Research Makes Gastrointestinal Health A Senior Care Priority (Part 1 of 2)

Research on newer long-term illness issues, personal habits and socioeconomic trends are prompting senior care facilities to make gastrointestinal health one of its top medical concerns, healthcare providers, federal biological science investigators and medical policymakers say.

Documented key trends factoring into the decisions of senior long-term care and short-term care facilities to prioritize gastrointestinal health include the aging of the Baby Boomers, past and present drug abuse, alcoholism and cigarette smoking, the onset of cancer and other deadly diseases, environmental pollution, the use of bottled water, poor eating, sleeping and exercise habits and a struggling economy.

All impact the health of the digestive tract, research reveals, as aging in general without intervention from a proper diet, obtaining enough sleep and practicing physical exercise places gastrointestinal health in decline.

Namely, abuse of certain categories of drugs such as heroin cause constipation. Alcoholism undermines the function of the liver. Smoking, environmental pollution and sometimes contaminated bottled water can lead to heartburn, gastroesophageal reflux disease (GERD), peptic ulcers, liver disease, Crohn’s disease, colon polyps, pancreatitis and gallstones.

Radiation and other therapies to treat cancer causes gastrointestinal problems. An economic crisis is likely to negatively affect an individual’s eating, sleeping and exercise routines and, thus, affect gastrointestinal health, which is dependent on them.

Research by federal agencies such as the National Cancer Institute (NCI), the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), the Food and Drug Administration (FDA) and professional trade associations such as the Liver Foundation, the American Accreditation Healthcare Commission, the American College of Gastroenterology, the American Gastroenterology Association, and the International Foundation for Functional Gastrointestinal Disorders connects the importance of the soundness of the gastrointestinal tract to overall physical and mental health.

With the outpouring of research on the total health of seniors and gastrointestinal illness over the years, senior care facilities have begun to collaborate more with nutritionists/dietitians, gastrointestinal specialists/gastroenterologists, surgeons, critical care nurses, activities directors, exercise specialists, physical therapists, occupational therapists, message therapists, medical assistants and radiologists to treat and rehabilitate their patients.

The digestive tract includes the mouth, teeth, esophagus, stomach, small and large intestines, rectum, anus, liver, pancreas and gallbladder. Care providers, researchers and policymakers say keeping the tract healthy is vital to good health, which means that each of these components must work properly.

Food is digested before it enters the small intestines where much of the process takes place between the enzymes in saliva and the stomach. More enzymes are made in the small intestines and pancreas. The remainder goes into the large intestine or the colon. Water is purged from what has not been digested.

However, with enzymes decreasing with age, digestion slows down as does, also, the body’s ability to take in nutrients. When this occurs, seniors start to lose benign bacteria, which leads to overuse of the liver and kidneys and courts a wide range of illnesses.

Symptoms of a deteriorating digestive tract include bloating, indigestion and constipation. As conditions worsen, so do the symptoms. Still, a malfunctioning tract can recover with proper nutrition. Enzymes to aid digestion can be bought in supplements to counteract bloating, indigestion and constipation.

Senior Care Concerns

In hospitals and senior care facilities, leadership-level dietitians advise directors of the nutrition department on management and development of clinical services and supervisors of the gastrointestinal surgery and critical care department on delivery, practice and design. These dietitians are expected to have extensive clinical nutritional experience and knowledge of gastrointestinal surgery and critical care.

In the case of seniors, they are aware that this cohort of patients face a unique set of health problems. Dietitians understand that the bodies of seniors differ from that of others and they are more vulnerable to a variety of illnesses and their attitudes towards health care are different as well.

Aging causes patients to change in body weight and composition as both men and women weigh more as they transition from young adult to middle age to senior adulthood. By their 70s, they start to lose weight. As they age, the bodies of seniors regulate blood pressure, body temperature and fluids less efficiently.

