Revealing the Nutrition–Mood Connection in Seniors

Foreign. Welcome back to this presentation. Today we're talking about nutrition issues in older adults that impact well being. I'm your host, Dr. Donnelly Snipes. As we age, our body's nutritional needs change. When we're infants, we need different nutrients and we need different amount, partly because we're smaller. And when we're older, we need different, different nutrients and different amounts. Without adequate nutrition, our body factory does not function. Nutrition is the building blocks. These are the inputs in our factory that are disassembled and reassembled to make whatever we need, whether it's hormones or neurotransmitters or tissue or neurons or whatever it is. Many older adults have nutrient deficiencies that contribute to inflammation, blood sugar, cognitive immunity and mood issues. And we've talked about a lot of that in the previous, in the previous sections that as soon as inflammation goes up, blood sugar goes up, cognition goes down, immunity goes down and mood can go all over the place. But people tend to become more irritable. And one thing I didn't mention earlier, cognition. Not only does inflammation contribute to cognitive issues, but when we are in fight or flight, and I want you to think about a time where you've been scared witless. Were you really thinking clearly when you were in fight or flight? Are you engaging your prefrontal cortex, all those executive functioning areas of your brain? The answer is no. We know from looking at brain scans that when people are in fight or flight, they are trying to survive. They are not engaging higher order thinking. So it makes it more difficult to think clearly, to remember things, et cetera. Think about a time when you were grieving or traumatized again or just really stressed out for some reason. How was your memory? How clearly were you thinking? How quickly were you thinking? Did it take you an extra minute to kind of process stuff? I, I know for me it does and it always has. And that's again because when we have our, our fight or flight engaged even a little bit, it disengages somewhat proportionally. Our executive functioning, our thinking brain, disengages from our emotional brain. If you want to think about it that way, we will explore the changes in nutrient intake and availability in older adults and consequences of those changes and strategies to improve nutrition in older adults. I will say again, I am not a registered dietitian. I am not a medical doctor. Any changes in the diet of your residents or patients needs to be through the their medical providers. However, we can educate them about what they need to discuss with their doctor to create an adequate treatment plan. We can educate ourselves. So we know what we might need to educate them about if we recognize that, hey, you know, there may be some nutrient deficiency that might be contributing to this. Maybe I should tell Sally about this so she can talk it over with their doctor. It, it's a little cumbersome, but it's the way it has to be because each person is on different medications, each person has their own different needs. And just because it seems like somebody is deficient in vitamin B12, for example, doesn't mean they are. There could be 15 other things going on that are causing that same symptom like hypothyroid or anemia or, or poor sleep, sleep apnea, you know, there's a lot of things. So we need to have them go to their doctor and get an assessment before they start taking steps forward. You can OD on vitamins, even the water soluble vitamins. You can get too much in your system. You can take too much vitamin B12. Vitamin D is fat soluble. A, E, those are fat soluble. You definitely can build up to toxic levels of those in your system. More is not always better. It's always the Goldilocks principle. You don't want too little, you don't want too much. You don't, you, you want just right. The other thing we need to remember about nutrients and I'm going off on a diatribe about supplements right now because so many people think, well, why don't I just increase my magnesium if I'm having trouble sleeping. No, don't do that, don't do that. Figure out if you have a magnesium deficiency first. Certain nutrients will argue if you will, will fight for absorption. So high levels of magnesium, for example, may suppress the bioavailability of zinc. Well, that creates its own set of issues. If you've got way too much magnesium, then you may not be getting enough zinc even if you're ingesting it because it's not getting absorbed. It's all about balance. Whole foods are the best way to get it because in general nature has put together these nutrients in a balance that is ideal. In a balance that works. It's something's not going to be so high in something in general. Now you have some foods like stinging nettle, that stinging nettle is super high in vitamin K, but people are probably not going to gorge on stinging nettle. It's one of my favorite vegetables, don't get me wrong, but I'm certainly not going to gorge on it. However, the whole take home from that is discourage people from randomly self medicating Discourage people from mega dosing, especially without a doctor's, without a doctor's consent. And encourage people to focus on eating high quality whole foods. Now