Chapter 14 Nutrition

Question 1

Factors impacting nutritional needs

Answer 1

related to

• chronic disease
• lifelong eating habits
• ethnicity
• socialization
• income
• transportation
• housing
• mood
• food knowledge
• functional impairments
• health and dentition

Question 2

Age-related requirements

Answer 2

Choose My Plate is a guide that provides a visual depiction of daily food intake

Older adults generally need less calories because activity decreases and metabolic rates slow down

Still require the same or higher amounts of nutrients
Increase Protein for “vulnerable adults”

Question 3

Dietary recommendations

Answer 3

Fats: less than 10% of total calories, limit saturated fat and trans fatty acids
Protein: increase for older adult who tends to experience protein deficiency when ill; minimizes frailty
Fiber: 25 g fiber recommended daily (Box 14-4)
Vitamins and minerals: consumption of five servings of fruits/vegetables provides adequate A,C,E, and potassium; changes of aging contribute to decreased absorption of B12

Question 4

Obesity

Answer 4

More than a third of persons over 60 years are obese
Obesity paradox: some research found that persons who survived to 70 years had lower mortality rate if they were overweight

Question 5

Malnutrition

Answer 5

• Rising incidence in acute care, long-term care (LTC), and in the community
• Institutionalized older adults at high risk for malnutrition due to chronic disease and functional impairments
• Increased risk of infection, pressure ulcers (PUs), anemia, hip fractures, hypotension, impaired cognition, and increased morbidity and mortality
• Can be related to inadequate consumption of micro and macro nutrients, or consequence of inflammation
• Comprehensive screening and assessment is critical to identify older adults at risk

Question 6

Factors Affecting Fulfillment of Nutritional Needs

Answer 6

• Lifelong eating habits
• Socialization
• Socioeconomic deprivation
• Transportation

-Chronic diseases and conditions
   Polypharmacy
   Inactivity
   High-fat, high-volume meals
   Inactivity
   Comorbid conditions

Question 7

Chronic Conditions That Affect Nutrition

Answer 7

GERD
Diverticular disease
Dysphagia

Question 8

Gerd

Answer 8

A syndrome where there is damage to the mucosa from gastric contents moving backward from the stomach to the esophagus.
Risk Factors
Hiatal hernia
Obesity
Cigarette smoking and second hand smoke
Older adults atypical symptoms 
Persistent cough
Exacerbations of asthma
Intermittent chest pain

Question 9

Dysphagia

Answer 9

Difficulty Swallowing
Prevalent in the elderly
Aspiration, Distress, Dehydration, Malnutrition
Can occur secondary to deficits in any of the phases of swallowing.
Stroke
Parkinson’s Disease
Neurological damage (Otopharyngeal Dysphagia)
Muscular damage
Refer to speech language pathologist

Question 10

Promoting Healthy Aging: Implications for Gerontological Nursing (1 of 2)

Answer 10

Nutrition screening and assessment
Several screening tools available
Minimum Data Set—includes risk factors and triggers for further evaluation
Interview and physical examination
Anthropometrical measurements
Weight/height considerations
Biochemical analysis/measures of visceral protein

Interventions
Formulated around specific problems
Nurses hold a pivotal role in ensuring adequate nutrition to promote healthy aging
Collaboration with interprofessional team
Considerations: modification of environment, supervision, feeding techniques that enhance intake and preserve dignity and independence
Evaluate the outcome

Question 11

Nutritional Problems in Institutional Setting

Answer 11

Feeding assistance
Estimated that 50% of all residents unable to eat independently (What will you assess for…?)
Inadequate staffing is associated with poor nutrition and hydration
The Centers for Medicare and Medicaid Services implemented a rule that allows feeding assistance, with 8 hours of approved training

Question 12

Approaches to Enhancing Intake in LTC

Answer 12

Interventions
Restorative dining rooms
Consideration of ethnic food choices
Easy access to refreshment stations with juices, water, healthy snacks, and finger foods
Family involvement when possible
See other best practices (Box 14-16)
Other considerations: restrictive diets and caloric supplements, pharmacological therapy, and patient education

Question 13

What is the estimated number of institutionalized older adults who are unable to eat independently?
A. 40%
B. 50%
C. 60%
D. 70%

Answer 13

B. 50%

Question 14

Which condition affects nutrition in the older adult?
A. Diabetes
B. Heart disease
C. Dysphagia
D. Gout

Answer 14

D. Gout