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Date: 13.08.2017

Producing Adults (2004)

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Download pdf version Abstract The prevalence of obesity in the United States is increasing in all age groups. During the past 30 years, the proportion of older adults who are obese has doubled. In this article the author describes the prevalence and causes of obesity among older adults as well as the consequences of obesity in older adults.

Recommendations for interventions to address obesity are also provided. Differences between the two groups of older adults, those 50 to 65 years of age, and those over 65 years of age, will be addressed.

In spite of the increase in obesity among older adults, it is important to note that the majority of older adults are not obese and continue to lead active and healthy lives. This article will describe the prevalence and causes of obesity among older adults, as well as the consequences of obesity in older adults.

Recommendations for interventions to address obesity will be provided. Differences between two groups of older persons, those 50 to 65 years of age, and those over 65 years of age, will be addressed. These substantial increases among older adults suggest that obesity among older Americans is likely to become a greater problem in the future Center on an Aging Society, By , the prevalence of obesity in people 50 to 69 years of age had increased to Chronic conditions, such as arthritis, diabetes, hypertension, and heart disease, are among some of the most common, debilitating, and costly chronic conditions in older adults.

These conditions are frequently accentuated by obesity Federal Interagency Forum on Aging, Causes of Obesity in Older Adults An important determinant of body-fat mass is the relationship between energy intake and expenditure.

Weight gain occurs when the balance is tipped and we take in more calories than we burn. Therefore it is likely that a decrease in energy expenditure, particularly in the to year-old age group, contributes to the increase in body fat as we age. In those 65 years of age and older, hormonal changes that occur during aging may cause the accumulation of fat.

Resistance to leptin could cause a decreased ability to regulate appetite downward Villareal et al. Genetic, environmental and social, as well as several other factors can all contribute to obesity. These factors will be discussed below. The observation, often made by nurses, that obesity tends to run in families may lead us to believe that obesity is related to the genes a person has inherited; and science does show a link between obesity and heredity NIH, Almost 20 years ago, researchers demonstrated the role of biological inheritance in fat variations Bouchard, Bouchard found that visceral fat is more influenced by the genotype than subcutaneous fat.

It appears that a genotype-overfeeding interaction component exists for body fat, which suggests that the sensitivity of an individual to changes in body fat following overfeeding is genotype dependent. These important studies provide a substantial contribution toward the understanding of gene expression and how it can be used to expand our knowledge of obesity. Environmental and Sociological Factors Just as genetics plays a role in obesity, so does the environment. The environment includes the world around us; it influences access to healthy food and safe places to walk.

What we eat, our level of physical activity, and our lifestyle behaviors are influenced by our environment. Poverty and lower levels of education have also been linked to obesity NIH, It has been suggested that one reason why poverty and lower educational levels are risk factors for obesity is that high-calorie, processed food is less expensive and quicker to prepare than fresh fruits and vegetables NIH, Through observation and the anecdotes patients have shared with me, I have come to believe the social environment indeed contributes to the increasing prevalence of obesity.

To date, only a few research studies have focused on this factor. Residents living in the more hazardous neighborhoods were more than twice as likely to be obese as those living in the least-hazardous neighborhoods, even after controlling for behavioral and socioeconomic individual-level risk factors.

The authors concluded that this significant finding demonstrates that neighborhood conditions can alter patterns of obesity. Community-level interventions that might lead to a reduction in environmental and sociological hazards include increasing educational attainment, increasing public safety, reducing crime rates, and eliminating vacant housing.

Other Causes of Obesity Other conditions and illnesses that are associated with both weight gain and obesity include: The older adults who are obese are more likely than those who are not obese to report symptoms of depression, such as feelings of sadness, worthlessness, and hopelessness Center on an Aging Society, Lack of sleep may contribute to obesity, as well as certain drugs, such as steroids and some antidepressants that may stimulate the appetite, cause water retention, or slow the metabolism rate NIH, Finally, the complex relationship between functional ability and lifestyle patterns merits attention as a contributor to obesity Center on an Aging Society.

Joint pain, decreased mobility, and activity intolerance may lead to weight gain because of decreased activity. Older adults are more likely than younger adults to experience functional limitations associated with chronic illnesses that may begin a stress-pain-depression cycle that can result in lifestyle patterns leading obesity Lorig et al. Consequences of Obesity in Older Adults Health problems associated with obesity are classified as either nonfatal or life threatening by the World Health Organization This section will discuss the consequences of obesity on both nonfatal and life-threatening health problems.

Interventions to address these particular consequences will be discussed as each consequence is presented. These conditions, which are aggravated by obesity, will be discussed below. In obese patients, lungs decrease in size.

Obesity is known to induce respiratory mechanical impairment that may be combined with abnormalities in gas exchange Zerah et al. In the obese elderly, these changes are accentuated by changes in the lung structure and function associated with normal aging.

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These changes in the lungs include decreased alveolar surface available for gas exchange, increased chest wall stiffness, and stiffening of the elastin and the collagen tissue supporting the lungs Tabloski, The mass loading of the ventilator system induced by obesity alters the static balance within the respiratory system. Obese older patients often have a reduced respiratory efficiency that can reach the point of respiratory insufficiency in the presence of cardiovascular insufficiency of various degrees.

