Download Elderly Assessment Katie Haarala Concordia College Moorhead

Elderly Assessment
Katie Haarala
Concordia College
Moorhead, MN
Lifecycle Nutrition
12/02/08
Introduction
The elderly population is at an increased risk of nutrient deficiencies due to their
decreased appetite and decreased physical activity. It is imperative that they receive
enough calories because once their body uses their lean muscle mass for fuel, it is
more difficult to replace it.
BK is a 74 (75 on December 29, 2008) white female who is a widow and lives
alone. She is a social individual who enjoys spending time with her family and eating
meals at the senior citizen center with her friends. She is a Type II diabetic, but claims
her doctor has stated her diabetes is “very controlled.” BK has a good appetite and
never finds she skips meals; she enjoys milk because she claims she knows “it’s good
for the bones!” She takes a number of different medications prescribed by her doctor.;
they are mainly taken to maintain cholesterol and blood pressure values.
3 Day Food Intake
Tuesday
B- 1 pc. Cinnamon toast w/ butter & 1 tsp. Honey
Cup Coffee w/ 2 tsp. Cream
Yoplait kids Yogurt Drink- Banana 3.1 oz.
Breakfast the same for every day
L- Tuna Casserole – 1 cup
8oz. Skim Milk
½ Cup Fruit Cocktail
1 pc. Wheat Bread
1 pad Margarine
Small square- pumpkin bar
D- 8 oz. Skim milk
½ cup Carrot & Broccoli Mix + 1 TBSP Miracle Whip
1 pc. Wheat bread
1 slice deli ham
Wednesday
B- Same as Tuesday
L- Chicken breast (size of a deck of cards)
1 TBSP. Garlic sauce
1 medium baked potato –
2 pat margarine
½ cup peas
1 slice multigrain bread
Cherry Chip Cake
Vanilla Ice Cream
8 oz. Skim Milk
D- 8 oz. Skim Milk
Chicken Pot Pie- Frozen
Thursday
B- Same as Tuesday
L- Hot Dog
Wheat Bun
1 TBSP Ketchup
8 oz. Skim Milk
D- 8 oz. Skim Milk
1 wheat bun
1 Pat Margarine
4 Meatballs Swedish in Mushroom sauce
½ cup mashed potatoes with 2 TBSP gravy
Energy Requirements
Energy requirements for the elderly are calculated according to the need to
maintain physiological status, especially muscle mass. Due to less physical activity and
muscle mass decline, energy requirements are usually less than those of adolescents
and early adulthood.
For patient BK, it was calculated that her BEE was approximately 1550. This
was discovered by using both the Harris-Benedict Formula and the Mifflin St. Jeor
Equation and taking an average. It was estimated that BK’s average energy intake is to
be around 1550 kcals daily.

Harris-Benedict = 655 + (9.6 x 67.73kg) + (1.8 x 160 cm) – (4.7 x 74 age) = 1240
kcals BEE x 1.3 activity factor = 1613 kcals

Mifflin St. Jeor = (10 x 67.73kg) + (6.25 x 160cm) – (5 x 75 age) – 161=
1141kcals BEE x 1.3 activity factor = 1483 kcals
Two of the three day assessment, BK consumed her recommended energy
intake. However, using a 3-day average, she fell around 100 kcals short. Energy intake
does not appear to be something of concern; if weight starts to decline investigate
calorie intake.
Energy Intake
Day 1
Day 2
Day 3
Average
Recommended
Intake
Energy
Intake
998 kcal
1760 kcal
1577 kcal
1445 kcal
1550kcal
Protein Requirements
Protein Intake
Day 1
Day 2
Day 3
Average
Recommended
Intake
Protein
50.38 g
Intake
82.67 g
61.23 g
64.76 g
68-85g
(1.0-1.25g/kg)
It is imperative that the elderly population receives adequate protein because it is
more difficult for their body to replace body protein once it has been broken down. A
general recommendation for this population is to consume around 1.0-1.25g of protein
for every kg or body weight.
