Nutrition and the Regular Assessments - Essay Example

Running head: LITERATURE REVIEW Literature Review of Nutritional Risk Assessment in Elderly Care You're Nutrition and the regular assessments that must be given in elderly care, with regard to nourishment, are a detrimental phase in trying to maintain a stable and manageable quality of life for the elderly population. This research will show that these nutritional assessments differentiate among ethnic groups due to the cultural beliefs that each group might have. What one region of the world might utilize to properly assess the elderly and the quality of nutrition they receive will not be the same in every single community or social environment. This has to do with the fact that some might have religious beliefs which dictate to them that they should not consume certain foods even though they might need them for the vitamins and minerals they contain. In this regard the research will define that alternative methods have to be used. This research spans a time frame of 16 to 20 years and often brings in a comparison of Western medical concepts, with inclusion of countries such as the United States and Canada in relation to the attitudes and perceptions of medical rehabilitative personnel in countries such as Australia, Belgium, and England who work with the elderly also. This is to show how the view points differ and the methodologies in the strategies change as well. To bring clear cohesion into this research subheadings and bulleted points are used throughout the body. The conclusion brings a direct and concrete statement, clearly showing that despite any external influences in rehabilitative care of the elderly the nutritional assessments are necessary whether carried out in the same manner or not. Proper nutrition is a given need in rehabilitation and the assessments guarantee that those needing more attentive care and a special dietary style are taken into consideration and monitored closely to bring positive and optimal results to their rehabilitative treatment regimen. Literature Review of Nutritional Risk Assessment in Elderly Care Introduction All of the literary studies reviewed defined nutritional assessments, and other necessary assessments as being carried out for a great many reasons but the realization of them is that they are fundamentally sound and bring about an appropriate way to meet the needs of a patient, by the nurse or other care giver (Green & Watson 2005, pg. 70). Anytime assessments are carried out a thorough investigation of the tool being used is necessary beforehand. This is to guarantee that a nurse or other medical professional will be able to gain a secure comprehension of patients' actual needs and in this case this is in the nutritional needs of the elderly going through a rehabilitative phase of treatment. The assessment tools are checked for sensitivity, validity, reliability, specificity, and acceptability as well (Arrowsmith 1999, pg. 1485). The main screening tool that was used in the studies by Destzky, Arrowsmith, and others was that of a subjective questionnaire which did not give the most important information that they needed in order to definitively detect whether or not some elderly where at higher risk of malnutrition or not (Arrowsmith 1999, pg. 1485). The reason for this is because, through reading these studies it could easily be determined that many of the questioning methods were biased and not directed at all groups of people but rather a subjective few instead (Green & Watson 2006, pg. 480). This of course limits the ability of a nutritional assessment tool such as this. Therefore the research can prove that a subjective questionnaire is not reliable nor does it hold the validity necessary to make accurate judgments on the elderly populations' health. Furthermore, more recent investigative studies have found that there is a high risk in this type of assessing tool as well (Wright 1999, pg. 437). This is due to the fact that the answers do come back with biased responses, or questions are not fully stated which affects the accuracy of the assessment. However, the methodology that was utilized in these studies and another carried out by Azad do correctly show that there is a severe decline in the health of many elderly people with regard to nutrition. The way in which this information was uncovered was accurate and included all minority groups and various culturally specific people through a means of objective questioning and observation as well (Thompson & Froelicher 2006, pg. 927). Needless to say however, these studies critiqued clarified that there is a great need for concern with how much of the research is carried out in a limited way and thereby can impact even the more positive results that are gained with appropriate methods that are utilized. Other factors that many studies have validated which promote adversity is the fact that this type of assessment does not take cultural beliefs or personal values into consideration which can make it less reliable as well (Barrocas et al 1995, pg. 679). According to the extremely in-depth study carried out by Destzky et al (1984), the main area of concern is that many of the