when I say whole foods that can be freeze dried powders if they can't chew effectively. But look for something that's whole. You don't want broccoli sprout extract. You, you want broccoli sprout powder or broccoli powder in order to get that whole food benefit. Okay, so I, I got all, all off target. Causes of changes in nutrient intake in older adults Loss of smell. As we get older, our sense of smell gets worse and our sense of smell takes longer to get from our nose to our brain. Just like every other sensory stimulation takes longer to get from input to process. It's just how it works. Our train has slowed down and we need to be cognizant of that. So for example, if you used to be able to, you know, really nurture that coffee and you could smell it the minute it started to brew and it smelled so good and now it's like eh, part of that could be your sense of smell is starting to go. People who smoke tend to have impaired sense of smell. People with a lot of allergies tend to have an impaired sense of smell. So sense of smell and, and if you've ever had a sinus infection and not been able to smell, you know, food, if it tastes like anything at all, it tastes weird. And that again is that our brain correlates what we're tasting with what we're smelling and it puts it together and if it can't smell, then it's, you're not going to get the whole signal back to where you need it to be. There's a reduction in sweet and salty. Now aside from just being a cruel joke, a lot of older adults will over sugar and over salt their food. You can see the problem in that, especially if they're diabetic or hypertensive or sensitive to salt. If they've got, you know, issues like congestive heart failure and they're are already taking diuretics, it can be a problem. We need to ideally help educate them and empower them with other spices in order to bring out the sweet and salty. Cinnamon is a great spice, if you will. Yeah, it's a spice to bring out the sweetness in things. It actually is somewhat sweet itself. And cinnamon helps with blood sugar regulation. Don't overdo it. You actually can get too much cinnamon. But cinnamon can help bring out the flavor a little bit. Salty is a Little bit harder. But experiment with other herbs like basil and oregano and parsley and garlic. Oh, I love my garlic. And see if you can find things that make it taste good, even if it doesn't taste exactly the same. Older adults may just not have an appetite. That could be because their circadian rhythms are out of whack or because they're depressed or if you can't smell, you're not getting triggered. A lot of us think about Thanksgiving. Thanksgiving's coming up. And I know when I walk into a house and I smell that turkey cooking, my salivary juices start going, my hunger hormones start getting released. I'm like, oh, I can't wait to eat that. It stimulates our desire to eat. Our appetite is stimulated. But if there is, if you can't smell and you don't expect to be able to taste, you may just not be all that motivated to eat. Because eating is not triggering the release of dopamine. People stress eat. We know this. Why do they stress eat? Because partly because when we chew, it stimulates the rest and digest, but also because when we eat high fat, high sugar foods, it triggers the release of dopamine and serotonin. So a lot of people, when they stress eat, gravitate towards those highly processed, high fat foods. Stress eating of junk throughout the day can be a habit just out of boredom. People, it gives them that dopamine release, it gives them a little surge, if you will, from the, from the blood sugar spike. And it can be comforting. When people are feeling lonely and isolated, they may gravitate toward foods that make them feel warm and fuzzy, that make them remember good times like the cinnamon rolls their mama used to make. Aging and stress related changes in the gut microbiome can make it harder for the gut to break down food and make it harder for the body to absorb it. There is reduced absorption in the gut in older adults. Unfortunately, everything starts to slow down and become more inefficient as we age. Now we can slow that down a little bit, but we can't stop that process. So we need to recognize that in older adults, a lot of them, especially if they're on medications, have reduced nutrient absorption in the gut. So what they've eaten, what they've broken down, it's kind of going, going out the other end. And especially if they're not chewing well, if they've got dry mouth, if they've got inflammatory bowel disease, if they've got ulcers or, you know, a variety of things. Monitoring the older adult's Nutrition is really important for the multidisciplinary team. There's reduced chewing ability because of pain, because of poorly fitting dentures, because of dry mouth. Difficulty swallowing comes in with dry mouth and with dementia. Unfortunately, as dementia progresses, some people will lose the ability to effectively navigate that chewing and swallowing activity. So they may not be able to get the nutrition in, which obviously is the point where medical staff steps in. But we need to recognize that early because it's not just going to happen one day where you wake up and Sally can't swallow. It's going to happen gradually. And if we notice it, there may be things that we can do to