From BK’s NDSR nutrient reports it can be determined that she is approximately
5 grams below the recommendation for her protein intake; an intake of at least 68 g/day.
It would be very simple to increase her protein intake as protein is found in many foods.
In order to increase her average intake it would be recommended that she consume at
least two serving of the following in addition to her regular diet:
Food Item
Grams of Protein
1 Egg
6g
8 oz. glass of milk
8g
Yogurt (1 cup)
10 g
Chicken Breast (3.5 oz)
30 g
Peanut Butter (2 TBSP)
8g
It is also to be noted that proteins found in animal products such as meat, eggs,
and milk are more bioavailable for humans. Therefore, it would be more beneficial to
choose foods from those categories while also making sure to limit fat intake.
Fiber Recommendation
Fiber Intake
Fiber
Day 1
Day 2
Day 3
Average
Recommended
Intake
8.36 g
13.31 g
10.38 g
10.68 g
21.5 g
Intake
Fiber is important for overall digestive health for individuals at any age. It is
recommended that individual’s adults consume 21- 30 grams of dietary fiber daily; or, a
recommendation of 14 grams of fiber for every 1,000 calories.
BK’s fiber recommendation was calculated to be around 21.5 grams of fiber on a
daily basis. This was found by using the formula 14 g/1000kcal. She did not meet her
fiber intake once, almost not even meeting it by half each day. In order to increase her
fiber it is imperative to include fruits, vegetables, and whole grain sources. Below is a
list of food items she can include in her diet in order to increase her fiber intake.
Food Item
Grams of Fiber
Oatmeal (1/2 cup) with wheat germ (1/4 cup)
8
Baked Potato w/skin
4
Banana
2
Pear
4
Orange
3
Green beans (1/2 cup)
3
Sodium Recommendation
Sodium Intake
Day 1
Day 2
Day 3
Average
Recommended
Intake
Sodium
1773 mg
2326 mg
3249 mg
2449 mg
< 2300 mg
Intake
Sodium is imperative in the balance of fluids in the body and muscle and nerve
regulation, but a high intake could potentially lead to Hypertension, heart problems, and
kidney problems.
BK, on average, consumed more than the recommended intake of Sodium. It is
recommended that women consume less than 2300 mg of Sodium daily. BK was above
the recommended limit two of the three days.
It is recommended that BK is aware or her Sodium consumption by checking the
nutrient labels on the back of food products. It has been noted that she often eats
frozen foods which commonly contain high amounts of Sodium.
Fluid Intake
As an individual gets older, their sense for whether or not they are thirsty tends to
decrease. Also, their reservoirs for water decrease as well so it is more likely an elderly
person will become hydrated. It is recommended that an elderly person receives 35 mL
of water for every kg of body weight. One cup of fluid is the equivalent of 240 mL.
It is recommended that BK consumes around 2380 mL of water on a daily basis
to stay hydrated and to maintain water reservoirs in her body.
Deficiencies
Nutrient
3-Day Average
% of RDA- Avg.
RDA
Vitamin C
29.21 mg
39%
75 mg
Vitamin E
3.27 mg
22%
15 mg
Magnesium
196 mg
61%
320 mg
251.3 mcg
63%
400 mcg
2245 mg
48%
4700 mg
Folate
Potassium
BK was deficient in the nutrients vitamin C, vitamin E, Magnesium, Folate, and
Potassium for the 3-day food tracking. The NDSR reported other deficiencies for BK,
but the deficiencies that were around the 60% threshold were the ones to focus
behavior change. It was seen that it will be especially necessary for BK to incorporate
more foods containing vitamin C and vitamin E, and the mineral Potassium into her diet.
