Tuesday, March 4, 2008

Preventing Malnutrition in the Elderly.

Clint Webster



Preventing Malnutrition in the Elderly

With the increasing number of baby boomers reaching an older age, malnutrition is a serious problem today. Many of these elderly will end up in nursing homes and up to 85% suffer from malnutrition (Crogen, 2006). This is an alarming number of malnourished patients for the Registered Nurse to take on. However, the knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition, and prevent the resulting problems. Three nursing strategies can include acquiring knowledge on malnutrition risk factors and signs/ symptoms, in order to identify the problem, know how to improve food consumption via different dining atmosphere, and supplement the types of foods the elderly consume by improving taste and nutrient density.
Malnutrition can be managed, but it requires skilled nurses and medical teams. In understanding that elderly malnutrition is a dramatic problem of epic scale today, this issue is not taken lightly by the medical community. Nursing homes are managed by nurses and this is where malnutrition is extremely prevalent. Mortality and morbidity are correlated with malnutrition (Brownie, 2006). Nutrition plays a large role in the severe problem of pressure sores due to protein loss. Adequate nutrition and protein are necessary in helping prevent and heal these pressure ulcers. Malnutrition makes pressure sores more likely and more difficult to heal (Dambach, 2005). The immune system is also hindered by malnutrition and this at risk population is already more susceptible to communicable diseases (Brownie, 2006). Conditions like pneumonia and bronchitis are much more serious in an elderly patient and malnutrition weakens their defenses. Registered Nurses are key in the fight against elderly malnutrition because they give the most direct care to elderly populations, and hence spend the most time with this high risk population. The nurse working with the elderly population should acquire detailed knowledge of malnutrition in order to identify the problem. The Mini Nutritional Assessment (MNA) is one valuable tool at the Registered Nurse’s disposal to judge malnutrition in the elderly. It consists of a survey of the patient’s level of malnutrition. Depending on the extent or score, it will recommend appropriate interventions that the Registered Nurse will implement (Vellas, 2006). Tools like the MNA incorporate many aspects of nutrition in the elderly to objectively identify who is at risk, but nurses still need to understand the process themselves. Knowing that the elderly client has decreased bodily function related to consuming and absorbing nutrients is important. Diminishing taste and smell senses can make food less appetizing than in the past. Dental problems can make consuming foods difficult. Poor fitting dentures can cause difficulty and pain in chewing and swallowing (Crogen, 2006). Factors such as reduced stomach acid and absorption problems can make garnering nutrients from food difficult. These can be exacerbated by the various medications the elderly take (Eliopoulos, 2005). Motor coordination is sometimes affected by medications. Elderly often already have some motor coordination deterioration. Further impairment by medications can hinder them from adequate consumption in limiting their ability to feed themselves (Crogen, 2006). The nurse should be educated on these issues and understand that they influence the clinical manifestations of malnutrition in the elderly. These can include “weight loss greater than five percent in the past month, weight ten percent below or above ideal range, serum albumin level lower than 3.5g/100mL, hemoglobin level below 12g/dL, and hematocrit value below 35 percent” (Eliopoulos, 2005, 202).
With knowledge on aging changes and identifying who is at risk, nurses should implement appropriate strategies to improve nutrient consumption. Elderly clients in nursing homes can be aided by an environment that is suitable for food consumption. The Registered Nurse in these settings can change lighting and table setting contrast to aid elderly nutrition. In one study, researchers found that placing white plates on blue trays laid out on a green table cloth with more evenly distributed light markedly increased nutrient consumption over three days (Brush, 2007). In those patients who eat in their rooms at the hospital or nursing home, it is especially important that unappetizing objects such as urinals and related items are not near or on the dining area. These objects detract from the dining environment (Calverly, 2007). Promoting a proper dining atmosphere is a valuable tool in nursing care of elderly malnutrition.
Improving the atmosphere of the dining experience can help in the nurse’s ability to manage elderly nutrition, but foods the elderly consume are the most important factor in preventing malnutrition. According to Dunn (2007), many foods and strategies for increasing their consumption do not work. Serving smaller more frequent meals does not improve nutrition. Oral supplements are also not very beneficial and often go wasted or conflict with medications. However, fortified foods (foods with added vitamins and minerals) and nutrient dense foods (foods that naturally have large quantities of vitamins and minerals for the amount of calories they contain) have been found to be effective. Fortified foods work best when they taste like their regular counterparts. Nutrient dense foods have been found to be very effective in promoting nutrition (Dunne, 2007). Improving taste is one of the best and simplest ways of improving nutrition. In some cases it is more important that elderly patients simply consume calories. Elderly patients have the same taste preferences as they have had all of their life, and thus low sodium, low fat meals are not always as appetizing as the normal version of a food with naturally high fat and sodium content (Calverley, 2007).
Malnutrition will always be an issue for the ever growing elderly population. It is important that this issue be dealt with correctly in order to prevent pain and suffering, increased healthcare costs, staff burden, and mortality (Brownie, 2006). A knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition. Nurses should be aware of the risk factors and signs via greater knowledge and insight, implementing strategies to improve food consumption, and offering different food choices to improve the amount of nutrients ingested. These strategies all help to minimize the devastating effects of malnutrition by promoting nutrition.

