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Older adults living in the community may suffer from loneliness and depression, leading to weight gain or loss, and ultimately malnutrition.

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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

Copyright © 2019, by Elsevier Inc. All rights reserved.

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

Copyright © 2019, by Elsevier Inc. All rights reserved.

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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

Copyright © 2019, by Elsevier Inc. All rights reserved.

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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

Copyright © 2019, by Elsevier Inc. All rights reserved.

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