refer them to their physician, an occupational therapist, changing, making changes in their food that can help them continue to ingest food orally for as long as possible. And as we age, just like we have a reduction in sensitivity in our hearing, in our smelling, in our sensory processing, there is a reduction in sensitivity of our thirst receptors. A lot of older adults just don't get thirsty. They're dehydrated, but they don't get thirsty because their thirst receptors are kind of on the fritz. Hypothyroid. As I mentioned in other presentations, a lot of older adults develop hypothyroid, especially after andropause or menopause. Hypothyroidism reduces peristalsis, or the movement of the squeezing of the gut to move the food through it. This leads to constipation. You know, food just kind of sits there like a rock. When we are constipated and food just sits there and rots, we start having bacterial overgrowth in our small intestine and malabsorption. So we start getting a whole bunch of nasty stuff going on in our gut. Additionally, when people are hypothyroid, they often have low gastric acid, so especially if they've already got dry mouth. So the enzymes that are breaking down the food in the in the mouth and the saliva aren't effective or very effective. They get it down to the gut and the stomach acid, it's minimal. So the food's not getting broken down in the gut like it's supposed to. So then we're sending whole foods basically into the small intestine. And the small intestine can't handle things that haven't been broken down and partially digested. So this impairs the absorption of iron, calcium, magnesium, vitamin B12, among other things. Check that thyroid and encourage people to talk with their doctor about not only testing T4 free T4 but also testing free T3 TSH and reverse T3. What is reverse T3? Reverse T3 is the enzyme that breaks down T3. So T4 is released and it's broken down because our body can't use that. It's broken down to make T3, which our body can use. Reverse T3 is sent out to clean up any T3 that our body doesn't use. So it basically, well, it cleans it up. If you've got too much reverse T3, which actually happens under stress, it may break down your available T3 before you're finished using it. It's kind of like sitting at the dinner table and the wait staff comes and clears your plate before you're finished eating. You're like, hey, hey, hey, wait up. I ain't finished with that yet. Well, that's what happens when we have too much reverse T3. You can also have too little. But it is important to look at all of those to figure out how the thyroid system is working. It's not just one hormone, it's not just one chemical, it's a whole system. Nutrient deficiencies impact inflammation, irritability, cognition and blood sugar regulation. Because when we have too much reactive oxygen species, oxidative stress, junk byproducts of living, whatever you want to call it, when you have too much of that buildup in your system, then it causes inflammation. Inflammation is perceived by your brain as stressful, which triggers the stress response, which makes us more irritable when we're more irritable. When our stress responses kicked off. When we're not using our thinking mind, we are staying in our fight orf flight mind. We are staying in our emotional based mind. So our cognition gets worse, our memory, our body's not diverting energy from memory and learning and organizing and stuff. Additionally, when our stress response is active, we are regularly dumping blood sugar. Blood sugar is what our body uses for, for the short term fight or flee. So when your body perceives a threat, you get this bolus of blood sugar so you have the energy to sprint away from the hungry lion. So let's talk about some of these nutrients and we are not going to be able to quote, diagnose what nutrients are adequate and deficient in people. But it's important just to be aware of these things. And if you think that you've got an older adult with some of these symptoms, then encourage them to talk with their doctor and think about, you know, are they eating well? One of the causes in. Besides circadian rhythm disruption, one of the most common causes of irritability and frailty and wasting in older adults is inadequate nutrition. Even if they're eating well, they're not absorbing it. It's not doing any good. So vitamin B12, if they've got reduced gastric acid, so if they're hypothyroid or if they're taking medications to reduce their gastric acid, then they're not going to absorb B12 as well. Now it's that Goldilocks principle. You don't want too little, you don't want too much. You got to have just the right amount of gastric acid. Deficiency in vitamin B12 can cause anemia, neuropathy. So pain or tingling or numbness in the, in the fingers, in the toes, cognitive decline and mood changes. Vitamin B6 or peroxidine declines in absorption and metabolism with age. It's just one of those things that we need more of as we age. Deficiency leads to anemia, neuropathy, irritability and immune dysfunction. Folate, vitamin B9 is poorly absorbed when there's poor diet, alcohol use, or if they're on certain medications. So there are some people that don't naturally process folate very well, but that's a whole different, it's a whole different issue. Encouraging them to eat a