Nutrition: Eating / Meals for Older Adults

2 Objectives Discuss demographics related to nutritional issues in older adults. Assess diet history and nutritional status, with special attention to cultural, ethnic, or religious preferences. Evaluate anorexia in older adults.

3 Objectives Identify contextual factors that contribute to optimal dining experiences. Plan care to maximize the self-feeding capacity of an older adult. Plan mealtime care for an older adult with cognitive and/or physical impairments.

4 Demographics Malnutrition in older adults  Independent living: 1% to 15%  Institutionalized:25% to 85%  Hospitalized:35% to 65% 10% Underweight: (low BMI)  Men: 40%  Women: 30%

5 Demographics Overweight older adults (75+ years)  Men:56.5%  Women: 52.3% Obesity in older adults (75+ years)  Men: 13.2%  Women:19.2%

6 Demographics Progressive loss of lean body mass - decreased BMR Disease, stress, injury, chronic drug use Overeating and lack of exercise Diminished sense of taste and smell Loneliness Physical and mental handicaps – immobility and chronic illness

7 Diet History and Nutritional Status Nutritional Screening within 24 hours of admission Three-day Food Diary “Determine your Nutritional Health” Checklist Track weights and weight changes

8 Diet History and Nutritional Status Physical Assessment: skin turgor, lesions, color, thick or brittle hair, muscle wasting, oral status (loose teeth; poorly fitting dentures), oral lesions, beefy red tongue Serologic parameters: prealbumin & serum transferrin (early markers); serum albumin (late marker)

9 Diet History and Nutritional Status Other serologic parameters: - total protein, BUN/Creatinine ratio, CBC, Blood glucose, iron stores, ferritin, B12, lipids Performance-based functional status Inconsistencies between reported diet and biochemical / physical parameters

10 Diet History and Nutritional Status Cultural, Ethnic, and Religious Preferences Mini Nutritional Assessment (MNA) tool  Anthropometric measurements  Dietary questionnaire  Global assessment  Subjective assessment

11 Diet History and Nutritional Status Geriatric Oral Health Assessment Index Nutrition and Hydration Assessment Evaluate Anorexia  Medications and their side effects  Depression  Chronic Inflammatory Diseases  Impaired Function - dysphagia

12 Optimal Dining Experience Decrease “traffic” in room Normalize the dining experience: remove food from tray and place on the table; placemats of contrasting color Watch the food temperature Direct conversation to the older adult receiving the meal Respect individual preference to dine alone or in congregate dining

13 Maximize Self-Feeding Sit in armchair – both feet on the floor; if poor posture – use adaptive seating devices Note mouth – loose or poorly fitting dental appliances, periodontal diseases, caries Chin-tuck position, not hyperextended

14 Maximize Self-Feeding Cues and Gestures  Nurse’s hand over the older person’s hand  Pantomime gestures  Sit across Use adaptive devices – eyeglasses, hearing aid, dentures, sports bottles Allow time - use finger-foods

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16 Cognitive and Physical Impairments Assess for possible unrecognized diseases or problems Allow smaller, more frequent meals Cue the person with cognitive impairments Sit next to or across the person Do not use a syringe to feed Schedule staff Burden-free attitude about feeding.

17 Summary Demographics Diet History and Nutritional Status Anorexia in older adults Instruments Optimal dining experience Self-Feeding