Hunger is Not Getting Any Younger

Amanda PanasClinical RDHunger is Not Getting Any Younger

Good Afternoon, Im Amanda Panas an inpatient clinical dietitian here at Sibley memorial hospital, for those of you who do not already know me, welcome and thank you for allowing me to speak with you today. In the past few months, I have noticed some concerning dietary practices among our patients here at sibley memorial hospital. Personally, I have identified patients at risk for malnutrition, also those doing some risky food practices. For example a 100 year old patient with second degree burns acquiring while making soup on the stove. An 80 year old, requesting PeaPod products which do not need to be frozen (after completing the research, I learned that she was living in a house with 3 flights of stairs, mostly living on the top floor, since the peapod driver provides a window for delivers the food had to be able to sit out for several hours). I am finding that it is common for an elderly person to continue to live independently while relying on help from neighbors, friends, and family whom do not live with them, these situations can be risky can be a cause for food insecurity.

Picture: http://www.google.com/imgres?q=elderly+malnutrition&um=1&hl=en&biw=1152&bih=654&tbm=isch&tbnid=w-XIlS4R09z3vM:&imgrefurl=http://thechart.blogs.cnn.com/2010/06/02/malnutrition-killing-elderly-in-u-s/&docid=vb-Ci0OLPbtABM&imgurl=http://i2.cdn.turner.com/cnn/2010/images/06/01/c1main.elderly.hands.jpg&w=416&h=234&ei=QsG0TtX5JKPm2gWct8TMDQ&zoom=1&iact=hc&vpx=464&vpy=320&dur=1151&hovh=168&hovw=300&tx=150&ty=107&sig=106513719543719791891&page=1&tbnh=113&tbnw=200&start=0&ndsp=17&ved=1t:429,r:8,s:01Sibley Memorial Hospital Elderly Patient Statistics Initiation of NICHE program at Sibley Memorial HospitalDesigned to meet the specialized needs of geriatric patientsIn general, 50% of hospitalized patients are at least 65 years old55% of Sibley Memorial Hospitals inpatient admissions are people over 65 years of ageWithin 30 years the population over 85 will double to 8.5 millionAverage age of Medicare patients is 7719% of patients admitted to Sibley Memorial hospital are over 85 (Vincent, 2011)

Sibley is applying to be a NICHE program, focuses on elderly patient needs, this includes discharge planning.

Picture: http://www.sibley.org/.2

National Food Insecurity40 million Americans struggle for enough to eat each dayUS poverty rate for adults over age 65 is 9.7%3.5 million elderly adults live in poverty (Society, 2011)5.3% of the people with food insecurity are elderly and 4.8% are elderly people living alone (Coleman, 2010)60% of low income seniors qualified for state or federal nutrition programs are not enrolled (Hunger, 2009)

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Elderly food insecurity in the DC area

DC consists of 61.4 miles, over 9,000 people live in each mile, 11.9% of this population is over the age 65, 17.1% of the DC population lives under the poverty line (DC, 2011)1 in 8 households struggle with hunger, 13% per USDA report 2008-2010DC priority to make programs easier to access per Alex Ashbrook, Director of DC Hunger Solutions (Healthy, 2006)The Older Americans Act Nutrition program works to improve the nutritional status of participants and helps them to maintain their independence and quality of life2 million of the 9 million older adults living alone believe that they have no one to turn to for assistance (Baker, 2005)Large amount of people in a small geographic areaGoal to connect elderly population with outreach programs

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Signs/Symptoms of Malnutrition

Malnutrition: deficiency of energy, protein, and other nutrients causing adverse effects on the body and functional outcome (Ahmed, 2010)Impaired muscles functionDecreased lean body muscleImmune dysfunctionAnemiaPoor wound healingMuscle wasting Cachexia (Ahmed, 2010)Low BMIDecreased albumin level/ pre-albumin levelVitamin/micronutrient deficiencies (Lane, 2011)I am aware that some of you have nursing degrees this will just be a little review for you.