nutritional assessment tools lack the ability to bring in the socio-cultural aspects of eating styles. This unquestionably limits there being irrefutable accuracy in any results that might be gained. That is, unless an interpersonal approach can be somehow intertwined with any assessment carried out on an elderly group (Destzky et al 1984, pg. 155). Destzky's study did not implement any form of interpersonal skills and this alone jeopardized the validity of the research found because some of the individuals assessed were unresponsive to specific questions. Also, when observed, many of the elderly that carried culturally specific beliefs did not like to be watched while eating so this placed limitations onto the study as well. Furthermore, literature reads that many of these nutritional assessments have never been placed against anything to check for the validity or reliability of the information that is gathered. These facts alone bring about adverse possibilities in any studies on nutritional intake among the elderly because they are lacking specificity, sensitivity, and acceptability which hurts these studies and demeans the gathered data due to the insufficient requirements and lack of inclusion of all ethnic groups. In other words, the direct point being clearly emphasized is that if the main principles of assessments are not followed to begin with then there is no adequate way that proper care can be given to all elderly people in a specific group. However, if all the principles in an assessment are considered and managed correctly then a positive result can follow. Principles of Assessments The three literature reviews studied clearly define an assessment as the first part of the nursing process and it is about collecting data or information involving the patient or client and their family or carers. In all health care settings, assessment is defined as "the gathering of information and formulation of judgments regarding personal health" (Hansebo & Kihlgren 2004, pg. 269). Therefore, assessments are a very crucial stage in gaining the necessary knowledge to care for the elderly in a rehabilitative program, specifically if a positive outcome is what the goal is for the medical professional and the patient. Information from an article by Kassean and Vythilingum (2005) suggest that the initial stage of the assessment allows the nurse to gather base line information, which will be used to compare new and ever changing data. Since dietary habits are often changing among the elderly and of course since not everyone consumes the same products this is indeed a logical and adaptable type of strategy to have in a nutritional assessment tool. However, two points have been clearly found in any type of assessment tool with regard to how the data is collected. It can either be objective or subjective. The subjective implementation is more focused on the patient which brings about the idea of more of an interpersonal relationship and which can also guarantee more accuracy in the data being gathered. Objective data gives the nurse or medical professional a more conventional type of way of looking at the patient's weight, temperature, and blood pressure through their own personal observations, not really asking the patient anything. So this method is not always wholly reliable but according to Kassean and Vythilingum (2005) it is used quite often, observatory techniques that is. As was said, subjective gathered data draws on the patients own experiences which allows for inclusion of their own personal identity and makes them feel included in their assessment, quite opposite an objective type of strategy. The subjective means goes along with the principles of assessment since it does show to allow for variation among the elderly population. There are also two sources from which information can be gathered that is the primary source, which is the patient, and then there are secondary sources such as relatives, carers and health records (Roper 2001). Roper (2001) points out that health data is vital to ensure effective assessment of nursing needs. The data required can be collected in many ways as mentioned above, but whatever data is obtained it is essential that the nurse ensure that they are kept confidential in keeping with their professional code of conduct and that any recorded data is protected. The Goal of Patient Assessments As has been emphasized, the two main tools of nutritional assessments are through observation and interviewing. The three studies critiqued used both of these processes. Also, literature compiled by McCall & Cotton (2001) makes it clear that it is a necessity in nutritional assessments to correctly gather the nutritional data so that it will have inclusion for a whole group. This of course takes a variety of tools and methods to ensure successful and reliable data collecting, and it was found that all three of the studies achieved only minimal results due to the minute use of observation tools (McCall & Cotton 2001, pg. 140). Research has also clearly validated that assessments are carried out for innumerable reasons with nutrition being just one of them in the process of rehabilitative care for the elderly. They are mainly