· web viewadults over 50, and especially those over 70, have different nutritional needs than do...

• Nutrition for Older Adults

Chapter 13

• Nutrition for Adults and Older Adults

• Adulthood represents a wide age range from young adults at 18 to the “oldest old”

• Adults over 50, and especially those over 70, have different nutritional needs than do younger adults

• Aging and Older Adults

• Aging is a gradual, inevitable, and complex process

• Eventually leads to impairment of organs, tissues, and body functioning

• Some changes have nutritional implications

• How and why aging occurs is unknown

• Most theories are based on genetic or environmental causes

• Aging and Older Adults (cont’d)

• Aging demographics

– Older adults, especially those older than 75 years of age, represent the fastest-growing segment of the American population

– Life expectancies at both 65 and 85 have increased

o Women and men who live to 65 can expect to live an average of 18.7 more years

o For those who live to 85:

Women will survive an average 7.2 years more

Men will survive an average 6.1 years more


• Aging demographics (cont’d)

– Heterogeneous group

o Varies in age, marital status, social background, financial status, living arrangements, and health status

– Approximately 80% of adults older than 65 years of age have one chronic health problem

– People define wellness and illness differently as they age


• Healthy aging

– Genetic and environmental “life advantages” have positive effects on both length and quality of life

– Preventing disease is the key to healthy aging

– Good nutrition

– Exercise

– Evidence shows that initiating healthy changes even in one’s 60s and 70s provides definite benefits


• Nutritional needs of older adults

– Knowledge growing

– Health status, physiologic functioning, physical activity, and nutritional status vary more among older adults (especially people older than 70 years of age) than among individuals in any other age group

– Calorie needs decrease yet vitamin and mineral requirements stay the same or increase

– 2 DRI groupings exist for mature adults

o People aged 51 to 70

o Adults over the age of 70


• Nutritional needs of older adults (cont’d)

– Calories

o Needs decrease with age

o Changes in body composition

o Physical activity progressively declines

o Estimated 5% decrease in total calorie needs each decade

o Undesirable consequences of aging can be improved or reversed

– Aging and Older Adults (cont’d)


– Protein

o The RDA for protein remains constant at 0.8 g/kg for both men and women from the age of 19 and older

o Estimated that 7.2% to 8.6% of older adult women consume protein below their estimated average requirement



– Protein (cont’d)

o Factors that may contribute to a low protein intake

Cost of high-protein foods

Decreased ability to chew meats

Lower overall intake of food

Changes in digestion and gastric emptying

o Groups at risk for inadequate protein intake

Oldest elderly

Those with health problems

Those in nursing homes

• Question

• Is the following statement true of false?

Approximately 60% of adults older than 65 years of age have one chronic health problem.

• Answer

False.

Rationale: Approximately 80% of adults older than 65 years of age have one chronic health problem.



– Water

o The AI for water is constant from 19 years of age through age 70 and above

o Represents total water intake

o Elderly are able to maintain fluid balance

o Altered sensation of thirst and an age-related decrease in the ability to concentrate urine increases risk for:

Dehydration

Hyponatremia



– Fiber

o The AI for fiber is based on median intake levels observed to protect against coronary heart disease

AI for fiber is 38 g/day for men through age 50 and 30 g/day thereafter

AI for fiber is 25 g/day for women from 19 to 50 years of age and 21 g/day thereafter



– Vitamins and minerals

o Most recommended levels of intake for vitamins and minerals do not change with aging

o Significant exceptions:

Calcium

Vitamin D

Iron for women

o DRI for sodium decreases

o People over 50 are advised to consume most of their B12 requirement from fortified food or supplements


• Modified MyPyramid for older adults

– Differs from MyPyramid in that:

o Physical activity forms the base of the pyramid

o 8 glasses of water appear just above physical activity

o Nutrient-dense food choices are used to illustrate each food group

o A flag appears at the top to alert older adults to their unique nutrient needs

o Is available in print form


• Modified MyPyramid for older adults (cont’d)

– Additional tips for healthy eating

o Limit foods with added sugar

o Choose healthy fats to limit the intake of saturated and trans fats

o Limit sodium by eating less salt and buying reduced-sodium soups and frozen entrees

o Choose high-fiber grains

o Aging and Older Adults (cont’d)

