Nutrition Status of The Elderly - Essay Example

The purpose of this paper is to assess or evaluate the nutrition status of the elderly, to determine qualities about their physiology which would entail a different type or level of nursing and health care. This paper was able to reveal that a large percentage of the elderly population suffers from malnutrition. The assessment process which is required for the elderly includes his anthropometric measurements, biochemical markers, and socio-economic conditions. The long-term care management plan for the elderly includes the community participation through home health agencies, congregate meals, and meals on wheels. A nutritional plan for the elderly also includes a diet high in bread and fibers, fruits and vegetables, water, and vitamin supplements; and low on salt, fat, and sugar. Patients who have difficulty swallowing, who refuse to eat, and those who cannot eat are the ones who need the most attention in long-term management. The elderly population is also prone to falls and emotional problems and the long-term care plan should therefore include fall management and mental health care. Nutrition Status of the Elderly Introduction The elderly, along with children and infants, comprise the vulnerable population in terms of health status and health care. Due to their advancing age, the immune system of the elderly population is severely compromised. This makes them susceptible to various infections which sometimes take longer than usual to treat. They are also prone to falls and fractures due to their brittle bones and diminished muscle strength (Kaufman, 1997). With these various vulnerabilities, it is therefore important to regularly assess or evaluate the nutrition status of this population. It is also important for the health care team to come up with a long-term care management plan which can prevent the usual injuries and diseases that may befall the elderly population. This care plan must be fashioned to their needs and to their individual characteristics. This paper shall discuss the nutrition status of the elderly. Based on such status and assessment, it shall then suggest a care plan for such population. A focus on a long-term care plan management shall be done for this paper. Discussion In 2003, a study by Berner revealed that about 5-10 percent of free-living elderly and 30-60% of those living in the nursing home, homebound or hospitalized suffer from malnutrition. Because of various physiologic changes and the increase in diseases suffered by the elderly, they are prone to decreased nutrients in their system which often leads to problems in the biochemical processes of their body, cellular, and tissue deterioration (Berner, 2003). Various processes and assessment tools are often used by the members of the health care team in order to adequately assess the nutrition of a patient. For the elderly, these tools use standards and values different from standards used for the infant, child, adolescent, and the adult population. They help the health care team come up with an appropriate evaluation of the patient and consequently enable the creation of a health care plan fashioned according to the needs of a patient. The patient’s anthropometric measurements include his height, weight, and skin-fold measures. The elderly patient’s height is usually the most affected because they often become shorter due to their thinning vertebrae, the compression of the vertebral discs, possible kyphosis, and the debilitating effects of osteoporosis or osteomalacia (Bernadier, et.al., 2008). The medical health professional also often finds it difficult to measure the patient’s height because of the patient’s inability to stand, to stand for a prolonged period of time, and to stand straight. The medical health professional is then expected to make the necessary adjustments when measuring the patient’s height based on the above considerations. In measuring a patient’s weight, the health care giver must also expect the patient’s weight to have altered throughout the years. The standard weight measures cannot be applied to the elderly population as these standard measures were not created with the elderly population in mind (Bernadier, et.al., 2008). Nevertheless, the patient’s BMI can be computed in order to generally assess the person’s classification based on his height and weight. Some experts however point out that the cut-off value for the elderly population’s BMI classification should be higher than the normal population. No standards yet in this regard have been made in favor of the elderly population. In terms of skin integrity, the health care professional must expect that the patient’s skin integrity should expect changes in the compressibility and elasticity (Bernadier, et.al., 2008). Since no standard measures for skin-fold have been fashioned for the elderly population, skin-fold measurement is not considered a reliable tool for assessment of the patient’s health and nutritional status. The patient’s loss of muscle mass and shifts in body fat composition are some of the expected changes in the elderly which ultimately affect their nutritional assessment (Bernadier, et.al., 2008). Biochemical changes are also expected in the elderly population. Their renal function often declines, there is fluid imbalance, and there are changes in the hydration status. The serum transferrin of the patient also becomes reduced, since more iron is often stored by the body instead of circulated in the body (Bernadier, et.al., 2008). A lower serum albumin in the elderly is also not a favorable marker. Lower serum albumin usually implies overhydration, cancer, renal or hepatic disease and would consequently mean rehospitalization, extended hospital stay, and possible complications (Bernadier, et.al., 2008). High serum cholesterol exposes the patient to possible dangers like coronary heart disease; however low serum cholesterol also implies