NUTRITION

Ten Tips for Teaching

PEGGY KLOSTER YEN

Nurses are in an excellent position tohelp.elders improve their nutritionalstatus. Nurses' influence is direct­feeding debilitated patients-or in­direct-suggesting changes in mealservice or teaching staff how to im­prove nutrition.

Here are 10 tips to keep in mindwhen you are counseling older adultsabout diet.

1. Many physical, environmental,and economic factors can adversely'affect the nutritional status ofolderindividuals.TRUE

Elderly people may be at risk ofnutritional deficiencies for a numberof reasons. Disability, sensory defi­cits, digestive problems, ~hronic dis­ease, depression, and other ailmentscan impair appetite and lead to poorfood intake.

Lack of money, adequate housing,and nutrition knowledge are all re­lated to nutritional status. Attentionto these and other factors affectingnutrition can guide nurses in makingassessments.

2. Vitamin and mineral supple­ments are not necessary for most el­derly people.TRUE

Statement ifl seems to suggest aneed for elders to take vitamin andmineral supplements, even if it's justfor insurance. The truth is that un­less a deficiency exists, a supplementcan be a waste of money. And sup­plements that exceed the Recom­mended Dietary Allowance for nu­trients can be dangerous.

3. Older people shouldn't eatmuch starchy food.FALSE

United States Dietary Guidelines

Peggy Kloster Yen, RD, MPH, is a nutritionconsultant, Preventive Medicine Administra­tion. Maryland Department of Health andMental Hygiene, Baltimore.

112 Geriatric Nursing March/April 1986

recommend that all Americans eatadequate amounts of starch-contain­ing foods because they are a sourceof many essential nutrients and fi­ber. Contrary to popular belief,

. starch is no more fattening than pro­tein and a lot less fattening than fatitself. Starch has less than half thecalories of fat.

Perhaps the reason for starch'sbad reputation is that it's thought ofas poor people's food whereas meatis considered rich man's food. Wewould all be richer, thinner, andhealthier if we ate less meat ,andmore foods that are high in starch,such as breads, cereals, beans, andpotatoes.

4. Onions and garlic have specialhealth properties.TRUE

This sounds like the latest fad, butscientists are studying the effects ofgarlic and onion on blood lipids,blood clotting, and blood pressure.Garlic also has antibacterial effects.Both bulbs contain a substance orsubstances that increase HDL cho­lesterol (the "good" cholesterol) anddecrease blood clotting factors. Gar­lic's ability to lower blood pressure isbeing investigated.

But don't encourage elders to eatexcessive amounts of these foods. Be­sides the social consequences of badbreath, excess amounts may not dothem any good. The amounts neededto produce any of the mentioned ef­fects are more than a palatable dietcontains. Garlic 'capsules that arecommercially available may be over­processed and have no healthfulproperties.

5. Elderly people often have"iron-poor blood" and should takeiron-rich supplements.FALSE

Only 4.4 percent of elderly menare anemic, according to the latestNHANES data.* And anemia iseven less prevalent among older

women. These statistics do not war­rant wholesale iron supplementationfor the old.

Supplementation of any nutrientshould begin only after thorough as­sessment. Although rare, there is arisk of excess iron accumulation,which may lead to hemochromatosisand possibly death.

6. Older women need more cal­cium than younger women.TRUE

Postmenopausal women who arenot taking estrogen need 1,500 milli­grams of calcium a day to help pre­vent osteoporosis. Postmenopausalwomen. treated with estrogen need1,000 milligrams daily, the sameamount as women who are men­struating.

Milk and milk products are thebest source of calcium, providingabout 300 milligrams per glass ofskim milk. When calcium supple­ments are needed, the best form iscalcium carbonate.

7. All old persons have higher nu­trient requirements than young per­sons have.FALSE

Healthy older people need thesame amount of most nutrients, ex­cept calcium, as they did when theywere young. They may actually needless of certain nutrients, such as ri­boflavin. This B vitamin is related tocalorie intake, and adults need fewercalories as they age.

Calcium is one exception to thepreceding . statements. And, ofcourse, acute infection or chronicdisease can increase the need for nu­trients in individual cases.

8. Certain foods or nutrients af­fect behavior adversely by causingdepression or by interfering withmental proccesses.TRUE

·National Health & Nutrition ExaminationSurvey.

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1801 Adams Avenue, P.O. Box 1922. San Lean dro , CA 94577. (415) 638 -5040

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Rhode Island Hospital Department ofNursing, "Confusion in the Elderly," Apr.10, at the Sheraton Islander ConferenceCenter. Fee: 540; students: 525. 0.7 CEU.Write: Lorraine Beal, RN, or MargaretBoger, Rhode Island Hospital, NursingEducation and Research Division, 593Eddy Street, Providence, RI 02902, or call(401)277-5721.

The Texas Dept. of Human Services,League of Women Voters, Education Fund,Foundation for Human Services, and Officeof the Governor, "National Debate onHealth Care," Apr. 20-23, at SheratonTowers and Plaza of the Americas hotels,Olive and Pearl Sts., Dallas. Leadingspeakers will address five questions: Shouldthe government require all employers toprovide health insurance? Who should payfor care of the growing number of agedand disabled Americans? Will spiralingcosts force rationing of life-saving services,such as heart and liver transplants? Whomakes these life and death decisions? Whopays-and what about those who can'tafford to pay? Fee: 5320. Write: RoyWesterfield, Symposium Director, P. O.Box 49287, Austin, TX 78765, or phone(512) 450-3005.

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Recent studies have shown that acarbohydrate-rich lunch can impairshort-term mental performance inolder but not younger adults. At­tempts to show that diet causes hy­peractivity or criminal behavior havenot been successful, however.

Mental confusion and depressionare symptoms of pellagra, the dis­ease caused by a deficiency of niacin.Pellagra is rare but may occur in al­coholics or others on severely restric­ted diets.

The effects of food on behaviorand mood require much clearer deli­neation before this information canbe used reliably to aid in the care ofthe elderly.

9. Milk is an important part of abland diet to treat ulcers.FALSE

The myth of milk's blandness per­sists. Although it tastes bland, its ef­fect on the stomach is anything butbland. Milk stimulates the release ofgastric acid, as other protein foodsdo. This doesn't mean that ulcer pa­tients should avoid milk. It meansthat milk isn't a necessary part of abland diet.

The main offenders for ulcer pa­tients are alcohol, coffee, pepper­and an empty stomach.

10. Cytotoxic testing and hairanalysis are effective methods forassessing nutritional problems.FALSE

Neither cytotoxic testing nor hairanalysis is sanctioned by recognizedauthorities in medicine and nutri­tion. The vitamin and mineral con­tent of hair reflects substances usedin shampoos and dye and such indi­vidual factors as age and type ofhair. Hair analysis does not indicatenutritional status.

Cytotoxic testing for food allergyis not recognized as valid by the U.S. Food and Drug Administration orthe American Academy of Allergyand Immunology.

Circle No. 15 on Reader Service CardGeriatric Nursing MarchIApril 1986 113