1. 1 Module 10 Obesity and Malnutrition in the Older Adult Geriatric Aide Curriculum NC Division of Health Service Regulation

2. 2 Obesity and Malnutrition in the Older Adult Objectives 1.Discuss the role of the nurse aide in assisting a resident who is obese with a diet plan. 2.Define malnutrition. 3.Discuss reasons why a resident may eat poorly.

3. 3 Obesity and Malnutrition in the Older Adult Objectives 4.Describe one way to determine an older adult’s nutritional status. 5.Recognize signs of malnutrition. 6.List predictors of malnutrition and the ones that nurse aides can affect most.

4. 4 Obesity and Malnutrition in the Older Adult Objectives 7.Demonstrate how to measure and record weight using a standing balance scale and a bathroom scale. 8.Demonstrate one method to record intake.

5. 5 Obesity and Malnutrition in the Older Adult Objectives 9.Relate activities of daily living to eating. 10.Recognize changes related to eating to report of the nurse or supervisor.

6. 6 Aging and Calories As one ages, muscle mass is lost and metabolism slows. Moderately active and active older adults need more calories.

7. 7 Obesity and Aging May have been overweight when younger or gained weight as one aged Muscle mass is replaced with fat Take in more calories than burned

8. 8 Obesity and Aging Obese live about as long as normal weight individuals Obese individuals have more disability earlier in life

9. 9 Obesity and Weight Loss in the Older Adult Complex Carefully planned and supervised Make sure weight loss in planned, not unintentional (unplanned)

10. 10 Diet Orders In a facility, a doctor writes a diet order Dietician determines dietary needs based on diet order Nurse aide encourages individual to follow diet order and assists as needed

11. 11 Burning Calories Encourage walking instead of using wheelchair Canes and walkers available for those who need them Take longer route to dining room Add activity during activities of daily living

12. 12 Weight Loss Plan in the Home Use weight loss plan only if it’s from healthcare provider Plan meals, types and amounts of food using weight loss plan Use MyPyramid as reference Individual has the right to choose what to eat Encourage activity

13. 13 Malnutrition Malnutrition can lead to death Malnutrition is not normal part of aging Nurse aides can help prevent and assist in treating malnutrition

14. 14 Why Adults Who Are Older May Eat Poorly Suddenly single Depression Sense of taste and smell may change Medications may change taste of food Special diets Chewing or swallowing problems Medical problems Lack of money

15. 15 Preventing Malnutrition Identify those at risk of malnutrition Identification of those at risk may be done by the professional in some settings Sometimes nurse aide is the only health care provider who sees individual on a regular basis

16. 16 Signs of Malnutrition Changes in hair or nails Dry, cracked lips Swollen and bleeding gums Swollen red tongue Dentures don’t fit Problems with skin: dry, flaking, color Skin tears easily

17. 17 Signs of Malnutrition Sunken cheeks and eyes Poor wound healing Infections Muscles wasting Muscle weakness and fatigue Higher rate of bone fractures Confusion

18. 18 Signs of Malnutrition Diarrhea Poor coordination Long hospitalizations Appears thin; clothes fit more loosely than usual Unintentional weight loss

19. 19 Nurse Aide Role in Malnutrition Nurse aide role –Nurse aides can watch for signs of malnutrition during personal care activities

20. 20 Nurse Aide Role in Malnutrition Nurse aide actions can influence three predictors of malnutrition recognized by the government: –weight loss –leaves 25% or more of food uneaten at most meals –decreasing ability to participate in activities of daily living

21. 21 Measuring and Recording Weight Weight loss is one the most important predictors of malnutrition Nurse aides must know how to measure and document weight accurately

22. 22 Measuring and Documenting Intake and Output I&O records how much person eats, drinks and eliminates Intake records document if individual left 25% or more of uneaten food Document intake as soon as meal is finished Accurate evaluation of food and drink is possible only with accurate I&O

23. 23 A method validated to accurately estimate food and drink intake: Food and Fluid Estimation Diagram (FFED for short)

24. 24 Activities of Daily Living Related to Eating Bathing Grooming (brushing teeth; combing hair; shaving) Toileting Dressing Ambulating

25. 25 Monitor for Changes in Eating or Intake Changes in eating or intake may signal other health problems Prompt “pick-up” on changes can reduce risk of long-term problems Important quality of care issues for families and regulators

26. 26 Reporting Changes in Eating and Drinking Habits Report: –What’s eaten –How much is eaten –How it is eaten

27. 27 Areas to Monitor for Change Intake Function Kinds of help needed Physical Cognitive Subjective Behavior

28. 28 Remember: The nurse aide is in the unique position as a direct caregiver to be the first to observe any changes in the resident and report the changes to the nurse or supervisor. Observation and reporting can keep a minor problem from turning into a major one.

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