healthy diet, they're going to get enough B vitamins, but lack of folate in older adults can lead to anemia, cognitive impairment and increased cardiovascular risk. Vitamin C. A lot of older adults don't eat enough fruits and vegetables because they're too high in fiber or the fruits and vegetables they eat are cooked to death. The more you cook them, the fewer nutrients they have. The brighter the color, the more nutrients they have. When you are being served a plate of green beans and they're just kind of this grayish greenish color. They may taste wonderful and be steeped in bacon grease, but they're probably not full of very, very many vitamins and minerals anymore because all that's been cooked out. And older adults have difficulty chewing. So one of the things they do when they start having difficulty chewing some of these vegetables, these high fiber foods, is they cook them. They're like, that'll make it softer and easier to eat. Well, yes, it does, that's true. But there's a, a compromise because, yes, you can eat it now, so you're getting some, but if you overcook it, you're depleting the nutrient value. Steamed is best, but again, a lot of older adults can't handle the, may not even be able to handle in their gut the fiber from a Lot of these, especially if they haven't had fiber for a while, don't encourage them to suddenly start eating a ton of fruits and vegetables high in fiber, because that's. Ooh, that'll create all kinds of problems. Work with your dietitian and their doctor to gradually increase their intake of foods that have vitamin C. Did you know potatoes, white potatoes are high in vitamin C? I was like, score. I love white potatoes. But anyway, you have to bake those. And so when you bake them, you lose some of the vitamin C. But I still hold to the fact that it's got some. When we don't have enough vitamin C, we, our immune system's impaired, our wound healing's impaired, our, our antioxidant defense is impaired, and our collagen formation is impaired. So older adults are thin, our skin thins as we age anyway, and we start having slower wound healing anyway. Add to that nutrient deficiencies and low vitamin C. You know, collagen helps our, our form, our skin. If we have low collagen formation and we have slower wound healing or can have a problem. Vitamin C is in most multivitamins. And again, if you're eating a colorful diet, you're probably getting plenty. But that is between the patient and their doctor. Vitamin D, the sunlight vitamin. Gotta love it. But you know what? Most older adults are not going to get enough vitamin D from the sun. Most younger adults don't get enough vitamin D from the sun either because we cover up or we put all kinds of sunscreen on. And, and yes, I understand we need to do that to prevent skin cancer. There's a whole thing about that. But the fact remains that vita low vitamin D is associated strongly associated with depression, fatigue, dry skin and inflammation. So when people are vitamin D deficient, it causes all kinds of problems. Lots of people, Most people, like 80 some percent of people during the winter months are vitamin D deficient because they're not getting enough from their food and they're not getting hardly any sunlight because. And the sunlight they get is far less in vitamin D. I grew up in Florida, so, you know, I, for a while, the parts in the year we were able to get a fair amount of vitamin D. As we age and our skin thins, we become less able to convert sunlight to vitamin D. So if we needed 30 minutes when we were younger, it may take an hour and a half now. Well, you don't want to send grandma out into the sun to bake for 90 minutes. That, that ain't right. That ain't healthy. So. And I don't think her doctor would be along with it either. So we need to look at other ways. Older adults also have less renal conversion, so their kidneys can't convert the raw products into usable vitamin D as efficiently. They still do it, but it's not as efficient. And if they've got kidney disease, well, it's going to be even worse. They also don't intake as much vitamin D. Vitamin D is in milk. A lot of older adults don't drink milk. It's in some cheeses. So we want to look at what foods is the person eating that may have vitamin D in it and how can they get it in their diet? Talking with their doctor. A lot of doctors will prescribe a vitamin D supplement, but again, that's one that you actually can develop toxic levels of. So it's important to encourage people not to think that if one is good, then four is better. No. Deficiency of vitamin D contributes to osteoporosis, muscle weakness, depression, inflammation and immune system dysregulation. Vitamin D and VI and calcium can compete with one another when they get too far out of whack. So again, something we don't want to mess with. Vitamin E is another fat soluble vitamin. And fat soluble vitamins are better absorbed into the body when they are taken, consumed in the presence of some healthy fats. Now, I'm not saying you want to chug a bunch of oil with it, but vitamin E, vitamin D, vitamin A do better when they're consumed in the presence of dietary fat. A lot of older adults have inadequate intake of healthy fats, which means the vitamin E is not effectively absorbed. Deficiency worsens oxidative stress, inflammation and cognitive decline. Calcium