Nutritional Problems and Interventions for Elderly

Malnutrition in older adults can lead to various health concerns, including:

 A weak immune system, which increases the risk of infections

 Poor wound healing

 Muscle weakness and decreased bone mass, which can lead to falls and fractures

 A higher risk of hospitalization

 An increased risk of death

 Many of the diseases suffered by older persons are the result of dietary factors, some of
which have been operating since infancy. These factors are then compounded by changes
that naturally occur with the ageing process.
 Dietary fat seems to be associated with cancer of the colon, pancreas and prostate.
Atherogenic risk factors such as increased blood pressure, blood lipids and glucose
intolerance, all of which are significantly affected by dietary factors, play a significant role in
the development of coronary heart disease.
 Degenerative diseases such as cardiovascular and cerebrovascular disease, diabetes,
osteoporosis and cancer, which are among the most common diseases affecting older
persons, are all diet-affected. Increasingly in the diet/disease debate, the role that
micronutrients play in promoting health and preventing noncommunicable disease is
receiving considerable attention. Micronutrient deficiencies are often common in elderly
people due to a number of factors such as their reduced food intake and a lack of variety in
the foods they eat.
 Another factor is the price of foods rich in micronutrients, which further discourages their
consumption. Compounding this situation is the fact that the older people often suffer from
decreased immune function, which contributes to this group’s increased morbidity and
mortality. Other significant age-related changes include the loss of cognitive function and
deteriorating vision, all of which hinder good health and dietary habits in old age.
 Elevated serum cholesterol, a risk factor for coronary heart disease in both men and women,
is common in older people and this relationship persists into very old age. As with younger
people, drug therapy should be considered only after serious attempts have been made to
modify diet. Intervention trials have shown that reduction of blood pressure by 6 mm Hg
reduces the risk of stroke by 40% and of heart attack by 15%, and that a 10% reduction in
blood cholesterol concentration will reduce the risk of coronary heart disease by 30%.
 Dietary changes seem to affect risk-factor levels throughout life and may have an even
greater impact in older people. Relatively modest reductions in saturated fat and salt intake,
which would reduce blood pressure and cholesterol concentrations, could have a substantial
effect on reducing the burden of cardiovascular disease. Increasing consumption of fruit and
vegetables by one to two servings daily could cut cardiovascular risk by 30%.
Factors contributing to malnutrition
The causes of malnutrition might seem straightforward — too little food or a diet lacking in
nutrients. In reality, malnutrition is often caused by a combination of physical, social and
psychological issues. For example:

 Normal age-related changes. Changes in taste, smell and appetite generally decline

with age, making it more difficult to enjoy eating and keep regular eating habits.
 Illness. Disease-related inflammation and illnesses can contribute to declines in appetite
and changes in how the body processes nutrients.

 Impairment in ability to eat. Difficulty chewing or swallowing, poor dental health, or

limited ability in handling tableware can contribute to malnutrition.

 Dementia. Behavioral or memory problems from Alzheimer's disease or a related

dementia can result in forgetting to eat, not buying groceries or other irregular food habits.

 Medications. Some medications can affect appetite or the ability to absorb nutrients.

 Restricted diets. Dietary restrictions for managing medical conditions — such as limits

on salt, fat or sugar — might also contribute to inadequate eating.

 Limited income. Older adults may have trouble affording groceries, especially if they're
taking expensive medications.

 Reduced social contact. Older adults who eat alone might not enjoy meals as before
and lose interest in cooking and eating.

 Limited access to food. Adults with limited mobility may not have access to food or the
right types of food.

 Depression. Grief, loneliness, failing health, lack of mobility and other factors might
contribute to depression — causing loss of appetite.

 Alcoholism. Too much alcohol can interfere with the digestion and absorption of
nutrients. Misuse of alcohol may result in poor eating habits and poor decisions about
nutrition.

Monitoring nutrition and preventing malnutrition

As a caregiver or adult child of an older adult, you can take steps to monitor nutritional health,
watch for weight loss and address risk factors of malnutrition. Consider the following:

 Monitor weight. Help the older adult check his or her weight at home. Keep a weekly
record. Changes in how clothes fit can also indicate weight loss.
 Observe habits. Spend mealtimes together at home — or during mealtime in a hospital
or care facility — to observe eating habits. Note what kinds of food are eaten and how
much.
 Keep track of medications. Keep a record of all medications, the reason for each
medication, dosages, treatment schedules and possible side effects.

