Undernutrition in Elderly - Essay Example

NAME : XXXXXXXXXX TUTOR : XXXXXXXXXX TITLE : XXXXXXXXXXX COURSE : XXXXXXXXXX INSTITUTION : XXXXXXXXXX @2009 Under nutrition in elderly in residential and hospital setting Introduction Under nutrition can simply be defined as the state of being poorly nourished. It is a situation that develops when the diet we feed in does not satisfy certain nutrients, energy and protein requirements of the body system. Under nutrition is a problem that is currently rampant in old people in Australia. This should sound an alarm to the Australian government and health care professional as Australia is going grey at an alarming rate. It is estimated that by 2021, those aged over 65 years will outnumber those less than 15 years. By 2051, 25% of the whole Australian population will be over 65 years, whereas 55 will be over 85 years. It is clear that with the high rate of the aging population, the rate of under nutrition, which is already too high, is set to rise further. It is therefore imperative for clinicians to recognize the features and understand the management and prevention of undernutrition. The prevalence of undernutrition in elderly people is higher and widespread. It has been found out that there are 24% of malnourished elderly people in the community, 46% in hospitals and 51% in nursing homes. Generally, there is a high prevalence of under nutrition in elderly people in long-term care as compared with those living at home (Thompson Martin et al 2006). Despite the fact that undernutrition is a major threat to the health of elderly people it has been given little attention. It is becoming difficult to diagnose elderly people who are malnourished as there has not been identified one best single measurement and it has been acknowledged that malnutrition is a continuum. There are few studies which have been conducted on nutritional status using anthropometric measures. There is also poor diagnosis of malnutrition and treatment. Studies have found out that although most physicians identify elderly people who are malnourished, they do not document such information in their medical records. Most hospitals do not have adequate interventions for malnourished elderly people in acute care. Most hospitals have also not been able to develop appropriate assessment tools that can be used to identify aspects of health and status which can be assessed and monitored objectively in elderly people with different stages of functional ability to accurately discriminate between those at risk and those not at risk (Amarantos et al. 2001). Malnourishment has been found to have a range of negative effects on the health of elderly people. Undernutrition makes it difficult to treat a disease and it even prolong discovery. It has lead to development of sores and fractured femurs. Nutritional deficiencies lead to muscle weakness and loss of skeletal-muscle mass in aged people. Under nutrition in elderly people is associated with increased morbidity and mortality. A study conducted by Ryan found out that elderly patients with chronic diseases and who had lost 5% or more weight in one month were likely to die within one year. Low body weight can lead decline in physical activity, disability and increased risk of hip fracture. Undernutrition in elderly people lead to reduced fat, lean body mass and protein, decreased bone density and micronutrients, and impaired immune function. Lack of micronutrients such as zinc can result to loss of appetite and taste sensation. These make elderly people to be prone to depression and lethargy, delayed wound healing, skin breakdown and susceptible to infection. Under nutrition in elderly people put them at high risks of acute or chronic disease. Illness such as trauma, surgery and infection drug therapy can alter nutrients requirements in elderly people body system making them prone to malnourishment (Hickson 2006). Under nutrition in elderly people has been associated with increase in economic and human costs. Under nutrition in elderly people has led to significant increase in cost to the individual, families, communities and the health care in general. It is imperative to address this problem as the failure to address it is not only unethical and detrimental, but also very costly. Under nutrition in elderly people has lead to increase in hospital admission and length of hospital stay, ICU stay and General Practitioners visits. Malnourished patients also require subsequent health care which involves readmission to hospital or referral to specialist health care professionals. Loss of functional status has been associated with acute care hospitalization in malnourished elderly people. Studies have shown that hospitalization of malnourished elderly people result in significant deterioration of daily activities such as bathing and dressing. Unless, earnest effort are made to develop prevention and management strategies to avert the problems caused by under nutrition in elderly people, the healthcare costs associated with this problem are bound to increase (Hickson M. 2006). Under nutrition is associated with severe weight loss which leads to both cardiovascular and gastrointestinal functions impairment. Weight loss is associated with decline in function status, disability, and delayed wound healing and decreased psychosocial