• Nutrient and food intake of older adults

– As calorie needs decrease with aging, so does the quantity of food eaten and the amount of calories consumed

– Mean calorie intake falls by 1,000 to 1,200 calories/day in men and 600 to 800 calories/day in women

– Nutrients with mean intakes less than the DRI

o Vitamin E, magnesium, fiber, calcium, and potassium


• Nutrient and food intake of older adults (cont’d)

– Consume less fruit and vegetables

– Older adults need to improve their intakes of:

o Whole grains

o Dark green and orange vegetables

o Dried peas and beans

o Fat-free and low-fat milk and milk products

– Snacking in older adults may help ensure an adequate intake


• Vitamin and mineral supplements

– In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods

o 50% of older adults have inadequate intakes of vitamin E and magnesium

– Supplements tend to have a positive impact on nutritional adequacy for adults 51 and older


• Nutrition screening for older adults

– Older adults at greatest risk of consuming an inadequate diet are those who are:

o Less educated

o Live alone

o Have low incomes

– Identifying nutritional problems in older adults can be a challenge

• Question

• Which older adult is at greatest risk of consuming an inadequate diet?

a. Lives with family

b. Is married

c. Has and adequate income

d. Is less educated

• Answer

d. Is less educated

Rationale: Older adults at greatest risk of consuming an inadequate diet are those who are less educated, live alone, and have low incomes.

• Screening Criteria for Malnutrition in Older Adults

• Disease

– Do you have an illness that makes you change the kind and/or amount of food you eat?

• Eating poorly

– Do you eat fewer than 2 meals/day? Do you eat few fruits, vegetables, or milk products? Do you have 3 or more drinks of beer, liquor, or wine almost every day?

• Tooth loss/mouth pain

– Do you have tooth or mouth problems that make it hard for you to eat?

• Screening Criteria for Malnutrition in Older Adults (cont’d)

• Economic hardship

– Do you sometimes not have enough money to spend on the food you need?

• Reduced social contact

– Do you eat alone most of the time?

• Multiple medications

– Do you take 3 or more prescribed or over-the-counter dugs a day?


• Involuntary weight loss/gain

– Have you gained or lost 10 pounds in the last 6 months without trying?

• Needs assistance in self-care

– Are you sometimes not physically able to shop, cook, and/or feed yourself?

• Elder years above age 80

– Are you older than age 80?

• Nutrition-Related Concerns in Older Adults

• Should be client-centered and based on the individual’s physiologic, pathologic, and psychosocial conditions

• Overall goals of nutrition therapy for older adults

– Maintain or restore maximal independent functioning and health

– Maintain the client’s sense of dignity and quality of life by imposing as few dietary restrictions as possible

• Nutrition-Related Concerns in Older Adults (cont’d)

• Cataracts and macular degeneration

– Prevalence of cataracts and age-related macular degeneration (AMD) are increasing as the population of older Americans increases

– AMD is the major cause of legal blindness in North America

– Appears that a multivitamin/multimineral supplement containing vitamin C, vitamin E, beta carotene, and zinc is effective in slowing AMD but not cataracts


• Cataracts and macular degeneration (cont’d)

– Observational studies show that a diet rich in antioxidants, especially lutein and zeaxanthin, and omega-3 fatty acids benefits AMD and possibly cataracts

– People who eat diets high in refined carbohydrates (high glycemic index) are at greater risk of AMD progression than people who eat a less refined carbohydrates


• Functional limitations

– Aging causes a progressive decline in physical function

– Major causes of functional limitations among older adults include:

o Arthritis

o Osteoporosis

o Sarcopenia

– Nutrition-Related Concerns in Older Adults (cont’d)

• Functional limitations (cont’d)

– Arthritis

o A leading cause of functional limitation among older adults

o Osteoarthritis (OA) is associated with aging and normal “wear and tear” on joints

Knee is the most commonly affected joint

Excess body weight is the greatest known modifiable risk factor

• Question

• Is the following statement true or false?

Nutrition-related concerns of older adults include cataracts and macular degeneration.

• Answer

True.

Rationale: Nutrition-related concerns of older adults are cataracts and macular degeneration and functional limitations such as arthritis, osteoporosis, and sarcopenia.