The natural decrease in respiratory function in older patients exacerbates the decrease caused by obesity which may in turn lead to an increase in the sleep apnea syndrome, which, in these patients, is related to a greater risk of developing hallucinatory and cognitive disorders caused by hypoxia during sleep Donini et al.

Endurance exercise when combined with a dietary weight loss program increases maximal oxygen consumption Dick, Diet in conjunction with resistance and endurance exercises improves peak oxygen consumption as well.

Nurses can teach patients with respiratory problems to do diaphragmatic or abdominal breathing to help strengthen respiratory muscles. Breathing exercises, as well as good posture, can help patients to exhale and inhale fully Lorig et al.

Pursed lip breathing may also be helpful for patients who are short of breath or breathless.

Pursed breathing includes pursing the lips as if blowing a whistle; using diaphragmatic breathing out through pursed lips without any force; and remembering to relax the upper chest, arms shoulders, and arms while breathing out. Patients with sleep apnea need to be referred for sleep studies. Arthritis is the leading cause of disability in older adults. This age-related increase in the prevalence of OA may reflect bodily changes as a result of a lifetime of being overweight which results in strain on weight-bearing joints Villareal et al.

Obesity, or even being overweight, increases the load placed on joints, especially the knee and hip joints. People with arthritis are particularly vulnerable to the stress-pain-depression cycle mentioned above, in which the pain and stiffness caused by the disease leads to decreased mobility, thereby increasing stress, pain, and depression and likely decreasing quality of life Newman, Obese older people above the age of 50 who have arthritis are more likely to say their condition limits their activities than non-obese adults in this age group Center on an Aging Society, For the older person with OA, the most important risk factor that can be modified is obesity.

The goal of managing arthritis is to maintain the maximum use and function of the joint and the surrounding muscles, tendons, and ligaments Lorig et al. Exercise is the key to meeting this goal. However, many people with OA and other joint diseases believe that exercise will cause their arthritis to flare up and increase the pain. This is a misperception that nurses can work to dispel. Stretching exercises of all muscle groups should be done ten minutes a day as well as daily active range of motion for all joints.

Isotonic exercises, which move the joint in an arc, are also helpful. Aquatic exercise and walking are usually well tolerated by older adults with mild to moderate lower extremity OA Resnick, Heat is also helpful in managing arthritis because it reduces stiffness and makes exercise easier.

Rest periods between activities help to control the fatigue of arthritis, which is compounded by obesity. Although many cognitive-behavioral programs have been found to help people with arthritis manage their chronic condition, The Arthritis Self-Management Course, designed by a nurse and endorsed by the Arthritis Foundation, has been the most successful Lorig, Nurses can make referrals to this program, or become self-management course leaders.

Many of the interventions described in the upcoming section on Interventions for Obesity in Older Adults also apply to those having OA. The two main causes of the reported skin problems were perspiration and friction.

Groin, limbs, and under breasts were identified as the most troubling areas. The first step in addressing skin problems is to conduct a skin assessment of obese patients. The specificity and degree of skin problems will determine the intervention. Nurses are advised to initiate measures to decrease friction as soon as possible after hospital admission.

Additionally, in older women, urinary incontinence from a large, heavy abdomen causing the valve on the bladder to weaken may result in the leaking of urine when coughing or sneezing.

Nurses should educate patients about keeping the area dry so as to prevent skin problems.

Obesity in Older Adults

Strategies to keep the area dry include wearing absorption pads in their underwear and changing underwear as soon as possible when leakage occurs. Life-Threatening Illnesses Related to Obesity The World Health Organization has noted that life-threatening illnesses related to obesity include cardiovascular disease; conditions associated with insulin resistance, such as type 2 diabetes; certain types of cancers, especially hormonally related and large-bowel cancer; and gallbladder disease.

The next few sections will discuss these illnesses. Coronary heart disease is responsible for significant morbidity and mortality in older patients who are 65 years and older. Dietary modification is the cornerstone of treating cardiovascular disease in older adults who are obese. Grundy has described obesity as a major underlying factor contributing to atherosclerotic cardiovascular disease ASCVD and a factor associated with multiple other ASCVD risk factors, including elevated blood pressure, hypertriglyceridemia, low high-density lipoproteins, high cholesterol, and high fasting plasma glucose.

It is also a risk factor for type 2 diabetes. Even though there is a strong association between obesity and ASCVD, the relationship underlying the mechanism is not well understood.

The fact that obesity acts on so many metabolic pathways, producing so many potential risk factors, makes it challenging to delineate the specific mechanism by which obesity contributes to ASCVD.

Gundy suggested that the fundamental question for controlling cardiovascular diseases related to obesity is: The widely disseminated Healthy People U. Department of Health and Human Services, n. Type 2 diabetes, the most common type of diabetes in older adults, results from interplay between genetic factors and environmental factors that contribute to obesity.

Coronary disease is the most common and lethal sequel of type 2 diabetes.

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