8 - Nutrition, Safe Feeding, and Oral Care Flashcards
10 Factors impacting older adult’s nutritional needs
1) Age-related changes
2) Lifelong eating habits
3) Ethnicity
4) Socialization
5) Income
6) Transportation
7) Housing
8) Food Knowledge
9) Health
10) Dentition
Lifelong Eating habits
- influenced by tradition, religion, and social influences
Interventions
- promote nutrient rich diet
Income
- adults with low income have to chose bw their basis need (ie. food, heat, shelter)
Interventions
- food stamps
- food banks
- income supplements
Socialization
- older adults often experience social isolation
- cooking and eating alone can cause them to overindulge or be uninterested in eating
Interventions
- home delivery meals
- shared dining sites/spaces
Transportation and Housing
- functional impairments can restrict their ability to carry groceries
- available transportation to restaurants and grocery stores is limited
Interventions
- home meal delivery
- group shopping trips
- online grocery shopping
Nutritional Needs
- there should be emphasis on fluid intake bec older adults have decreases thirst sensation
Malnutrition causes:
1) Clinical signs - muscle wasting, low body mass index (weight loss)
2) Biochemical changes - decreased albumin
Consequences: infections, pressure ulcers, anemia, hypotension, impaired cognition, and increased mortality and morbidity
Psychosocial Risk Factors of Malnutrition
- Limited income
- Misuse of alcohol
- Isolation &loneliness
- Depression
- Memory loss
- Inability topartake in usual cultural patterns
Mechanical Risk Factors of Malnutrition
- Reduced strength/mobility
- Diminished vision
- Loss of teeth or chewingdifficulties
- Shortness ofbreath
- Polypharmacy
- Inability togrocery shop or prepare food
Comprehensive assessment of malnutrition includes
- interview
- diet history
- physical exam
-biochemical exam
Assessment for Malnutrition: Interview
- recent life changes
- current state of health
- social activities
- how food is prepared
- financial resources
- how food i obstained
visual difficulties - meds
- mouth pain
- bowel and bladder function
Assessment for Malnutrition: Diet History
- compare their diet with their age and with the gender specific recommendations from the food guide
Assessment for Malnutrition: Physical Exam
- vital signs
- functionality
- general appearance
- skin turgor, texture, colour
- heigh, weight, BMI
- condition of lips, mouth, tongue
Assessment for Malnutrition: Biochemical Exam
- serum albumin (protein)
- cholesterol
- serum transferrin (iron transport protein)
Risk factors for inadequate nutrition amongst residents in LTC include:
- social isolation
- long periods of nothing by mouth
- resricted diets
- insufficient support from staff for meals
ImprovingNutritional Intake for Older Adults in Long-term Care
- kitchen on units
- visually appealing food
- encourage family presence
- music
- food available 24/7
- high quality protein choices
- home-like dining rooms
- choice of mealtime
- finger foods
- nurse sitting with person
Malnutrition Interventions
Pharmacological Therapy
- appetite-stimulating meds
Enteral Feeding
- when all interventions fail, use feeding tube
Why does dysphagia?
Neurological conditions
- stroke
- parkinsons
- MS
- dementia
Symptomsof Dysphagia
- Difficult, laboured swallowing
- Drooling
- Copious oral secretions
- Coughing or choking while eating
- Holding or pocketing food in the mouth
- Difficulty moving food or liquid from mouth to throat
- Difficulty chewing
- Nasal voice or hoarseness
- Wet or gurgling voice
- Excessive throat clearing
- Sensation of something stuck in the throat during swallowing
- Reflux of food or liquid into the throat, mouth, or nose
- Heartburn
- Chest pain
- Hiccups
- Weight loss
- Frequent respiratory infections, pneumonia
Dysphagia Assessment
Nurse
- observe during meal time
- contact speech pathologist
Speech Pathologist
- help determine causes of dysphagia
- identify ways to prevent aspiration
Dysphagia Complications
1) Aspiration
- when oral or gastric contents enter bronchial tree
2) Aspiration Pneumonia
- early symptoms: high resp rate and alterations in mental status
- silent aspiration (under-diagnosed)
Preventing Aspiration in Older Adults with Dysphagia
- Rest 30-minutes before feeding; a rested person will likely have less difficulty swallowing
- maintain position for 1 hour post intake
- place food on unimpaired side of mouth (ie.s troke)
- avoid mixed-consistency foods (ie. fruit cups)
- alternate solids and liquids
- adjust rate of feeding and size of bites
- modify food consistency (ie. pureed, thickened)
- avoid sedatives that impair cough/gag reflex
- supervise all meals
Poor oral health is a risk factor for:
- missing teeth, oral pain
- chewing and swallowing problems
- inadequate nutritional intake
- dehydration
There is a relationship between _____ health and ______ health.
Oral, general
Barriers/Facilitators to Adequate Oral Health
- Functional or cognitive limitations
- access to dental care
- cost of dental care
- access to fluoridated water (ie. wellls)
Oral Care for ppl with natural teeth
- brush and floss twice a day
- using a fluoride and non-alcoholic mouthwash
Oral care for supporting ppl with impaired dexterity
- use an ultrasonic toothbrush
- add foam grip to toothbrush
Oral Care and Enteral Feeding
- for ppl with gastrostomy tubes, oral care must be dome every 4 hours
- brush teeth after each feeding
- lips are at risk of drying out (coat with balm or vaseline)
Reasons for poor oral care in residential settings
- insufficient knowledge about how to asses and provide care
- inadequate training and staffing
- lack of appropriate supplies
- difficult to provide oral care to cognitively impaired adults
How to care for dentures
- Rinsed after each meal
- Brushed thoroughly once a day, ideally at night
- Not worn at night, to allow relief from compression on the gums
- Broken, damaged or ill-fitting dentures are a common problem for older adults can lead to oral problems & poor nutrition