• Arthritis (cont’d)

– Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise, trauma, and bone density

– Symptoms of OA usually appear after the age of 40 and by 65 years of age or above

– Objective of treatment is to control pain, improve function, and reduce physical limitations



– Osteoporosis

• Bone remodeling

• After menopause, women experience rapid bone loss related to estrogen deficiency

• Estimated direct-care costs of osteoporotic fractures are $12 to $18 billion annually

• Process actually begins early in life



• Osteoporosis (cont’d)

– Interventions implemented late in life can effectively slow or halt bone loss

• Sarcopenia

– Defined as loss of muscle mass and strength

– Chronic muscle loss is estimated to affect 30% of people over the age of 60 and may affect more than 50% of those over 80 years of age

– Related to a sedentary lifestyle and less-than-optimal diet


• Sarcopenia

– Strength training using progressive resistance is the best intervention shown to slow down or reverse sarcopenia

– Adequate protein intake is also essential


• Alzheimer’s disease (AD)

– Most common form of dementia in the U.S., it affects an estimated 4.5 million Americans

– Risk of AD increases with increasing age

– Cause of AD is unknown and there is no cure

– Genetic and nongenetic factors (e.g., inflammation of the brain, stroke) have been identified in the etiology of AD


• Alzheimer’s disease (AD) (cont’d)

– Development of AD may also be related to oxidative stress

– People who eat fish have less cognitive decline than people who do not eat fish

• DHA, an omega-3 fatty acid, may offer some protection against AD

– AD can have a devastating impact on an individual’s nutritional status


• Obesity

– Major public health problem

– Appropriateness of treating obesity in older adults is controversial

• Weight loss can be harmful to older adults

– Goal of weight loss therapy for older adults should be to improve physical function and quality of life


• Social isolation

– Eating alone is a risk factor for poor nutritional status among older adults

• Congregate meals

• Meals on Wheels

• Modified diets, such as diabetic diets and low-sodium diets, are provided as needed

• Long-Term Care

• Residents tend to be frail elderly with multiple diseases and conditions

• Estimated 23% to 85% of long-term–care residents suffer from malnutrition or dehydration

• Malnutrition has a negative impact on both the quality and length of life and is an indicator of risk for increased mortality

• Have same risk factors as those who live independently

• Long-Term Care (cont’d)

• Additional risks among long-term–care residents include:

– Loss of appetite

– Pressure ulcers may be a symptom of inadequate food and fluid intake

– Dysphagia

– Loss of independence, depression, altered food choices, and cognitive impairments can negatively impact food intake


• The downhill spiral

– Loss of appetite is a major cause of undernutrition in long-term care

– Undernutrition increases the risk of illness and infection

– Undernutrition is exacerbated and a downward spiral ensues

– Minimum Data Set (MDS) requires food intake be assessed so that residents at risk from inadequate intake are identified

– Long-Term Care (cont’d)

• The downhill spiral (cont’d)

– Intake assessment system is flawed:

• Food intake records may be neglected

• Lack of skill in accurately judging the percentage of food consumed

• A practical approach to convert individual item estimates into meaningful estimates not assessed

– Question

• What is a risk among long-term–care residents?

a. Dependence

b. Dysphagia

c. Overhydration

d. Increased appetite

• Answer

b. Dysphagia

Rationale: Additional risks among long-term– care residents include loss of appetite, pressure ulcers, dysphagia, loss of independence, depression, altered food choices, and cognitive impairments.


• Preventing malnutrition

– A quality of life issue

– Commercial supplements are often given between meals

– Potential benefits must be weighed against the potential negative consequences

– Increase of nutrient-dense foods included in diet


• The use of diets

– Use of restrictive diets as part of medical care in long-term–care facilities is controversial

– Goals of preventing malnutrition and maintaining quality of life are of greater priority

– Restrictive diets

o Potential to negatively affect quality of life

o Should be used only when a significant improvement in health can be expected


• A liberal diet approach

– Holistic approach is advocated

– Low-sodium diets used in the treatment of hypertension are often poorly tolerated by older adults

– Imposing dietary restrictions on long-term–care residents with diabetes is unwarranted

– Epidemiologic studies indicate that the importance of hypercholesterolemia as a risk factor for CHD decreases after age 44 and virtually disappears after the age of 65


• A liberal diet approach (cont’d)

