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Chapter 16
Nutrition and Hydration
Components of the Nutritional
Assessment
• History
• Physical Examination
• Biochemical Evaluation
• Cognition and Mood
• Anthropometric Measurement
History
• Review health history and medical record for evidence of
diagnoses or conditions altering the purchase,
preparation, ingestion, digestion, absorption, or excretion
of foods.
• Review medications for those that can affect appetite and
nutritional state.
• Assess patient’s description of diet, meal pattern, food
preferences, and restrictions.
• Keep a diary of all food intake for a week.
Physical Assessment
• Inspect hair.
• Inspect skin.
• Test skin turgor.
• Note muscle tone, strength, and movement.
• Inspect eyes.
• Inspect oral cavity.
• Observe person drinking or eating for difficulties.
Biochemical Evaluation
• Obtain blood sample for screening of:
– Total iron binding capacity
– Transferrin saturation
– Protein; albumin
– Hemoglobin; hematocrit
– Electrolytes; vitamins
– Prothrombin time
• Obtain urine sample for screening of specific gravity.
Cognition and Mood
• Test cognitive function.
– Note alterations in mood, behavior, cognition, level
of consciousness.
– Be alert to signs of depression.
– Ask about changes in mood or cognition.
Anthropometric Measurement
• Measure and ask about changes in height and weight.
• Determine triceps skinfold measurement (TSM).
• Measure the midarm circumference (MC) with a tape
measure (using centimeters).
• Use this to calculate midarm muscle circumference
(MMC) with formula:
– MMC in cm = MAC in cm – (0.314 x TSM in mm)
Factors Contributing to Reduced Need for
Calories of the Elderly
• The older body has less body mass and a relative
increase in adipose tissue.
– Adipose tissue metabolizes more slowly than lean
tissue and does not burn calories as quickly.
• Basal metabolic rate declines 2% for each decade of life.
• The activity level for most older adults is usually lower
than it was during younger years.
Harris-Benedict Equation (REE)
Males
66 + [13.7 x weight (kg)] + [5 x height (cm)] – [6.8 x
age] = kcal/day
Females
655 + [9.7 x weight (kg)] + [1.8 x height (cm)] – [4.7 x
age] = kcal/day
Recommended Diet for Elderly
• Should contain calories of a high quality including:
– Fibers
– <30% total calories from dietary fat.
– At least 1 g protein per kg body weight daily;
approximately 15% daily calories from proteins.
Examples of at Risk Nutrition-related
Conditions for Women
• Heart disease
• Cancer
• Osteoporosis
Hydration
• Total body fluids are reduced with age, thereby
contributing to the risk for dehydration.
• Older adults require approximately 1500 ml fluid daily.
• Factors that may cause elders to consume less fluid:
– Reduction in thirst sensation
– Fear of incontinence
– Lack of accessible fluids
Signs of Periodontal Disease
• Bleeding gums, particularly when teeth are brushed
• Red, swollen, painful gums
• Pus at gumline when pressure is exerted
• Chronic bad breath
• Loosening of teeth from gumline
Nutritional Supplements
• Inquire about supplement use during the assessment.
• Increasing numbers of people are using nutritional
supplements on a daily basis.
– Supplements can compensate for inadequate intake
of nutrients.
– Supplements can interact with medications.
Reasons for Increased Ingestion in the
Elderly
• Decreased stomach motility
• Less gastric secretion
• Slower gastric emptying time
Non-Pharmacologic Measures for
Managing Indigestion
• Eat several small meals rather than three large ones.
• Avoid or limit fried foods.
• Identify and eliminate specific foods from the diet to
which an intolerance exists.
• Sit in a high Fowler position while eating and for half an
hour after meals.
• Ensure adequate fluid intake and activity.
Forms of Dysphagia
• Transfer Dysphagia
– Difficulty moving food from the mouth to the
esophagus.
• Transport Dysphagia
– Difficulty moving food down the esophagus.
• Delivery Dysphagia
– Difficulty moving food from the esophagus into the
stomach.
Causes of Dysphagia
• Neurological conditions, such as a stroke
• Most cases are due to gastroesophageal reflux disease
(GERD).
Factors to Consider When Assessing
Swallowing Problems
• Onset
• Types of foods that present the most problems
– Solids or liquids
• Occurrence
– Consistent or periodical
• Other symptoms and related complications
– Aspiration
– Weight loss
Nursing Measures for Swallowing
Difficulties
• Have the person sit upright whenever food or fluid is
being consumed.
• Allow sufficient time for eating.
• Assure there is no residual food in the mouth before
feeding additional food.
• Place small portions in the mouth.
• Discourage the person from talking while eating.
Nursing Measures for Swallowing
Difficulties (cont.)
• Keep a suction machine readily available.
• Monitor intake, output, and weight.
• Tilt the head to a side and placing food on a particular
part of the tongue.
• Correct underlying problems.
Causes of Constipation in the Elderly
• Slower peristalsis
• Inactivity
• Side effects of drugs
• A tendency toward less bulk and fluid in the diet.
Measures to Prevent Constipation
• Drink plenty of fluids.
• Eat plenty of fruits and vegetables.
• Exercise regularly.
• Allow adequate time for a bowel movement.
Factors That Increase the Risk for
Malnutrition
• Reduced taste and smell sensations
• Slower peristalsis
• Decreased hunger contractions
• Reduced gastric acid secretion
• Less cells on intestinal surface
Clinical Signs of Malnutrition
• Weight loss greater than 5% in the past month or 10% in
the past 6 months.
• Weight 10% below or 20% above ideal range.
• Serum albumin level lower than 3.5 g/100 mL
• Hemoglobin level below 12 g/Dl.
• Hematocrit value below 35%.
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).