Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Geriatric Nutrition: How Dietitians can make a positive impact on our
aging population Meridith Paterson, MS, RDN,CSG, LDN
[email protected] West Virginia Academy of Nutrition and
Dietetics
Learning Objectives
• Recognize the challenges of the aging population and the direct impact on nutrition outcomes.
• Understand the role the dietitian in improving not only nutrition but quality of life as well.
• Understanding the importance of learning each individual’s needs and wishes and not a one size fits all approach.
• Learning Codes: 4190, 5100, 5430
Challenges of the aging population….
Aging Population
• Between 2012 and 2050, the United States will experience considerable growth in its older population (65 years and older).
• From 43.1 million (2012) to 83.7 million (2050)
• Baby Boomers are a significant contributing factor to the increase in the older population.
Ortman, Jennifer M., Victoria A. Velkoff, and Howard Hogan. An Aging Nation: The Older Population in the United States, Current Population Reports, P25-1140. U.S. Census Bureau, Washington, DC. 2014.
Challenges Facing the Elderly
• Physical Changes
• Cognitive Changes
• Environmental Changes
• Financial Changes
Physical Changes
• Common changes noted: – Vision Impairment
– Hearing Impairment
– Taste Bud changes
– Sense of smell
– Sleep Disturbances
– Oral Changes (tooth loss, dentures, implants)
(May also have physical changes related to medical condition/ disease process)
Cognitive Changes
• “Slowing down”
• Forgetfulness
• Memory may be effected related to dementia, depression, delirium and other medical conditions.
Oral Care
• Approximately 25% of those 65 years and older have no natural teeth.
• Diet and nutrition intervention for older adults with compromised oral integrity must target individual needs based on current diseases and disabilities.
• Dietetics practitioners must address oral health as part of nutrition diet and screening, assessment, intervention, and monitoring of older adults.
• Position of the Academy of Nutrition and Dietetics: Oral health and Nutrition. 2013;113(5).
Environmental Changes
• No longer to be able to maintain their home
• Moved to new environment (Apartment, move in with a family member, SNF, PCH)
• May require giving up driver’s license
• Giving up independent activities (cooking, shopping, going to church, etc.)
Financial Changes
• May have went from two incomes to one income due to death of spouse or partner.
• Income may not cover current expenses (utilities, food, medicine, car, etc.)
• Increase cost of prescriptions
Direct impact on Nutrition
• Food insecurity
• Isolation
• Depression
• Chronic diseases
• Dependent of others- decrease in independence
• Oral hygiene (ill fitting dentures, mouth sores, thrush)
Other areas to consider
• Education Level (Can they read?)
• Evaluate the basics:
Do they have a working kitchen that is accessible to them? Do they have support (family/ friend/ church) to help? Can they manage their finances?
The role of the Dietitian…
Role of the RDN
• To look at the entire picture when it comes to nutrition
• Think outside the box
• Look at each person individually and nutrition plan should not be a one size fits all approach.
EOL Nutrition Issues
Dietitian's Role
• Active role in educating and advocating for our patients. Dietitians are part of the palliative/ hospice team.
• The dietitian should talk with the patient and/or family member about wishes prior to a crisis. Be Proactive!
• Schedule family meetings to discuss what the patient would want so that everyone is on the same page.
• The goal is to provide an opportunity for patient to discuss his/ her wishes and to provide comfort and dignity at the end of life by honoring what they would want.
To Feed or Not to Feed?
• Dietitian to educate patient and/or caregiver on palliative and/or EOL nutrition related issues and provide support.
• Tube feedings, IV hydration, MBS studies
• Issues surrounding feeding at the EOL.
• The “waiver” to go against what is recommended- is this valuable to complete?
Dietitian’s Role
• Liberalize diet ( this can be difficult for family members- diabetics)
• Assess for constipation which may be related to pain medication, decrease mobility, inadequate fluid intake
• Medications which may have negative effect (i.e. vitamins/ minerals may increase GI distress) recommend to discontinue any unnecessary medications
EOL Strategies
• Offer comfort/ pleasure foods (encouraging family members to provide favorite foods)
• Assess oral hygiene (for the demented patient cleaning their mouth before and after meals)
• Offering smaller portions
• Offering one food at a time
• Monitoring for pain and constipation
Conclusion
“To make a difference in someone’s life, you don’t have to be brilliant, rich, beautiful, or perfect. You just have to care.”
Mandy Hale
Questions???