Download - Nutrition in Older Adults with voice overs
Nutrition and HydrationNutrition and Hydrationin the Older Adultin the Older Adult
ObjectivesObjectives
Discuss demographics related to nutritional issues in older adults.
Assess diet history and nutritional status, with special attention to cultural, ethnic, or religious preferences.
Evaluate anorexia in older adults. Identify contextual factors that contribute to optimal dining
experiences. Plan care to maximize the self-feeding capacity of an older
adult. Plan mealtime care for an older adult with cognitive and/or
physical impairments.
DefinitionsDefinitions
Malnutrition: any disorder of nutrition status
including disorders resulting from inadequate intake (too little in)
over-nutrition (too much in)
improper metabolism Overweight older adults (75+ years)
Men=56.5% Women=52.3%
Obesity in older adults (75+ years) Men=13.2% Women=19.2%
DemographicsDemographics
Frequency of Malnutrition in Older Adults:
Independent Living: 1% TO 15%
Institutionalized: 25% TO 85%
Hospitalized: 35% TO 65%Worsens during hospitalization
Increased RisksIncreased Risks
Malnourished older adults are more likely to experience:Longer hospital staysIncreased hospital costsDiminished muscle strengthFunctional impairments
Increased RisksIncreased Risks
Nutrition affects CO, HR, BPMedications bound to protein have higher levels
Standard dose could be toxic (dilantin/coumadin)
Immune systemPoor wound healing and new pressure ulcers
InfectionsPost operative complications
Higher risk for emboliEdema/ascites and/or diarrhea if protein drops
Death
Factors InvolvedFactors Involved
Progressive loss of lean body mass - decreased BMR
Disease, stress, injury, chronic drug use Overeating and lack of exercise Diminished sense of taste and smell Loneliness Physical and mental handicaps – immobility
and chronic illness
Screening and AssessmentScreening and Assessment
Nutritional Screen needs to be completed within 24 hrs of admission current weight & weight history
Three-day food diary (if memory intact)Assessments should include
Baseline- nutritional patterns, abilities
Lab results- albumin, prealbumin
Unintentional weight loss prior to admission – red flag if 10# in 6 months!
Screening and AssessmentScreening and Assessment
Calorie countsLess than 50% eaten
document and intervene!NPO for more than a few hours Inconsistencies between reported diet
and what you see physically may indicate poverty, elder neglect/abuseFluid intake correlates to food intake
Screening and AssessmentScreening and Assessment
Physical Assessment skin turgor, lesions, color, thick or brittle
hair, muscle wasting, oral status (loose teeth; poorly fitting dentures), oral lesions, beefy red tongue
Serologic parametersprealbumin & serum transferrin (early
markers); serum albumin (late marker)
Diet History and Nutritional Diet History and Nutritional StatusStatus
Other serologic parameterstotal protein, BUN/Creatinine ratio, CBC,
Blood glucose, iron stores, ferritin, B12, lipids
Performance-based functional status Inconsistencies between reported diet
and biochemical / physical parameters
http://www3.utsouthwestern.edu/geriatrics
DehydrationDehydration
50% mortality if untreated Often primary or secondary reason why the
patient is in the hospital Hydration status must be performed on all
older people Normal aging causes decrease in total fluids I/Os are very important!
DehydrationDehydration
Elderly may present differently than younger people, symptoms can be subtle:Irritability, confusion, lightheadedness,
change in mental status, headache, loss of appetite, lethargy (very tired) or fatigue, low urine output or dark urine, constipation, fecal impaction, infection, muscle weakness
Dehydration Dehydration AssessmentAssessment
Poor skin turgor, dry mouth and lips, subtle change in baseline: families may report “Mom doesn’t seem herself today”
DehydrationDehydration
Check Orthostatics A fall in blood pressure of 20mm Hg systolic
(from lying to standing) and/or a rise in pulse by 15 beats per minute
often means a person is dehydrated
Lab tests NA (hyper and hyponatremia) K+ (hyperkalemia) creatinine (not as reliable in elderly- Why?) BUN urine specific gravity urine electrolytes
DehydrationDehydration
Alleviate dry mouth:Avoid caffeine, dry, bulky, spicy, salty foodsSugarless hard candy or chewing gum to
stimulate saliva (not for patients with dementia or dysphagia)
Applying petroleum jelly to lips or denturesFrequent small mouthfuls of waterArtificial saliva
Cognitive and Physical Cognitive and Physical ImpairmentsImpairments
Assess for possible unrecognized diseases or problems
Allow smaller, more frequent meals Cue the person with cognitive impairments Sit next to or across the person Do not use a syringe to feed Schedule staff Burden-free attitude about feeding.
Be ProactiveBe Proactive
Improve oral intake:Mealtime checksEncourage family members Small, frequent intakePain medsPleasant environmentOOB
Be ProactiveBe Proactive
Cues and Gestures Use adaptive devices that work Allow time – use finger foods Difficulty in swallowing referred to SLP. Dysphagia occurs in advancing dementia
patient may eventually lose the ability to swallow and eat or drink.
Supplements
What Do You Think?What Do You Think?
Which of these situations is an example of nosocomial malnutrition?
1. Decreased intake related to a disease process
2. Failure to replace meals held for tests3. Anorexia related to an underlying
eating disorder
What Do You Think?What Do You Think?
Malnutrition in a hospital usually refers to
1. Carbohydrate- fat intake2. Protein-carbohydrate intake3. Fat-protein intake4. Protein-calorie intake
What Do You Think?What Do You Think?
A patient who fails to consume adequate calories and protein is at increased risk for which of these complications?
1. Thromboembolism2. Heart failure3. Hepatitis
What Do You Think?What Do You Think?
A patient who develops hypoalbuminemia related to protein deficiency should be monitored for toxicity to which of these meds?
1. Warfarin2. Dilantin3. Meperidine4. Digoxin
What Do You Think?What Do You Think?
Which of these approaches would you use with a patient whose appetite deteriorates throughout the day?
1. Limit stimulation at meals2. Encourage a big breakfast3. Reduce physical activity4. Offer double portions
Stechmiller, J. K. (2003). Early nutritional screening of older adults. Journal of Infusion Nursing, 26, (3). 170-176.
http://www3.utsouthwestern.edu/geriatrics Guigoz, Y., Bruno, U., & Garry, P. J (1996). Assessing the nutritional status of the
elderly: The Mini Nutritional Status as part of the geriatric evaluation. Nutrition Review. 54, S59-S65.
www.johnahartfordfoundation.org