould\tnot\tbe\tused\tto\tdescribe\tmoisture\tassociated\n\tskin\tdamage\t(MASD)\tincluding\nincontinence\tassociated\tdermatitis\t(IAD),\tintertriginous\tdermatitis\t(ITD),\tmedical\tadhesive\trelated\nskin\tinjury\t(MARSI),\tor\ttraumatic\twounds\t(skin\ttears,\tburns,\tabrasions).\nStage\t3\nStage\t3\tPressure\tInjury:\tFull-thickness\tskin\tloss | [
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are\toften\tpresent.\tSlough\tand/or\teschar\tmay\tbe\tvisible.\tThe\tdepth\tof\ntissue\tdamage\tvaries\tby\tanatomic\tlocation;\tareas\tof\tsignificant\tadiposity\tcan\tdevelop\tdeep\twounds.\nUndermining\tand\ttunneling\tmay\toccur.\tFascia,\tmuscle,\ttendon,\tligament,\tcartilage,\tand/or\tbone\tare | [
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not\texposed.\tIf\tslough\tor\teschar\tobscures\tthe\textent\tof\ttissue\tloss,\tthis\tis\tan\tunstageable\tpressure\ninjury.\nStage\t4\nStage\t4\n\tPressure\tInjury:\tFull-thickness\tskin\tand\ttissue\tloss\nFull-thickness\tskin\tand\ttissue\tloss\twith\texposed\tor\tdirectly\tpalpable\tfascia,\tmuscle,\ttendon,\tligament, | [
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cartilage,\tor\tbone\tin\tthe\tulcer.\tSlough\tand/or\teschar\tmay\tbe\tvisible.\tEpibole\t(rolled\tedges),\nundermining,\tand/or\ttunneling\toften\toccur.\tDepth\tvaries\tby\tanatomic\tlocation.\tIf\tslough\tor\teschar\nobscures\tthe\textent\tof\ttissue\tloss\tthis\tis\tan\tunstageable\n\tpressure\tinjury.\nUnstageable | [
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pressure\tinjury.\nUnstageable\nUnstageable\tPressure\tInjury:\tObscured\tfull-thickness\tskin\tand\ttissue\tloss\nFull-thickness\tskin\tand\ttissue\tloss\tin\twhich\tthe\textent\tof\ttissue\tdamage\twithin\tthe\tulcer\tcannot\tbe\nconfirmed\tbecause\tit\tis\tobscured\tby\tslough\tor\teschar.\tIf\tslough\tor\teschar\tis\tremoved,\ta\tstage\t3\tor | [
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stage\t4\tpressure\tinjury\twill\tbe\trevealed.\tStable\teschar\t(i.e.,\tdry,\tadherent,\tintact\twithout\n\terythema,\nor\tfluctuance)\ton\tthe\theel\tor\tischemic\tlimb\tshould\tnot\tbe\tsoftened\tor\tremoved.\nNational\tPressure\tUlcer\tAdvisory\tPanel\t(NPUAP)\tannounces\ta\tchange\tin\tterminology\tfrom\tpressure\tulcer\tto\tpressure\tinjury\tand\tupdates\tthe\tstages | [
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person.\tAmong\tolder\tpersons\tdepression\toften\tis\tcaused\tby\tother\tconditions\tsuch\tas\theart\tdisease,\nstroke,\tdiabetes,\tcancer,\tgrief,\tor\tstress.\tDepression\tin\tolder\tpeople\tfrequently\tis\tundiagnosed\tor\nmisdiagnosed\tbecause\tsymptoms\tare\tconfused\twith\tother\tmedical\tillnesses.\tUntreated\tdepression | [
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can\thave\tserious\tside\teffects\tfor\tolder\tadults.\tIt\tdiminishes\tthe\tpleasures\tof\tliving,\tincluding\teating;\nit\tcan\texacerbate\tother\tmedical\tconditions;\tand\tit\tcan\tcompromise\timmune\tfunction.\tDepression\tis\nassociated\twith\tdecreased\tappetite,\tweight\tloss,\tand\tfatigue.\tNutritional\tcare\tplays\tan\timportant\trole | [
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in\taddressing\tthis\tcondition\t(see\t\nChapter\t40\n).\tProviding\tnutrient-\tand\tcalorie-dense\tfoods,\n\tadditional\nbeverages,\ttexture-modified\tfoods,\tand\tfavorite\tfoods\tat\ttimes\twhen\tpeople\tare\tmost\tlikely\tto\teat\tthe\ngreatest\tquantity\tcan\tbe\tvery\teffective.\tIn\tthat\tcomorbidities\tlead\tto\tpolypharmacy\tand\tconcern | [
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regarding\tdrug-drug\tinteractions,\tproviders\tmay\tchoose\tto\tomit\tantidepressants,\twhich\tleaves\tthe\ndepression\tuntreated.\nGiven\tthe\tuntoward\tconsequences\tof\tunintentional\tweight\tloss\twith\taging\n\tand\tthe\tlack\tof\tFood\tand\nDrug\tAdministration–approved\tmedications\tfor\tappetite\tstimulation\tin\tolder\tadults,\tfood\tand | [
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With\tappropriate\nmonitoring\tfor\tside\teffects,\tmirtazapine\tmay\tbe\ta\tdrug\tof\tchoice\tfor\tolder\tpersons\texperiencing\nweight\tloss\tand\tdepression\t(\nRudolph,\t2009\n)\tand\tcould\tpotentially\tdecrease\tgastroparesis,\tnausea,\nand\tvomiting\t(\nMalamood\tet\tal,\t2017\n).\nFood\tand\tnutrition\tcontribute\tto\tone’s\tphysiologic,\tpsychological,\tand\tsocial\tquality\tof\tlife\n( | [
