Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.
Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.
Chapter 9
Nutrition
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Food means life, comfort, and security.
Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.
Food
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Social factors include isolation, loneliness, poverty, dependency, lack of caregivers, and transportation.
Psychological factors include depression, anxiety, and dementia.
Weight loss, psychotropic drugs = anorexia, apraxia
Biological factors include hypermetabolism, anorexia, swallowing difficulty, or malabsorption.
Stroke, tremors, arthritis, infection, COPD, Parkinson’s
Nutritional Risks in Older Adults
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Several medications associated with poor appetite and weight loss
Interactions between nutrients and medicines may affect metabolism, absorption, digestion, or excretion of drugs.
Carefully assess all medications including over-the-counter drugs for drug–drug and drug–nutrient interactions.
Drug Nutrient Interactions
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Nutritional interventions that do not take into account the social, cultural, and emotional aspects of food are rarely effective because few individuals “eat to survive”; most of us “survive to eat.”
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Three main forms
Isotonic dehydration—results from the loss of sodium and water, as during a gastrointestinal illness
Hypertonic dehydration—results when water losses exceed sodium losses. Most common, from fever or limited fluid intake
Hypotonic dehydration—may occur with diuretic use when sodium loss is higher than water loss
Dehydration
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Micronutrients—vitamin D, calcium, and vitamin B12 are commonly found deficient in older adults
Vitamin D deficiency—cancer progression, osteoporosis, and fractures
Vitamin B12 deficiency—pernicious anemia, bone health, and cognitive decline
Supplementation might be necessary.
Micronutrient Deficiency
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Sarcopenia is defined as “the decline in skeletal muscle mass that can result from physical inactivity, disuse of muscles, reduced levels of growth hormone and testosterone, neuromuscular changes, insufficient dietary protein and impaired protein metabolism.”
Can occur after long hospitalization
Cachexia is characterized by a loss of fat and muscle mass accompanied with anorexia.
Terminal cancer or/and stage renal disease
Malnutrition
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Oral health is a strong predictor or measure of quality of life.
Xerostomia, or dry mouth, is one of the most common causes of poor food intake.
Drug induced can lead to dental carries.
Older adults with cognitive impairment are at increased risk for dental caries, oral infections, and periodontal disease.
Oral Health
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Nutritional screening: abbreviated assessment of nutritional risk factors determining which clients need a more comprehensive assessment and nutritional interventions
Nutritional assessment: comprehensive evaluation of client’s nutritional status
Demographic and psychosocial data, medical history, dietary history, anthropometrics, medications and laboratory values, and physical assessment
Nutritional Screening and Assessment
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Clients at nutritional risk require a more specific evaluation of their dietary intake patterns.
Number of meals and snacks per day; chewing or swallowing difficulties; gastrointestinal problems or symptoms that affect eating; oral health and denture use; history of diseases or surgery; activity level; use of medications; appetite; need for assistance with meals and meal preparation; and food preferences, allergies, and aversions
Food recall
Diet History
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Height and weight
Triceps skin fold and mid-upper arm muscle circumference
Dual-energy x-ray absorptiometry (DXA)
Anthropometrics
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Serum albumin
Levels below 3.5 g/dL may indicate some degree of malnutrition.
Transferrin
< 200 mg/dL indicate mild-to-moderate depletion.
<100 mg/dL indicate severe depletion.
Prealbumin
Levels from 15 to 5 mg/dL—mild-to-moderate protein depletion
<5 mg/dL—reflective of severe protein depletion
Laboratory Values
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Albumin has a half-life of about 21 days, so it is not always reflective of current nutritional status.
Transferrin
Carrier protein for iron and has half-life of 8–10 days.
Prealbumin
Half-life of 2–3 days
Sensitive to sudden demands on protein synthesis
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MyPlate method
Dietary guidelines 2016
Eat a variety of nutrient-dense foods and manage portion sizes
Shift current food and drink choices to healthier alternatives
Maintain a healthy diet throughout your life
Limit caloric intake from added sugars and saturated fats, and reduce intake of sodium
Support others in healthy eating
Components of a Healthy Diet
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A problem that often affects nutritional status
Cerebrovascular accident, oral or neck cancer treatment, or a neuromuscular or neurologic disorder
Early detection, screening, evaluation, and treatment
Modification of foods and fluids
Dysphagia
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Your patient is not eating well, and you have consulted a dietician to see the patient. Which of the patient’s assessment and laboratory findings have you most concerned? (Select all that apply.)
The patient has COPD and usually does not finish all her food on the tray.
The patient wears dentures and cares for them daily.
The patient is widowed and does not seem to have visitors during meal time.
The patient’s serum albumin level is 4 g/dL.
The patient’s transferrin level is 188 mg/dL.
The patient’s prealbumin level is 10 mg/dL.
Quick Quiz!
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ANS: A, C, E, F
Answer to Quick Quiz
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Enteral feeding tubes
NG, PEG, or PEJ tubes
Several different types of enteral formulas available
Parenteral nutrition
Indicated when GI tract cannot be used
Administered via vascular access device-central venous catheter, tunneled catheter, peripherally inserted central catheter, or implanted port
Solution: dextrose, amino acids, vitamins, minerals, electrolytes, trace elements, water, and lipids
Specialized Nutritional Support
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