 Help with meal plans. Help plan healthy meals or prepare meals ahead of time. Help
prepare a shopping list or shop together. Help with money-saving shopping choices.

 Use local services. Contact local service agencies that provide at-home meal deliveries,
in-home visits from nurses or dietitians, access to a food pantry, or other nutrition services.
The local Area Agency on Aging or a county social worker can provide information about
services.

 Make meals social events. Drop by during mealtime or invite the older adult to your
home for occasional meals. Go out to eat at a restaurant with senior discounts. Encourage
participation in social programs where members of the community can eat together.

 Encourage regular physical activity. Daily exercise — even if it's light — can stimulate
appetite and strengthen bones and muscles.

Improving nutrition
Mealtime strategies to help an older adult maintain a healthy diet and good eating habits
include the following:

 Nutrient-rich foods. Plan meals with nutrient-rich foods that include a variety of fresh
fruits and vegetables, whole grains, fish, and lean meats.
 Herbs and spices. Use herbs and spices to add flavor to meals and improve interest in
eating. Experiment to find favorites.

 Healthy snacks. Plan nutrient-rich snacks between meals with fruits, vegetables or low-
fat dairy products.

 Nutritional supplements. Use supplemental nutrition drinks to help with calorie intake.

Add egg whites or whey powder to meals to increase proteins without adding saturated
fats.

Talking to your doctor

Talk to your family member's doctor about any concerns you have regarding the older adult's
weight, changes in appetite, or other concerns about health and nutrition. The doctor's role
may include:

 Regularly monitoring weight and screening for malnutrition

 Assessing for medical conditions that may be affecting weight loss or nutritional health
 Treating underlying conditions causing malnutrition

 Changing a restricted diet for diabetes or other medical conditions

 Recommending an appropriate daily calorie intake

 Recommending vitamin and mineral supplements

 Changing prescription medications

Nutrition for older persons

Defining the specific nutritional needs of older persons

Older persons are particularly vulnerable to malnutrition. Moreover, attempts to provide them with adequate
nutrition encounter many practical problems. First, their nutritional requirements are not well defined. Since both
lean body mass and basal metabolic rate decline with age, an older person’s energy requirement per kilogram of
body weight is also reduced.
The process of ageing also affects other nutrient needs. For example, while requirements for some nutrients may
be reduced, some data suggest that requirements for other essential nutrients may in fact rise in later life. There
is thus an urgent need to review current recommended daily nutrient allowances for this group. There is also an
increasing demand worldwide for WHO guidelines which competent national authorities can use to address the
nutritional needs of their growing elderly populations.
Malnutrition and older persons
Many of the diseases suffered by older persons are the result of dietary factors, some of which have been
operating since infancy. These factors are then compounded by changes that naturally occur with the ageing
process.
Dietary fat seems to be associated with cancer of the colon, pancreas and prostate. Atherogenic risk factors such
as increased blood pressure, blood lipids and glucose intolerance, all of which are significantly affected by
dietary factors, play a significant role in the development of coronary heart disease.
Degenerative diseases such as cardiovascular and cerebrovascular disease, diabetes, osteoporosis and cancer,
which are among the most common diseases affecting older persons, are all diet-affected. Increasingly in the
diet/disease debate, the role that micronutrients play in promoting health and preventing noncommunicable
disease is receiving considerable attention. Micronutrient deficiencies are often common in elderly people due to
a number of factors such as their reduced food intake and a lack of variety in the foods they eat.
Another factor is the price of foods rich in micronutrients, which further discourages their consumption.
Compounding this situation is the fact that the older people often suffer from decreased immune function, which
contributes to this group’s increased morbidity and mortality. Other significant age-related changes include the
loss of cognitive function and deteriorating vision, all of which hinder good health and dietary habits in old age.
Elevated serum cholesterol, a risk factor for coronary heart disease in both men and women, is common in older
people and this relationship persists into very old age. As with younger people, drug therapy should be
considered only after serious attempts have been made to modify diet. Intervention trials have shown that
reduction of blood pressure by 6 mm Hg reduces the risk of stroke by 40% and of heart attack by 15%, and that a
10% reduction in blood cholesterol concentration will reduce the risk of coronary heart disease by 30%.
Dietary changes seem to affect risk-factor levels throughout life and may have an even greater impact in older
people. Relatively modest reductions in saturated fat and salt intake, which would reduce blood pressure and
cholesterol concentrations, could have a substantial effect on reducing the burden of cardiovascular disease.
Increasing consumption of fruit and vegetables by one to two servings daily could cut cardiovascular risk by
30%.