Picture: http://www.google.com/imgres?q=nutrient+malnutrition&um=1&hl=en&sa=X&biw=1152&bih=654&tbm=isch&tbnid=HKDzk5z8VSEn7M:&imgrefurl=http://www.livestrong.com/article/462191-what-can-be-done-to-reverse-malnutrition/&docid=V2j5AEgi5s8BhM&imgurl=http://photos2.demandstudios.com/DM-Resize/photos.demandstudios.com/getty/article/236/193/200285863-001_XS.jpg%253Fh%253D10000%2526w%253D315%2526keep_ratio%253D1&w=315&h=400&ei=W8a0TqG6MuOU2wWY6e3MDQ&zoom=1&iact=hc&vpx=763&vpy=285&dur=102&hovh=253&hovw=199&tx=118&ty=277&sig=106513719543719791891&page=6&tbnh=135&tbnw=103&start=93&ndsp=19&ved=1t:429,r:17,s:935

Causes of Malnutrition

Following a meal, older adults experience less hunger and remain satisfied/fuller longer following a meal Aging leads to decreased food intake, anorexia of agingLoss of taste and sense of smellLess responsive to hunger cues, leads to decreased energy intake (Gregersen, 2011)Social isolation (Ahmed, 2010)Hunger and poverty High cost of multiple medications (Wellman, 2007).Picture: http://www.google.com/imgres?q=isolation&um=1&hl=en&biw=1152&bih=654&tbm=isch&tbnid=duf8xrNBSM1wrM:&imgrefurl=http://brokenbelievers.com/2011/07/01/the-curse-of-social-isolation/&docid=GeYKXYHFUJzD4M&imgurl=http://alaskabibleteacher.files.wordpress.com/2010/03/isolation.jpg&w=589&h=385&ei=Sse0To-3EOv-2QXy1cjMDQ&zoom=1&iact=hc&vpx=81&vpy=358&dur=48&hovh=181&hovw=278&tx=133&ty=132&sig=106513719543719791891&page=3&tbnh=123&tbnw=164&start=36&ndsp=18&ved=1t:429,r:12,s:366Focus of the negative health consequences of malnutritionOlder adults living alone do not consume adequate amounts of food, 40% of the frail homebound suffer from protein-energy malnutrition (Baker, 2005). Decrease quality of lifeIncreased frailtyDepressionMortality (Jutkowitz, 2011)

Picture: http://www.google.com/imgres?q=decreased+quality+of+life&um=1&hl=en&biw=1152&bih=654&tbm=isch&tbnid=837CZ1I5QN4i_M:&imgrefurl=http://brainblogger.com/2010/07/27/beauty-sleep-is-more-than-skin-deep/&docid=G6WMnkBrO53tzM&imgurl=http://dna.brainblogger.com/wp-content/uploads/Elderly-couple-asleep-on-couch-300x196.jpg&w=300&h=196&ei=I8i0TuX3BMeg2AWN_MGNDA&zoom=1&iact=hc&vpx=583&vpy=345&dur=4736&hovh=156&hovw=240&tx=143&ty=79&sig=106513719543719791891&page=4&tbnh=109&tbnw=151&start=56&ndsp=21&ved=1t:429,r:3,s:567

Factors that lead to Food Insecurity

Lack of transportation to the grocery storeFunctional limitationsInability to stand long enough to prepare mealsFinancial constraintsPoor dentition (Baker, 2005)Cognitive impairment (Lane, 2011)Medications which decrease appetite, altered taste, and interfere with absorption (Hunger, 2009)Very important to get patient to consume some food which they can tolerate, adapt with new medications.

