Question 1

Adhering to low-sodium or diabetes dietary guidelines is difficult for patients with anosmia. Root caries are prevalent in patients with xerostomia, a condition that affects half of all older adults.

Accepted Answer

Anosmia (loss of sense of smell) affects a significant portion of adults over the age of 50. This condition, coupled with hypogeusia (loss of taste), makes it difficult for patients to adhere to low-sodium and diabetes guidelines. To enhance flavor, foods are overseasoned with sugar and salt.

Question 2

The primary cause of confusion in older hospitalized patients is thought to be:

Accepted Answer

Dehydration is probably the primary cause of confusion in older hospitalized patients and can occur because of the kidney's inability to concentrate urine, altered thirst sensations, and side effects of medications. Dehydration frequently results in hospitalization as a result of fecal impaction, cognitive impairment, and overall functional decline. Atropic gastritis is chronic stomach inflammation with mucous membrane atrophy. Sarcopenia is the reduction of skeletal muscle mass and its replacement by fat.

Question 3

Requirements for folate are increased in older adults because a deficiency in this mineral may increase risk of cancer mortality.

Accepted Answer

Folic acid (folate) supplementation was encouraged in the past for cardiovascular disease; however, further studies indicate higher folate levels can increase the risk of cancer mortality. Men and women taking supplements are more likely to have elevated folate levels; however, ironically smoking reduces the amount of folate in the blood.

Question 4

Each of the following dental conditions increase the risk of malnutrition in older adults except one. Which one is the exception?

Accepted Answer

Homeostatic mechanisms are the body processes that correct imbalances, such as the ability to increase absorption of a particular nutrient when its supply is deficient. Another example is retention of body water in times of dehydration. Loss of teeth, edentulous status, and conventional dentures negatively affect nutritional status because of their effect on food selection and ability to chew. For partially edentate individuals, nutrient intake decreases as the total number of teeth decreases. Dysphagia (difficulty swallowing) is related to changes in esophageal motility and deterioration of nerve function, and it directly impacts nutritional status.

Question 5

Regardless of diet, sodium should be restricted. Milk-based food supplements are economical and can help prevent nutrient deficiencies.

Accepted Answer

Rigid and severe dietary restrictions, even with sodium, can seriously affect food acceptance. Individualization is crucial. This does not mean that sodium intake should not be evaluated as excessive levels can have deleterious consequences in many diseases. Milk-based food supplements make excellent snacks to prevent weight loss, which is a recognized risk factor for disease and disability.

Question 6

Gingival recession predisposes teeth to root caries because the enamel covering the root becomes roughed as it is exposed to the oral environment.

Accepted Answer

Note that the root surface, whether exposed by gingival recession or covered by gingival tissues, does not have an enamel covering. The surface covering of the roots of teeth is cementum. Once exposed by recession, a process that increases with age and is more prevalent in men, the root surfaces are vulnerable to the acidic oral environment. Demineralization related to the lower pH makes these areas highly susceptible to dental caries.

Question 7

Which of the following are associated with malnutrition in older adults? (Select all that apply.)

Accepted Answer

Malnutrition is associated with a wide range of complications and maladies, many of which stem from food selection, inability to eat, or poor digestion and absorption of nutrients. Note that advising older adults to eat slowly and chew food well is wise; this facilitates digestion, absorption, and the enjoyment of eating. Use of an appropriate salivary substitute, one that is noncariogenic, is invaluable for many patients who have lost salivary function to disease, medications, or age. Dental hygienists should evaluate salivary substitutes, as many healthcare providers recommend lemon glycerin swabs to moisten oral tissues in patients with xerostomia. These products contain lemon, an acid, as well as glycerol, which is drying to oral tissues because it is an alcohol.

Question 8

Each of the following nutritional directions are appropriate for older adults except one. Which one is the exception?

Accepted Answer

Nocturia, excessive urination at night, is often a problem for older adults. Restriction of fluids is inadvisable because it increases susceptibility to fluid imbalances secondary to physiological changes. Protein and exercise play a pivotal role in maintenance of bone health; however, exercise increases the body's need; therefore, a slight increase in protein is advisable. Physiologic requirements for vitamins B₆ and B₁₂ are increased to prevent a decline in cognitive function.

Question 9

Approximately 33% of older adults take multiple prescription drugs and multiple dietary supplements. Mature renal and liver function in older adults facilitates clearance of medications from the body.

Accepted Answer

Note that approximately 33% of older adults take three or more prescription drugs and three or more supplements. Also pertinent, 10% combine five or more prescription drugs with as many dietary supplements. The potential for drug interactions and interference with appetite and nutrient absorption is great. Liver and renal clearance of these substances is decreased because of physiologic and pathophysiologic changes. These effects result in greater variability of drug action and less predictability of a drug's effects.

Question 10

Each of the following accurately depicts aspects of genomics except one. Which one is the exception?