carried out to support the nurse to ensure that the patient receives the right care, which assists a speedy recovery, and helps prevent reoccurrence of the problem that led to the need for rehabilitative care in the first place. Also, this philosophy results in the patient not requiring a hospital bed and therefore freeing it for another patient. The act of nursing in itself is concentrated on helping people to cope and adjust with problems. Therefore, when carrying out an assessment such as something on nutritional qualities and dietary intake, care and consideration is necessary to incorporate (Tierney 1996, pg. 230). Therefore, the model being used has to have strong interpersonal qualities and not just view the elderly patient as a body but as a whole human being. This brings in the idea that a holistic assessment is a good idea to consider utilizing as it is even true that many cultures prefer a more natural way of treating and assessing their needs (Crogan & Schultz 2000, pg. 216). When carrying out nutritional assessments or any medical assessment for that matter, the nurse needs to take a holistic approach which requires the nurse to look at the whole picture when assessing, taking into account, not only the patient's problem but their overall lifestyle and how they will cope after they have been discharged home (Parsley & Corrigan 1999). These three studies did not approach this in this type of fashion but instead kept with a more conventional approach that seemingly alienated some of the elderly patients within the studies or discluded them altogether. Furthermore, any approach to health care that emphasizes the patient's total well-being, including psychological, social and spiritual as well as physical aspects is considered to be holistic. None of these studies seemed to have the qualities that would define them as holistic methodologies. This is what this research is definitely trying to emphasize, that with regard to nutritional assessments on the elderly all points of social, environmental, and personal areas have to be included to accurately gather the data and make a positive difference in the patients outcome and recovery. This is due to the common facts, there are a myriad of factors that can affect an assessment. These main factors that influence the quality of the assessment the most are the communication techniques used and the environment that the patient is coming from (Broome 1998). All these factors can have an effect on the assessment process and may hinder the outcome of the patients care. Verbal and non verbal communication may effect the assessment process such as if a patient is deaf or has a speech impairment an important aspect may be missed, for example, if a nurse misunderstands what the patient is saying, they may provide inadequate or the wrong care resulting in a prolonged recovery time . The environment may also affect the outcome of the nursing assessment; this may be due to a patient not feeling that they can confide in the nursing staff over certain aspects as other people may hear what they are saying. If any factor hinders the information the nurse obtains from the patient it may result in the patient requiring to stay hospitalized for a longer time than required. Primary Pinpointed Problems in Nutritional Assessments among the Elderly Malnutrition among elderly patients within clinical settings and those that are going through rehabilitative care has become a high concern among many medical specialists and caregivers. This is spanning across various regions of the globe but the main ones lie in the United States, Great Britain, Australia, and Scandinavia (Azad et al 1999, pg. 165). The study carried out by Azad et al (1999) showed that this problem is indeed prevalent and therefore their research showed that in order to correctly intervene in cases such as these the nutritional assessment tools need to be checked for sensitivity and reliability more thoroughly. This is of course if the best and most reliable results to provide treatment are going to be obtained. Of course malnutrition is just one of the concerns that have been pinpointed in many of these studies. Specific cultural problems have come into play as well as it has been found that some ethnic groups are often discluded from research such as this and therefore suffer medically due to not having proper assessments given to them (Greene & Watson 2005, pg. 69). Also, malnutrition can be difficult to determine among the elderly, specifically those who are already ill and struggling to combat their disease diagnosis, or whatever their medical problem might be. Another problem that exists is the cost associated with nutritional assessments. Because of this cost only those elderly who appear the most at risk of becoming faced with malnutrition or who are already in the throes of it are predominantly the ones who are assessed. Also, it is clear that those elderly who reside in poorer areas of the globe might face improper treatment or only partial treatment due to their inability to afford the expense, such as those on Medicare in the United States (Institute of Medicine 2000, pg. 59). This shows that there exists disclusion for a