Vitamin C
Vitamin C acts as an antioxidant by preventing the oxidation of LDL cholesterol,
DNA, eye tissues, and other lipids. It is also imperative for the synthesis of collagen
and is vital for neurotransmitter and steroid hormone synthesis. A long term deficiency
in vitamin C could result in bleeding and bruising easily, fatigue, depression, slow
recovery from infection, and poor wound healing. Vitamin C is found in a variety of
sources such as: oranges, lemons, limes, strawberries, cantaloupe, honeydew melon,
grapefruit, kiwi, mango, papaya, broccoli, green and red peppers, collards, cabbage,
tomato, asparagus, potatoes, and ready-to-eat cereals. In order to increase vitamin C
intake, it is recommended that BK consumes two or more of the following items in
addition to her regular diet:
Food Item
Grams of vitamin C
Kiwi
74 g
Orange
70 g
Grapefruit
44 g
Tomato
27 g
Strawberries (1 cup)
97 g
Red Peppers (1/2 cup)
95 g
Broccoli (1/2 cup)
39 g
Vitamin E
Vitamin E is an important compound that acts as an antioxidant in the body. Its
antioxidant properties help prevent damage to the cellular membranes in the tissues by
repairing damage done by free radicals. It also helps to reduce the oxidation of LDL
cholesterol. A deficiency in vitamin E could lead to muscle loss, nerve damage,
anemia, and weakness.
BK was below the RDA for her vitamin E 3 consecutive days during her charting.
It is important that she increases her vitamin E intake by including foods such as eggs,
nuts and seeds, leafy green vegetables, tomatoes, whole grains, oils and fats, and
salad dressings. Below is a list of recommended sources; she should try to include at
least two servings throughout the day in addition to her regular diet to increase her
vitamin E intake.
Food Item
Grams of vitamin E
Peanut Butter (2 TBSP.)
2.5 mg
Sunflower Seeds (1oz.)
7.4 mg
Almonds (1 oz.)
7.4 mg
Avocado (1/2)
2.1 mg
Tomato Sauce (1/2 cup)
2.5 mg
Wheat Germ (2 TBSP.)
2.3 mg
Magnesium
The mineral magnesium is a component of bones and teeth. It is needed for
nerve activity and to activate enzymes used in protein and energy formation. A longterm deficiency has been found to be associated with weakness, muscle spasms, and
personality changes.
BK can incorporate magnesium into her diet by including foods such as spinach,
bread, pasta, dried beans, iron-fortified cereals, prunes, apricots, and raisins. Below is
a list of sources with recommended servings. Include at least one serving daily in
addition to regular diet.
Food Item
Grams of Magnesium
Tofu (1/2 cup)
134 mg
Peanuts (1/4 cup)
247 mg
Almonds (1/4 cup)
80 mg
Breakfast ceral-fortified (1 cup)
85 mg
Lentils, cooked (1/2 cup)
134 mg
Folate
Folate is a water-soluble vitamin that is important in the conversion of
homocysteine into methionine. It is also imperative for the normal function of red blood
cells and other cells. A long-term deficiency in folate could potentially lead to diarrhead,
weakness, irritability, paranoid behavior, increased blood homocysteine levels,
megaloblastic cells and anemia. Folate is found in dried beans, milk, yogurt, cheese,
oranges, bananas, grapefruit, dark green-leafy vegetables, and fortified grain products.
It is important that BK consumes at least one extra serving of the following
recommendations in addition to her normal diet to increase folate intake.
Food Item
Grams of Folate
Garbanzo beans (1/2cup)
141mcg
Romaine lettuce (1cup)
86 mcg
Orange
59 mcg
Oatmeal (1/2cup)
97 mcg
Sweet Potato (1/2cup)
43 mcg
Potassium
Potassium is important in the maintenance of body fluid balance, activation of
muscles and nerves, and acts very similar to the mineral Sodium. A long-term
deficiency of Potassium could lead to weakness, irritability, mental confusion, irregular
heartbeat, and potentially paralysis.
Potassium intake is particularly important for BK due to her taking the medication
Hydrochlorothiazide. It is a diuretic and usually flushes Potassium out of the body with
the water. In order to increase Potassium consumption, BK should consume foods
such as meats, milk and milk products, potatoes, squash, lima beans, tomatoes,
oranges, bananas, and other plant foods. To increase her daily intake it would be
necessary to include at least two servings of the following food items in addition to her
regular diet.
Food Item
Grams of Potassium
Potato (1 med.)
