NCM 114: CARE OF OLDER ADULT

Health Care of the  Non-compliance - failure or refusal to

comply with something(such as a rule or
Older Adults: regulation.
Ex. Failure to wear a personal protective
HEALTH PROMOTION, equipment (PPE).

HEALTH
RECOMMENDED HEALTH
MAINTENANCE, AND PRACTICES

HOME HEALTH FOR OLDER ADULTS

 Diet - Older adults should consume a well-
CONSIDERATION balanced, plant-based diet with the
recommended daily allowances of

Definition of Terms nutrients. Helpful nutrition guides for

healthy eating especially on fruits and
 Health Maintenance - a guiding principle
veggies.
in health care that emphasizes health
promotion and disease prevention rather
 Exercise - can help keep joints flexible,
than the management of symptoms and
maintain muscle mass, control blood
illness.
glucose levels and weight, and promote a
sense of well-being. Exercise does not
 Health Promotion - the process of
need to be aerobic to benefit older adults.
enabling people to increase control over,
Walking at least 30 minutes a day and
and to improve, their health.
other activities such as gardening.
Ex. Increase access to healthy foods,
Excessive consumption of alcohol is never
quit smoking and less consumption of
recommended.
alcohol.

 Non-adherence - passive process in which

PHYSICAL EXAMINATIONS AND

the patient may be careless or forgetful PREVENTIVE OVERALL CARE

about adhering to treatment regimen.  Physical Examination should be done
annually that should include
evaluations of height and weight, blood
pressure, and a rectal examination

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 NCM 114: CARE OF OLDER ADULT
 Women should have a pelvic
examination, mammogram,
Papanicolaou (Pap smear) test, and
bone mineral density (after age 65 or
earlier, depending on risk factors).
 Older men need a prostate
examination and blood test to rule out
prostate cancer.
 Colonoscopy, occult blood screening
for person with identified risk factors
such as colon cancer.
IMMUNIZATIONS FOR OLDER
ADULTS
 Pneumonia Vaccine
 Flu Vaccine
 Shingles (zoster) vaccine: The risk of
developing shingles, a herpes
infection that causes a classic rash and
painful neuralgia, increases with age.
SIGNS AND SYMPTOMS
INDICATING A NEED FOR PROMPT
MEDICAL ATTENTION
 Severe pain; radiating or crushing
chest, neck, or jaw pain;
 Severe unremitting headache
 Difficulty breathing
 Loss of consciousness
 Loss of movement or sensation in any
body part(s)
 Sudden vision changes
 Unusual drainage or discharge from
any body cavity; Wounds that do not
heal
 Nausea or vomiting over 24-hour
duration
 Elevated body temperature
 Inability to urinate
 Swelling of the lower extremities
 Excessive (greater than 10%) weight
gain or loss Sudden or dramatic
zoster
behavior changes
 Sudden changes in speech or ability to
follow directions

 Prophylactic use of medications such as

ADVISE TO OLDER ADULTS AND
aspirin (to prevent cardiovascular disease)
and vitamin E (thought to decrease risk for
CARE GIVERS
stroke, heart attack, and Alzheimer  Take prescription medications only as

disease) is gaining increased acceptance ordered.

in the medical community.  Store medication as directed.

 Report any suspected side effects to your
primary care provider

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 NCM 114: CARE OF OLDER ADULT
 Keep a card with names of all medications,
dose, and name of primary care provider
with you at all times. Keep the card up to
date. Show the card to all health care
providers
 Do not take anyone else’s medication or
share your medication with anyone.
FACTORS THAT AFFECT HEALTH
 Older adults have their own beliefs about
what is normal and expected with aging.
 Some are willing to accept declining health
as a normal part of aging, whereas others
are not.
 Those who perceive a decline in health as
normal and expected with aging may do
little to prevent loss of function, simply
accepting the changes.

PROMOTION AND MAINTENANCE

 RELIGIOUS BELIEFS RECOMMENDED HEALTH
 CULTURAL BELIEFS PRACTICES TO MAINTAIN
 KNOWLEDGE AND MOTIVATION WELLNESS
 MOBILITY  Eat a well-balanced, plant-based diet.
 Establish a regular exercise program.
INEFFECTIVE HEALTH  Quit smoking.
MAINTENANCE  Consume alcohol in moderation.

 Lack of adequate knowledge about  Get routine immunizations as

recommended health practices recommended. Stay involved in

 Physical limitations activities and with others.