https://www.who.int/nutrition/topics/ageing/en/index1.html

Nutrition Problems in the Elderly

Nutritional problems in the elderly can cause a number of complications,
including weakened immune systems, lowered energy levels and chronic health
problems such as type 2 diabetes, high blood pressure, heart disease, stroke
and osteoporosis. Making changes in their diet to match the changes in elders'
changing caloric, energy, taste and access needs helps prevent malnutrition,
which often goes undiagnosed.

Weight
Both weight loss and weight gain are problems in the elderly related to nutrition. The elderly have
reduced metabolisms, meaning they burn fewer calories than they did before age 40. Additionally,
the elderly often have less energy, especially if they suffer from chronic medical conditions. A
slowed metabolism coupled with reduced activity can lead to obesity, which is on the rise in the
elderly, according to a March 2004 article in “Current Opinion in Gastroenterology.”
On the other side, limited access to food, decreased appetites, medication side effects and medical
problems can cause weight loss. Poverty and fixed incomes keep some elderly people from
purchasing foods rich in vitamins and minerals. An elderly person with weight loss of at least 5
percent should see a doctor. Even a weight loss of 5 percent over three years can signal a health
problem
Taste
When an elder oversalts his food, the problem more likely arises from a decreased sensitivity to salt
than dissatisfaction with the cooking. The elderly often have trouble recognizing salty and bitter
tastes, resulting in increased salt intake, which can lead to high blood pressure. Because the elderly
usually retain their ability to appreciate sweet tastes the longest, they may go overboard on the sugary
snacks, desserts and beverages. Sugary foods can cause weight gain in anyone, but because of their
slowed metabolisms, the elderly are more susceptible to it.
Dehydration
Dehydration is common in the elderly for a number of reasons. The elderly have a reduced ability to
conserve water, are less attuned to their thirst, and may avoid drinking fluids because of overactive
bladder problems. Additionally, the elderly are more likely to lack proper hydration in warm-weather
months and during illness. Medications and chronic medical conditions often increase the risk of
dehydration. Mild to moderate complications from dehydration include constipation, headache,
dizziness, low blood pressure, rapid heartbeat and los of consciousness. Severe complications include
seizures, kidney failure, swelling of the brain, heat injury and death.
Recommendations
The elderly should eat foods rich in B12, magnesium and vitamins A, C and D. They should focus on
high-fiber foods, leafy green vegetables, whole grains, and low-fat or nonfat milk and milk products.
Rather than adding salt, the elderly should eat foods seasoned with herbs and olive oil. To satisfy
sweet cravings, they should munch on foods that are naturally sweet, such as fruits, and cook with
sweet peppers. To prevent dehydration, the elderly should drink small amounts of fluids throughout
the day, consuming at least 1.7 liters of fluid every 24 hours.

Preventing Malnutrition in Older Adults

Malnutrition is when your body doesn’t get enough nutrients from the foods
you eat to work properly. Nutrients include fats, carbohydrates, protein,
vitamins, and minerals. These substances give your body energy. They help
your body grow and repair tissues. They also regulate bodily functions such
as breathing and the beating of your heart.

As the U.S. population ages, malnourishment is a growing concern. Good

nutrition is very important for all older adults. It is especially important for older
adults who are ill or have been diagnosed with a chronic disease or dementia.

Malnutrition in older adults can lead to a number of health problems, including

the following:

 Unintentional weight loss.

 Tiredness and fatigue (feeling out of energy).

 Muscle weakness or loss of strength. This could lead to falls, which

could cause broken bones or fractures.

 Depression.

 Problems with memory.

