Nutrition, Feeding, and Oral Health

Digestive Changes

neurodegeneration of the gut nervous system (dysphasia, reflux, constipation)

decreased gastric secretion (malabsorption and nutrient deficiencies)

decreases sensitivity of thirst detecting (dehydration and constipation)

dental deterioration (difficulty chewing solid foods)

less active lifestyle and loss of body mass (increased abdominal and visceral fat mass with age but decreased muscle mass; decreased caloric requirement)

decreased sense of taste and smell

slower metabolism

decreased appetite/food consumption (less hungry, fuller between meals, eat more slowly, smaller meals)

Anorexia of Aging

decreased appetite/intake leads to inability to maintain body weight in normal range

Unintended Weight Loss

half of older adults in nursing home are below average caloric consumption and body weight

appetite decreases with age but pathological weight loss is from other factors.

Consequences of Wight Loss

decreased bone mineral density

decreased muscle mass

leads to poor activity tolerance

increased fall risk

frailty and loss of function

Reversible Weight Loss

target underlying factors contributing (not just eating more)

depression: treating motivation for intake and socialization

nutritional supplements: promote weight gain

boor dentition and oral health

Daily Diet Recommendations

50-60% carbohydrates

15-20% proteins (older adults often have decreased protein intake but may have increased need for protein to prevent excess loss of muscle mass)

30% fat (percentage of total calories)

Vitamin and Minerals

older adults are prone to certain deficiencies vitamin d, vitamin b12, folate

risk factors: physiologic factors, reduced caloric intake, reduced variety of foods, medications (interfere with absorption and metabolism), smoking/EtOH

Vitamin D

decreased sun exposure, thinning of skin can mean decreased production

risk of worsening bone loss, osteopenia/osteoporosis

Folate

reduced intake (poor diet, excess alcohol)

associated with cancers

risk for cognitive impairment, depression

Hydration Considerations

normal recommendations: six to seven 8 ounce glasses

varies depending on individual older adult

important to be aware of fluid restrictions

thirst declines with age!

Aspiration

entry of foreign substance into the lungs

Dysphasia

difficulty with any stage of swallowing or eating

Pocketing

keeping food between teeth and cheek

Reflux

food goes back to esophagus from stomach

Silent Aspiration

aspiration without coughing or choking

Food Consistencies: Regular

normal food consistency

Food Consistencies: Advanced

soft foods that require more chewing ability

Food Consistencies: Mechanical Altered

cohesive, moist, semisolid foods that require some chewing

Food Consistencies: Pureed

homogenous, pudding like, little chewing

Liquid Consistencies: Thin

normal fluid viscosity

Liquid Consistencies: Nectar Like

fluid viscosity that is slightly thicker than water

Liquid Consistencies: Honey Like

fluid viscosity that is close to honey

Liquid Consistencies: Spoon Like

approximately as thick as pudding

Proper Positioning

hips, knees, feet at 90 degrees

weight evenly distributed to both sides of body

head upright and slightly angles forward

mouth 10-15 inches from plate

seated vertically at 90 degrees for digestion

Feeding Interventions

grocery shopping

meal preparation

equipment

feeding techniques

swallowing

Oral Health Concerns

dentures

periodontal disease

dental decay

oral cancer

dry mouth

Oral Health Interventions

sequencing and practice

adaptive equipment

education and training

use of external memory aids to compensate for cognitive changes

Dietary Assessment

24 hour recall

food records for 7 days

Clinical Assessment

thin, skin, hair, nails, wound healing

vitals