Illnesses in seniors can interrupt cell production. For instance, Alzheimer’s disease can lead to the early death of brain cells and Parkinson’s disease can eliminate an excessive number of nerve cells. By comparison, cancer delays cell death and enables cancer cells to proliferate.

The sum of these changes affect how a senior lives, the amount and the type of physical exercise he or she conducts as well as his or her health care needs.

Aside from the fact that seniors present a specific set of health concerns, no single aging adult has the same problems. No two seniors age at the same rate. Additionally, even within one senior, not all body systems changes are entirely synchronized.

Seniors process medicines, whether herbal or pharmaceutical, differently than young and middle-aged adults.

Seniors weigh less and have more body fat than they have muscle. As the percentage of body fat increases, the bodies of seniors metabolize drugs and other substances in fatty tissue, which means that these elements stay in their bodies longer and may be more stronger than similar medications in the bodies of young and middle-aged adults.

These medications collect in the bodies of seniors because their kidneys don’t function as effectively as they did when they were younger adults. As a result, for example, nonsteroidal anti-inflammatory drugs, also known as NSAIDs, are more at risk of causing gastrointestinal bleeding and kidney trouble in seniors than in young or middle-aged adults.
Gastrointestinal Health

Especially after a gastrointestinal surgical procedure or therapy, dietitians provide senior patients with advice about improving their health. While a variety of reasons exist for poor gastrointestinal health, food is the main one.

As a result, dietitians recommend that seniors prevent a range of digestive diseases, including gastrointestinal ones, by eating properly. This means eating a balanced diet of protein, carbohydrates and fats, fresh foods and fiber-rich fruits and vegetables.

A balanced diet clears the intestines, improves bowel movements and decreases constipation. Whole wheat carbohydrates are more fiber-rich than white-flour-based ones.

Seniors are encouraged to consume five portions of fruit and vegetables per day as part of the recommended daily intake with research revealing that this habit guards against life-threatening illnesses such as cancer and maintains a healthy digestive tract.

They are advised to drink fresh and uncontaminated water, specifically two liters, which does not include coffee, tea or carbonated drinks, to stay hydrated and flush out poisons. Two liters equals six glasses daily. Habitual coffee drinkers are asked to remember to drink a glass of water after each cup as coffee has a dehydrating effect on the body.

In an age of national fracking and offshore oil and gas drilling, private home walls tainted by lead paint, radon gas seeping underground, carbon monoxide in homes and garages and electromagnetic waves emanating from nearby electrical poles and generators and other forms of environmental pollution, activities such as drinking safe, purified water becomes more critical to gastrointestinal health.

Tainted water contains bacteria, which may damage the intestines and destroy the digestive system, leading to vomiting and diarrhea.

Additionally, dietitians ask senior patients to steer clear of spicy foods. Extra spices cause high acidity and alkaline content in the intestines, kidney problems requiring dialysis and severe burning.

High acidity can be halted by consuming such foods sparingly, keeping the blood stream at a pH of 7.4 and using liver salts. For similar reasons, seniors are asked to avoid sour foods.

They are cautioned to eat light meals every two hours or to generally eat little but often and to space meals apart daily. Eating a large meal within hours of sleep for the night should be avoided.

Such practices, dietitians say, improve gastrointestinal health by decreasing the burden on the liver and the small intestine from which the blood supply declines and absorption of the nutrients from large amounts of food is made more difficult.

Seniors are also recommended to shy away from foods containing high fat, including deep-fried foods, and to adopt a low-fat diet instead. Avoiding high fat in the diet, dietitians say, prevents the development of gall stones.

Patients are told to cease smoking and drinking excess alcohol, as both or either lead to the formation of small sores in the stomach known as ulcers, compromising gastrointestinal health.

While seniors are prescribed a cocktail of painkillers and anti-inflammatory medication, they are instructed to avoid excess as these, too, lead to stomach ulcers.