declining intake and absorption. Now, calcium's in a lot of foods we eat, especially if you eat brassicas like cabbage and broccoli and spinach. There's a lot of calcium in there. There's a lot of calcium in cheese and milk. But again, look at what the person is eating. How much are they actually consuming? Deficiencies of calcium accelerate bone loss, increase fracture risk and impair serotonin and melatonin production. Well, earlier we learned that serotonin is made first thing in the morning. Its production ramps up first thing in the morning and declines throughout the day. And then it's broken down to make melatonin. Well, how do we break it down there? Think of vitamins and minerals like spark plugs and you've got serotonin sitting there and it takes has to be broken down in the presence of calcium and iron. And folate and a bunch of other zinc in order to be broken down effectively to make melatonin. So if people don't have the spark plugs, if they don't have the vitamins and minerals, they then their in engine is kind of dead. They may have all the gasoline and oil in the world, but if they can't spark off the the chemical reaction, they're kind of screwed. Magnesium is commonly low from poor intake of magnesium, rich foods, medications like diuretics and proton pump inhibitors, stomach acid like oh, I can't even think of what it is. The pills you take when you've got indigestion and reduced absorption deficiency contributes to muscle cramps, heart arrhythmias, insulin resistance and inflammation. Insulin resistance is when your body doesn't respond to insulin very well and the blood sugar, instead of going into the muscles where it's needed, stays in your bloodstream. That's not good, we don't want that. And when people don't have enough magnesium, then their body is less able to use the insulin to put the put the glucose into the muscle cells. Zinc, reduced intake, impaired absorption and medication interactions all contribute to potential zinc deficiencies. Deficiency impairs taste, appetite immunity, wound healing, memory and cognition. Likewise for some people, excess zinc may also impair taste and appetite. I know if I take any of the like emergency sort of things that have zinc in them, my taste buds are off for an hour or so afterwards. But so it is interesting to recognize that if somebody doesn't have enough zinc, or maybe if they've got too much, depending it may be contributing to their inability to taste food or off tastes in food and lack of appetite. Zinc is involved in neurotransmission, so getting those signals from wherever we receive them from the brain or from our touch or whatever into the places where they need to be. Synaptic plasticity, that's your brain's ability to basically heal itself. When you have synaptic plasticity and you have a brain injury, your brain is able to find a workaround. Basically your brain is able to adapt more effectively. And when you don't have enough zinc, the brain can't do that. And neurogenesis, which is something we all want, that's your body's ability to replace neurons. When we're stressed, especially when we're stressed for too long, the stress chemicals are just bathing our brain in cortisol and glutamate. So I liken stress chemicals to hot water and relaxation chemicals to cold water just for the analogy purposes. So the hot Having your brain steeped in that hot water for too long, you start literally killing off brain cells. We, we see in brain scans of people who have chronic stress. They have lower volume in certain areas of their brain. They've actually lost brain cells. The beauty is once you turn down that inflammation and turn down that stress, if the person is eating a healthy diet and stuff, there, you are capable of regenerating neurons, you are capable of healing your brain. Maybe not 100%, but you can make significant progress towards getting back to a good place. Zinc modulates the activity of neurotransmitters like glutamate, our stress hormone, and gaba, our, our relaxation hormone, which are critical for learning, memory and relaxation. A little bit of glutamate, a little bit of cortisol, sometimes we need it, we need that energy, but we don't want to be steeping in it. 24 7, 365. It's just not good. Older adults sometimes have iron deficiencies due to GI blood loss, so they can be bleeding in their gut, they can have ulcers or something they don't even know about. Older adults also their, their intestinal walls are a lot more fragile, so they tear more easily. They can tear a lot more easily with significant constipation even, and it can be a life threatening emergency. My, my husband's granny ended up in the hospital. She had lost nearly half of her blood volume. She was in the ICU for a couple of weeks after, after this incident because she had lost so much blood. Now that's obviously an acute injury and a medical emergency. You're going to notice that. But older adults may have occasional blood in their stool and not pay attention to it. Occasional may not be bad, but it's important for them to monitor it and talk about it with their doctor because you don't know how much is actually bleeding in their gut. Sometimes people don't ingest enough iron rich foods, which are your dark green leafy vegetables and your red meats and, you know, kidney beans. There are a lot