Case Study

NSG360CH14Nutrition.pptx

Chapter 14

Nutrition

The quality and quantity of diet are important factors in preventing, delaying onset, and managing chronic illnesses associated with aging

Diet can affect longevity, and when combined with lifestyle changes, reduces disease risk

About half of all American adults have one or more preventable diet-related chronic diseases, including cardiovascular disease, type 2 diabetes, and overweight and obesity

Nutrition

Age-related changes affect the gastrointestinal (GI) system (Box 14-1), but are not the primary cause of inadequate nutrition in older persons

Factors impacting nutritional needs are most likely related to

Chronic disease

Lifelong eating habits

Ethnicity

Socialization

Income

Transportation

Housing

Mood

Food knowledge

Functional impairments

Health

Dentition

The nurse will want to assess for each of these factors. Think about how you eat—how has that impacted what diet you follow today

This is the same issue for your older adult who is also faced with special diets, loneliness, etc

To help them get adequate nutrition, we must identify what is affecting it!

Nutrition

Age-related requirements

Based on 2015-2020 Dietary Guidelines for Americans

Choose My Plate is a guide that provides a visual depiction of daily food intake

Older adults generally need less calories because activity decreases and metabolic rates slow down

Still require the same or higher amounts of nutrients

Image of MyPlate for older adults that shows various food choices for each of the food groups

Nutrition

Dietary recommendations

Fats: less than 10% of total calories, limit saturated fat and trans fatty acids

Protein: increase for older adult who tends to experience protein deficiency when ill; minimizes frailty

Fiber: 25 g fiber recommended daily (Box 14-4)

Vitamins and minerals: consumption of five servings of fruits/vegetables provides adequate A,C,E, and potassium; changes of aging contribute to decreased absorption of B12

Obesity (Overnutrition)

Obesity is a global epidemic and major public health concern

It is associated with increased costs, functional impairments, disability, chronic disease, and admission to nursing home

More than a third of persons over 60 years are obese

Obesity paradox: some research found that persons who survived to 70 years had lower mortality rate if they were overweight

Malnutrition (Undernutrition)

Rising incidence in acute care, long-term care (LTC), and in the community

Institutionalized older adults at high risk for malnutrition due to chronic disease and functional impairments

Increased risk of infection, pressure ulcers (PUs), anemia, hip fractures, hypotension, impaired cognition, and increased morbidity and mortality

Can be related to inadequate consumption of micro and macro nutrients, or consequence of inflammation

Comprehensive screening and assessment is critical to identify older adults at risk

Factors Affecting Fulfillment of Nutritional Needs

Lifelong eating habits

Socialization

Socioeconomic deprivation

Transportation

Chronic diseases and conditions

Polypharmacy

Inactivity

High-fat, high-volume meals

Comorbid conditions

Chronic Conditions That Affect Nutrition

GERD

Diverticular disease

Dysphagia

Promoting Healthy Aging: Implications for Gerontological Nursing

Nutrition screening and assessment (Box 14-14)

Several screening tools available

Minimum Data Set—includes risk factors and triggers for further evaluation

Interview and physical examination

Anthropometrical measurements

Weight/height considerations

Biochemical analysis/measures of visceral protein

Promoting Healthy Aging: Implications for Gerontological Nursing

Interventions

Formulated around specific problems

Nurses hold a pivotal role in ensuring adequate nutrition to promote healthy aging

Collaboration with interprofessional team

Considerations: modification of environment, supervision, feeding techniques that enhance intake and preserve dignity and independence

Evaluate the outcome

Nutritional Problems in Institutional Setting

Feeding assistance

Estimated that 50% of all residents unable to eat independently

Inadequate staffing is associated with poor nutrition and hydration

The Centers for Medicare and Medicaid Services implemented a rule that allows feeding assistance, with 8 hours of approved training

See Box 14-15

Approaches to Enhancing Intake in LTC

Interventions

Restorative dining rooms

Consideration of ethnic food choices

Easy access to refreshment stations with juices, water, healthy snacks, and finger foods

Family involvement when possible

See other best practices (Box 14-16)

Other considerations: restrictive diets and caloric supplements, pharmacological therapy, and patient education

Question 1

What is the estimated number of institutionalized older adults who are unable to eat independently?

40%

50%

60%

70%

ANS: B

Question 2

Which condition affects nutrition in the older adult?

Diabetes

Heart disease

Dysphagia

Gout

ANS: C