 A weak immune system. This makes it hard for your body to fight off
infections.

 Anemia.

Because of these health problems, malnourished adults tend to make more

visits to their doctor, the hospital, and even the emergency room. They don’t
recover from surgery or other procedures as quickly as adults who are well
nourished.

What causes malnutrition in older

adults?
Malnutrition occurs when a person doesn’t have enough food or doesn’t eat
enough healthy foods. A number of things may affect the amount and type of
food that older adults eat. These include:

 Health problems. Older adults may have health problems that cause a

loss of appetite or make it hard to eat. This could include conditions such
as dementia and other chronic illnesses. They may be on restricted diets
 that make foods taste bland. They may also have dental problems that
make it hard to chew or swallow foods.
 Medicines. Certain medicines can decrease appetite or affect the taste
and smell of food.

 Low income. Older adults may be on a fixed income. They may be

paying for expensive medicines to help manage health conditions. They
may have trouble paying for groceries, especially the healthy foods they
need.

 Disability. Older adults who have dementia or physical disabilities may

not be able to shop for groceries or cook for themselves.

 Social issues. Mealtimes can be social occasions. As we age, we may

start to lose friends and family members. Older adults who usually eat
alone may lose interest in cooking and eating.

 Alcoholism can decrease appetite and affect how the body absorbs

nutrients from food.

 Depression in older adults can lead to loss of appetite.

It can be hard to tell if an older adult is malnourished. Check the refrigerator

and pantry to find out the amount and type of food your loved one has on
hand. Be sure to visit during mealtimes so you can observe their eating habits.
Watch for signs of weight loss, such as clothing that is looser than normal.
Easy bruising and slow wound healing are also signs of malnutrition.
Know which medicines your loved one takes, and ask a doctor or pharmacist
if any of the medicines may cause loss of appetite. If your loved one is
depressed or is an alcoholic, help him or her seek treatment.

Keep their doctor informed about what you observe. Ask the doctor about their
risk of nutrition problems. Watch out for signs of the health problems listed
above. If you suspect that your loved one has a medical condition that is
causing malnutrition, help him or her seek treatment.

Path to improved wellness

To improve your loved one’s nutrition, try some of the following:

 Encourage healthier food choices. The best foods are those that are
full of nutrients, such as fruits, vegetables, whole grains, and lean meats.
Help your loved one limit his or her intake of solid fats, sugars, alcoholic
beverages, and salt. Suggest ways to replace less healthy foods with
healthier choices.
 Snacking on healthy foods is a good way to get extra nutrients and
calories between meals. It may be especially helpful for older adults who
quickly get full at mealtimes.

 Make food taste good again. If your loved one is on a restricted diet,
herbs and spices can help restore flavor to bland foods. Just remember to
avoid herb or spice blends that are heavy in salt.

 Consider adding supplements to your loved one’s diet. He or she

may benefit from a supplement shake or other nutritional supplements.
Talk to their doctor about these options.
 Encourage exercise. Even a little bit of exercise can help improve your
loved one’s appetite and keep his or her bones and muscles strong.

 Plan social activities. Make mealtimes and exercise a social activity.

Take your loved one on a walk around the block. Encourage him or her to
meet a neighbor or friend for lunch. Many restaurants offer discounts for
seniors.

Things to Consider
Managing your health and nutrition as you age can seem like a difficult task. If
you are helping your loved one, talk to their family doctor and ask for help
when you need it. The doctor can talk to you about their risk for malnutrition,
health conditions, and medicines.

You may need help making sure your loved one is eating right. Home health
aides can help shop for groceries and prepare meals. Check with your local
Council on Aging and other senior community resources and community
programs, such as Meals on Wheels. They may be able to help you care for
your loved one.

NUTRITION IN THE ELDERLY

Nursing Standard of Practice Protocol: Nutrition in Aging

Rose Ann DiMaria-Ghalili, PhD, RN, CNSN

Evidence-Based Content - Updated July 2012

Reprinted with permission from Springer Publishing Company. Evidence-Based Geriatric Nursing
Protocols for Best Practice, 4th Edition, © Springer Publishing Company, LLC. These protocols were
revised and tested in NICHE hospitals. The text is available here.
The information in this "Want to know more" section is organized according to the following major
components of the NURSING PROCESS:

Goal
Overview
Background
Parameters of Assessment
Nursing Care Strategies
Evaluation and Expected Outcomes
Follow-up Monitoring
Relevant Guidelines
References

Goal

Improvement in indicators of nutritional status in order to optimize functional status and general well-
being and promote positive nutritional status.