– Can be modified to meet the needs of residents with increased needs

– Foods may be made more nutrient dense

– Supplemental vitamin C and zinc may be ordered to promote healing

– Frequent and accurate monitoring of the resident’s intake, weight, and hydration status is vital

• Nutrition for Older Adults

Chapter 13

• Nutrition for Adults and Older Adults

• Adulthood represents a wide age range from young adults at 18 to the “oldest old”

• Adults over 50, and especially those over 70, have different nutritional needs than do younger adults

• Aging and Older Adults

• Aging is a gradual, inevitable, and complex process

• Eventually leads to impairment of organs, tissues, and body functioning

• Some changes have nutritional implications

• How and why aging occurs is unknown

• Most theories are based on genetic or environmental causes


• Aging demographics

– Older adults, especially those older than 75 years of age, represent the fastest-growing segment of the American population

– Life expectancies at both 65 and 85 have increased

o Women and men who live to 65 can expect to live an average of 18.7 more years

o For those who live to 85:

Women will survive an average 7.2 years more

Men will survive an average 6.1 years more


• Aging demographics (cont’d)

– Heterogeneous group

o Varies in age, marital status, social background, financial status, living arrangements, and health status

– Approximately 80% of adults older than 65 years of age have one chronic health problem

– People define wellness and illness differently as they age


• Healthy aging

– Genetic and environmental “life advantages” have positive effects on both length and quality of life

– Preventing disease is the key to healthy aging

– Good nutrition

– Exercise

– Evidence shows that initiating healthy changes even in one’s 60s and 70s provides definite benefits


• Nutritional needs of older adults

– Knowledge growing

– Health status, physiologic functioning, physical activity, and nutritional status vary more among older adults (especially people older than 70 years of age) than among individuals in any other age group

– Calorie needs decrease yet vitamin and mineral requirements stay the same or increase

– 2 DRI groupings exist for mature adults

o People aged 51 to 70

o Adults over the age of 70



– Calories

o Needs decrease with age

o Changes in body composition

o Physical activity progressively declines

o Estimated 5% decrease in total calorie needs each decade

o Undesirable consequences of aging can be improved or reversed

– Aging and Older Adults (cont’d)


– Protein

o The RDA for protein remains constant at 0.8 g/kg for both men and women from the age of 19 and older

o Estimated that 7.2% to 8.6% of older adult women consume protein below their estimated average requirement



– Protein (cont’d)

o Factors that may contribute to a low protein intake

Cost of high-protein foods

Decreased ability to chew meats

Lower overall intake of food

Changes in digestion and gastric emptying

o Groups at risk for inadequate protein intake

Oldest elderly

Those with health problems

Those in nursing homes

• Question

• Is the following statement true of false?

Approximately 60% of adults older than 65 years of age have one chronic health problem.

• Answer

False.

Rationale: Approximately 80% of adults older than 65 years of age have one chronic health problem.



– Water

o The AI for water is constant from 19 years of age through age 70 and above

o Represents total water intake

o Elderly are able to maintain fluid balance

o Altered sensation of thirst and an age-related decrease in the ability to concentrate urine increases risk for:

Dehydration

Hyponatremia



– Fiber

o The AI for fiber is based on median intake levels observed to protect against coronary heart disease

AI for fiber is 38 g/day for men through age 50 and 30 g/day thereafter

AI for fiber is 25 g/day for women from 19 to 50 years of age and 21 g/day thereafter



– Vitamins and minerals

o Most recommended levels of intake for vitamins and minerals do not change with aging

o Significant exceptions:

Calcium

Vitamin D

Iron for women

o DRI for sodium decreases

o People over 50 are advised to consume most of their B12 requirement from fortified food or supplements


• Modified MyPyramid for older adults

– Differs from MyPyramid in that:

o Physical activity forms the base of the pyramid

o 8 glasses of water appear just above physical activity

o Nutrient-dense food choices are used to illustrate each food group

o A flag appears at the top to alert older adults to their unique nutrient needs

o Is available in print form


• Modified MyPyramid for older adults (cont’d)

– Additional tips for healthy eating

o Limit foods with added sugar

o Choose healthy fats to limit the intake of saturated and trans fats

o Limit sodium by eating less salt and buying reduced-sodium soups and frozen entrees

o Choose high-fiber grains

o Aging and Older Adults (cont’d)

• Nutrient and food intake of older adults

– As calorie needs decrease with aging, so does the quantity of food eaten and the amount of calories consumed