 Lack of adaptive behaviors to  Keep a healthy attitude.

environmental changes  See the dentist and primary care

 Limited financial resources provider regularly

 Altered cognitive or perceptual function

 Difficulty accessing health-related CHARACTERISTICS OF OLDER
goods or services ADULTS WHO ARE LIKELY TO BE AT
 Loss of motivation because of grief, RISK FOR NONCOMPLIANCE
hopelessness, or powerlessness
 Cognitive, perceptual, or developmental
problems
PERCEPTIONS OF AGING  Deficient knowledge of the treatment plan
 Perceptions of good health and good  Lack of adequate financial resources
health practices vary widely among the  Poor self-esteem or altered body image
aging population.
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 NCM 114: CARE OF OLDER ADULT
 Lack of a support system of friends and emphasis on what a person does. Often
family one’s work gives social position and
 Lack of motivation influence, is a source of social contacts,
 Substance abuse problems and provides a feeling of satisfaction from
 Negative past experiences with the health productivity.
care system
 Differing cultural, religious, or health
COMMUNICATING
NURSING INTERVENTIONS FOR WITH OLDER ADULT
HOME-BASED CLIENTS  Communication - is the process of
 Assess the support system exchanging information: sending
 Help structure the environment to promote messages back and forth between
compliance. individuals or groups of people.
 Enlist the help of family, friends, and
neighbors to provide reminders.  Verbal communication involves sending and
 Involve social service agencies in receiving messages using words. Some
promoting compliance. verbal communication is formal, structured,
 Use any appropriate interventions that are and precise; some is informal, unstructured,
used in the institutional setting and flexible.
 Formal or therapeutic communications
PSYCHO-SOCIAL CARE OF OLDER have a specific intent and purpose.

ADULT
 Family changes: The family unit is a major  Informal or social conversations are

source of satisfaction for older adults as less specific and are used for

they enjoy the love, companionship, and socialization. Both have a place in

achievement of spouse, children, and nursing. Nurses must be effective in

grandchildren. Their role within the family both formal and informal

has changed multiple times in their lifetime.

In old age they are cared for by their EFFECTIVE COMMUNICATION
children versus the other way around. REQUIRES THE FOLLOWING:
1. The need or desire to share information
 Retirement: This can be a difficult time 2. Acceptance that there is value and merit in
because our society places so much what the other person has to say,

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 NCM 114: CARE OF OLDER ADULT
demonstrated by a willingness to treat
the other person with genuine dignity and
respect
3. Understanding of factors that may interfere
with or become barriers to communication
4. Development of the skills and techniques
that facilitate effective interchange
information
COMMUNICATION DO’S WHEN
WORKING WITH OLDER ADULTS
 Identify yourself
 Address the person using their preferred
name (e.g., Mrs. Smith and Bill).
 Speak clearly and slowly in a low tone
voice.
 Get to know the person.
 Listen empathetically.
 Pay attention to body language, yours and
theirs.
 Use touch appropriately and frequently
 Don’t pay too much attention to tasks and
forget the person.
 Don’t consider nonverbal messages as
insignificant.
 Don’t be afraid to use touch as a method of
communication
of
NONVERBAL COMMUNICATION
 Symbols - white uniform and cap were
symbols that helped older adults
distinguish nurses from other caregivers,
and to distinguish the level of education
attained by that nurse.
 Tone of Voice
 Body Languages
 Space Distance and position
 Personal space - refers to how close we
allow someone to get to us before we
feel uncomfortable. The amount of
space that separates two individuals
when they communicate is significant.

COMMUNICATION DONT’S WHEN  Gestures - are a specific type of nonverbal

communication intended to convey ideas.
WORKING WITH OLDER ADULTS
Gestures are highly cultural and
generational; those that are acceptable in
 Don’t assume that the person knows who
one culture may be offensive in another.
you are.
 Don’t use “baby talk” or patronizing names
 Facial Expressions - are yet another form of
such as “sweetie” or “honey.”
communication. The human face is most
 Don’t shout.
expressive, and facial expressions have
 Don’t make generalizations about older
been shown to communicate across
people.
cultural and age barriers.