of things that are rich in iron. But if your older adult only eats, you know, boiled chicken and mashed potatoes, then their nutrient profile is probably pretty poor. Deficiency of iron leads to anemia, fatigue and cognitive impairment. I've shared with other people in other classes about a patient I worked with who was not an older adult who presented with extreme depression. And she just, she, she couldn't shake it and she was like, I've tried the cognitive things. I, I just don't know what's wrong And I'm like, when was the last time you had a visit to your doctor? And she said, I don't know. It's been a couple years. I said, go see your doctor. Well, long story short, they actually admitted her to the hospital and put her on an iron infusion because she was so anemic. She was that anemic, and I'm not sure why she was that anemic. But once she got her iron levels up and her anemia under control, she felt markedly better. Now, she had other stuff going on in her life that was contributing to stress. But we went from being in an episode of severe major depressive disorder to mild major depressive disorder and. Which seems like an oxymoron to say now that I say it out loud, but it is what it is. Selenium, lower dietary intake. Deficiency in selenium impairs antioxidant functioning. Thyroid function, which in turn impacts energy. Now, you notice I'm not giving you a whole bunch of foods and stuff because we cannot tell people what to eat. That is outside of our scope. That is something the dietitian has to do. That is something the doctor has to do. They can research it. And I actually have other videos on the YouTube channel that do go into detail about which foods have which nutrients in them. But ultimately, if somebody's eating a relatively healthy, not overcooked diet, they're probably getting most of what they need. Now, selenium is another one you can take too much of. Get in toxic levels. Brazil nuts. My favorite nut in the whole world, Brazil nuts. One Brazil nut has, like 400% of your recommended daily allowance of selenium. And if you eat too many of them, you can get really nauseous, really sick, really fast. So just kind of being aware that even some foods, if they're super high in a particular vitamin or mineral and you go hog wild on them, it can be a problem. Which explains why when you get the mixed nuts, there's usually only like four or five Brazil nuts in there. I always thought they were just being chintzy, but it was probably a legal issue because they didn't want somebody getting sick from just picking out all the Brazil nuts and eating them. But anyhow, potassium is often low if somebody's on diuretics or because they're not taking in enough foods that are high in potassium, or they have problems in their kidney functioning. Like everything else, as we age, our liver's not as efficient, our kidney's not as efficient. Doesn't mean we have kidney disease or Liver disease, it just means, you know, everything's slowing down a little bit. Deficiency in potassium increases hypertension, arrhythmias, dehydration, fatigue and confusion. This can also indirectly contribute to social withdrawal, loss of routine and circadian rhythm disruption. My mother in law, what went through a period where she was having leg cramps at night and found that taking having a banana with dinner was helpful. Bananas are high in potassium. There's a lot of foods that are high in potassium if you don't like bananas, but bananas actually have a lot of positives to them and they're a yellow food. There aren't that many yellow foods out there. So we've been talking about nutrient deficiencies and it is important to recognize the whole point of that was to recognize that if your older adult is showing symptoms of irritability, cognitive decline, lethargy, let's take a look. Slow wound healing. Let's take a look at their diet. You know, let's check their sleep first and their circadian rhythms because that's almost always not great. But let's also look at what they're eating, have them keep a food diary and then have them talk with your dietitian or with their medical provider to make sure that they are getting all of the nutrients and actually absorbing all of the nutrients that they need. Unfortunately, a lot of older adults get constipated, which contributes to a lack of appetite. When they're all backed up, when that food, the peristalsis is slowed and that food's just sitting in the small intestine kind of rotting, you don't feel like eating. I don't blame them. They don't feel like eating. Additionally, there's a reduced sensitivity of thirst receptors, so they're not drinking as much, which means the system, if you will, is not as well lubricated. There's lower total body water. When we start to get, when we're hydrated, we can tent our skin and it pops right back in place. When we're dehydrated, we tent our skin and it just kind of hangs out there for a while and you can't do it if you're hydrated enough. So no matter how many times I tent my skin, it's going to pop right back. But it's important to recognize and that's something you can do or have your, your residents do is just take, have them take their hand and not hard enough to bruise themselves, but just take their hand and tent that skin on the back of their hand. And if they drop it and it goes back into