Nutrition for the Second Half of Life
Full Review

Reviewed by: Cecilia S Acuin, Public Health and Nutrition Consultant, Philippines
Review posted 11 August 2006
Review No. 85

CD-ROM Information

Content: This CD-ROM is designed as a self-directed tool for teaching medical students about nutrition for the elderly. It provides essential information on the relationship between diet and disease in this age group and how genetic, environmental, and lifestyle conditions influence aging, response to intervention, and therapeutic outcomes.
Publication Date: 2 January 2002
Audience: Although intended for US medical students, the module can serve as an excellent review or guide about nutrition of the elderly for all health professionals. Users will need a good command of spoken and written English, an understanding of basic human anatomy, physiology, biochemistry, and pathology, as well as knowledge of the US health care system in order to recognize what may or may not be directly applicable to their own settings.
Producer: Medeor Interactive Information
Size: 558MB
Price: US$29.95/Free to medical schools
Manual needed: No, as clear instructions are given at the start of the CD-ROM.
How to order:

Download order form for audiences other than medical schools.*

Order online for medical schools.*

*These links take you outside the ADBI website. Please use the back button to return to ADBI.org.

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Full Review

Content Overview

This CD-ROM is a tool for teaching medical students about nutrition in the elderly. It presents the normal aging processes that affect nutrition as well as the nutritional contributions to the well being of the elderly. There is detailed coverage of nutrition problems and issues in disease, and the care and management of the elderly with these conditions in the home, institution or hospital settings. Although produced for teaching medical students in the US, the CD-ROM can serve as an excellent guide for all health professionals.

The material is organized into five sections:

Part 1: The aging body describes the physical changes that take place starting at around 45 years of age. It focuses on changes that affect diet and other factors that influence the pace of aging. The diversity of the elderly is emphasized: every person ages differently depending on genetic and environmental factors as well as lifestyle choices.

Part 2: The needs of older adults discusses fluid and nutrient requirements. Strategies for managing nutritional problems are made specific to the living conditions of the elderly – at home in a community, in a long-term care institution, or when hospitalized for other conditions.

Part 3: Lifetime exposure deals with the interaction between nutrition and disease in the elderly. There is a strong emphasis on chronic diseases and how nutrition, due to inherited and acquired characteristics, might alter the consequences of these diseases.

Part 4: Age-typical diseases is about primary, secondary, and tertiary nutrition intervention approaches among the elderly that might influence the progression of common diseases. Such diseases discussed are cardiovascular disease, diabetes, cancer, osteoarthritis, and osteoporosis.

Part 5: Nutritional rehabilitation talks about the nutritional consequences of these diseases, the nutritional deficiencies common in ill elderly people, and possible interventions for these conditions. There is also a short discussion of drug-nutrient interactions, and the role of nutritional supplements in this age group.

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Content Comments

Each section begins with the learning objectives and ends with a summary of the key concepts and a short quiz. Throughout the section there are video discussions with a physician/teacher, several actual patient examples, quizzes, graphic illustrations (in some cases, interactive), and occasional opportunities for feedback.

Two cases – one of a relatively healthy woman, and the other of a diabetic, hypertensive man – are presented to illustrate the information needed, the decision-making process, and the actions physicians might take to manage nutritional concerns of elderly patients. Quality of life is emphasized as an important consideration in selecting recommendations for patients in this age group.

The accompanying manual is a guide to the material covered in the CD-ROM. Built-in software facilitates use of the manual. There is an extensive glossary of terms and concepts as well as key clinical information cards for some of the nutrition pages. There are up-to-date reference and reading lists and a link to the University of North Carolina-Nutrition in Medicine (UNC-NIM) website for access to online web courses, nutrition websites, instructor assistance, and other nutrition education opportunities. The reference section includes videos on how to carry out basic anthropometric measurements. This section also includes an audio-based tutorial on how to read nutrition labels and notes on nutritional allowances and how to conduct a nutritional assessment. Additionally, an index of nutrition supplements commonly used in the US and normal ranges of related diagnostic tests are included.

This CD-ROM is for self-directed learning and concepts are reinforced in several ways, not only through exams. It is an engaging and challenging teaching tool. The presentation is down-to-earth and occasionally humorous: there are even songs about the key concepts interspersed. Each section increases in complexity so that users are pushed one step further in their learning.

Specific Comments on Applicability for Asians

It is important for users to be guided by an instructor, particularly if they are not American-based. There are assumptions about health care protocols and the availability of tests, equipment, and patient care practices that may be different in Asian countries. The context in which the elderly in Asia live may differ: long-term institutional care is not common and many Asian elderly continue to live in an extended family situation. This might present other management choices and considerations, not the least of which is financial.

A separate set of Body Mass Index (BMI) cut-offs for Asians are being debated because of differences in body build. The instructor may help guide a separate discussion on this based on the available literature for further learning. This is not covered in the CD-ROM.

Food examples and dietary recommendations will need to be contextualized to the Asian setting. Milk and other dairy products may not be acceptable since a large proportion of adult Asians are lactose-intolerant. Soy, fish, and seafood products may be more accessible and preferred in Asia than in the US. Vegetarian diets are also more common in Asia: this may not have been given much attention in the CD-ROM because a smaller proportion of Americans are vegetarians.

The section on dietary and nutritional supplements will certainly differ, even if many Asian herbal treatments are available in the US market. The use of alternative and complementary nutritional and health practices and products is far more prevalent and complex in many parts of Asia compared to the US. Herbal supplements are much less regulated and standardized and are therefore more difficult to assess in Asia.

The material and exams are based on US medical board requirements, and this may be of interest to students considering further training and practice in the US.

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User-Friendliness and Navigability

The CD-ROM is easy to use even for novices. It does not require an internet connection except to access the provided reference links. The menu, instructions on how to use, and volume control keys are always on screen and can be changed any time without losing continuity. There are some moments of hesitation when a video begins, but the screening always proceeds smoothly thereafter.

Each time when starting there is a note that reminds users of a continuing session and allows them to choose to continue or start a completely new session. It is easy to return to the last section accessed because a marker appears on the sections completed. However, users need to go through the different parts and pages of that section to find where they left off. Moving to unopened pages is not possible, although it is easy to move back. It would be useful to have page numbers on the menu so users could move from one part to another depending on their interest. A facility to insert a bookmark would also be helpful.

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Interactivity

There are many effective interactive facilities that reinforce learning: quizzes, exams, video discussions, and engaging exercises. For example, there is a sliding scale of energy expenditure to illustrate the effect of body build, and a food plate exercise to show how requirements can be met with different food combinations.

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Distribution

The CD-ROM can be ordered free online by medical schools. It can be ordered for US$29.95 by audiences other than medical students by e-mail or fax. Details for both parties are noted above in the "How to Order" section.

From August 2006 the UNC-NIM started posting its courses online. This particular course is not on the public demo site, but the demonstration course on Pediatric Overweight has the additional features of allowing the user to make notes, mark the pages of interest, and tap into online weblinks for related learning opportunities. The online course also requires a fast and stable internet connection for optimum use. Back to Top

Sustainability

Research and technology on the needs of the elderly is proceeding at such a fast rate that it may be necessary to update this material within the next few years. For this reason the online course might actually be a better option, as it would be easier to update with more current information.

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