References

Brownie, S (2006).Why are elderly individuals at risk of nutritional deficiency?. Journal of Nursing Practice. 2, 115.
Brush, J. A., Meehan, R. A., & Calkins, M. P. (2002). Using the environment to improve intake for people with dementia. Alzheimer's Care Quarterly. 4, 330-339. Retrieved January 9, 2007, from Expanded Academic ASAP database.
Calverley, D (2007).The Food Fighters. Nursing Standard. 22, 20-21.
Crogen, N, & Alvine, C (2006). Testing of the Individual Nutrition Rx assessment process among nursing home residents. Applied Nursing Research. 19, 102-104.
Dunne, J.L., & Dahl, W.J. (2007). A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutrition Reviews. 65. Issue 3, 135-139.
Eliopoulos, C (2005). Gerontological Nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Vellas, B, Villars, H, Abellan, G, Soto, ME, Rolland, Y, & Guigoz, Y (2006). Overview of the MNA--Its history and challenges. Journal of Nutrition, Health, and Aging. 10, 456-463.

Intervention 1: Improving the dining atmosphere to improve nutrient consumption in elderly.
#1) While it is documented that improving the dining atmosphere will increase nutrition in the elderly, there are obstacles to overcome. One issue is that some elderly in nursing homes are very messy eaters for various health related reasons. This can be a distracting and unappetizing occurrence for the rest of the elderly eating there. Even if the lighting and contrast are adjusted for proper atmosphere, the elderly themselves can end up being a distraction. This can be dealt with by having these individuals in a side room (Andreoli, 2007).
#2) The timing of meals is also important. No matter how nicely laid out the dining atmosphere is, if the meal is during a portion of the day when an individual does not have an appetite, then that person will miss out on a meal until the next one comes around (Jhavari, 2006). This system will prevent a proper dining atmosphere from counting for anything because of poor timing.

Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.

Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58


Intervention 2: Improving nutrient density of foods, implementing fortified foods, and improving taste will help the elderly improve nutrition.

#1) While these techniques and foods have been shown to work, they do not account for the economic status of the elderly. Some may not have the financial means to afford these services and foods (Holman, 2005). The elderly may have someone else doing the shopping for them if they are not in a home, and this can leave their nutritional options in the hands of the person shopping (Holmes, 2006). Similarly, a common problem can be an elderly person who had a spouse or relative do their shopping for them and they are suddenly no longer capable of shopping. In these instances it leaves those elderly to do shopping on their own or not at all, and if they do end up shopping on their own, their nutritional knowledge could be a new problem.
#2) In other instances the elderly may have a host of issues that deter them from adequate consumption of nutrient. Of these, psychosocial issues such as an elderly person losing a loved one and being lonely can make them disinterested in eating (Holmes, 2006). Many other issues may affect a persons desire to eat as well, limiting nutrition.

Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54

Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2



References:


Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.

Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2

Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54

Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58
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1 comment:

John Miller said...

Yes, these problems do contribute to nutritional deficits and are very complex, as you mentioned.