Factors that may contribute to altered nutrition in elderly. Introduction: Factors influencing nutritional status in elderly persons may be divided into three categories: psychological, social, and medical. For instance, psychological disorders such as depression and dementia are highly correlated with loss of body weight in nursing homes and are the major causes of weight loss in free-living elderly individuals. In addition, numerous studies have suggested that social isolation, low socioeconomic status, and poverty are also associated with reduced dietary intake and weight loss. Moreover, numerous medical factors such as the use of prescription medicines, poor dentition, institutionalization, a decrease in taste and smell sensations, and an inability to regulate food intake have all been suggested to decrease appetite and adversely affect nutritional status in older adults.
Three factors identified to contribute to altered nutrition in elderly are as:
1. Changes in the gastrointestinal tract.
2. Decreased neuromuscular coordination.
3. Personal factors e.g. fixed income, loneliness and susceptibility to health claims
Changes in the gastrointestinal tract.
Many changes occur in the gastrointestinal tract, including loss of teeth, reduced production of saliva, diminished taste and smell, and increased ability to digest foods. When these changes occur, chewing may become painful, and a diet with soft foods is preferred. Eating pleasure declines when taste and smell are impaired. Some adults prefer strongly flavored foods, while others avoid food because it does not taste good anymore. The decrease of gastric secretions may interfere with the absorption of iron and vitamin B12.Fat digestion may be impaired if the liver produces less bile or the gallbladder is non functional.
Decreased neuromuscular coordination
Neuromuscular coordination decreases with age and conditions such as arthritis may hamper food preparation and the use of eating utensils. Muscles in the lower gastrointestinal tract become weaker with advancing age and constipation is a common problem. Many nutrient absorption .Kidney repair and maintenance deteriorates with age, and renal function is impaired in some individuals. Fluid and electrolyte balance is difficult to maintain, especially during illness.
Personal factors e.g. fixed income, loneliness and susceptibility to health claims
Fixed income: Often the elderly exist on a fixed income that prevents an adequate food supply. This income deficit affects housing and facilities, limiting cooking frequency and food storage. Without transportation, the elderly often purchase food from nearby store or one that will deliver groceries. Such stores usually charge more for foods.
Loneliness: Social isolation affects the eating behaviors of the aged to a great extent. Elderly persons living alone lose their desire to cook or eat. Lonely people become apathetic, depressed, and fail to eat. They are more susceptible to illnesses and other stresses.
Health claims: Many of the elderly purchase foods and supplements from health food stores because of advertisements claiming that the foods have curative power and may in fact retard the aging process.
This is progressive loss of weight resulting in a low BMI of 16/m3.This involves general wasting away of the body tissue as a result of severe malnourishment.
Roles of the RN in assessing risk factor for altered Nutrition in the health care setting.
1. Perform regular assessment of nutritional status of the patients. This achieved continuous clinical observations of the patients especially with special regards to the patientâ€™s nutritional history, medical history, growth history, physical examination and investigation of the blood count. Carrying out comprehensive nutrition assessment that involves identifying and screening patients at risk of developing protein energy malnutrition .This is done routinely in order to detect any changes in the level of nutritional risk.
2. Monitor the response to nutritional intervention. This is achieved through periodic nutritional assessments, monitoring weight gain and BMI in response to therapy to determine adequate dietary intake, quality of patientâ€™s life, functional status, and complications of nutritional support measures among others
3. Administer nursing diagnosis. This include documentation of weight, determining of body fat composition by skin fold measurements, calculation of body mass index as a ratio of height, performing nutritional assessment, exploring the importance and meaning of food with the patient, assessing knowledge regarding nutritional needs and level of activity or other factors, ability to read food labels, access to plan menu, making appropriate food selections among others.
Describe specific nursing interventions that need to be implemented to overcome the 3 problems identified.
1. Eating meals alone (social isolation): Encourage the patient to eat food in a group as this increases the ability to eat more food since eating is a social activity. Also the food can be served attractively to increase his appetite.
2, Anorexia: The nurse intervention on overcoming the problem of anorexia includes: serving the patients with foods at the right temperatures, and with foods that are spiced or herbs added, by offering small servings of food frequently, providing an opportunity for oral hygiene before meals which stimulates salivation increasing patients appetite, catering to patients food preferences, arranging for the patient to eat in company of others which increases his ability and by ensuring that the patient takes a rest before taking of meals to increase his desire to eat.
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3. Impaired swallowing: The nurse interventions that need to be implemented to overcome the problem of impaired swallowing include: keeping the client in a sitting position or semi-sitting position for at least an half before eating, encouraging the patient to use his tongue or finger to sweep retained food from the cheek and repeat the swallowing , inspecting the patients mouth after each swallowing attempts and by encouraging him to do same while by looking in the mouth with the aid of an hand-held mirror.
Discharge planning and teaching that should be initiated for a client who will be discharged.
Emaciation: The client or his family is thought by the nurse on several activities to be done to assist in weight gain while discharged. These include: taking a rest after taking a meal, by disguising extra of calories meals by fortifying foods with powdered milk, gravies or sauces, eating of small amounts of food frequently, eating a variety of foods from small amounts and gradually increasing in terms of number of servings or serving sizes, eat in a company of others, garnishing food with cubed or grated cheese, diced meat, nuts or raisins and including high calorie and nutritious food such as cheese, milkshakes and nuts in his diet.
Obesity: The client prior to discharge is advised to use fats, oils and sugar sparingly. Also, to practice eating food in small amounts frequently as compared to large amounts sparingly. The client is also advised to eliminate consumption of junk foods and alcoholic beverages as well as increasing fiber in the diet from fresh fruits, vegetables and whole grains. The client is also advised to participate in regular exercises which help to raise metabolic rates while suppressing appetite.
2. Anorexia: the client and his family members are thought on how to serve the patient with foods at the right temperatures, foods that are spiced, offering food in small servings frequently, and providing an opportunity for oral hygiene before meals which serves to stimulates salivation thus increasing patientâ€™s appetite.
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