number of other elderly people who might fit the profile of having deficiencies later on, in their rehabilitative treatment program (Azad et al 1999, pg. 166). This and the other mentioned problems appeared to hinder the research of Azad et al (1999), clearly dictating that there needs to be an improved way of locating those elderly people who need more thorough medical assessments in order to prevent there from being an adversity in their recovery or treatment program. All of these problems were seen equally as every study that has been reviewed has shown that there are serious issues such as poverty, race, cultural beliefs, religious beliefs, emotional status, and medical diagnosis that have a great deal to do with the nutritional phase of care with the elderly patients in these countries. It isn't just the way the nutritional assessments are carried out, it is also if they are carried out, as well as the attitude of those who are responsible for gathering the data from the assessments as well (Chandra et al 1991, pg. 1475). Socio-cultural Problems with Nutritional Assessments Out of all of the studies examined the review can clearly state that malnutrition is one of the main adversities being pinpointed among the elderly. This is of course a socio-cultural problem and can stem from disparity issues and lack of medical services in rural areas as well. There are many logical explanations for it through a sociological perspective (CDC 1992, pg. 809). Although the sociological issues are rampant in the United States, they are even more so in countries within the UK, such as in Russia, Australia, and Armenia as well. Nutritional Assessments simply can not be accurate when there is already a high level of malnutrition ongoing among specific cultural groups. Also the rehabilitative care is severely affected as well because lack of nutrition is going to create problems with recovery from illness and other medical problems for elderly people. The statistics of this occurrence are staggering as well, as after reviewing several studies it was found that within the elderly population in nursing homes 59% suffer from malnutrition and in hospitalized environments 65% are suffering from it (Ferro & James 1996, pg. 883). Also 5% to 22% of the elderly who live in the rural community settings within Britain, the United States, Russia and Australia are suffering from bouts of malnutrition as well due to lack of proper medical intervention and social support. Because of these negativities there has developed a growing recognition in many countries, defining malnutrition among the elderly as a growing problem which is affecting third world populations and those who are homeless far more severely than even those subsequently mentioned. Because nutritional assessments are often not given to those in these groups then the issues of malnutrition will only continue to grow more abundant and create more adversities in the elderly population. The perception is that in order to work around obstacles such as these there has to be a way to conduct nutritional assessments on the elderly in mass areas, not in just specific environments. If this can not be done then those in more rural and deprived areas will never receive the care that they need much less get rehabilitative care services. One specific study that was reviewed according to the problems with socio-cultural factors present evaluated 1,566 elderly participants. Elderly individuals who were not the head of the household were not taken into consideration for this study purposely, because this would allow the focus to be on those elderly who made the food choices within the household. It was shown clearly that women in the elderly population have the traditional responsibility of preparing food for the household. Each category taken into consideration showed variable and sometimes definite results. Upon looking at the region and degree of urbanization, the study shows that the geography of elderly individuals does have an impact on nutrient intake (Wood & Creamery 1996). For example, urban elderly residents received lower amounts of iron compared to non urban elderly. The degree of urbanization also shows that elderly living in urban environments have the ability to be exposed to a greater variety of food stores, cultural and economic opportunities, and mass media. The socialization factor did not show a significant effect on nutrient intake for the elderly in this study, although researchers have reported that the elderly may experience a lack of appetite as well as the desire to eat when they are alone. This alone can have a heavy affect on how well an elderly patient might do in a rehabilitative program due to lack of specific nutrients in their body. Looking at nutrition in the elderly from an economic view, poverty appeared to play the largest role in a low nutrient intake among the aging, with an exception of vitamin E, calcium, and iron. However, the use of food stamps increases the ability to purchase a healthier range of foods, this particular study found no correspondence to the two factors. The results of race, age, and gender showed the most dramatic results when looking at nutrient intake, according