The elderly are a group of people that are susceptible to nutritional problems. There are many factors that contribute to this problem. Some of the factors that may contribute to altered nutrition in elderly include the following; Changes in the gastrointestinal tract, Decreased neuromuscular coordination and personal factors for example fixed income, loneliness and susceptibility to health claims.
Changes in the gastrointestinal tract
Many changes occur in the gastrointestinal tract, including loss of teeth, reduced production of saliva, diminished taste and smell, and increased ability to digest foods. When these changes occur, chewing may become painful, and a diet with soft foods is preferred. Eating pleasure declines when taste and smell are impaired. Some adults prefer strongly flavored foods, while others avoid food because it does not taste good anymore (Berman Et al. 2007).
Decreased neuromuscular coordination
Neuromuscular coordination decreases with age and conditions such as arthritis may hamper food preparation and the use of eating utensils. Muscles in the lower gastrointestinal tract become weaker with advancing age and constipation is a common problem. Many nutrient absorption .Kidney repair and maintenance deteriorates with age, and renal function is impaired in some individuals. Fluid and electrolyte balance is difficult to maintain, especially during illness.
The personal factors to health claims are fixed income, loneliness and susceptibility. Fixed income makes the elderly to often exist on a fixed income that prevents an adequate food supply. This income deficit affects housing and facilities, limiting cooking frequency and food storage. Elderly people are also lonely which affects their eating behaviors to a great extent. Elderly persons living alone lose their desire to cook or eat. Lonely people become apathetic, depressed, and fail to eat. Health claims: Many of the elderly purchase foods and supplements from health food stores because of advertisements claiming that the foods have curative power and may in fact retard the aging process. The elderly are mainly emaciated due to progressive loss of weight resulting in a low BMI of 16/m3.This involves general wasting away of the body tissue as a result of severe malnourishment.
Roles of the RN in assessing risk factor for altered Nutrition in the health care setting
It performs regular assessment of nutritional status of the patients. This entails the carrying out comprehensive nutrition assessment that involves examining clients to determine their chances of developing protein energy malnutrition. It monitor’s the response to nutritional intervention. This is achieved through periodic nutritional assessments, monitoring weight gain and BMI in response to therapy to determine adequate dietary intake, quality of patient's life, functional status, and complications of nutritional support measures among others.
It administers nursing diagnosis. This include documentation of weight, determining of body fat composition by skin fold measurements, calculation of body mass index as a ratio of height, performing nutritional assessment, exploring the importance and meaning of food with the patient, assessing knowledge regarding nutritional needs and level of activity or other factors, ability to read food labels (Norton, 1984).
Nursing interventions that need to be implemented to overcome the 3 problems identified.
Eating meals alone (social isolation), encourages the patient to eat food in a group as this increases the ability to eat more food since eating is a social activity. Also the food can be served attractively to increase his appetite. The nurse intervention on overcoming the problem of anorexia includes: serving the patients with foods at the right temperatures, and with foods that are spiced or herbs added, by offering small servings of food frequently, providing an opportunity for oral hygiene before meals which stimulates salivation increasing patients appetite. They experiences impaired swallowing. The nurse interventions that need to be implemented to overcome the problem of impaired swallowing include: keeping the client in a sitting position or semi-sitting position for at least an half before eating, encouraging the patient to use his tongue or finger to sweep retained food from the cheek and repeat the swallowing.
Planning and teaching that should be initiated for a client who will be discharged
A client who is emaciated the family members or those who are taking care of him are taught by the nurse on several activities to be done to assist in weight gain while discharged. These include: taking a rest after taking a meal, by disguising extra of calories meals by fortifying foods with powdered milk, gravies or sauces, eating of small amounts of food frequently, eating a variety of foods from small amounts and gradually increasing in terms of number of servings or serving sizes.
Those who are obese, prior to their discharge they are advised to use fats, oils and sugar sparingly. Also, to practice eating food in small amounts frequently as compared to large amounts sparingly. The client is also advised to eliminate consumption of junk foods and alcoholic beverages as well as increasing fiber in the diet from fresh fruits, vegetables and whole grains (Sharkey Et al. 2002). The client is also advised to participate in regular exercises which help to raise metabolic rates while suppressing appetite. Those suffering from anorexia the family members and care givers are thought on how to serve the patient with foods at the right temperatures, foods that are spiced, offering food in small servings frequently.