Back to top
Overview

Older adults are at risk for malnutrition, with 39% to 47% of hospitalized older adults malnourished or
at risk for malnutrition (Ref 1).

Back to top
Background

A. Definitions:

1. Malnutrition: Any disorder of nutritional status, including disorders resulting from a deficiency of
nutrient intake, impaired nutrient metabolism, or over-nutrition.

B. Etiology and/or Epidemiology. Older adults are at risk for under-nutrition due to dietary, economic,
psychosocial, and physiological factors (Ref 2).

1. Dietary intake

a. Little or no appetite (Ref 3; 4 ; 5)

b. Problems with eating or swallowing (Ref 6).

c. Eating inadequate servings of nutrients (Ref 6).

d. Eating fewer than two meals a day (Ref 5).

2. Limited income may cause restriction in the number of meals eaten per day or dietary quality of
meals eaten. 6

3. Isolation

a. Older adults who live alone may lose desire to cook because of loneliness. 7

b. Appetite of widows decreases. 7

c. Difficulty cooking due to disabilities. 6

d. Lack of access to transportation to buy food (Ref 2).

4. Chronic Illness

a. Chronic conditions can affect intake (Ref 6).

b. Disability can hinder ability to prepare or ingest food (Ref 5).

c. Depression can cause decreased appetite. 8, 9

d. Poor oral health (e.g., cavities, gum disease, and missing teeth) and xerostomia, or dry mouth,
impairs ability to lubricate, masticate, and swallow food (Ref 5).

e. Antidepressants, antihypertensives, and bronchodilators can contribute to xerostomia (dry mouth)

(Ref 2).

5. Physiological changes

a. Decrease in lean body mass and redistribution of fat around internal organs lead to decreased
caloric requirements. 10, 11

b. Change in taste (from medications, nutrient deficiencies, or tastebud atrophy) can also alter
nutritional status (Ref 2).

Back to top
Parameters of Assessment

A. General: During routine nursing assessment, any alterations in general assessment parameters
that influence intake, absorption, or digestion of nutrients should be further assessed to determine if
an older adult is as nutritional risk. These parameters include the following:

1. Subjective assessment, including present history, assessment of symptoms, past medical and
surgical history, and co-morbidities. 12.

2. Social history. 12

3. Drug–nutrient interactions: Drugs can modify the nutrient needs and metabolism of older people.
Restrictive diets, malnutrition, changes in eating patterns, alcoholism, and chronic disease with long-
term drug treatment are some of the risk factors in older adults that place them at risk for drug–
nutrient interactions. 13.

4. Functional limitations. 14

5. Psychological status (Ref 14)

6. Objective assessment: physical examination with emphasis on oral exam (see Oral Health Care
topic at www.ConsultGeriRN.org), loss of subcutaneous fat, muscle wasting, BMI12 and dysphagia.

B. Dietary Intake: in-depth assessment of dietary intake during hospitalization may be documented
with a 3-day calorie count (dietary intake analysis).(Ref 2)

C. Nutrition Risk Assessment Tool: The Mini-Nutritional Assessment (MNA) should be administered
to determine if an older hospitalized patient is either at risk for malnutrition or has malnutrition. The
MNA determines risk based on food intake, mobility, BMI, history of weight loss, psychological
stress, or acute disease and dementia or other psychological conditions. If the score is 11 points or
less, the in-depth MNA assessment should be administered (Ref 15).
See:

Try This Issue 9 - Assessing Nutrition in Older Adults

D. Anthropometry

1. Obtain an accurate weight and height through direct measurement. Do not rely on patient recall. If
patient cannot stand erect to measure height, then knee-height measurements should be taken to
estimate height using special knee-height calipers. Height should never be estimated or recalled,
due to shortening of the spine with advanced age; self-reported height may be off by as many as 2.4
cm (Ref 15).