well-being of the elderly people in nursing homes. Weight loss is an independent predictive factor for the increased mortality rate in elderly people. Low calories, protein and micro nutrient deficiencies in old people impair their immune system exposing then to infections which may lead to reduction in absorption of essential nutrients enhancing the cycle of under nutrition and infection (Gillette-Guyonnet et al. 2007). Under nutrition in elderly people has many unpleasant consequences and this is founded fact. Certain micronutrient deficiencies are associated with decline in cognitive ability in elderly people. As people grow older, their energy intake rate, resting metabolic rate and physical activity level reduces making them prone to malnutrition. There are certain psychiatric disorders associated with under nutrition in elderly people which include anxiety, depression and dementia. Depression is a common problem in elderly people and it lead to loss of appetitive, decreased physical activities and reduced energy, which contribute to decreased food consumption. Dementia is associated with certain behavioral disturbances, such as aversive eating behavior and restlessness, which can contribute to severe malnutrition. Under nutrition may also lead to mobility impairment which can further affect the nutritional status of elderly people as this can hinder them from participating in food production, acquisition and preparation (Faxen-Irving et al 2005). Health care system’s barriers to nutrition care Lack of sufficient knowledge among nutritional professionals has been cited as the major barrier to nutritional health care. Most health nutritional professionals do not have training on nutrition issues and they do not understand the association between elderly people nutrition status and their physical, social and psychological requirements. Nurses have a tendency to overestimate elderly patient’s actual food intake in many incidences. They also do not keep documented records for elderly patient’s nutritional deficiencies and this can result to confusion as regards assessment of food and energy consumption among elderly patients in nursing homes. Most physicians fail to take weight measurements for their patients. Nurses, social workers and food service personnel in institutions and nursing homes do not have knowledge as regards nutritional problems of elderly people and hence cannot respond effectively to the individual nutritional requirements of elderly people (Lauque et al 2004). Existing nutritional programmes do not reflect on attitudes in nutritional care nor do they offer opportunities for nurses to further their nutritional knowledge. The recent approach used in most hospitals to assess the causes of weight loss and under nutrition in elderly people is generally chaotic. Medical staff completes nursing intake forms in an inconsistent manner. Shortage of health nutritional workforce in nursing homes and hospitals is a major barrier to nutritional health care among the elderly people. There are few trained and qualified health nutrition professions within the health care system. This shortage of workforce has been accelerated by the high burnout rates due to lack of respect, autonomy, extrinsic rewards, like adequate wages and health benefits and opportunities for career advancement. This presents a graver problem than financing and delivery problems as it has lead to increase in workload and low workers’ morale. Lack of adequate qualified staff has led to lack of personal care, poor quality of care during mealtimes, poor positioning of trays during mealtimes, staff-enhanced dependency, patients being hurriedly and forcibly fed, some patients receiving little or no food, solid food being mixed with liquids, dysphagia being undiagnosed and unrecognized and patients being served their meals in bed (Woo et al. 2005). Nursing homes gives low priorities to nutritional issues are compared to other nursing care activities (Xia and McCutcheon 2006). There is low use of oral nutritional supplements and energy dense meals in nursing homes. Meals offered in hospitals and nursing homes do not meet the protein intake level that is recommended for elderly people. It has also been observed that elderly people do not get any assistance from staff at mealtimes and most of the time they leave their food half eaten (Xia and McCutcheon 2006). It has also been observed that elderly patients in hospitals are not given enough food and most of the time their energy and nutrients requirement are not met (Dupertuis et al 2003). The mealtimes schedules adapted by most nursing homes and hospital are not flexible and do not meet the elderly patients’ needs and habits rather they are framed to suite the administration needs. Hospital food has also been frequently described as unappetizing and patients who need aid to feed do not get it and hence, end up not eating. There are also no special meals for elderly patients without teeth and most butter packs remain unopened as patients with frail arthritic fingers cannot be able to open them. Nurses sometimes places food outside the reach of bedridden elderly patients. All these lead to decrease in energy intake among the elderly patients and hence worsening their nutritional status. Social barriers: Poverty, lack of public health education, food