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 NCM 114: CARE OF OLDER ADULT
 Pace or Speed of communication - Slower is EMPATHY, ACCEPTANCE, DIGNITY,
better” should be the motto impressed in AND RESPECT IN COMMUNICATION
the mind of anyone who chooses to work
 Empathy is defined as the willingness to
with older adults.
attempt to understand the unique world of
another person. It is the ability to put
 Eye Contact - Looking someone in the eye
oneself in another person’s place and to
is perceived in our culture and other
understand what he or she is feeling and
cultures as a measure of honesty. Yet in
thinking in that situation. Empathetic
some cultures
listening involves actively trying to truly
 Pace and Timing
understand the other person.
 Touch - is a form of communication. No
words are required, and there is no need  Elderspeak also includes incorrect use of
for high-level sensory or cognitive the pronoun we—as in “Are we ready to
functioning
get dressed now?” when the correct
pronoun would be you. Elderspeak should
Nonverbal communication signals that the nurse is
always be avoided, because it has a subtle
interested in the patient and in what he or she is
way of diminishing an older person’s self-
saying.
esteem.

 Also, be mindful of the possible negative

connotation that words can have to older
adults or their family members; substitute
more positive terms when possible. For
example:

Comfort and well-being can be promoted with  Instead of diapers, say briefs, pads, or

eye contact and gentle touch. use a trade name, such as Depends.
 Instead of blind or deaf, say visually or
hearing- impaired.
 Instead of senile or dementia, say
cognitively challenged.
 Instead of nursing home, say care
facility.

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 NCM 114: CARE OF OLDER ADULT
BARRIERS TO COMMUNICATION Recommended Approach:

Hearing Impairment 1. Talk about one thing or ask only one

The following may be beneficial: question at a time.

1. Stand in front of the person, at eye level. 2. Limit choices; too many options are

2. Do not eat or drink while you are having a confusing.

conversation. 3. Keep the conversation in the here and now.

3. Keep your hands away from your face 4. Ask simple yes/no questions.

when speaking. 5. Try “filling in” or “repairing” thoughts.

4. Try different ways (words) of saying the Rather than letting a person get upset

same thing. trying to find the right words, you may offer

5. Speak more slowly and slightly louder some likely choices.

while modulating the voice to a lower pitch. 6. Try increasingly specific guesses or

6. Avoid exaggerated mouth motions during questions to determine concerns (e.g., Is

speech. something wrong with your meal? The

7. Use visual cues or written materials that coffee? It’s too hot? You want milk?).

support the spoken words 7. Praise attempts to speak, and avoid

correcting or criticizing errors.

Aphasia - a language disorder caused by 8. Reassure the person that it is okay to be

damage in a specific area of the brain that frustrated, but avoid empty platitudes such

controls language expression and as “You’ll be fine.”

comprehension due to stroke. 9. Avoid asking questions that require

information or recall, such as “How was

Commonly recommended approach for your day?”

Older adult with Aphasia: 10. Use gestures or demonstrate an action so

1. Keep messages simple but adult. that the person can mimic your behavior.

2. Use nonverbal modes of communication, 11. Avoid the use of an intercom, which may

such as picture boards, gestures, yes/no confuse the person.

responses, and facial expressions. 12. Avoid arguing if the person does not

3. Use visual aids to support. accept your reality.

13. Redirect the person who is acting out to a

Dementia – impaired ability to remember, think more appropriate activity.

or make decisions that interferes with doing 14. Share activities such as looking at a

everyday activities magazine, viewing family photos, or

listening to music.
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 NCM 114: CARE OF OLDER ADULT
15. Avoid trying too hard to communicate. If
words do not work, try gentle touch.
16. Watch your tone of voice because patients
with dementia are often very sensitive to
nonverbal cues and may sense your
frustration and become more agitated or
upset.
SKILLS AND TECHNIQUES IN
family members, and visitors of your
patient. These people make up the older
adult’s social network and support system.
Families and friends are interested and
concerned about what is happening to their
loved ones.
 Delivering Bad News
How the Nurse can break bad News to

