to make eating less interesting. These aging changes are compounded by common diseases (periodontal) and medications (Besdine & Wu, 2008).
This decreased taste sensation leads to a change in the type of foods that older people prefer. They generally like highly seasoned foods or simply more sugar or salt in food so it can be tasted. The ability to taste and smell starts to diminish when individuals are in their 50s. Both senses are needed to enjoy the full range of flavors in food. The tongue can identify only five basic tastes: sweet, sour, bitter, salty, and umami (commonly described as meaty or savory). Also, the mouth tends to feel dry more often, partly because less saliva is produced, and dry mouth further reduces the ability to taste food.
Guided Practice Exercise 1.1 provides an opportunity to obtain the perception of taste sensation and its effect on adequate nutrition from an older adult. Adequate nutrition is critical to maintaining one’s health at all points in life.
Guided Practice Exercise 1.1
Visit an assisted living facility and interview an older adult regarding the changes in his or her sense of taste over time. Inquire as to what effect it has had on his or her nutritional intake and satisfaction with meals.
Smell
As individuals age, the olfactory (smell) function declines. Not only is there a loss of sense of smell, but also a loss of ability to discriminate between smells (Boyce & Shone, 2006). More than 75% of people over the age of 80 years have evidence of major impairment in ability to smell, and smell declines considerably after the seventh decade (Boyce & Shone, 2006). A major consequence of the loss of smell could pose a threat to the health and well-being of the older persons and other individuals within the environment. For example, if an older adult does not know that the pot is burning on the stove, a fire could develop. An older person who is unable to smell a gas leak places himself or herself in danger and potentially others in close proximity. If the elder cannot smell the freshness of food in the refrigerator, which has now spoiled, they will consume harmful foods, which may lead to hospitalization for an illness. Older persons may become depressed at the changes they are experiencing, and a mental health professional can provide counseling and referral services to manage the depression. Mental health practitioners can also provide education and support services to facilitate a continued good quality of life for their clients while facilitating coping and adaptation to their environment.
Smell activity declines with aging. There is atrophy of olfactory bulb neurons, and central processing is altered. The result is decreased perception and less interest in food. Again, these age-related changes are compounded by disease. For example, Alzheimer’s disease (AD) and Parkinson’s disease (PD) are related to diminution and alteration of smell (Besdine & Wu, 2008). The ability to smell diminishes because the lining of the nose becomes thinner and drier and the nerve endings in the nose deteriorate. However, the change is slight, usually affecting only subtle and complex smells. Because of these changes, many foods tend to taste bitter, and foods with subtle smells may taste bland.
The olfactory nerves are also thought to have fewer cells functioning in older adults. Because the odor of foods stimulates salivation and hunger, a diminished sense of smell often contributes to a decreased appetite. A decreased sense of smell also leads to the inability to smell danger in the environment, such as leaking gas stove burners that are not completely turned off, and spoiled food. Older adults who live alone should develop the habits of checking all burners after use to be certain they are turned completely off and marking the date food is placed in the refrigerator to prevent eating spoiled food (Talbot & Hogstel, 2001). Changes in the ability to smell negatively impacts quality of life for older adults as does changes in sensation with aging.
Sensation
Changes in sensation common to older adults include the peripheral nerve function that controls the sense of touch declines slightly with age and the ability to perceive painful stimuli is preserved in aging; however, there may be a slowed reaction time for pulling away from painful stimuli with aging (Cacchione, 2005). Consequences of decreased sensations include the possibility of falls due to inability to recognize position sense or inability to ascertain where feet are on the floor and development of calluses or serious foot lesions. Older adults who fall may develop a fear of falling, which will negatively impact all activities of daily living and social endeavors. Older adults may become anxious and depressed, which may warrant psychological interventions. Mental health practitioners can facilitate coping mechanisms with their older clients, coordinate service providers, provide psychosocial interventions, and facilitate social interaction, which is essential if the older client has become withdrawn.
Sensations may be diminished or changed in older adults. Peripheral nerve function that controls the sense of touch declines slightly with age. Two-point discrimination and vibrating sense both decrease with age. The ability to perceive painful stimuli is preserved in aging; however, there may be a slowed reaction time for pulling away from painful stimuli with aging (Cacchione, 2012). The sense of touch may decrease, and a firmer touch may be needed to elicit a response. Many older adults respond positively to touch; perhaps it indicates a special sense of caring by another person. However, sensations are also compounded by disease, and most older adults will have at least one or more chronic diseases. Diabetic patients will have difficulties in the area of pain sensation. Osteoporosis can produce a sense of being off-balance when ambulating.
The sensation of pain varies considerably in older adults. It may be more difficult to evaluate acute pain because of an older adult’s reduced ability to locate the source of pain. The autonomic response to pain, such as rapid pulse, elevated blood pressure, pallor, and nausea, may not occur in older adults. Every person exhibits learned behaviors in response to pain, and older adults may have experienced chronic discomfort for such a long time that they fail to respond to a new stimulus. Also, the inflammatory response is often reduced or delayed, resulting in a decreased stimulus for pain. A combination of assessment skills to detect the presence of pain is necessary. It is essential to differentiate acute from chronic pain because the cause and treatment may be quite different.
Typically, painful disorders are often less or not at all painful in elders. In the cortex, populations of neurons continuously receive input from upstream neurons, integrate it with their own ongoing activities, and generate output destined for downstream neurons. Such cortical information processing and transmission is limited, and pain sensation appears to decline with age. The brain has a neural (relating to the nervous system) circuit and endogenous (developing from within) substances to modulate pain and as individuals age endogenous pain inhibition is reduced with aging. Some pain thresholds show age-related changes. Although sensitivity to heat pain decreases with age, sensitivity to pressure pain is enhanced. Sensory nerves lose myelin, which is a layer of tissue that surrounds the nerve fibers (axons) selectively, and perhaps predisposing individuals to neuropathy (problem with the nerves). Vibration sensation perception diminishes with aging, especially in the legs (Besdine & Wu, 2008). Changes in sensation may negatively impact older adults and create an unsafe environment, while issues with balance pose similar safety issues within the environment.
Balance
Having good balance means being able to control and maintain your body’s position, whether you are moving or remaining still. An intact sense of balance helps you walk without staggering, get up from a chair without falling, climb stairs without tripping, and bend without falling (NIH Senior Health, 2014). Good balance is important to help elders move around, maintain independent functioning and carry out daily activities. As individuals get older, many people experience problems with their sense of balance. They feel dizzy or unsteady, or feel that their surroundings are in motion, and usually disturbances of the inner ear are a common cause (NIH Senior Health, 2014).
Balance problems in older persons can result in falls.
