Post on 18-Dec-2014
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Oral Health and Smell and Taste Problems in Older Adults
Chapter 6
Age-Related Changes to Oral Cavity
• Changes in olfactory nerves and receptors • Poor chewing and swallowing• Declining sensitivity• Medical conditions• Medication• Nicotine• Caffeine• Alcohol
Oral Cavity• Oral and Pharyngeal cancers
– Survival rate = 50%– Risk factors
• Age• Male • Smoking or smokeless tobacco• Drinking alcohol• Sunlight exposure (lips)• Diet low in fruits and vegetables• HPV
– Infectious diseases
Oral Cavity
• Anatomy of the Oral Cavity
Source: Insel, P, Turner, RE, Ross D. Discovering Nutrition. 2nd ed. Sudbury, MA: Jones and Bartlett, 2006, p 117.
Oral Cavity
• Tongue
Source: NIH SeniorHealth. Problems with taste. July 2005. Available at: http://nihseniorhealth.gov/problemswithtaste/toc.html. Accessed February 13, 2007.
Source: Chernoff, R. Geriatric Nutrition. 3rd ed. Sudbury, MA: Jones and Bartlett; 2006, p. 119.
Tongue
• Physiologic role– Trigger reflex– Enhances pleasure and satiety– Distinguishes nutrients
• Taste dysfunction– May alter food choices and patterns
Problems of the Tongue
• Appearance may indicate nutrition problems– Dehydration– Hypothyroidism– Malnutrition– Black hairy tongue– Geographic red tongue
Salivary dysfunction(dry mouth)
• Xerostomia or hyposalivation– Caused by medication use
• Three pair of salivary glands– Protect tissues– Maintain speech– Chewing and swallowing – Taste perception– Neutralize bacterial acid
Salivary dysfunction (dry mouth)
• Causes of dry mouth– Some chronic illnesses– Depression– Stress– Dehydration
• Often cannot be cured• Treatment options
– Gene therapy to manage this disorder
Dental and Gingival problems
• Periodontal disease– Gingivitis– Periodontitis
Source: NIH SeniorHealth. Problems with taste. July 2005. Available at: http://nihseniorhealth.gov/problemswithtaste/toc.html. Accessed February 13, 2007.
Dental and Gingival problems
• Dental caries– If abscess goes untreated may cause infections in
any part of the body• Increase risk of MI and stroke
• Dentures – Potential problems with food intake
Chemosensory Perception
• Taste perception and olfaction decline– Cells regularly replaced throughout lifespan– Pharmaceutical agents– Pathophysiologic problems and diseases
Taste
• True tastants – Salt – Sugar– Sour– Bitter– Umami
• Ageusia and hypogeusia• A function of multiple nerves in the tongue
Taste• Cause of impaired taste
– Damage to taste buds– Damage to hippocampus of the brain– Nutrition deficiencies– Damage to nerves– Chemotherapy treatments– Loss of third molar– Metallic taste caused by medication use– Persistent salty taste– Loss of salivary gland function
Taste
• Renewal of taste bud cells– Turnover ~ 10 ½ days– Pronounced by age 70– Slower renewal
• Menopause• Protein and zinc shortages
Smell
• Loss of smell– Risk factors– Olfactory receptors are continually renewed
• 30 – 120 days– Caranial nerve 1 carries odors
• Nostrils• Nasopharynx
Smell
• Causes of smell loss– Upper respiratory infection– Head trauma– Rapid head movement– Rhinosinusitis– Exposure to toxic agents– Neurologic diseases
Smell
• Degree of smell loss– Hyposmia– Parosmia– Cacosmia– Anosmia
Flavor
• Taste, smell, appearance, temperature, texture, sound, and feel in the mouth
• Perception impaired in older adults
Causes of Chemosensory Losses in Older Adults
• Sense of smell depends on one nerve• Receptors are lodged in a small sinus region
– Directly exposed to environmental toxins and agents
• Full sense of smell depends on adequate chewing
Causes of Chemosensory Losses in Older Adults
• Impairments of taste and smell caused by– Age-related factors– Medical conditions– Medical treatments (radiation, etc.)– Medication use
Ingredients that Enhance Flavor and Sensory Enjoyment
• Extracts to amplify flavor– Strongly flavored foods and ingredients– Concentrated fruit sauces and jams– Sour– Herbs and Spices– Dry Rubs– Sugar– Fat– Monosodium Glutamate– Wine
Techniques That Enhance Flavor and Sensory Enjoyment
• Foods must appeal to all senses– Visual appeal– Sounds that they produce
Techniques That Enhance Flavor and Sensory Enjoyment
• Choose high-quality foods• Focus on appearance• Arouse hunger• Activate smell memory• Contrast texture, size, and shape• Vary temperature• Liberalize diet• Encourage good mastication
Applications of Flavor Enhancement
• Home and Institutional Menus• Restaurant Menus• Hispanic-Inspired and High-Flavor Cuisine• Appetizers as Entrees
Conclusion
“No food is nutritious unless it is consumed and little food is consumed unless it tastes good.”
“Sensory enhancement of food for older adults makes good sense.”