Chapter 9 Nutrition Copyright © 2019, by Elsevier Inc. All rights reserved. Food   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. Copyright © 2019, by Elsevier Inc. All rights reserved. 2 Nutritional Risks in Older Adults   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 Copyright © 2019, by Elsevier Inc. All rights reserved. 3 Drug Nutrient Interactions    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 overthe-counter drugs for drug–drug and drug– nutrient interactions. Copyright © 2019, by Elsevier Inc. All rights reserved. 4 Dehydration     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 Copyright © 2019, by Elsevier Inc. All rights reserved. 5 Micronutrient Deficiency     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. Copyright © 2019, by Elsevier Inc. All rights reserved. 6 Malnutrition  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 Copyright © 2019, by Elsevier Inc. All rights reserved. 7 Oral Health   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. Copyright © 2019, by Elsevier Inc. All rights reserved. 8 Nutritional Screening and Assessment   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 Copyright © 2019, by Elsevier Inc. All rights reserved. 9 Diet History  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 Copyright © 2019, by Elsevier Inc. All rights reserved. 10 Anthropometrics    Height and weight Triceps skin fold and mid-upper arm muscle circumference Dual-energy x-ray absorptiometry (DXA) Copyright © 2019, by Elsevier Inc. All rights reserved. 11 Laboratory Values  Serum albumin ➢  Transferrin ➢ ➢  Levels below 3.5 g/dL may indicate some degree of malnutrition. < 200 mg/dL indicate mild-to-moderate depletion.
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