Picture: http://www.google.com/imgres?q=dentures&um=1&hl=en&biw=1152&bih=654&tbm=isch&tbnid=-RvJy9FdvxJfnM:&imgrefurl=http://www.intelligentdental.com/2011/08/06/what-materials-are-dentures-made-from-3/&docid=-SIgYyH0FXDsxM&imgurl=http://www.intelligentdental.com/wp-content/uploads/2011/08/dentures-advice.jpg&w=544&h=450&ei=xsi0TuOMMc7y2gWruOzMDQ&zoom=1&iact=hc&vpx=243&vpy=320&dur=152&hovh=204&hovw=247&tx=148&ty=114&sig=106513719543719791891&page=1&tbnh=127&tbnw=152&start=0&ndsp=18&ved=1t:429,r:7,s:08 Local Resources within Five Miles of the Hospital, including MD & N. VAOAA is the largest federally funding program for people over the age of 65, initiated in 1972US Administration of Aging- Meals on WheelsEach DC site must be individually contacted to determine eligibility requirementsAnnually produces 250 million nutritious meals, and social opportunities for 3 million adultsSometimes only meal of the day for elderly participantsNutrition services- screenings, education, counseling4,000 local agencies, 20-1000 clients per siteEat Better & Move program (Wellman, 2007) Increased social contact, promotes healthful eating (Hunger, 2009)9Obtaining Material of Local Programs

25 locations for Free meals and emergency groceries sources within 4 miles of Sibley Memorial HospitalCapital Area Food Bank Hunger lifeline (202) 639-9770, website: http://www.dchunger.org/resources/dcfoodfinder.html4 food pantry and soup kitchens available in Bethesda MD, within 5 miles of the hospitalOther Options: So Others Might Eat, increase self-reliant, provided 262,101 hot nutritious meals for residents of Dwelling Place Shelter for Abused and Neglected Elderly, 133 low income seniors enjoyed meals, activities, and case management, 63 seniors, homebound, received 362 case manager visits, 595 food deliveries with Homebound Senior ProgramBethesda Cares- 4 churches providing lunch, feed homeless and food insecureHome Instead Senior Care (VA)- offers errands, shopping, meal assistance (companionship, transportation, personal, meal preparation, household chores, home monitoring, medication) including grocery shopping, meals planning and preparation, monitoring diet and eating, record and arrange recipes, monitoring food expirations, clip coupons for shopping Food & friends- 7 miles from Sibley, supplies meals to homebound HIV + and cancer pts10Obtaining Material of Local ProgramsMeals on Wheels in DC is complicated, grassroots program, each site has its own eligibility requirements and application, Central Headquarters (703) 548-5558Meals on Wheels locations within 5 miles from Sibley Memorial Hospital: Arlington AAA 4.3 milesBethesda-Chevy chase Meals on Wheels 4.6 milesArlington Meals on Wheels 5.0 miles

11Obtaining paperwork for Programs

IONA Senior Service center, 1 mile, serves DC ward 2 & 3, call 24 hours in advance to make an appointment, deliver two meals on Saturday for homebound/frail adults, those unable to afford additional helpSt Albans Episcopal Church, Super Sixties, group meal, exercise, recreation, creative writing, nutrition counseling/education, field trips, 1.4 miles, $2 donationVIDA Senior Centers, improve maintenance and quality of life, increase wellness, increase self sufficiency, independence for seniors, Latinos and other older adults, living in isolationHarvard Towers, 3 miles, senior meals, group meals, recreation, health promotion programs, nutrition counseling/education

Most sites are not just about the free meal, these clients get extra services and programs12Obtaining paperwork for ProgramsSarahs Circle, 3.25 miles, group meal center and wellness programsColumbia Heights, 3.5 miles, group mealsCampbell Heights, 3.6 miles, group meals for seniors, library, daily clinic for nursing assistance and weekly podiatrist careSt. Marys Court, 3.7 miles, ID must be shown, provides lunches, social services, transportation services, referrals, adult day care, flu shots, fitness and computer classesEmmaus Services for the Aging, 4.4 miles, DC residents over 60, free grocery market on Fridays, free lunch, legal help, referrals, assistance enrolling in benefits13

ConclusionMulti-disciplinary communication and teamworkProactive discharge planning, involve patient in discussion if appropriate, as the population of older adults increases (Baker, 2005)Open dialogue, flexibility (Scarinci, 2009)Effective discharge planning prevent re-admission, offering services to maximize effectiveness, care at home, assistance options (Wong, 2011) Discuss hiring nursing aid to provide meal assistance Not intention to make more work, busy, responcibilities