to the research gathered in the study by Wood & Creamer (1996). Compared to elderly whites, elderly blacks consumed fewer calories, less fat, vitamin E and B6, niacin, calcium, phosphorus, magnesium, iron, and zinc. Other races showed differences as well in nutrient intake compared them to elderly whites, but none as profound as those of elderly blacks. Protein intake was also determined to be higher in that of elderly people younger than 70, but older than 60. Surprisingly, women were found to be lower in all nutrients, except for vitamin C (Finch 1998, pg. 32). This shows that there are a number of sociological factors that have a definite part in the nutritional eating habits of the elderly. As has been stated, nutritional assessments can not always gather the necessary data to come to an accurate decision on the health status of some elderly people. Some of these assessments are simply not sensitive or reliable enough which as has been said, poses severe problems in gaining the reliability needed to know what type of treatment might work best for those elderly who need medical care or rehabilitative treatment, etc (Webb & Cooperman 1996). Conclusion The research has shown that nutritional assessments do have good qualities but they are not as efficient as they need to be nor are they wholly practical either. However, these assessments are able to pinpoint the fact that there does exist severe nutritional problems in the elderly population and those identify do get the medical care they need to help them through rehabilitative care. The gathered research through these assessments shows that 85% of seniors have nutrition-related problems due to the effects of the digestive system from aging. Such things as, type 2 diabetes, hypertension, cardiovascular disease and osteoporosis are the most common. The excretory, nervous, reproductive and urinary systems are all affected as well. Alzheimer's, arthritis, cancer, diabetes, depression, are all very common too. All the systems of the body work together so any physiological change will require nutritional changes. Physiological changes that take place as aging occurs affect the need for several essential nutrients. Metabolism, chronic disease, social conditions, and medicine intake affect the nutritional needs of the elderly. Changes in basal metabolism and physical activity may cause a decrease in energy needs. Loss of taste and smell allow the elderly to neglect their diets. Some clearer ideas of why there is such an outstanding problem with nutrition and dietary habits among the elderly based on several studies that utilized the nutritional assessments is outlined in the following paragraph: Food is no longer enjoyable because of declining taste and smell, medication further impairs these senses Dentures or poor dental health make chewing food difficult Loneliness and depression affect the diet of the elderly as they do not want to eat Being on a fixed income so this would be the cost of food is to great The elderly body can not process food the way it use to so there need to be dietary changes but without a proper assessment then this can't be corrected in a rehabilitative program These points give a clear idea of why there is such a problem in the dietary habits of the elderly and why many rehabilitative programs have such difficulty with the elderly. Again, nutritional assessments are great and can work wonders when carried out in the appropriate manner and with a wide-berth but there are too many elderly who are being neglected and not receiving interventive care that they need. Therefore there needs to be definite changes to meet the growing demand for proper nutritional assessments among the elderly population. Without these changes then there will continue to be too high of a morbidity rate among the elderly due to lack of nutrition and lack of rehabilitative care as well. Research Question for Study Hypothesis Socio-cultural issues must be acknowledged within nutritional assessments of the elderly in order to gain highly reliable and accurate results to prevent so many in the elderly population from falling through the cracks and not receiving rehabilitative care. Question How can the necessary Socio-cultural issues reach an inclusion status within nutritional assessments among the elderly in order to bring about highly reliable and accurate results so that there well be less of the elderly falling through the cracks in the system and not receiving the care they are entitled too References Arrowsmith, H. (1999). A Critical Evaluation of the use of Nutrition Screening Tools by Nurses. British Journal of Clinical Nursing 22, 1483-1490. Azad, Nahid & Murphy, Joseph & Stephanie, R. D. & Toppan, Julie. (1999). Nutrition Survey in an Elderly Population Following Admission to a Teritary care Hospital. Canadian Medical Association 161-165. Barrocas, A. & Belcher, D. & Champagne, C. & Jastram, C. (1995). Nutrition Assessment Practical Approaches. Clinics in Geriatric Medicine 11, 675-713. Broome, A. (1998). Managing Change. London: McMillian Press. CDC. (1992). Nutritional Needs Surveys Among the Elderly: Russia and Armenia. 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