– Mean calorie intake falls by 1,000 to 1,200 calories/day in men and 600 to 800 calories/day in women

– Nutrients with mean intakes less than the DRI

o Vitamin E, magnesium, fiber, calcium, and potassium


• Nutrient and food intake of older adults (cont’d)

– Consume less fruit and vegetables

– Older adults need to improve their intakes of:

o Whole grains

o Dark green and orange vegetables

o Dried peas and beans

o Fat-free and low-fat milk and milk products

– Snacking in older adults may help ensure an adequate intake


• Vitamin and mineral supplements

– In theory, older adults should be able to obtain adequate amounts of all essential nutrients through well-chosen foods

o 50% of older adults have inadequate intakes of vitamin E and magnesium

– Supplements tend to have a positive impact on nutritional adequacy for adults 51 and older


• Nutrition screening for older adults

– Older adults at greatest risk of consuming an inadequate diet are those who are:

o Less educated

o Live alone

o Have low incomes

– Identifying nutritional problems in older adults can be a challenge

• Question

• Which older adult is at greatest risk of consuming an inadequate diet?

a. Lives with family

b. Is married

c. Has and adequate income

d. Is less educated

• Answer

d. Is less educated

Rationale: Older adults at greatest risk of consuming an inadequate diet are those who are less educated, live alone, and have low incomes.

• Screening Criteria for Malnutrition in Older Adults

• Disease

– Do you have an illness that makes you change the kind and/or amount of food you eat?

• Eating poorly

– Do you eat fewer than 2 meals/day? Do you eat few fruits, vegetables, or milk products? Do you have 3 or more drinks of beer, liquor, or wine almost every day?

• Tooth loss/mouth pain

– Do you have tooth or mouth problems that make it hard for you to eat?


• Economic hardship

– Do you sometimes not have enough money to spend on the food you need?

• Reduced social contact

– Do you eat alone most of the time?

• Multiple medications

– Do you take 3 or more prescribed or over-the-counter dugs a day?


• Involuntary weight loss/gain

– Have you gained or lost 10 pounds in the last 6 months without trying?

• Needs assistance in self-care

– Are you sometimes not physically able to shop, cook, and/or feed yourself?

• Elder years above age 80

– Are you older than age 80?

• Nutrition-Related Concerns in Older Adults

• Should be client-centered and based on the individual’s physiologic, pathologic, and psychosocial conditions

• Overall goals of nutrition therapy for older adults

– Maintain or restore maximal independent functioning and health

– Maintain the client’s sense of dignity and quality of life by imposing as few dietary restrictions as possible


• Cataracts and macular degeneration

– Prevalence of cataracts and age-related macular degeneration (AMD) are increasing as the population of older Americans increases

– AMD is the major cause of legal blindness in North America

– Appears that a multivitamin/multimineral supplement containing vitamin C, vitamin E, beta carotene, and zinc is effective in slowing AMD but not cataracts


• Cataracts and macular degeneration (cont’d)

– Observational studies show that a diet rich in antioxidants, especially lutein and zeaxanthin, and omega-3 fatty acids benefits AMD and possibly cataracts

– People who eat diets high in refined carbohydrates (high glycemic index) are at greater risk of AMD progression than people who eat a less refined carbohydrates


• Functional limitations

– Aging causes a progressive decline in physical function

– Major causes of functional limitations among older adults include:

o Arthritis

o Osteoporosis

o Sarcopenia



– Arthritis

o A leading cause of functional limitation among older adults

o Osteoarthritis (OA) is associated with aging and normal “wear and tear” on joints

Knee is the most commonly affected joint

Excess body weight is the greatest known modifiable risk factor

• Question

• Is the following statement true or false?

Nutrition-related concerns of older adults include cataracts and macular degeneration.

• Answer

True.

Rationale: Nutrition-related concerns of older adults are cataracts and macular degeneration and functional limitations such as arthritis, osteoporosis, and sarcopenia.


