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Chapter 10

Nutrition

The key element is preserving the health of older adults
The quality and quantity of a diet will help prevent, delay the onset of, and manage chronic disease processes
Fulfillment of nutritional needs in aging is often affected by numerous factors

Nutrition

Generally, older adults need fewer calories
Still require same or higher levels of nutrients
Limit intake of saturated fat and trans fatty acids
Fiber intake is generally lacking in older adults
Vitamin intake is generally good for older adults; they should increase the consumption of the crystalline form of vitamin B12

U.S. Dietary Guidelines

Usually, older adults are viewed as underweight and frail; however, the concern of obesity in older adults is increasing
Obesity is associated with increased health care costs, functional impairments, disability, chronic disease, and nursing home admission
Weight loss recommendations for older adults must be carefully considered on an individualized basis

Obesity

Recognized geriatric syndrome
Rising incidence in all settings
Has serious consequences, including infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, prolonged hospital stays, institutionalization, and increased morbidity and mortality

Malnutrition

Complex syndrome that develops along two primary trajectories
One occurs when the person does not consume sufficient micronutrients and macronutrients to maintain organ function and healthy tissue
Inflammation-related malnutrition develops as a consequence of injury, surgery, or disease that triggers inflammatory mediators that increase metabolic rate and impair nutrient use

Characteristics of Malnutrition

Lifelong eating habits
Acute and chronic illness
Medication regimens
Ethnicity and culture
Ability to obtain and prepare food
Mood
Socialization
Socioeconomic deprivation
Transportation and housing
Food knowledge

Factors Affecting Fulfillment

Are developed out of tradition, ethnicity, and religion
Reflects the individual’s dietary history and present food practices
Older adults may fall prey to advertisements that claim specific foods can reverse aging or rid them of chronic conditions
Essential nutrients should be obtained from food sources rather than supplements

Lifelong Eating Habits

Older adults may be isolated from social events during which food is provided
Effects of medications or a disease process may cause a disinterest in food
Excessive drinking decreases eating habits

Socialization

Functional and cognitive impairments associated with chronic disease interfere with the ability to shop, cook, and eat independently
Medication side effects may further impair nutritional status
Dysphagia can be the result of behavioral, sensory, or motor problems and is common in those with neurologic disease and dementia

Chronic Diseases

Obtain a history of the response to dysphagia
Observe the person during mealtime
Determine risk for aspiration
Assume those referred for a dysphagia evaluation (“swallowing study”) are at risk for aspiration
Maintain NPO status until the evaluation is completed
Nutrition and hydration needs can be met by intravenous, nasogastric, or gastric tubes

Assessment of Dysphagia

Goal: Safe oral intake to maintain optimal nutrition and caloric needs
Compensatory interventions include
Postural changes and proper positioning
Modification of bolus volume, consistency, temperature, and rate of presentation
Modified diets
Neuromuscular electrical stimulation

Interventions for Dysphagia

The nurse is feeding an older adult patient with dysphagia after a stroke. Which intervention is most important when feeding this patient?

Serve only pureed foods

Offer small sips of fluid with each bite

Place food on the impaired side of the mouth

Have the patient swallow twice between each mouthful

Question

D—Have the patient swallow twice between each mouthful. If facial weakness is present, place food on the nonimpaired side of the mouth. Alternate solids and liquid boluses. Not all persons require pureed foods.

Answer

Comprehensive nutritional screening and assessment are essential in identifying older adults at risk for nutrition problems or who are malnourished
The role of nursing assessment and intervention should be comprehensive and include
Increased attention to the process of eating and the entire ritual of meals
Assessment of nutritional status
Thorough medication review

Implications for Gerontological Nursing and Healthy Aging

Nutrition Screening Initiative Checklist
Mini Nutritional Assessment (MNA)
Both a screening tool and a detailed assessment
Only valid for those older than age 65 years
Intended for use by professionals
Minimum Data Set (MDS)
Food and nutrient intake
24-Hour dietary recall
3-Day dietary history

Nutrition Screening Tools

Interview
History
Physical examination
Anthropometric data
Laboratory data
Food and nutrient intake
Functional assessment

Nutrition Assessment Components

Anthropometric measurements
Height and weight
Midarm circumference
Triceps skinfold thickness
There is no single biochemical marker of malnutrition
Serum albumin level

Nutrition Data

Goal: Increase food intake and enhance and manage the environment to promote increased food intake
Feeding assistance
Environment enhancements
Calorie supplements
Pharmacological therapy
Patient education

Interventions to Increase
Food Intake

Knowledge of nutritional needs and the many factors contributing to inadequate nutrition is essential
Use of evidence-based practice protocols is important in determining nursing interventions to support and enhance nutritional status
Preventing undernutrition, malnutrition, and the maintenance of dietary needs are ethical responsibilities

Implications for Gerontological Nursing and Healthy Aging (Cont.)

Which action should the nurse take first when teaching a widowed older patient living with his son about ways to improve nutrition?

Recommend a liquid caloric supplement

Determine who shops and prepares meals

Arrange for weekly transportation to the store

Collaborate with a social worker for food stamps

Question

B—Assessment is the first step in determining nutrition interventions.

Answer