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setting,\tit\tis\tto\tthrive,\tnot\tto\tdecline.\tThis\nmovement,\taway\tfrom\tinstitutional\tprovider-driven\tmodels\tto\tmore\thumane\tconsumer-driven\nmodels\tthat\tembrace\tflexibility\tand\tself-determination,\thas\tcome\tto\tbe\tknown\tas\tthe\t\nculture\nchange\tmovement\n.\tThe\tbelief\tis\tthat\tthe\tquality\tof\tlife\tand\tliving\tfor\tolder\tAmericans\tis\trooted\tin | [
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a\tsupportive\tcommunity\tand\tcemented\tby\trelationships\tthat\trespect\teach\n\tindividual\tregardless\tof\nage,\tmedical\tcondition,\tor\tlimitations.\nThe\tmission\tof\tthe\tPioneer\tNetwork\tis\tto:\n•\t\nCreate\tcommunication,\tnetworking,\tand\tlearning\topportunities\n•\t\nBuild\tand\tsupport\trelationships\tand\tcommunity\n• | [
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•\t\nBuild\tand\tsupport\trelationships\tand\tcommunity\n•\t\nIdentify\tand\tpromote\ttransformations\tin\tpractice,\tservices,\tpublic\tpolicy,\tand\tresearch\n•\t\nDevelop\tand\tprovide\taccess\tto\tresources\tand\tleadership\nValues\tand\tprinciples\n•\t\nKnow\teach\tperson.\n•\t\nEach\tperson\tcan\tand\tdoes\tmake\ta\tdifference.\n• | [
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Know\teach\tperson.\n•\t\nEach\tperson\tcan\tand\tdoes\tmake\ta\tdifference.\n•\t\nRelationship\tis\tthe\tfundamental\tbuilding\tblock\tof\ta\ttransformed\tculture.\n•\t\nRespond\tto\tspirit,\tas\twell\tas\tmind\tand\tbody.\n•\t\nRisk-taking\tis\ta\tnormal\tpart\tof\tlife.\n•\t\nPut\tperson\tbefore\ttask.\n•\t\nAll\telders\tare\tentitled\tto\tself-determination\twherever\tthey\tlive.\n• | [
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All\telders\tare\tentitled\tto\tself-determination\twherever\tthey\tlive.\n•\t\nCommunity\tis\tthe\tantidote\tto\tinstitutionalization.\n•\t\nDo\tunto\n\tothers\tas\tyou\twould\thave\tthem\tdo\tunto\tyou.\n•\t\nPromote\tthe\tgrowth\tand\tdevelopment\tof\tall.\n•\t\nShape\tand\tuse\tthe\tpotential\tof\tthe\tenvironment\tin\tall\tits\taspects:\tphysical,\torganizational,\npsycho/social/spiritual.\n• | [
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psycho/social/spiritual.\n•\t\nPractice\tself-examination,\tsearching\tfor\tnew\tcreativity\tand\topportunities\tfor\tdoing\tbetter.\n•\t\nRecognize\tthat\tculture\tchange\tand\ttransformation\tare\tnot\tdestinations\tbut\ta\tjourney,\talways\na\twork\tin\tprogress.\nFunctionality | [
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a\twork\tin\tprogress.\nFunctionality\nFunctionality\tand\tfunctional\tstatus\tare\tterms\tused\tto\tdescribe\tphysical\tabilities\tand\tlimitations\tin,\nfor\texample,\tambulation.\t\nFunctionality\n,\tthe\tability\tto\tperform\tself-care,\tself-maintenance,\tand\nphysical\tactivities,\tcorrelates\twith\tindependence\tand\tquality\tof\tlife.\tDisability\trates\tamong\tolder | [
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such\tas\tmanaging\tmoney,\tshopping,\ttelephone\tuse,\ttravel\tand\ntransportation,\thousekeeping,\tpreparing\tmeals,\ttaking\tmedications\tcorrectly,\tand\tother\tindividual\nself-performance\tskills\tneeded\tin\teveryday\tlife,\tare\tused\tto\n\tmonitor\tphysical\tfunction\t(\nFederal\nInteragency\tForum\ton\tAging-Related\tStatistics,\t2012\n). | [
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intake\tmay\thasten\tloss\tof\tmuscle\tmass\tand\tstrength,\twhich\tcan\thave\ta\tnegative\teffect\ton\tperforming\nADLs.\tAmong\tthe\tolder\tadults\twho\thave\tone\tor\tmore\tnutrition-related\tchronic\tdiseases,\timpaired\nphysical\tfunction\n\tmay\tcause\tgreater\tdisability,\twith\tincreased\tmorbidity,\tnursing\thome\tadmissions,\nor\tdeath.\nFrailty\tand\tfailure\tto\tthrive | [
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associated\tinversely\twith\tprevalent\tand\tfuture\tfrailty\tstatus\tin\ta\tlarge\tcohort\tof\tcommunity-living\nolder\tmen,\tmore\tattention\tto\tthe\ttotal\tdietary\tintakes\twhen\tadvancing\tage\tis\tcritical\t(\nGalvin\tand\nSadowsky,\t2012\n).\tLiberalization\tof\toverly\trestrictive\tdiet\tprescriptions\tis\toften\tkey\tto\timproving\ncalorie\tintake\tand\tdietary\tquality\t(\nRaymond,\t2019 | [
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