• Arthritis (cont’d)

– Other risk factors for OA include genetics, age, ethnicity, gender, occupation, exercise, trauma, and bone density

– Symptoms of OA usually appear after the age of 40 and by 65 years of age or above

– Objective of treatment is to control pain, improve function, and reduce physical limitations



– Osteoporosis

• Bone remodeling

• After menopause, women experience rapid bone loss related to estrogen deficiency

• Estimated direct-care costs of osteoporotic fractures are $12 to $18 billion annually

• Process actually begins early in life



• Osteoporosis (cont’d)

– Interventions implemented late in life can effectively slow or halt bone loss

• Sarcopenia

– Defined as loss of muscle mass and strength

– Chronic muscle loss is estimated to affect 30% of people over the age of 60 and may affect more than 50% of those over 80 years of age

– Related to a sedentary lifestyle and less-than-optimal diet


• Sarcopenia

– Strength training using progressive resistance is the best intervention shown to slow down or reverse sarcopenia

– Adequate protein intake is also essential


• Alzheimer’s disease (AD)

– Most common form of dementia in the U.S., it affects an estimated 4.5 million Americans

– Risk of AD increases with increasing age

– Cause of AD is unknown and there is no cure

– Genetic and nongenetic factors (e.g., inflammation of the brain, stroke) have been identified in the etiology of AD


• Alzheimer’s disease (AD) (cont’d)

– Development of AD may also be related to oxidative stress

– People who eat fish have less cognitive decline than people who do not eat fish

• DHA, an omega-3 fatty acid, may offer some protection against AD

– AD can have a devastating impact on an individual’s nutritional status


• Obesity

– Major public health problem

– Appropriateness of treating obesity in older adults is controversial

• Weight loss can be harmful to older adults

– Goal of weight loss therapy for older adults should be to improve physical function and quality of life


• Social isolation

– Eating alone is a risk factor for poor nutritional status among older adults

• Congregate meals

• Meals on Wheels

• Modified diets, such as diabetic diets and low-sodium diets, are provided as needed

• Long-Term Care

• Residents tend to be frail elderly with multiple diseases and conditions

• Estimated 23% to 85% of long-term–care residents suffer from malnutrition or dehydration

• Malnutrition has a negative impact on both the quality and length of life and is an indicator of risk for increased mortality

• Have same risk factors as those who live independently


• Additional risks among long-term–care residents include:

– Loss of appetite

– Pressure ulcers may be a symptom of inadequate food and fluid intake

– Dysphagia

– Loss of independence, depression, altered food choices, and cognitive impairments can negatively impact food intake


• The downhill spiral

– Loss of appetite is a major cause of undernutrition in long-term care

– Undernutrition increases the risk of illness and infection

– Undernutrition is exacerbated and a downward spiral ensues

– Minimum Data Set (MDS) requires food intake be assessed so that residents at risk from inadequate intake are identified


• The downhill spiral (cont’d)

– Intake assessment system is flawed:

• Food intake records may be neglected

• Lack of skill in accurately judging the percentage of food consumed

• A practical approach to convert individual item estimates into meaningful estimates not assessed

– Question

• What is a risk among long-term–care residents?

a. Dependence

b. Dysphagia

c. Overhydration

d. Increased appetite

• Answer

b. Dysphagia

Rationale: Additional risks among long-term– care residents include loss of appetite, pressure ulcers, dysphagia, loss of independence, depression, altered food choices, and cognitive impairments.


• Preventing malnutrition

– A quality of life issue

– Commercial supplements are often given between meals

– Potential benefits must be weighed against the potential negative consequences

– Increase of nutrient-dense foods included in diet


• The use of diets

– Use of restrictive diets as part of medical care in long-term–care facilities is controversial

– Goals of preventing malnutrition and maintaining quality of life are of greater priority

– Restrictive diets

o Potential to negatively affect quality of life

o Should be used only when a significant improvement in health can be expected


• A liberal diet approach

– Holistic approach is advocated

– Low-sodium diets used in the treatment of hypertension are often poorly tolerated by older adults

– Imposing dietary restrictions on long-term–care residents with diabetes is unwarranted

– Epidemiologic studies indicate that the importance of hypercholesterolemia as a risk factor for CHD decreases after age 44 and virtually disappears after the age of 65


• A liberal diet approach (cont’d)

– Can be modified to meet the needs of residents with increased needs

– Foods may be made more nutrient dense

– Supplemental vitamin C and zinc may be ordered to promote healing

– Frequent and accurate monitoring of the resident’s intake, weight, and hydration status is vital

v

· web viewadults over 50, and especially those over 70, have different nutritional needs than do...

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