COMMUNICATION Older Adults

1. Prepare yourself. Make sure you have all
 Informing uses direct statements regarding
of the information and that it is accurate.
facts. A good information statement is
Think through what you want to say so that
clear, concise, and expressed in words the
the message is compassionate and
patient can understand.
culturally sensitive.
2. Establish an environment respectful of
 Direct Questioning - it is best to keep
patient’s privacy.
communication conversational and not too
3. Determine whether anyone else (chaplain,
aggressive.
family members, etc.) should be present
when the news is delivered.
 Using Open-Ended Techniques - open-ended
4. Make sure there is adequate time, free
communication techniques include open-
from interruptions, to deal with the
ended questions, reflective statements,
expected emotional response.
clarifying statements, and paraphrasing.
These techniques allow the patient more
leeway to respond, thus establishing a MAINTAINING FLUID BALANCE AND
more empathetic climate. MEETING NUTRITIONAL NEEDS
 Nutrition of Aging
 Confronting - confronting is used when  Nutritional needs do not remain static
there are inconsistencies in information or throughout life. Like other needs, older
when verbal and nonverbal messages adults’ nutritional needs are not exactly
appear contradictory. the same as those of younger
individuals. An understanding of older
 Communicating with Visitors and Families - adults’ nutritional needs is essential to
be prepared to interact with the friends, providing good nursing care.
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 NCM 114: CARE OF OLDER ADULT
 To assess nutritional adequacy and  Many factors influence how many
select interventions that promote good calories will be used by a person:
nutrition, nurses must be activity patterns, gender, body size,
knowledgeable about basic nutrition age, body temperature , emotional
and diet therapy. status, and the temperature of the
climate in which the person lives.
 Good nutrition practices play a vital
role in health maintenance and health  Basal Metabolic Rate
promotion.  (the rate at which the body uses
calories) decreases.
 Good eating habits throughout life
promote physical wellness and mental  The normal decrease in physical
well-being. activity commonly seen with aging
further slows the rate at which the body
 Inadequate nutrition and fluid intake burns calories.
can result in serious problems such as
malnutrition and dehydration.  Healthy individuals who maintain an
active lifestyle that includes exercise
 Poor nutrition practices can contribute may see little need to change their
to the development of osteoporosis caloric intake.
and skin ulcers, and can complicate
existing conditions, such as  Inactive individuals may need to
cardiovascular disease and diabetes restrict caloric intake significantly.
mellitus.
 The lowest recommended daily intake
 Caloric Intake to adequately meet nutritional needs is
 Calories are units of heat that are used 1,200 calories.
to measure the available energy in
consumed food. Because people’s WAYS TO INCREASE PROTEIN
energy requirements differ widely, the INTAKE
number of calories they require also
 Add eggs. Add extra whites to pancakes,
differs significantly.
omelets, and scrambled eggs; add
hardboiled eggs to casseroles and salads.

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 NCM 114: CARE OF OLDER ADULT
 Add cheese. Sprinkle on salads, melt on  An obese older adult may be malnourished
sandwiches, serve on crackers, add to whereas someone thin may be well
casseroles, use to top vegetables, blend in nourished
mashed potatoes, use in cheesecake.
 Frailty syndrome in older adults, a
 Add milk, cream, and yogurt. Add when syndrome characterized by increased
baking or making pancakes. Use in hot susceptibility to stressors that can lead to
cocoa, sauces, milk shakes, smoothies, on negative health outcomes and functional
fruit, with cereal, as a desert topping. impairment.

 Add legumes and beans. Cook these in soups  The associated nursing diagnosis Frail
and stews. Use bean curd on salads. Elderly Syndrome can be used to address
Serve ethnic dishes made with chickpeas, this complex problems
such as hummus or falafel.
 Nurses working in all health care settings
 Add peanut butter. Use in cookies, as a dip must assess, plan, and implement
for fruit or vegetables, in sauces, and on strategies to maintain or improve the
sandwiches. nutritional status of the older adults in their
care.
MALNUTRITION AND THE OLDER
ADULT FACTORS AFFECTING NUTRITION
 Malnutrition is defined as a disorder of IN OLDER ADULTS
nutrition resulting from unbalanced,  Chronic health factors such as chronic
insufficient, or excessive diet or from obstructive pulmonary disease, chronic
impaired absorption, assimilation, or use of heart failure, arthritis, dementia, and many
food. others can interfere with obtaining and
preparing adequate nutritional food.
 The risk for developing nutritional
deficiencies increases with aging, but PHYSIOLOGIC HEALTH FACTORS
determining nutritional status can be  Alcoholism is suspected to be a risk factor
challenging. in a larger percentage of older adults than
is commonly recognized. Although small
 Older adults who appear to be healthy may amounts of alcohol may stimulate the
have unhealthy nutritional practices.
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 NCM 114: CARE OF OLDER ADULT
appetite, consumption of large amounts of  Problems with chewing, swallowing, or
alcohol suppresses appetite, interferes digesting are common causes of impaired
with the absorption of essential nutrients, nutrition. Poor oral hygiene, lost teeth,
and all too often takes the place of meals. cavities, poorly fitted dentures, and
decreased oral secretions affect the taste
 Sensory changes can cause problems with of food and can interfere with the ability of
safe preparation and storage of food. the older person to chew foods.
Reading small print on labels can be
difficult for an individual with presbyopia,  Malabsorption caused by decreased
cataracts, or other vision problems seen production of digestive enzymes can
with aging. This can be problematic for interfere with protein break- down and
someone on a restricted diet who needs to absorption of vitamin B12, calcium, and
read the label to choose foods that are folate.
permitted. Older adults with altered senses
of taste and smell may not be able to ECONOMIC RISK FACTORS
detect the changes that indicate spoilage.  Cost of food is a concern for many older
If spoiled food is eaten, the risk for GI adults with limited income. They may skip
infection or upset is increased. meals or consume inadequate portion to
save money.
 Pain, whether it is chronic or acute, can
interfere with an older person’s appetite  Difficulty getting transportation to obtain
and desire to procure, prepare, and food is a serious problem for older adults,
consume food. particularly those who live alone.