Seniors are also advised to stop eating foods that cause allergies and this habit will lead to sounder gastrointestinal health. Symptoms include vomiting, itchy spots on the skin and reddishness around the mouth.

They are asked to take part in a moderate amount of daily exercise, especially those related to the abdomen, yoga or relaxation through message therapy as these are the means of ensuring sound gastrointestinal health and avoiding mental stress. Mental stress leads to gastrointestinal illness, particularly acidity in the stomach and ulcers.

Swimming is ideal as a form of exercise because it not only keeps a patient fit but also tones all the major muscle groups of the body.

Dietitians say sufficient hours of sleep and sleeping at the same time every night also leads to optimal gastrointestinal health as insufficient sleep leads to depression, which triggers unsoundness eating habits that compromise gastrointestinal health.

Gastrointestinal Exams, Programs

Physicians also recommend that seniors, especially those with gastrointestinal problems, participate in specific radiological health programs that include esophageal and anorectal manometry, pelvic muscle retraining, also known as biofeedback, and defecography.

The NCI and the American College of Gastroenterology report that colon and rectum cancers are the fourth most commonly diagnosed cancers and are second among cancer deaths nationally. Screening for colorectal cancer is regularly permitted by most insurers for patients aged 50 years or older and patients with family histories of cancer.

Some common gastrointestinal exams include colonoscopy, liver biopsy, paracentesis, esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancretography (ERCP), endoscopic ultrasound, and percutaneous endoscopic gastrostromy (PEG). Pulmonary tests include bronchoscopy, thoracentesis, bracheotherapy and tracheostomy. Other programs include photodynamic therapy.

Symptoms that warrant a esophageal motility study (EMS) include heart burn, difficulty swallowing, unexplained chest pain, pre-operative evaluation, anti-reflux surgery and diagnostic tool to identify scleroderma, achalasia and nutcracker esophagus.
Conditions that qualify for 24-hour pH monitoring include heart burn, difficulty swallowing, unexplained chest pain, chronic cough and hoarseness.

Problems that satisfy the need for anorectal motility with electromyography (ARM w/EMG) include evaluation of fecal incontinence, chronic constipation, evaluation of rectal pain, retraining on incontinence, pre-operative evaluation, rectal surgery and anal surgery.

To undergo radiological defecography, senior patients must present with the symptoms of prolapsed rectum, intussusception and enterocele. To receive pelvic muscle retraining, patients must exhibit symptoms of fecal incontinence, chronic constipation, difficult evacuation and anal pain.

Physicians also steer senior patients, who experience bleeding, pain, swallowing difficulties and a change in bowel movements, in the direction of endoscopy services that include non-invasive gastrointestinal and pulmonary procedures that last an hour to three hours on an outpatient basis.

Endoscopy involves examining inside the human body with an endoscope, a flexible tube holding a small camera. The type of endoscope used is named for the organs of the body they are meant to examine such as an arthroscope for the joints, a bronchoscope for the lungs, cystoscope for the bladder and a laparoscope for the abdomen.

A gastrointestinal endoscope is inserted through the mouth or anus or rectum and an ultrasound probe can be added to the endoscope, thus called an endoscopic ultrasound.

Small instruments can be used to take samples of possibly diseased tissues. Probes that pertain to the gastrointestinal tract include colonoscopy for colon polyps or colon cancer, EGD or esophagogastroduodenoscopy, enteroscopy and sigmoidoscopy. A patient may be asked to clear out his or her large intestine by enemas and laxatives to prepare for these tests.

For senior patients suffering from diarrhea, physicians may may also order fecal smears, a lab test to inspect a stool sample for bacteria, fungi, viruses or other type of microorganisms that start illnesses in the gastrointestinal tract.

There are multiple ways to collect the sample. One is to capture it in plastic wrap in a washroom and keep it in a clean container in the doctor’s office. Once the physician receives the results of the lab test, he or she can prescribe the most appropriate antibiotic treatment.