Picture: http://www.flickr.com/photos/lumaxart/2137737248/14ReferencesBaker, E. B., & Wellman, N. S. Nutrition concerns in discharge planning for older Americans: a need for multidisciplinary collaboration. J Am Diet Assoc. 2005(105),603-607. Retrieved October 8, 2011.Scarinci, I. C., Johnson, R. E., Hardy, C., Marron, J., & Partridge, E. E. Planning and implementation of a participatory evaluation strategy: a viable approach in the evaluation of community-based participatory programs addressing cancer disparities. Eval Program Plann. 2009. 32(3):221-228. Retrieved Ocoober 8, 2011. Vincent, J. M. Introduction to the NICHE program. Sibley memorial hospital power point presentations. (2011). Washington, DC.Jutkowitz, E., Gitlin, L. N., Pizzi, L. T., Lee, E., & Dennis, M. P. Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults in place at home. J Aging Res. 2011(12),106. Retrieved October 17, 2011 from PMC 3157760.Wong, E. L. Y., Yam, C. H. K., Cheung, A. W. L., Leung, M. C. M., Chan, F. W. K., Wong, F. Y. Y., & Yeoh, E. K. Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Services Research.2011. (11),242. Retrieved October 17, 2011, from PMC 3190337.Society of St. Andrew. 2010. Retrieved October 8, 2011, from http://www.endhunger.org/.Gregersen, N. T., Moller, B. K., Kristensen, S. T., Holm, L., Flint, A., Astrup, A., & Raben, A. Determinants of appetite ratings: the role of age, gender, BMI, physical activity, smoking habits and diet/ weight concerns. Food Nutr Res. 2011 (55). Retrieved October 3, 2011, from PMC ID: PMC3160809.Lane, R. L., Talley, M. C., Shamilyan, T., & Pacula, J. T. Common syndromes in older adults related to primary and secondary prevention. Agency for health care research and quality. 2011. Retrieved October 3, 2011, from PMID: 21901865.Ahmed, T., & Haboui, N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010. 2010(5), 207-216. Retrieved October 3, 2011, from PMCID: PMC2920201.Wellman, N. S, Kamp, B, Kirk-Sanchez, N. J., & Johnson, P. M. Eat better and move more: a community based program designed to improve diets and increase physical activity among older adults. Am J Public Health. 2007, 97(4), 710-171. Retrieved October 3, 2011, from PMC 1829349.DC MapStats. Retrieved October 3, 2011, from http://www.fedstats.gov/qf/states/11000.html.Coleman-Jensen, A., Nord, M., Andrews, M., & Carlson, S. Household food security in the US in 2010. USDA. 2011. Retrieved October 3, 2011, from http://www.ers.usda.gov/Publications/ERR125/ERR125.pdf.Healthy food, healthy communities. DC Hunger Solutions. 2006. Retrieved October 7, 2011, from http://www.dchunger.org/pdf/healthfoodcomm.pdf.Hunger and the senior: 5 million seniors at risk of malnutrition. Comfort Keepers. (2009). Retrieved October 3, 2011, from http://www.comfortkeepers.org/information-center/news-and-highlights/hunger-and-the-senior.

15Questions?

Picture: http://www.google.com/imgres?q=questions&um=1&hl=en&biw=1152&bih=654&tbm=isch&tbnid=fF9zIZCh14BJXM:&imgrefurl=http://chem-eng.blogspot.com/2011/05/questions-and-answers-for-engineers.html&docid=aSpE0AHQSWpkQM&imgurl=http://1.bp.blogspot.com/-jRHSjzVJQRo/TdedE9NkzyI/AAAAAAAAB5I/OyoJD14T12M/s400/questions-answers-chemical-engineering.jpg&w=300&h=300&ei=p8m0TqKeJI2H2AXrhszMDQ&zoom=1&iact=hc&vpx=622&vpy=313&dur=1734&hovh=225&hovw=225&tx=81&ty=110&sig=106513719543719791891&page=1&tbnh=132&tbnw=104&start=0&ndsp=21&ved=1t:429,r:18,s:016