2. Weight history: A detailed weight history should be obtained along with current weight. Detailed
history should include a history of weight loss, whether the weight loss was intentional or
unintentional, and during what period. A loss of 10 pounds during a 6-month period, whether
intentional or unintentional, is a critical indicator for further assessment (Ref 2; 16).

3. Calculate body mass index (BMI) to determine if weight for height is within the normal range of
22–27. A BMI below 22 is a sign of under-nutrition (Ref 16).

E. Visceral Proteins. Evaluate serum albumin, transferrin, and prealbumin are visceral proteins
commonly used to assess and monitor nutritional status (Ref 2). However, these proteins are
negative acute-phase reactants; therefore, during a stress state, production is usually decreased. In
an older hospitalized patient, albumin levels may be a better indicator of prognosis than nutritional
status (Ref 17).

Back to top
Nursing Care Strategies (Ref 2)

A. Collaboration

1. Refer to dietitian if patient is at risk for or has under-nutrition.

2. Consult with pharmacist to review patient's medications for possible drug–nutrient interactions.

3. Consult with a multidisciplinary team specializing in nutrition.

4. Consult with social worker, occupational therapist, and speech therapist as appropriate.

B. Alleviate Dry Mouth

1. Avoid caffeine; alcohol; tobacco; and dry, bulky, spicy, salty, or highly acidic foods.

2. If patient does not have dementia or swallowing difficulties, offer sugarless hard candy or chewing
gum to stimulate saliva.

3. Keep lips moist with petroleum jelly.

4. Encourage frequent sips of water.

C. Maintain adequate nutritional intake: Daily requirements for healthy older adults include 30 kcal
per kg of body weight and 0.8 to 1g/kg of protein per day, with no more than 30% of calories from
fat. Caloric, carbohydrate, protein, and fat requirements may differ depending on degree of
malnutrition and physiological stress.

D. Improve oral intake

1. Assess each patient's ability to eat within 24 hours of admission. (Ref 18)

2. Mealtime rounds to determine how much food is consumed and whether assistance is needed.
(Ref 18)

3. Limit staff breaks to before or after patient mealtimes to ensure adequate staff are available to
help with meals. (Ref 18)

4. Encourage family members to visit at mealtimes.

5. Ask family to bring favorite foods from home when appropriate.

6. Ask about and honor patient food preferences.

7. Suggest small frequent meals with adequate nutrients to help patients regain or maintain weight.
(Ref 19)

8. Provide nutritious snacks. (Ref 19)

9. Help patient with mouth care and placement of dentures before food is served. (Ref 18)

E. Provide conducive environment for meals

1. Remove bedpans, urinals, and emesis basin from room before mealtime.

2. Administer analgesics and antiemetics on a schedule that will diminish the likelihood of pain or
nausea during mealtimes.

3.Serve meals to patients in a chair if they can get out of bed and remain seated.

4. Create a more relaxed atmosphere by sitting at the patient’s eye level and making eye contact
during feeding.

5. Order a late food tray or keep food warm if patients are not in their room during mealtime.

6. Do not interrupt patients for round and nonurgent procedures during mealtimes.

F. Specialized nutritional support. (Ref 20)

1. Start specialized nutritional support when a patient cannot, should not, or will not eat adequately
and if the benefits of nutrition outweigh the associated risks.

2. Prior to initiation of specialized nutritional support, review the patient's advanced directives
regarding the use of artificial nutrition and hydration.

G. Provide oral supplements

1. Supplements should not replace meals but rather be provided between meals but not within the
hour preceding a meal and at bedtime. (Ref 19, 21)2. Ensure that oral supplement is at appropriate
temperature. (Ref 19)
3. Ensure that oral supplement packaging is able to be opened by the patients. (Ref 19)
4. Monitor the intake of the prescribed supplement. (Ref 19)
5. Promote a sip style of supplement consumption. (Ref 19)
6. Include supplements as part of the medication protocol. (Ref 19)
H. N.P.O. orders
1. Schedule older adults for test or procedures early in the day to decrease the length of time they
are not allowed to eat and drink.