poor nutritional status among the elderly (Chernoff, 2003). The elderly’s socioeconomic status can also be used as a marker in assessing a patient’s nutritional status. Socioeconomic status often includes: social history, economic status, drug history, family and living conditions, and person’s ability to perform his ADLs (Bernadier, et.al., 2008). The above factors ultimately help in determining the risks that the patient may be exposed to and the factors which may prevent him from achieving optimum levels in his health and nutrition. Long-term Case Management Manfred Huber, through the Euro Centre, published a summary of concepts which substantially cover long term care and management (2009). In the conceptual model, Huber points out that an elderly patient often has two areas or aspects of health care needs, which are: health related (physical, cognitive, and chronic); socio-economic (poverty, exclusion, discrimination, abuse/neglect) (2009). These needs often demand long-term care which may be classified into formal and informal long-term care. Informal care involves family, friends, neighbors, and volunteers; whereas, formal care involves public and private services (Huber, 2009). The long-term care management that is now to be planned is based on a holistic plan of care which covers the different aspects of the patient’s life—from the socio-economic to the health-related. First and foremost, the patient’s ability to care for himself or to conduct his activities of daily living (ADLs) independently is one of the determining factors which health care givers use in determining the type of care to be administered to the patient (Williams and Schlenker, 2003). Nursing homes are facilities which often deliver long-term health; however, in recent years, the emphasis now has shifted to community long-term health care. In this instance, the patient often stays with his family, and the members of the family assist the patient in his ADLs. Home health agencies and other private caregivers or nurses are also often recruited to assist in the delivery of care to the community or to the patient’s home (Williams and Schlenker, 2003). In simple matters such as doing groceries or running errands for this elderly population, the community, through community assistance programs can now assist. The government has set aside monetary support for food and nutrition services for the elderly who are under long-term care. These programs are actually managed by local agencies who home-deliver meals or who provide transportation assistance for the delivery of groceries to the elderly (Williams and Schlenker, 2003). The congregate meal program is another program which was developed in accordance with the dietary requirements of the elderly. This program has been provided in various community centers churches, municipal buildings and even business complexes and this program provides 5 meals a week served every noon to the elderly. The meals which are served contain the necessary and essential caloric intake for the elderly patients (Williams and Schlenker, 2003). Meals on wheels is also another programs developed for community long-term care management. These meals are mostly for those who are physically unable to leave their homes or are homebound because they are caring for a sick spouse (Williams and Schlenker, 2003). The meal is also delivered 5 times a week every noon. During the start of this program, the meals brought to the patients were supplemental sources of food; however, in the years that have now followed the implementation of this program, “the meals that are now delivered are their major source of food, and these meals are divided across the day and the week” (Williams and Schlenker, 2003). However, it is still enlightening to note that this program helps to ensure that the patients are getting the necessary nutrients which are appropriate to their needs. Hegner and Needham (2002) suggest a nutritional and caloric intake plan in order to maintain the nutritional status of the elderly in long-term care. Through the USDA recommendations, they emphasize that the elderly should drink at least 8 glasses of water daily, 6 servings of bread, cereal, and pasta, 2-3 servings of fruits and vegetables, 3 servings of milk, and 2 servings of meat, poultry, fish, and dry beans. Fats, oils, and sweets should be taken sparingly by the patient (Hegner and Needham, 2002). Calcium, Vitamin D, and Vitamin B12 are also vital to the elderly patient’s well-being. Bread, cereals, and pasta contain fibers which consequently help during elimination (Cassel, 2003). Fruits and vegetables are excellent sources of vitamins and minerals which help the patient fight off infection and build-up resistance and strength. And for milk intake, this helps prevent bone degeneration (Hegner and Needham, 2002). Intake of fats among the elderly increases cholesterol build up in the body, and this increases their risk for coronary or heart diseases. For sugars and sweets, they contribute to dental caries and can eventually expose the patient to the dangers of diabetes. On the other hand, too much salt in the diet can eventually lead to increased blood pressure (CASH, 2005). Alcohol should also be taken in moderation because they can potentially lead to addiction, and in the long term, a host of other illnesses and injuries (Hegner and Needham, 2002). In instances when the elderly patient who is admitted to long-term care has difficulties in swallowing, the responsibility of the caregiver is to ensure that the food to be given to the patient is of a consistency which can be swallowed by the patient (Rosdahl and Kowalski, 2008). Semi-solid or thickened liquids may also be given to these patients who may prefer small frequent meals instead of large and less frequent meals. The patient should be placed in a sitting position in order to facilitate swallowing and to prevent aspiration (Rosdahl and Kowalski, 2008). The