 Medications can cause an unpleasant  Obtaining an appropriate variety and

change in the taste of food; suppress
appetite; or cause nausea and vomiting.
Other medications, such
antihypertensives, drugs used to treat
Parkinson disease, bronchodilators, and
antidepressants can cause a dry mouth,
which makes chewing and swallowing
more difficult
sufficient amount of food can be difficult for
older adults. Most foods are packaged in
as sizes appropriate for families of four or
more.
SOCIAL RISK FACTORS
 Loneliness or social isolation is one of the
more common risk factors for nutritional
problems in older adults.
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 NCM 114: CARE OF OLDER ADULT
 Lack of motivation to cook is commonly an
issue for older adults. Preparing food for
one or two people can be more difficult.
 Metabolic disorders (diabetes, thyroid
disturbances)
 Neurologic or musculoskeletal problems
that interfere with food preparation, eating,
or swallowing
Special dining tables are used for assistive dining
 Disturbances of the gastrointestinal tract
programs. Residents are fed three at a time, in the
 Inadequate resources to obtain food
company of others. (From Sorrentino SA: Mosby’s
 Loss of nutrients as a result of medication,
textbook for nursing assistants, ed 7, 2008, St.
hemorrhage, vomiting or diarrhea.
Louis, Mosby.)
 Inadequate or excessive energy because
of exercise or disease process.
RISK FACTORS FOR DEFICIENT
 Living alone
 Selective eating habits related to culture
FLUID VOLUME IN OLDER ADULTS
or habits.  Altered swallow reflex (patients with stroke)

 Grief or other emotional difficulties.  Nausea and an unwillingness to eat or

drink

Nursing home residents enjoy a pleasant meal in  Acute emotional distress and decreased

the dining room. (From Kostelnick C: Mosby’s interest in personal needs

textbook for long-term care nursing assistants, ed  Inability to obtain adequate fluids without
7, 2015, St. Louis, Mosby.) assistance (bedridden patients)

NURSING CARE PLAN

RISK FOR ASPIRATION
Mr. Thomas is a 74-year-old man who
recently suffered a stroke. His level of
consciousness is decreased, he has no gag
reflex, and the left side of his face shows some
paralysis. His physician has ordered
intermittent feedings (every 4 hours) of a
commercial nutrient solution through a
nasogastric tube.
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 NCM 114: CARE OF OLDER ADULT
NURSING DIAGNOSIS 6. Allow adequate time (approximately 30
Risk for aspiration minutes) for instillation of 250 mL.

DEFINING CHARACTERISTICS 7. Keep the head elevated for 30 to 45 minutes

 Decreased level of consciousness after feeding.
 Facial paralysis
 Absence of gag reflex 8. Keep suction equipment at the bedside.
Check at regular intervals to verify that this
PATIENT GOALS/OUTCOMES equipment is functioning properly.
IDENTIFICATION
Mr. Thomas will remain free from EVALUATION
episodes of aspiration. Physical assessment reveals no signs
of stomach distention. The residual stomach
NURSING contents before feedings range from 25 to 70
INTERVENTIONS/IMPLEMENTATION ml. No episodes of coughing or silent tearing
1. Assess for signs of stomach distention, are noted with feedings. His lungs are clear on
cough, or excessive respiratory secretions auscultation. You will continue the plan of care.
during each feeding.