Doctors can also direct senior patients to take a rectal culture, a lab test to determine the type of microorganisms that cause gastrointestinal illnesses. With this type of test, a cotton swab is placed in the rectum, turned around and retrieved. A smear is used to grow bacteria or other organisms to observe the culture for growth.

The culture may be carried out in a hospital or nursing home to test a senior patient for vancomycin-resistant enterococcus or VRE in their intestine, a highly communicable disease.

Gastrointestinal Gas

Gastrointestinal gas is defined as flatus or gas eliminated by burping or passing through the rectum. Research finds that individuals produce a normal quota of about one to three pints a day and experience flatulence 14 times a day though some believe they release too much.

The gas is made mostly of odorless substances, carbon dioxide, nitrogen, hydrogen and oftentimes methane. Foods containing carbohydrates cause gas while foods with fats and protein cause little.

The unpleasant scent stems from bacteria in the large intestine that emit gases containing sulfur. The gas comes from swallowed air and the breakdown of undigested foods by benign bacteria in the large intestine.

Air swallowed by a person is also known as aerophagia. Any person can swallow air when eating and drinking. Still, eating and drinking quickly, chewing gum, drinking with a straw, smoking and wearing loose dentures can cause some individuals to breathe in more.

Symptoms of gas include belching, flatulence and abdominal bloating and pain. Crucial factors are likely how much gas the body eliminates and an individual’s sensitivity to gas in the large intestine.

However, large amounts of flatus may signal an abnormality in which the intestine absorbs nutrients, especially if diarrhea or weight loss is present.

While eliminating gas is a healthy, daily digestive process, physicians recommend the omission of certain foods, including high-fat ones, from a patient’s diet to cut down on bloating and discomfort. Scaling back enables the stomach to empty more quickly, letting gas move onto the small intestine.

Gas-emitting foods include broccoli, baked beans, beer, brussels sprouts, cabbage, carbonated drinks, cauliflower, chewing gums, citrus fruits, corn, eggs, greens, milk products, oats, onions, potatoes, red wine and wheat. Doctors also recommend the start of a lactose-free diet to cut down on human gas emissions.

Enzymes such as lactase supplements aid digestion of carbohydrates and empower individuals to eat foods that produce gas. For example, the enzyme product Beano cuts down on gas production connected with baked beans.

Decreasing the amount of air swallowed or aerophagia is also presented as a solution. Aerophagia is associated with excess salivation and many physicians recommend avoiding such habits as too much gum chewing or smoking. They also seek to treat such digestive conditions as peptic ulcer, which may lead to hypersalivation or nausea.

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Vladimire Herard, M.S.

A print journalist for 23 years, Vladimire Herard wrote for the National Senior Living Providers Network, (nslpn.com), the Guidance Channel and Longtermcare.com. Under CD Publications, Ms. Herard wrote about senior health, substance abuse prevention, and elderly housing. Under Inside Washington Publishers, she covered health care financing for Inside HCFA and food and product safety issues for FDAWeek. Ms. Herard also covered education, crime, and county affairs for daily newspapers such as the Chicago Defender. She currently serves as Chief Communications Officer for several companies, covering senior long-term care, the pharmaceutical industry, regulatory issues and education. Ms. Herard resides in Chicago.

Vladimire Herard, M.S.

Author: Vladimire Herard, M.S.

A print journalist for 23 years, Vladimire Herard wrote for the National Senior Living Providers Network, (nslpn.com), the Guidance Channel and Longtermcare.com. Under CD Publications, Ms. Herard wrote about senior health, substance abuse prevention, and elderly housing. Under Inside Washington Publishers, she covered health care financing for Inside HCFA and food and product safety issues for FDAWeek. Ms. Herard also covered education, crime, and county affairs for daily newspapers such as the Chicago Defender. She currently serves as Chief Communications Officer for several companies, covering senior long-term care, the pharmaceutical industry, regulatory issues and education. Ms. Herard resides in Chicago.

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