attitudes, isolation, institutionalization, inappropriate medical training and lack of access to medical care are some of the factors leading to undernutrition in elderly people. Research studies have shown that income is significantly correlated with nutrient deficit in older people. Under nutrition is high in elderly people in low socio-economic status as they cannot afford to access nutritional care to the high cost associated with health care. They can also not be able to buy certain foods such as vegetables and fruits that are high in micronutrients such as of calcium, vitamin A and vitamin C. Most of the elderly people in the society are not educated and trained on appropriate lifestyles modification to prevent them from under nutrition. The increased institutionalization of elderly people in hospitals has put them at high risks of malnutrition as they become isolated from their families. These have tended to negatively affect their food consumption rate. Food anxieties are common in older people and they include not just inappropriate eating attitudes but also phobia and obsession. Elderly people have over-developed anxiety as regards food and weight which make them developing eating disorders (Crogan et al. 2001). Medical complication barriers: Elderly people suffer from stroke, neurological disorders which make them experience problems when swallowing food and therefore they avoid or refuse eating most of the times. These diseases can also lead to loss of hands making it difficult to feed unless they are fed by someone who may not be available. They also experience deteriorating dentition, ill fitting dentures and other periodontal diseases which make eating a hard task. Diminished sensory ability such as taste changes, less smell perception, hard hearing and reduced appetite are also some of health problems leading to undernutrition in elderly people. All these factors affect the intake, digestion, absorption, utilization and metabolism of food and nutrients. Changes in the gut microflora prevent digestion and absorption of nutrients. The ageing process brings about decreased efficiency of motility of gut muscle. The decline in the immune system in elderly people bring about bacteria overgrowth in the gut, whereas, the continued use of antibiotics may affect the functioning of the gut flora negatively. Neurological disorders may lead to dysphagia such as cerebrovascular accident which can result to less food intake. Drug use can also affect the absorption and metabolism of some nutrients. As people grow older, they experience deprived health and are forced to use a large percentage of prescribed medication and over-the-counter medicines. Apart from affecting the metabolism rate, the use of these drugs can lead to loss of appetite and changes in taste due to chemotherapy and analgesics (Crogan et al. 2001). Prevention and management of undernutrition in elderly people Undernutrition can be potentially prevented or reversed by use of various appropriate intervention measures; Screening and assessing nutritional status in elderly people: The detection and monitoring of nutrition status of elderly people should be part of the overall assessment of elderly people health status. It is important to assess the weight and dental of elderly people at least once in a month. The aim of assessing the nutritional status for elderly people is to identify those who are at risk of malnutrition in order to come up with appropriate prevention and intervention measures. Screening for malnutrition in elderly people should involve identifying risk factors such as disease, tooth loss or pain, economic hardship, isolation, involuntary weight loss, poor eating habits, multiple medicines and those who need assistance in self-care (Soini et al. 2004). Conducting a comprehensive nutritional assessment for elderly patients gives professionals who take care of these patients an opportunity to design specific care plans for nutritional intervention (Vella et al 2006). Therefore, nutritional assessment ensures that nutritional interventions are implemented immediately. It is therefore critical for a hospital or nursing home to have assessment tools which can be used to identify patients who are at risk of malnutrition. There are various assessment tools such as Mini-nutritional Assessment and Subjective Global Assessment. Oral nutritional supplements: Oral nutritional supplements have the capacity to decrease mortality and morbidity and increase muscle strength in old people (Milne 2006). Early use of oral nutritional supplements immediately after the diagnosis of an acute disease cam leads to increase in weight. Oral nutritional supplements have also been found to lead to improvement in nutritional status, energy intake and eating pattern for elderly patients who are institutionalized. Oral nutritional support should include lean meat and fish, nuts, fruits, formulated foods and drinks and low-fat dairy products. In case of severe under nutrition, enteral nutrition may be given until oral intake is considered adequate (Wouters-Wesseling et al. 2006). Enriched food and menu planning: Research studies have found out that combining both enriched food and small food portion has resulted to increase in energy intake, weight and physical activity in elderly patients. Giving elderly patients meals