Topic 9: NUTRITION AND HYDRATION

● Teeth have various degrees of erosion, abrasions of crown and root structure.

● Reduction in saliva.

● Inefficient digestion of starch.

● Decreased thirst sensation.

● Lower fat tolerance.

● Weaker gag reflex, reduced stomach motility.

● Decreased colonic peristalsis.

● Less efficient cholesterol stabilization

Factors That Affect Dietary Requirements in Late Life

1. The older body has less lean body mass and a relative increase in adipose tissue.

2. Basal Metabolic Rate (BMR) declines 2% for each decade of life after age 25.

3. The activity level for most older adults is usually lower than that during their younger years.

Factors Contribute to Reduced Need for Calories:

1. Decreased caloric needs.

2. Monitor the quantity and quality of caloric intake.

3. Fiber is particularly important in the older adult's diet.

4. Increased CHO (Carbohydrate) intake.

5. 1 gram of protein per kilogram of body weight.

6. Five servings of fruits and vegetables daily.

7. Calcium intake

Quantity & Quality of Caloric Needs

Nutritional Supplements

can compensate for inadequate intake of nutrients & deficiencies.

● Calcium consumption

1. Niacin 2. Riboflavin 3. Thiamine 4. Vitamin B6, C, and D

Most Common Deficient Nutrient:

1. Vitamin D 2. Vitamin K 3. Folic Acid 4. Calcium 5. Potassium

Possible Effects with High Doses:

a. Heart Disease b. Cancer c. Osteoporosis d. Postmenopausal

Risk of Women in Nutrition-Related Conditions

Factors That Cause to Consume Less Fluid:

1. Age-related reductions in thirst sensations.

2. Fear of incontinence.

3. Lack of accessible fluids.

4. Inability to obtain or drink fluids independently.

5. Lack of motivation.

6. Altered mood or cognition.

7. Nausea, vomiting, and gastrointestinal distress.

● Infection ● Constipation ● Decreased Urine Output ● Dehydration

Limiting fluid intake will result to:

Promotion of Oral Health

1. Pain-free, intact gums and teeth

2. Good dental care

3. Use of a toothbrush

4. Mouthwash

5. Extraction of loose teeth

6. Dentures

7. Malnutrition

1. Bleeding gums

2. Red, swollen, painful gums

3. Pus at gum line

4. Chronic bad breath

5. Loosening of teeth from gum line

Fluid Signs of Periodontal Disease Include:

1. Decreased stomach motility

2. Less gastric secretion

3. Slower gastric emptying time

Fluid Indigestion and Food Intolerance Causes:

1. Eating several small meals

1. Avoiding or limiting fried foods

2. Identifying problem foods

3. High Fowler’s position

4. Adequate fluid intake and activity

Management:

Anorexia

Causes:

1. Medication side effects

2. Inactivity

3. Physical illness or age-related changes

4. Reduced production of the hormone

5. Gastric changes

6. Losses and stresses

Management:

1. Identify the cause

2. High-caloric diet/tube feeding/psychiatric consult/drugs

3. Food stimulation

4. Monitor intake, output, and weight

Dysphagia

Causes:

1. Gastroesophageal reflux disease (GERD)

2. Cerebrovascular accident / stroke (CVA)

Management:

1. Proper Eating Strategies

1.1. Sit upright whenever food or fluid is being consumed.

1.2. Allow sufficient time for eating.

1.3. Ensure there is no residual food in the mouth before feeding additional food.

1.4. Place small portions in the mouth.

1.5. Placing small portions in the mouth

1.6. Discouraging the person from talking while eating

2. Keeping a suction machine readily available

3. Monitoring intake, output, and weight

4. Providing thickened liquid

Constipation

Causes:

1. Slower peristalsis

2. 2. Inactivity

3. 3. Side effects of drugs

4. 4. Less fiber and fluid

Management:

1. Plenty of fluids, fruits, and vegetables

2. 2. Increase activity

3. 3. Increase fiber intake

4. 4. Administer laxatives as prescribed

Malnutrition

Causes:

1. Decreased taste and smell sensation

2. Reduced mastication capability

3. Slower peristalsis

4. Reduced gastric acid secretion

5. Less absorption of nutrients

6. Side effects of medications

7. Socioeconomic factors

8. Lifelong eating patterns

Clinical Signs Of Malnutrition:

1. Weight loss greater than 5% in the past month or 10% in the past 6 months

2. Weight 10% below or 20% above ideal range

3. Serum albumin level lower than 3.5 g/100 ml

4. Hemoglobin level below 12 g/dl 5. Hematocrit value below 35%

Management:

1. Develop keen assessment skills

2. Encourage good nutritional practices