Oral Health and Smell and Taste Problems in Older Adults

Chapter 6

Age-Related Changes to Oral Cavity

• Changes in olfactory nerves and receptors • Poor chewing and swallowing• Declining sensitivity• Medical conditions• Medication• Nicotine• Caffeine• Alcohol

Oral Cavity• Oral and Pharyngeal cancers

– Survival rate = 50%– Risk factors

• Age• Male • Smoking or smokeless tobacco• Drinking alcohol• Sunlight exposure (lips)• Diet low in fruits and vegetables• HPV

– Infectious diseases

Oral Cavity

• Anatomy of the Oral Cavity

Source: Insel, P, Turner, RE, Ross D. Discovering Nutrition. 2nd ed. Sudbury, MA: Jones and Bartlett, 2006, p 117.

Oral Cavity

• Tongue

Source: NIH SeniorHealth. Problems with taste. July 2005. Available at: http://nihseniorhealth.gov/problemswithtaste/toc.html. Accessed February 13, 2007.

Source: Chernoff, R. Geriatric Nutrition. 3rd ed. Sudbury, MA: Jones and Bartlett; 2006, p. 119.

Tongue

• Physiologic role– Trigger reflex– Enhances pleasure and satiety– Distinguishes nutrients

• Taste dysfunction– May alter food choices and patterns

Problems of the Tongue

• Appearance may indicate nutrition problems– Dehydration– Hypothyroidism– Malnutrition– Black hairy tongue– Geographic red tongue

Salivary dysfunction(dry mouth)

• Xerostomia or hyposalivation– Caused by medication use

• Three pair of salivary glands– Protect tissues– Maintain speech– Chewing and swallowing – Taste perception– Neutralize bacterial acid

Salivary dysfunction (dry mouth)

• Causes of dry mouth– Some chronic illnesses– Depression– Stress– Dehydration

• Often cannot be cured• Treatment options

– Gene therapy to manage this disorder

Dental and Gingival problems

• Periodontal disease– Gingivitis– Periodontitis

Source: NIH SeniorHealth. Problems with taste. July 2005. Available at: http://nihseniorhealth.gov/problemswithtaste/toc.html. Accessed February 13, 2007.

Dental and Gingival problems

• Dental caries– If abscess goes untreated may cause infections in

any part of the body• Increase risk of MI and stroke

• Dentures – Potential problems with food intake

Chemosensory Perception

• Taste perception and olfaction decline– Cells regularly replaced throughout lifespan– Pharmaceutical agents– Pathophysiologic problems and diseases

Taste

• True tastants – Salt – Sugar– Sour– Bitter– Umami

• Ageusia and hypogeusia• A function of multiple nerves in the tongue

Taste• Cause of impaired taste

– Damage to taste buds– Damage to hippocampus of the brain– Nutrition deficiencies– Damage to nerves– Chemotherapy treatments– Loss of third molar– Metallic taste caused by medication use– Persistent salty taste– Loss of salivary gland function

Taste

• Renewal of taste bud cells– Turnover ~ 10 ½ days– Pronounced by age 70– Slower renewal

• Menopause• Protein and zinc shortages

Smell

• Loss of smell– Risk factors– Olfactory receptors are continually renewed

• 30 – 120 days– Caranial nerve 1 carries odors

• Nostrils• Nasopharynx

Smell

• Causes of smell loss– Upper respiratory infection– Head trauma– Rapid head movement– Rhinosinusitis– Exposure to toxic agents– Neurologic diseases

Smell

• Degree of smell loss– Hyposmia– Parosmia– Cacosmia– Anosmia

Flavor

• Taste, smell, appearance, temperature, texture, sound, and feel in the mouth

• Perception impaired in older adults

Causes of Chemosensory Losses in Older Adults

• Sense of smell depends on one nerve• Receptors are lodged in a small sinus region

– Directly exposed to environmental toxins and agents

• Full sense of smell depends on adequate chewing

Causes of Chemosensory Losses in Older Adults

• Impairments of taste and smell caused by– Age-related factors– Medical conditions– Medical treatments (radiation, etc.)– Medication use

Ingredients that Enhance Flavor and Sensory Enjoyment

• Extracts to amplify flavor– Strongly flavored foods and ingredients– Concentrated fruit sauces and jams– Sour– Herbs and Spices– Dry Rubs– Sugar– Fat– Monosodium Glutamate– Wine

Techniques That Enhance Flavor and Sensory Enjoyment

• Foods must appeal to all senses– Visual appeal– Sounds that they produce

Techniques That Enhance Flavor and Sensory Enjoyment

• Choose high-quality foods• Focus on appearance• Arouse hunger• Activate smell memory• Contrast texture, size, and shape• Vary temperature• Liberalize diet• Encourage good mastication

Applications of Flavor Enhancement

• Home and Institutional Menus• Restaurant Menus• Hispanic-Inspired and High-Flavor Cuisine• Appetizers as Entrees

Conclusion

“No food is nutritious unless it is consumed and little food is consumed unless it tastes good.”

“Sensory enhancement of food for older adults makes good sense.”