Chapter 16 Nutrition and Hydration

1. Chapter 16Nutrition and Hydration

2. Components of the Nutritional Assessment • History • Physical Examination • Biochemical Evaluation • Cognition and Mood • Anthropometric Measurement

3. History • Review health history and medical record for evidence of diagnoses or conditions altering the purchase, preparation, ingestion, digestion, absorption, or excretion of foods. • Review medications for those that can affect appetite and nutritional state. • Assess patient’s description of diet, meal pattern, food preferences, and restrictions. • Keep a diary of all food intake for a week.

4. Physical Assessment • Inspect hair. • Inspect skin. • Test skin turgor. • Note muscle tone, strength, and movement. • Inspect eyes. • Inspect oral cavity. • Observe person drinking or eating for difficulties.

5. Biochemical Evaluation • Obtain blood sample for screening of: • Total iron binding capacity • Transferrin saturation • Protein; albumin • Hemoglobin; hematocrit • Electrolytes; vitamins • Prothrombin time • Obtain urine sample for screening of specific gravity.

6. Cognition and Mood • Test cognitive function. • Note alterations in mood, behavior, cognition, level of consciousness. • Be alert to signs of depression. • Ask about changes in mood or cognition.

7. Anthropometric Measurement • Measure and ask about changes in height and weight. • Determine triceps skinfold measurement (TSM). • Measure the midarm circumference (MC) with a tape measure (using centimeters). • Use this to calculate midarm muscle circumference (MMC) with formula: • MMC in cm = MAC in cm – (0.314 x TSM in mm)

8. Factors Contributing to Reduced Need for Calories of the Elderly • The older body has less body mass and a relative increase in adipose tissue. • Adipose tissue metabolizes more slowly than lean tissue and does not burn calories as quickly. • Basal metabolic rate declines 2% for each decade of life. • The activity level for most older adults is usually lower than it was during younger years.

9. Harris-Benedict Equation (REE) Males 66 + [13.7 x weight (kg)] + [5 x height (cm)] – [6.8 x age] = kcal/day Females 655 + [9.7 x weight (kg)] + [1.8 x height (cm)] – [4.7 x age] = kcal/day

10. Recommended Diet for Elderly • Should contain calories of a high quality including: • Fibers • <30% total calories from dietary fat. • At least 1 g protein per kg body weight daily; approximately 15% daily calories from proteins.

11. Examples of at Risk Nutrition-related Conditions for Women • Heart disease • Cancer • Osteoporosis

12. Hydration • Total body fluids are reduced with age, thereby contributing to the risk for dehydration. • Older adults require approximately 1500 ml fluid daily. • Factors that may cause elders to consume less fluid: • Reduction in thirst sensation • Fear of incontinence • Lack of accessible fluids

13. Signs of Periodontal Disease • Bleeding gums, particularly when teeth are brushed • Red, swollen, painful gums • Pus at gumline when pressure is exerted • Chronic bad breath • Loosening of teeth from gumline

14. Nutritional Supplements • Inquire about supplement use during the assessment. • Increasing numbers of people are using nutritional supplements on a daily basis. • Supplements can compensate for inadequate intake of nutrients. • Supplements can interact with medications.

15. Reasons for Increased Ingestion in the Elderly • Decreased stomach motility • Less gastric secretion • Slower gastric emptying time

16. Non-Pharmacologic Measures for Managing Indigestion • Eat several small meals rather than three large ones. • Avoid or limit fried foods. • Identify and eliminate specific foods from the diet to which an intolerance exists. • Sit in a high Fowler position while eating and for half an hour after meals. • Ensure adequate fluid intake and activity.

17. Forms of Dysphagia • Transfer Dysphagia • Difficulty moving food from the mouth to the esophagus. • Transport Dysphagia • Difficulty moving food down the esophagus. • Delivery Dysphagia • Difficulty moving food from the esophagus into the stomach.

18. Causes of Dysphagia • Neurological conditions, such as a stroke • Most cases are due to gastroesophageal reflux disease (GERD).

19. Factors to Consider When Assessing Swallowing Problems • Onset • Types of foods that present the most problems • Solids or liquids • Occurrence • Consistent or periodical • Other symptoms and related complications • Aspiration • Weight loss 

20. Nursing Measures for Swallowing Difficulties • Have the person sit upright whenever food or fluid is being consumed. • Allow sufficient time for eating. • Assure there is no residual food in the mouth before feeding additional food. • Place small portions in the mouth. • Discourage the person from talking while eating.

21. Nursing Measures for Swallowing Difficulties (cont.) • Keep a suction machine readily available. • Monitor intake, output, and weight. • Tilt the head to a side and placing food on a particular part of the tongue. • Correct underlying problems.

22. Causes of Constipation in the Elderly • Slower peristalsis • Inactivity • Side effects of drugs • A tendency toward less bulk and fluid in the diet.

23. Measures to Prevent Constipation • Drink plenty of fluids. • Eat plenty of fruits and vegetables. • Exercise regularly. • Allow adequate time for a bowel movement.

24. Factors That Increase the Risk for Malnutrition • Reduced taste and smell sensations • Slower peristalsis • Decreased hunger contractions • Reduced gastric acid secretion • Less cells on intestinal surface

25. Clinical Signs of Malnutrition • Weight loss greater than 5% in the past month or 10% in the past 6 months. • Weight 10% below or 20% above ideal range. • Serum albumin level lower than 3.5 g/100 mL • Hemoglobin level below 12 g/Dl. • Hematocrit value below 35%.

26. Source • Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).