based on their individual needs and status, personal preferences can lead to increase in energy intake, nutritional status and functional ability. Changing menu and consulting as regard the proper diet for elderly people can lead to increase in weight in patients admitted in hospitals (Keller et al 2003). Boosting taste and enhancing flavor in meals is an effective way to improve food intake and body weight in elderly patients at home (Essed et al 2000). Elderly patients who are at home should be given meals which are high in carbohydrates content as this will increase average energy intake (Young et al 2005). All the staff in institutions and nursing homes should cooperate to maintain a good nutrition status among elderly patients. For example, the food catering staff should ensure that the food contains adequate energy and nutrients and the food is delicious. The nurses’ role should be to assist elderly patients during mealtimes and to measure their nutritional status (Evans et al. 2005). Meal time and meal environment in nursing homes: Nursing homes should provide a meal environment that can enable elderly patients to socialize with staff and other residents, to make choices as regards their individual preferences and to implement physical care to enhance quality life among elderly patients. A good social environment during mealtimes may also lead to increase sense of security, food intake and improve quality of life among elderly patients in nursing homes. The physical and social environment factors that can lead to favorable food intake among elderly patients include food accessibility, eating places, food intake time, ambient sounds, environment temperature, color, smell, texture, size and presentation of the food (Stroebele and de Castro 2004). Elderly patients should be encouraged to eat together as this can increase food intake up to 76% as compared to eating alone because it simulate a homelike environment and can promote food consumption. Nursing homes should adapt a homelike service delivery system as opposed to the pre-plating service delivery as this can result to significant increase in food consumption among elderly patients. Nursing home should practice good nutritional care services such as family style mealtimes as this would increase daily energy intake (Nijs et al 2006b). Family-style mealtimes can also improve quality of life and physical performance among elderly patients in nursing homes. The communication between elderly patients and nurses at meal times is imperative as it has the capacity to improve food consumption (Gillette-Geyonnett et al 2007). Educating and training health professionals and the public: It is important to educate professional on the relevance of good nutrition for elderly patients in nursing homes. Educating professionals can result to improved nutritional care. To increase awareness as regards undernutrition and nutrition care measures among nurses and general practitioners, it is imperative to educate them. Educating nutritional health professionals based on constructive learning theory can lead to improvement in the nutritional status of elderly people. The elderly people and the community should also be educated as regards diet and other preventive strategies. Recommendations for further research: There is little research studies which have been conducted to understand the nutritional status of elderly people. It is important to carry out more research studies as regards undernutrition in elderly people to increase our understanding the factors that result to malnutrition in order to come up with proper interventions mechanisms (Thompson 2006). There is also need for further cross-cultural studies to address the impacts of societal attitudes to food. With a heightened understanding of the normal together with the knowledge of the pathological psychological and physiological changes in elderly people, much can be attained in pre4venting and treating eating and nutritional problems in later life. There is also need for more research studies to evaluate how efficient primary preventive measures and psychological treatments are in preventing secondary morbidity and mortality and to improve the quality of life of the aged people. There is also need for further study to find out more general use of nutritional support in malnourished elderly people. Conclusion Under nutrition is a major problem affecting elderly people and which has been under-explored. Under nutrition in elderly people has led to increase in mortality and morbidity rates, health complications and economic and human costs. Certain barriers in the health care system have prevented proper management and prevention of under nutrition in elderly people. They include shortage of nutrition health professionals, lack of sufficient knowledge in health care professionals, higher costs involved in caring for malnourished elderly people, health complications associated with aging. However, under nutrition in elderly people can be prevented, treated or reversed if appropriate nutrition interventions are undertaken. To effectively manage under nutrition in elderly people, it is important to adapt a multi-disciplinary approach that treat the root causes and employs both social and dietary forms of intervention. 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