Week 9: Nutrition, Hydration And Oral Care Flashcards
Changes in caloric requirements for older adults
- Generally need less calories because Activity decreases and metabolic rate slows down.
- Still require the same or higher amounts of nutrients
Dietary Recommendations: Fats
- 20-35% of total calories.
- Limit saturated fat and trans fatty acids.
Dietary Recommendations: Protein
-Increase to 20-25% total calories for older adults who tends to experience protein deficiency when ill (minimizes fragility)
Dietary Recommendations: Fiber
25 grams daily
Dietary Recommendations: Vitamins and minerals
- Consumption of five servings of fruits/vegetables provides adequate A,C,E and K.
- Changes of aging contribute to decreased absorption of Vit B12
Malnutrition can increase the risk for
- Infection
- PU
- Anemia
- Hip fractures
- Hypotension
- Impaired cognition
- Increased morbidity and mortality
Malnutrition can be related to
Inadequate consumption of micro and macro nutrients or a consequence of inflammation
Factors Affecting Fulfillment of Nutritional Needs
- Age-related changes in taste and smell
- Lifelong eating habits
- Socialization
- Chronic diseases and conditions
- GI disorders
- Socioeconomic deprivation
- Transportation
Nutrition screening and assessment includes
- 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
Approaches to enhancing intake in LTC
- 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
-Other considerations: restrictive diets and caloric supplements, pharmacological therapy, patient education, and dysphagia
Risk factors for dysphagia
- Cerebrovascular accident
- Parkinson’s disease
- Neuromuscular disorders: amyotropic lateral sclerosis, multiple sclerosis, myasthenia gravis, dystonia
- Dementia
- Head and neck cancer
- Traumatic brain injury
- Aspiration pneumonia
- Inadequate feeding technique
- Poor dentition
Signs and Symptoms of Dysphagia include
- Difficult, labored swallowing
- Drooling
- Copious oral secretions
- Coughing, choking at meals
- Holding or pocketing of food in the mouth
- Difficulty chewing
- Nasal voice or hoarseness
- Wet or gurgling voice
- Excessive throat clearing
- Food or liquid leaking from nose
- Prolonged eating time
- Discomfort during swallowing
- Sensation of something stuck in throat during swallowing
Feeding Tubes
- Do not prevent aspiration or risk of aspiration.
- Interfere with basic psychological, biological and cultural needs associated with eating.
Feeding tubes are not associated with
- Improved survival
- Reduced incidence of pneumonia
- Improved function
- Fewer PU
Feeding tubes are associated with complications including
- Cellulitis
- Diarrhea
- Aspiration pneumonia
- Metabolic problems
Before enteral feedings, what factors should be assessed
-Poor nutritional uptake including meal environment, feeding techniques, food preferences, medications and depression.
Water is important for
- Thermoregulation
- Dilution of water-soluble medications
- Facilitation of bowel and renal function
- Maintaining metabolic processes
What are age related changes that affect hydration?
- Thirst sensation diminishes
- Creatinine clearance declines
- Total body water decreases
- Loss of muscle mass and increase in fat cells
- Other factors include: medications, functional impairment, other comorbid conditions such as diabetes.
Dehydration
-Complex problem that results in reduction of total body water.
Significant issues associated with dehydration include:
- Thromboembolic complications
- Kidney Stones
- Constipation
- Falls
- Medication toxicity
- Renal failure
- Seizure
- Electrolyte imbalance
- Hyperthermia
- Delayed wound healing
Risk factors for dehydration include
- Emotional illness
- Surgery
- Trauma
- Higher physiological demands
Signs and Symptoms of Dehydration include
- Often atypical in the older adult
- Skin turgor is not a reliable indicator in older adults
- Look for dry mucous membranes in mouth and nose, furrows on the tongue, orthostasis, speech incoherence, rapid pulse, decreased urine output, extremity weakness, dry axilla, and sunken eyes
Dehydration: Lab Tests
- Labs: serum sodium, urine specific gravity
- Most cases of dehydration have an elevated blood urea nitrogen (BUN); however, there are many other causes for elevation of BUN/creatinine ratio
- Urine color chart may be helpful in monitoring hydration status
- Better indicator when monitored over a couple of days
Dehydration Interventions
- Monitor closely and implantation of intake and output is essential
- Oral hydration is the first treatment approach
- Water is the best fluid to offer
Rehydration: IV
Replace 50% of loss within first 12 hours or sufficient quantity to relieve tachycardia and hypotension
Rehydration: Hypodermoclysis
- Infusion of isotonic fluids into the subcutaneous space
- Not for severe dehydration
Oral Care
-Poor oral health is associated with dehydration, malnutrition and other systemic diseases.
Xerostomia
Mouth dryness
What are common oral problems in older adults?
Xerostomia and hyposalivation
Treatment for Xerostomia and Hyposalivation
- Review Medications
- Good oral hygiene
- Adequate water
- Avoid alcohol and caffeine
- Over-the-counter oral salvia substitutes
Risk factors for oral cancer include
- Tobacco use
- Alcohol use
- HPV infection
- Genetic susceptibility
Assessment of Oral Health
- Physical examination of oral cavity and oral health
- Federal regulations mandate annual examination for LTC residents
- Oral health instrument: The Kayser-Jones Brief Oral Health Status Examination (BOHSE)
What are interventions for oral health?
- Promote oral health through teaching persons and caregivers recommended interventions, screening for oral disease, making dental referrals
- Provide supervision and evaluation of oral care in hospitals and LTC facilities
Dentures
- Need to give education on proper cleaning techniques
- Damaged and ill-fitting dentures are a common problem
Oral Hygiene in Hospitals and LTC
- Cleaning teeth with a toothbrush after meals lowers risk of aspiration pneumonia
- Crucial in prevention ventilator-associated pneumonia
Tube Feeding and Oral Hygiene
- Tube feedings are associated with significant pathological colonization in the mouth
- Provide oral care every 4 hours for persons with gastrostomy tubes and brush teeth after each feeding
- Only toothbrushes assist in the removal of plaque; use foam swabs to clean mouth of endentulous
