2270 WEEK 8

Geriatric Syndromes II: Incontinence and Malnutrition
Week 8 Lecture Overview

  • Instructor: David Reid

Course Goals

  • Impact of Inadequate Nutrition: Understand how inadequate nutrition affects the health of older adults.

  • Team Roles: Identify roles of interprofessional team members in supporting older adults.

  • Incontinence in Older Adults: Learn types, causes, and consequences of incontinence.

  • Nursing Care: Understand nursing care for clients experiencing incontinence, including assessment and interventions to promote health.

  • Nutrition Barriers and Facilitators: Identify barriers and facilitators regarding adequate nutrition for older adults.

Importance of Nutrition

  • Health Promotion: Vital for maintaining health in older adults.

    • Reduce intake of sugar, fatty foods, and sodium to prevent hypertension and diabetes.

  • Illness: Illness can affect appetite and eating ability.

  • Diet Restrictions: Some conditions may require thickening liquids or liquefying solids, which can complicate intake.

  • Barriers: Older adults may face unique obstacles in maintaining healthy nutrition.

Nutrition & the Older Adult

  • Statistics: Nutrition is a leading health indicator for Canadians (Statistics Canada, 2019a).

  • Critical Aspects of Nutrition: Adequate nutrition is essential for health, happiness, independence, quality of life, and mental, physical, and social functioning (Boscart et al., 2023, p.100).

Canada’s Food Guide

  • Contextual Awareness: Consider the ties to colonization and reliability of the food guide when assessing dietary recommendations.

  • Reliability: The food guide may not be fully reliable for all populations due to historical and cultural contexts.

Client Case Scenario

  • Background: Client decided to sell his home for an apartment due to reliability and mobility concerns.

    • Assessment of nutritional barriers and facilitators to be conducted, along with interprofessional collaboration (IPC) considerations.

Factors Impacting Nutritional Needs in Older Adults

  • Age-related Changes: Impact on dietary recommendations, e.g., sodium intake should be minimized.

  • Lifelong Eating Habits: Nutrition is influenced by historical dietary patterns developed through tradition and social influences.

  • Ethnicity: Cultural background may influence dietary practices and nutritional needs.

  • Socialization: Important for food intake and nutritional engagement.

  • Income: Low income correlates with poor nutrition; understanding safety and moderation in alcohol consumption is crucial (Boscart et al., 2023).

  • Transportation & Housing: Impact on access to food sources and nutrition.

  • Food Knowledge: Awareness of nutritional requirements and cooking skills enhances dietary choices.

  • Health and Dentition: Oral health directly affects the ability to consume adequate nutrition (Boscart et al., 2023).

Nutritional Needs for Older Adults

  • Increased Requirements: Older adults need more calcium, vitamin D, and vitamin B12.

  • Caloric Intake: Total caloric intake should decline as metabolism slows, reducing energy needs.

  • Sodium Intake: Recommended daily value for sodium is 1500-2000 mg; excessive sodium must be avoided.

  • Fluid Intake: Emphasis on maintaining adequate hydration due to declining thirst function and kidney efficiency.

  • Major Concerns: Risk of obesity and malnutrition (Boscart et al., 2023).

Malnutrition in Older Adults

  • Prevalence: Malnutrition is prevalent among older adults, with rates soaring up to 60% in long-term care (LTC) or hospital settings.

  • Clinical Signs: Muscle wasting, low body mass index (BMI).

  • Biochemical Signs: Decreased albumin indicates protein-calorie malnutrition (PCM).

  • Consequences: Can lead to serious health issues including infections, pressure ulcers, anemia, hypotension, impaired cognition, and increased mortality and morbidity (Boscart et al., 2023).

Risk Factors for Malnutrition

  • Psychosocial Factors: Limited income, alcohol misuse, social isolation, depression, memory loss, inability to participate in cultural patterns.

  • Mechanical Factors: Reduced strength/mobility, diminished vision, loss of teeth, chewing difficulties, shortness of breath, polypharmacy, inability to grocery shop or prepare food (Boscart et al., 2023).

Assessing Malnutrition

  • Comprehensive Assessment: Essential to confirm malnutrition; includes interviews, diet history, physical examination, and biochemical tests (Boscart et al., 2023).

  • Interview Content: Current health status, social activities, dietary patterns, financial resources, medications, bowel and bladder function, and any recent life changes.

  • Diet History Options: 24-hour diet recall, 3-day dietary record, comparisons with age- and gender-specific recommendations.

  • Physical Exam Components: Height, weight, and BMI measurement; assessment of skin condition, vital signs, and general appearance (Boscart et al., 2023).

Biochemical Examination

  • Key Tests: Serum albumin (protein), cholesterol, serum transferrin (iron transport protein) measurements (Boscart et al., 2023).