Accepted Answer

The word genome refers to the entire DNA sequence of an organism. Located within the cellular nucleus, DNA contains the instruction for developing and directing activities of nearly all living organisms. Nutrigenomics, the scientific study of how foods or their components interact with genes, is also called nutritional genomics.

Question 11

With aging, intraabdominal fat increases more than subcutaneous or total body fat. A slightly higher basal metabolic rate (BMR) seems to be protective in maintaining immunity to diseases.

Accepted Answer

In addition to increase in intraabdominal fat, peripheral muscle declines more than central muscle mass. As musculature shrinks, fat tissue accumulates. Healthcare providers would be wise to advise older patients to focus on increasing muscle and reducing fat rather than losing weight.

Question 12

Patients with xerostomia benefit from lemon glycerin swabs to moisten mucosa because the glycerin contains an alcohol and the swab is flavored with lemon.

Accepted Answer

Dental hygienists should evaluate salivary substitutes that patients with xerostomia may be using. Lemon glycerin swabs, often recommended by healthcare professionals to moisten mucosal tissues, contain lemon, which is acidic and results in a lower pH and more cariogenic environment. Also detrimental, glycerin is an alcohol, which is drying to oral tissues.

Question 13

The most common nutritional disorder in older adults is cardiovascular disease. Dietary quality and obesity are two modifiable health risks and behaviors that can improve longevity and quality of life.

Accepted Answer

The most common nutritional disorder in older individuals is obesity. The prevalence of obesity increases progressively from 20 to 60 years of age and decreases after 60 years. Obesity contributes to some of the chromic conditions commonly seen in older adults, including cardiovascular disease, diabetes, cancer, and Alzheimer disease.

Question 14

Metabolism to maintain body functions in older adults requires several different nutrients because energy needs and metabolic rates are lower in older adults than in younger adults.

Accepted Answer

Although it is true that energy needs and metabolic rates are lower in older adults, metabolism to maintain body functions requires all the same nutrients. The distinction in nutritional needs for these groups is found in requirements micronutrients. Recommendations for most micronutrients are higher in older adults because of the effects of aging on absorption, use, and excretion.

Question 15

Older adults at highest risk of consuming minimal amounts of fruits and vegetables include each of the following except one. Which one is the exception?

Accepted Answer

Older adults with minimal income levels typically have inadequate monetary resources to purchase fruits and vegetables. Obesity, isolation, and missing pairs of posterior teeth are predictive factors for avoidance of adequate fruit and vegetable intake. Substitute foods are typically soft and high in carbohydrates and associated with a higher mortality risk.

Question 16

Older individuals differ from one another in physiologic and health status more than any other age group because chronologic age and functional capacity generally correlate closely.

Accepted Answer

While it is true that, more than any other age group, older individuals differ from each other in physiologic and health status, an important factor is that chronologic age and functional capacity do not always correlate. This means that chronologic age is not useful in predicting physiologic abilities and health status.

Question 17

Most patients with xerostomia eat significant portions of vegetables because crunchy foods stimulate salivary flow.

Accepted Answer

Although crunchy foods such as vegetables stimulate salivary flow and are beneficial for patients with xerostomia, patients tend to avoid such foods because their lack of saliva makes vegetables difficult and uncomfortable to eat. They also tend to shun dry foods such as bread and sticky foods, such as peanut butter that are nutrient dense. Instead, many rely on hard candies or gum to stimulate saliva; however, this frequent exposure to fermentable carbohydrate promotes root caries.

Question 18

Each of the following is true of vitamin D requirements except one. Which one is the exception?

Accepted Answer

Note that although older patients synthesize and use vitamin D less efficiently than their younger counterparts, they continue to synthesize this vitamin. Nevertheless, supplementation reduces bones loss and reduces risk of falling and fracture. It is important to ensure that patients receive adequate calcium in addition to vitamin D.

Question 19

Generally, patients who wear dentures have reduced masticatory efficiency. Mandibular implant-supported dentures can have positive effects on the clinical aspects of mastication and swallowing.

Accepted Answer

Patients who wear dentures have 75% to 85% less masticatory efficiency than their dentate counterparts do. After edentulous individuals fully adjust to new dentures, caloric intake increases, but dietary intake of magnesium, folic acid, fluoride, zinc and calcium levels continue to be low because of food selection. Mandibular implant-supported dentures can positively affect chewing, because these appliances provide stability not possible with traditional dentures.

Question 20

Cariogenic food choices can increase in patients with hypogeusia because gustatory and olfactory sensitivities increase.

Accepted Answer

Hypogeusia (loss of taste) often causes an increase in cariogenic food choices because when "nothing tastes good," selection of high-quality food often declines. Decreased gustatory (taste) and olfactory (smell) sensitivities are strong drivers of food choices and quantity. Further complicating nutritional status and its effect upon oral health, olfactory and taste receptors are affected by impaired chewing and swallowing.

Quiz 15: Nutritional Requirements for Older Adults and Eating Habits