place pretty well. Great. That means they're probably pretty well hydrated. But if it just hangs out there like, you know, like a bump in the sheets or something may indicate they're dehydrated. As I mentioned, as we age, we get reduced kidney function. We just do. And it's a progressive thing. It's slowly progressive, but it is a progressive thing. A lot of older adults also drink caffeinated drinks at the expense of other fluids. Coke, diet coke, tea. Whether it's plain tea or sweet tea, coffee. Very rarely do I see people ingesting decaf coffee, decaf tea. So they're drinking caffeine. Caffeine is a diuretic. Caffeine is also a stimulant. So it's going to trigger that stress response and it's going to purge water out of the system and potentially leave the person feeling dehydrated. And there's also. Older adults may not drink enough and get dehydrated or, and, and may not move enough and get constipated because they have reduced mobility. Now, whether that means they can't move around because as we move, it encourages everything to kind of move through or for a lot of older adults, they have difficulty getting to the kitchen to get water and then getting to the bathroom to go pee. So they're just like, nah, it's not worth the effort. I'm just, I. I don't have it in me to try to go through all the rigmarole to get into the kitchen and get myself some water. We need to recognize that reduced access is a big, big issue for. We mentioned earlier, when we're talking about oral health for brushing teeth and taking care of dentures. If people don't have access to the supplies they need, if people don't have access to healthy foods that they need or that are prepared for them. And we're going to talk about creating a safe environment in the next presentation, but we need to know that they have access to the nutritious foods and to ample adequate water. My husband got his father this cup and it apparently lights up when you haven't drunk from it in a particular period of time or something. So that was kind of cool just to prompt him to drink, because he doesn't drink. He's in his 80s. His thirst receptor is not so good. He doesn't think about it. And that has helped him increase his, increase his hydration because he was struggling a lot with postural hypotension when he would stand up from sitting or Lying down, he'd feel like he was going to pass out. He increased his hydration and that largely has stopped, which has been a blessing. Dietary factors also contribute to poor nutrition and constipation. Low fiber intake and insufficient fluid consumption lead to harder, drier stools that are difficult to pass. Now, you would think the more fiber, the harder the stool. You know, that seems to make sense, but that's not it. When we, when we eat fiber, especially soluble fibers, they absorb water and they're, they kind of like a sponge. So it actually makes the stools softer. Encouraging the intake of adequate fiber can be helpful. My stepfather used to have these little fiber cookies in his applesauce every morning. Um, whatever works for your people is helpful. If they decide that they're going to increase their fiber or if you make a decision with the dietary staff to increase fiber in the overall menu, just make sure to do it slowly so they don't suddenly have, you know, a lot of gas and bloating and constipation. And when older adults are constipated, in addition to having difficulty with some of their pelvic floor muscles and actually moving that stool out, as I mentioned earlier, their intestinal walls are a lot more fragile, so they can tear more easily. And that is terrifying when, when it happens because the amount of blood can be copious and it can be a life threatening emergency. So then after that happens, once the older adults like, yeah, I don't think I really want to poop anymore because that was, that was awful. We may need to work with them on managing their fear about evacuating their bowels after they have an episode like that, or if they have a really painful, painful bowel movement, because when you have that happen, then they will tend to retain. And when you retain, you're actually just going to worsen that constipation. Many drugs common in older adults, such as opioids for pain, blood pressure medications, diuretics, water pills, iron supplements, some antihistamines, the list goes on, can actually cause constipation as a side effect. Look at the older adults medications. If they're on medications that may be contributing to dehydration, may be contributing to water loss, they may need more water. Encourage them to watch their turgor, that's what they call it with the skin tenting. That's the best way to monitor that on a day to day basis and work with their doctor. If they're struggling with constipation, see their doctor. It's a medical issue because when you're constipated again. That food's just sitting in there kind of rotting, and they're going to feel awful. It's going to disrupt their sleep, and you're not going to effectively absorb nutrients from, from that food. I mean, think of it kind of like eating rotten leftovers out of the, out of the refrigerator. There's nothing in there that's going to be helpful for your system. Diseases affecting nerves, muscles or metabolism, like Parkinson's disease, diabetes, stroke and hypothyroid.