Problems with eating and nutrition: geriatric self-learning module

MedSurg Nursing, Dec, 2004 by Virginia K. Lee

The Geriatric Resource Nurses at the University of Virginia developed the Self-Learning Modules in Geriatric Care (Lee, Fletcher, Westley, & Fankhauser, 2004). The SPPICEES pneumonic addresses eight distinct modules, each targeting a commonly encountered health concern of older adults across health care settings. These include:

S: Sleep

P: Problems with eating and nutrition

P: Pain

I: Immobility

C: Confusion

E: Elimination

E: Elder abuse

S: Skin

The modules were designed using a case study approach in order to encourage the learner to gain new knowledge as well as apply this knowledge. Each module includes two case studies, one applicable to the care of an older adult in the inpatient setting and the other applicable to an older adult in the outpatient setting. Each module will take approximately 20 to 30 minutes to complete.

The completion of these self-study modules alone does not ensure the staff member is age-specific competent; this is determined through the observation and demonstration of behaviors while working directly with older adults. However, these modules will enhance the staff member's knowledge as a foundational step in developing competent behaviors.

Purpose

The purpose of this module is to provide age-specific educational information related to nutritional problems in older adults for the inpatient and outpatient staff.

Target Audience

This self-study module is for use by health care professionals caring for older adult inpatients and outpatients.

Directions

1. Read and review the learning objectives.

2. Read both case studies and the self-study module information.

3. Answer the post-test questions.

Objectives

At the conclusion of this module the professional patient care staff will be able to:

* Discuss reasons why the risk of poor nutrition is increased in older persons.

* Identify cues that indicate a need for more in-depth assessment.

* Discuss interventions that help address nutrition problems.

Overview

The food pyramid continues to be a good basic guide for a healthy diet as people age. Recent changes to the recommended daily allowances address those over age 50 for the first time. Nutrient needs tend to increase as people age, although their caloric needs generally do not increase because of diminished activity and decreased metabolism. If extra weight is a health concern, the older adult needs to eat nutritionally dense food to get more nutrients in fewer calories than a younger counterpart; this is often a challenge. However, the opposite problem of weight loss and protein calorie malnutrition is extremely common in elders, particularly among the sick and hospitalized. Inadequate fluid intake is also very prevalent. Because older adults have a diminished sense of thirst, they often drink less but still usually need approximately 2,000 cc of fluid a day.

Multiple problems and changes occur as people age which make obtaining, eating, enjoying, and metabolizing adequate amounts of food a challenge. By some estimates as many as 25% of Americans age 60 and older are malnourished. Nutrition is extremely important to good health, and even subclinical deficiencies can impact body function (Johnson, 1997). Risk factors for poor nutrition in the older adult are typically cumulative and interrelated. A great variety of diverse issues can influence an elder's ability to be nutritionally healthy. A partial list includes the following:

* Normal aging changes in smell and taste.

* Ill-fitting dentures and other oral or dental problems.

* The impact of disease which may change nutritional needs or interfere with adequate intake.

* Depression, confusion, and memory loss.

* The effects of multiple medications.

* Substance abuse (an estimated 10% of elderly abuse alcohol).

* Diminished function which limits ability to shop, cook, and prepare meals.

* Social isolation.

As the number of risk factors increases, the prevalence and degree of impaired nutrition also increase.

Unintentional weight loss of over 10 pounds in 6 months should be investigated. It is often a sign of illness. Many older persons suffer from inadequate food intake and protein energy malnutrition, not only in the community but also in acute and long-term care settings. In these settings, food intake is often inadequate for a variety of reasons. Appetites are poor because of illness, anxiety, medication side effects, lack of physical activity, and/or depression. Tests and studies may require NPO status that is sometimes continued longer than necessary. Patients may be unable to obtain food they find appealing. Negative comments about hospital food are common. The variety, preparation, and presentation of hospital food have definitely improved but it is still a challenge for patients to get food they want, prepared as they would like, at the time they feel like eating, and at the correct temperature. For patients in questionable or poor nutritional health, not eating well has significant implications for energy, wound healing, cognition, and their sense of well-being.