Long-Term Care Assessment

  • Increased Risks in LTC: Higher risk for malnutrition due to staffing shortages; over 80% of residents require assistance with feeding.

  • Supplement Use: Recommended to use nutritional supplements, ideally taken 1 hour prior to meals (Boscart et al., 2023).

Improving Nutritional Intake in LTC

  • Dining Experience: Enhancing the dining experience through home-like environments, individualized menus, accessible 24/7 food, finger foods, visually appealing puréed foods, and encouraging family presence.

  • High-Quality Protein Choices: Important to include in the diet of older adults (Boscart et al., 2023).

Interventions for Malnutrition

  • Pharmacological Therapy: Appetite-stimulating medications may have limited success, causing small weight gains.

  • Enteral Feeding: Considered when other interventions fail, requires careful decision-making by families and residents (Boscart et al., 2023).

Scenario on Aspiration Risk

  • Client Profile: Older adult experiencing a raspy voice and cough after eating, indicating potential swallowing difficulties.

  • Barriers and Facilitators: Assessment of barriers to nutrition alongside IPC suggestions.

Dysphagia and Safe Feeding

  • Dysphagia: Defined as difficulty swallowing leading to increased risk for aspiration and nutritional deficits (Boscart et al., 2023).

  • Common Causes: Dementia, stroke; signs to observe include altered voice tone, pocketing food, and coughing during meals.

  • Symptoms: Include difficult swallowing, drooling, cough/choking, food pocketing, nasal voice or hoarseness, weight loss (Boscart et al., 2023).

Nutrition Options with Dysphagia

  • Dietary Restrictions: NPO (nothing by mouth) diet may be required; IV hydration for fluid replacement.

  • Therapeutic Diet: Therapeutic diet and enteral feeds (e.g., NGT, G-tube) may improve nutritional delivery but raise quality of life concerns due to tube dependency.

  • TPN: Total parenteral nutrition delivers nutrients intravenously and poses significant health challenges (Boscart et al., 2023).

Promoting Safe Swallowing Related to Dysphagia

  • Recommended Actions: Includes resting before meals, positioning, placing food on the unimpaired side, avoiding mixed-consistency foods, and not rushing meals (Boscart et al., 2023).

Diet Progression and Therapeutic Diets

  • Different Diet Types: Ranging from clear liquids to full diets based on individual needs and recommendations by speech-language pathologists (Boscart et al., 2023).

Client Discussion on Dietary Choices

  • Scenario: Client must adjust to a pureed diet and questions regarding alcohol intake, food preferences, and potential tube feeding options.

  • Long-Term Choices: Selection between various nutritional support systems.

Understanding Enteral Feeding

  • Short-Term vs Long-Term:

    • NGT: Short-term, easier to insert but uncomfortable; risks include aspiration.

    • G-tube/PEG: Long-term solution, surgically inserted but still at risk for aspiration, requires regular care (Boscart et al., 2023).

Oral Health and Geriatric Concerns

  • Importance of Oral Health: Basic need for older adults; poor oral health directly impacts general health and nutrition (Boscart et al., 2023).

  • Common Issues: Missing teeth, oral pain, and associated eating issues lead to inadequate nutrition and dehydration.

Barriers to Oral Health

  • Factors Impacting Care: Functional limitations, access to dental care, costs, and absence of fluoridation impact oral health quality (Boscart et al., 2023).

Xerostomia (Dry Mouth)

  • Overview: Common condition among older adults thanks to medications.

    • Symptoms: Can complicate eating and speaking, impacting dental health. Treatment includes artificial saliva and maintaining hydration (Boscart et al., 2023).

Nursing Assessment of Oral Health

  • Assessment Elements: Good oral hygiene involves evaluating various aspects of the oral cavity, including the secure fit of dentures (Boscart et al., 2023).

Oral Care & Enteral Feeding Considerations

  • Guidelines: Regular oral care and hydration of oral mucosa are vital, especially for patients with gastrostomy tubes (Boscart et al., 2023).

Oral Care in Long-Term Care Settings

  • Neglect in Care: Oral care often overlooked in LTC; needs significant attention due to impacts on nutrition and likelihood of complications (Boscart et al., 2023).

Challenges in Oral Care in Residential Settings

  • Concerns: Lack of knowledge, training, staff shortages, and appropriate supplies contribute to poor oral health practices (Boscart et al., 2023).

Nutrition in Older Adults Summary

  • Conclusions: Inadequate nutrition poses risks that must be managed across both LTC and community settings, emphasizing the need for interventions such as dietary adjustments, regular assessments, medication management, and addressing psychosocial factors (Boscart et al., 2023).