caregiver or nurse should have a suction apparatus ready just in case the client would have need of it. For medications and supplements, it is vital for the nurse or caregiver to inform the client about the different medications he is taking. More often than not, elderly patients are taking several medications for various ailments and medical problems. The caregiver should make an inventory of all these medications and make sure that the client knows what each medication is for and the considerations associated to each medication (Rosdahl and Kowalski, 2008). Another risk among the elderly population is the fact that they are vulnerable to falls and injuries. Kane, et.al., (2004) recommends some remedies which can be applied to long-term care facilities in order to prevent these falls. First and foremost, staff education programs can help enlighten the staff about measures they can take in order to decrease the risk of falls in long-term care facilities (Kane, et.al., 2004). Gait training and appropriate assistive devices can also be used in order to prevent injuries and falls. The health care professionals must also review and modify patient’s medications, especially, those which may compromise the patient’s consciousness and alertness (Kane, et.al., 2004). Also, by maintaining a healthy and balanced diet and through exercise, the degeneration of the body that usually comes with age can be prevented, and consequently, falls may then be avoided (Care Directions, 2000). The elderly patient who is living in long-term care may also be faced with emotional and mental coping problems (Goldsmith, 1993). Since he is away from his family, he may face depression and anxiety and previously existing mental health problems may also manifest at this period. In order to prevent or manage these mental health problems, the team approach which focuses on both physical and mental status of the patient can be applied. The patient’s medications must also be assessed in order to detect drugs which may cause depression or other mental problems (Goldsmith, 1993). Community programs can also be implemented on the elderly in order to allow them to live in their homes, with their families, or within their familiar communities (Metteri, 2004). This program can help improve communication and interaction with the patient and consequently reduce moments of despair and depression. Elderly patients who most require nutritional support are those who cannot eat, those who refuse to eat, and those whose caloric and nutritional requirements cannot be met through their usual diet (Matarese and Gottsclich, 2003). Those with esophageal obstructions, dysphagia, Huntington’s, multiple sclerosis, coma, Parkinson’s, and thermal injuries belong to these group of patients who have a compromised nutritional support. There is a need, therefore to provide them with enteral feedings. The responsibility of the caregiver, in these instances, is to note the patient’s tolerance and individual needs (Matarese and Gottsclich, 2003). The enteral feeding program must be adjusted based on each patient and on each patient’s condition. Conclusion The above discussion exemplifies the complexities of caring for the elderly population who have needs which are very much different from the general population. Due to their advancing age, the elderly population has a compromised immune system; has a high risk for falls, for mental health problems, and for various health problems. The focus in elderly care has recently shifted to community long-term care in order to allow the patients to stay with their families or within their communities. Through programs like meals on wheels and congregate meals the necessary caloric intake for this population is ensured. Long-term care plan management for this population focuses on ensuring their independence and health through a nutritional plan which is high in fiber, vitamins, minerals, and water, and is low in salt, sugar, and fats. The management of the elderly population is largely based on qualities unique to this population; it is based on evidence and on patient needs. Works Cited Bernadier, C. Dwyer, J. and Feldman, E. (2008) Handbook of nutrition and food. Florida: CRC Press Berner, Y. (2003) Assessment Tools for Nutritional Status in the Elderly. Tel Aviv University. Retrieved 26 November 2009 from http://www.ima.org.il/imaj/ar03ma-15.pdf Cassel, C. (2003) Geriatric Medicine: An Evidence-based Approach. New York: Springer Publications Chernoff, R. (2003) Geriatric Nutrition: The Health Professionals Handbook. Massachusetts: Jones and Bartlett Massachusetts Goldsmith, S. (1993) Long-term care administration handbook. Maryland: Aspen Publishers Hegner, B. and Needham, J. (2002) Assisting in Long Term Care. New York: Delmar Publishing Huber, M. (September 2009) Monitoring Long‐term Care of the Elderly. European Centre. Retrieved 26 November 2009 from http://www.euro.centre.org/data/1253898305_12231.pdf Kane, R., Ouslander, J., and Abrass, I. (2004) Essentials of clinical geriatrics. USA: McGraw- Hill Publishing Kaufman, D. (1997) Injuries and Illnesses in the Elderly. Missouri: Mosby Elsevier Maltese, L. and Gottslich, M. (2003) Contemporary nutrition support practice: a clinical guide. Missouri: Elsevier Health Sciences Metteri, A. (2004) Social work approaches in health and mental health from around the globe. New York: Haworth Press Rodwell, S. and Schlenker, E. (2003) Essentials of nutrition and diet therapy. Missouri: Elsevier Health Sciences Rosdahl, C. and Kowalski, M. (2008). Textbook of basic nursing. Philadelphia: Lippincott Williams and Wilkins Staying healthy at home (2000) Care Directions. Retrieved 25 November 2009 from http://www.caredirections.co.uk/stay_home/h_health.htm Salt and the older population (January 2005) Consumers Action of Salt and Health. Retrieved 26 November 2009 from www.worldactiononsalt.com/.../salt_and_the_older_population_factsheet.doc Read More