MEDICATIONS OF
2. Position Mr. Thomas in the Fowler position
before feeding OLDER ADULTS
FACTORS THAT INCREASE THE RISK FOR
3. Verify placement of the nasogastric tube
MEDICATION-RELATED PROBLEMS
using approved methods before each feeding.
 Drug-testing methodology
 Physiologic changes related to aging
4. Measure the stomach contents before
 Use of multiple medications, OTC
beginning feeding. Withhold feeding and notify
medications, and herbal supplements
the primary care provider if the volume of
 Cognitive and sensory changes
stomach contents is greater than 50 to 100 mL.
 Knowledge deficits
 Financial concerns
5. Return the stomach contents through
nasogastric tube.

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 NCM 114: CARE OF OLDER ADULT transplant rejection, cancer, respiratory
FACTORS AFFECTING DRUG RESPONSE
disorders, and antidepressants
IN OLDER ADULTS
Chamomile Calms upset - Increases bleeding for people on
 Pharmacokinetics is the study of drug
stomach, Helps warfarin; intensifies effect of sedatives
actions within the body, including with sleep  Ginseng – Boost Immune
System; lowers blood sugar;
absorption, distribution, metabolism, and improves learning

excretion.
 Green tea - Numerous claims
 Drug Absorption including prevention cancers
promotion of weight loss;
 Drug Distribution
alleviates stomach disorders,
 Drug Metabolism and many others

 Drug Excretion  Soy - Helps with high

 Pharmacodynamics - responses to cholesterol, hypertension,

Diabetes and other claims
medications are less predictable in the
 Glucosamine sulfate – helps
aging person. Pathologic changes in target
and relieves pain and arthritis
organs may affect the response to
medications.
FAT-SOLUBLE VITAMINS
Vitamin A Found in milk, butter, cheese, fortified margarine, liver, green and
yellow vegetables, and fruits Promotes healthy epithelium, ability to see in
 Polypharmacy, the prescription,
dim light, normal mucus formation
administration, or use of more medications
Many older people may be deficient in vitamin A because of chronic
than are clinically indicated, is a common conditions that interfere with fat absorption, such as gallbladder disease

problem in older adults . and colitis

Vitamin D Found in fortified milk and margarine, cod liver oil, fatty fish, and
eggs Promotes absorption of calcium
SELECTED HERBAL AND
SUPPLEMENT CONSIDERATIONS May contribute to skeletal changes with aging

FOR OLDER ADULTS Vitamin E Found in corn and safflower oils, margarine, seeds, nuts, and
leafy green vegetables
HERB OR HEALTH CLAIM OLDER ADULT
SUPPLEMENT CONSIDERATIONS
Promotes integrity of red blood cells
Black Cohosh decreases hot Increases the effects of digoxin
flashes and other and antihypertensives
Vitamin K Found in leafy green vegetables and liver; synthesized by
menopause
bacteria in the colon Essential for formation of prothrombin, which is
symptoms.
necessary for blood clotting
Ginkgo Biloba Improves memory; Can cause excessive bleeding,
improves blood especially if anticoagulants among
WATER-SOLUBLE VITAMINS
circulation in the older adults.
Vitamin B1 (thiamine Found in organ meats, pork, legumes, and whole
brain.
grains hydrochloride) Essential for carbohydrate metabolism

St. John’s Wort Relieves Reduces the effect of at least a dozen

Vitamin B2 (riboflavin) Found in milk, cheese, eggs, organ meats, legumes,
depression. cardiac medications; interferes with
and leafy green vegetables
numerous other
medications, including medications for

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 NCM 114: CARE OF OLDER ADULT
Essential for normal tissue maintenance and tear production

Niacin Found in lean meats, liver, whole grains, and legumes

Essential for energy release from fats, carbohydrates, and proteins

Vitamin B6 (hydrochloride) Found in whole grains, vegetables, legumes, m

eats, and bananas Acts in the processes of protein synthesis and amino aci
d metabolism

May interact with levodopa (taken by patients with Parkinson disease)

Folacin (folic acid) Found in whole wheat, legumes, and green vegetables
Important in hemoglobin synthesis and in metabolism of amino acids

Common deficiency in older adults

Vitamin B12 Found in muscle and organ meats, eggs, shellfish, and dairy p
roducts
(cyanocobalamin) Requires production of intrinsic factor by the stomach for
absorption; inadequate absorption

can result in pernicious anemia

Needed for maturation of red blood cells
Deficiency is commonly seen with folacin deficiency
Vitamin C (ascorbic acid) Found in citrus fruits, tomatoes, cabbage, melons
, strawberries, green peppers, and leafy green vegetables

Important in the formation and maintenance of collagen structure of connec

tive tissue Promotes healing and elasticity of capillary walls

15