2. If testing late in the day is inevitable, ask physician whether the patient can have an early
breakfast.

3. See American Society of Anesthesiologists practice guideline regarding recommended length of

time patients should be kept N.P.O. for elective surgical procedures. (Ref 22)

Back to top
Evaluation/Expected Outcomes

A. Patient

1. Will experience improvement in indicators of nutritional status.

2. Will improve functional status and general well-being.

B. Provider

1. Should ensure that care provides food and fluid of adequate quantity and quality in an
environment conducive to eating, with appropriate support (e.g., modified eating aids) for people
who can potentially chew and swallow but are unable to feed themselves. (Ref 16)

2. Should continue to reassess patients who are malnourished or at risk for malnutrition. (Ref 16)

3. Should monitor for refeeding syndrome. (Ref 16)

C. Institution

1. Will ensure that all health care professionals who are directly involved in patient care receive
education and training on the importance of providing adequate nutrition. (Ref 16)

D. QA/QI

1. Establish QA/QI measures surrounding nutritional management in aging patients.

E. Educational

1. Provider education and training includes the following:

a. nutritional needs and indications for nutrition support

b. options for nutrition support (oral, enteral, and parenteral)

c. ethical and legal concepts

d. potential risks and benefits

e. when and where to seek expert advice (Ref 16)

2. Patient and/or caregiver education includes how to maintain or improve nutritional status, as well
as how to administer, when appropriate, oral liquid supplements, enteral tube feeding, or parenteral
nutrition.

Back to top
Follow-up Monitoring (Ref 16)
A. Monitor for gradual increase in weight over time.

1. Weigh patient weekly to monitor trends in weight.

2. Daily weights are useful for monitoring fluid status.

B. Monitor and assess for refeeding syndrome.

1. Carefully monitor and assess patients the first week of aggressive nutritional repletion.

2. Assess and correct the following electrolyte abnormalities: Hypophosphatemia, hypokalemia,

hypomagnesemia, hyperglycemia, and hypoglycemia.

3. Assess fluid status with daily weights and strict intake and output.

4. Assess for congestive heart failure in patients with respiratory or cardiac difficulties.

5. Ensure caloric goals will be reached slowly more than 3 to 4 days to avoid refeeding syndrome
when repletion of nutritional status is warranted.

6. Be aware that refeeding syndrome is not exclusive to patients started on aggressive artificial
nutrition but may also be found in elderly individuals with chronic co-morbid medical conditions and
poor nutrient intake started with aggressive nutritional repletion via oral intake.

Nutrition and Its Multiple Roles in Prevention

Nutrition is composed of three types of prevention. In aging it is important not to assume that nutrition
care is only medical nutrition therapy. It is never too late to emphasize nutrition for health promotion
and disease prevention. Older Americans, more than any other age-group, want health and nutrition
information and are willing to make changes to maintain their independence and quality of life.

They often a bit more help in improving self-care behaviors. They want to know how to eat healthier,
exercise safely and stay motivated to do both.

Nutrition as Primary Prevention

-The timing is right to emphasize nutrition in health promotion and disease prevention, the first steps in
improving the health of older Americans. It is also an ideal time to pair healthy eating with physical
activity.

Nutrition as Secondary Prevention

-Nutrition as secondary prevention is risk reduction and slowing the progression of chronic nutrition-
related diseases to maintain functionality and quality of life. Function ability is a more positive way to
discuss levels of disability and dependence.
In aging, terms are used such as functional fitness, physical fitness, just plain fitness and physical
activity. Yet EXERCISE is a term that doesn’t appeal to older adults.

Most dietitians realize that common diseases of adding are

-heart disease

-diabetes

-osteoporosis

-cancer

-compromise functional fitness

We need to help older people understand that functionality is a food issue and functionality is preserved
simply by eating a wide variety of healthy foods.

Nutrition as Tertiary Prevention

-Medical nutrition therapy is the most common way nutrition has been related to health.

Newer roles for registered dietitians (RDs) in tertiary prevention include case management and
discharge planning. Although case managers are strongly influenced by nutrition issues such as chewing
and appetite problems, modified diets and functional limitations, in discharge planning they infrequently
consult dietitians. Dietitians who provide case management say they are comfortable handling all cases
just as nurses and social workers do and in fact have an advantage because so many clients have
nutrition-related chronic diseases.