780 mg
Tomato (1 med.)
300 mg
Broccoli (1/2cup)
205 mg
Avocado (1/2 med.)
680 mg
Orange Juice (1cup)
469 mg
Banana (1 med.)
440 mg
Chicken (3 oz.)
208 mg
Skim milk (1cup)
400 mg
Fat Allowance
Day 1
Day 2
Day 3
Average
Recommended
Intake
Fat
26 g
69 g
79 g
58 g
Intake
% of
caloric
~ 30% of
kcals
23%
35%
45%
34%
52 gms
Intake
On average it is recommended that an individual consumes around 30% of their
calories from fat calories. Fat is vital in important in the absorption of fat-soluble
nutrients.
BK was approximately 6 grams beyond maximum fat allowed on average. In
fact, one day was 18 grams excess. She often eats at a senior citizen center at may
often consume unknown sources of fat. It is recommended that she keep track of her
fat intake.
Food Pyramid
In order to compare BK’s diet record to the USDA Pyramid, her intakes were
logged into the website www.mypyramidtracker.gov. The three days noted that she had
a good intake of grains, milk, and below 300 mg of cholesterol a day. However, her fruit
intake was always below the recommended amount. Two out of the three days the
amount of total fat consumed was more than the pyramid’s recommendation for fat
being 20 to 35% of your calories. This included two of the three days have a slightly
high saturated fat intake, an intake over 10% of the total fat calories. BK’s meat and
beans intake was generally good, meeting the goal two out of three days. However, the
Sodium was too high two out of the three days, exceeding the pyramid’s
recommendation of less than 2300 mg daily. It is important that BK is aware of what
she is consuming adequate amounts of, but also that she is aware of the food groups
she may be consuming too much of and too little of.
Nutrition Care Process
Assessment
BK is a white female
75 Y.O.
Height = 5’3’’ / 63 in. / 160 mm
Current Weight = 149 lbs.
Usual Weight = 149 lbs.
BMI = 26.56 – Slightly Overweight
Diagnosis
BK appears to be a generally healthy individual with a healthy appetite.
However, BK appears to be deficient in vitamin C, E, Potassium, Folate, and
Magnesium, due to low intake of fruits, vegetables and other nutrient containing foods
as evidence by a 3-day average intake of vitamin C at 29.21 mg, vitamin E at 3.27 mg,
magnesium at 196 mg, folate at 251.3 mcg, and an intake of 2245 mg for Potassium.
Intervention
Set-up menu plans that focuses on including foods that are high in the nutrients
that BK is deficient in. Make sure to note the serving size of each food and how much
of the nutrient the food contains. Also, make sure to stress the importance of fluid
intake, keeping her fat intake within range, and healthy levels of Sodium and Potassium
Monitoring
Set-up appointments with BK to discuss the importance of including foods into
her diet that contain the nutrients she is shown to be deficient in. Also, during the first
meeting stress the importance of fluid intake, keeping her fat intake within range, and
healthy levels of Sodium and Potassium. Plan for follow-up meetings in which she will
again keep a record of her food intake for at least 3 days.
Nutrient/Drug Interactions
Medication
Purpose
Amount
Paroxetine
Antianxiety/
10mg/day
Tryptophan may
increase drug side
effects
Antidepressant
Nutrient
Interaction
Zetia
Reduce cholesterol
via intestinal
absorption
10mg/day
Unknown
Crestor
Reduce cholesterolLDL specifically
2.5 mg/day
Avoid grapefruit, not
with high niacin
doses, could lead to
myopathy.
Hydrochlorothiazide
Antihypertensive,
diuretic
25 mg/day
Avoid natural licorice,
may need to reduce
Na, cal; increase K,
Mg
Atenolol
Antihypertensive
100mg/day
Avoid natural licorice;
reduction in Na and
cal may be necessary
Avapro
Antihypertensive
150mg/day
Avoid natural licorice;
reduction in Na and
cal may be necessary
Potassium
Replacement
8mEq/day
Baby Aspirin
NSAID, CVA
81 mg/day
Consume with food
and drink