Nutrition at the Bedside

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1 Nutrition at the Bedside Linda Varnell, RD, LDN Clinical Dietitian February 26, 2010 Objectives Identify risk factors for malnutrition in the older adult Recognize physical signs of malnutrition Gain skills to increase nutritional intake for patients at risk The Older Adult: 1 in 10 Americans are > 65 years of age, and this number will double in the early years of the 21 st century The fastest growing segment of the elderly population are those > 85 years old The elderly population is the largest user of health care resources 1

2 The Older Adult: 30-50% of hospitalized elderly are malnourished 50% of patients with dementia are malnourished, with Alzheimer s s patients at greatest risk Malnutrition and the Older Adult Changing body composition means less reserves when they are ill. - decrease in lean body mass - increase in body fat - decrease in total body water - decrease in bone density Age > 70 years Nursing Home Placement Poverty Social Isolation 2

3 Infection/acute illness/chronic disease Dementia Dysphagia Depression and anxiety Alcoholism Polypharmacy/chronic medication use Decline in gastric acid production Constipation Poor oral health poorly fitting dentures, missing and/or decayed teeth, mouth sores, infection/thrush Inadequate food intake during hospital stay Intake < 75% Modified diets 3

4 Decreased taste acuity Poor vision Dependence, disability, functional decline Braden nutrition score < 3 Physical Signs and Symptoms of Malnutrition Muscle wasting -temporal area, interosseous muscle, clavicle, thighs, calves Loss of subcutaneous fat -loose skin, squared shoulders, underweight/ematiated ematiated appearance Physical Signs and Symptoms of Malnutrition Hair -dull, dry, shedding, easily plucked, decreased pigmentation Gums -bleeding, swollen, red Tongue -fissured, bald and smooth surface, ulcerations, decreased sense of taste 4

5 Manage depression Speech evaluation of swallowing function, if problems are suspected Evaluate medication causes of decreased appetite Maintain regular bowel function watch patients on pain medications closely Increase patient s s activity level/have patient up in a chair for meals, if possible -increases appetite, builds muscle, improves strength Resistant weight training/pt evaluation -can actually improved nitrogen balance Liberalize diets, if possible Pay attention to ethnicity and food preferences Family visits at mealtimes, if possible Larger meals earlier in the day 5

6 Softer foods with gravies/sauces, finger foods Extra feedings between meals Nutritional supplements and/or high calorie/high protein snacks Chopped foods (or help patients cut up foods at the bedside) Feeding assistance and/or tray set-up as needed Consider vitamin and/or mineral supplements if the diet is deficient Assist patient with menu marking -add whole milk each meal, extra butter/margarine Offer softer meat alternatives macaroni and cheese, cottage cheese, peanut butter, beans Increase fluid intake (unless fluids are restricted). minimum for most older patients is 1500 ml/24 hr Appetite stimulants???? 6

7 Good Nutrition is Important! Improves quality of life Supports immune function Helps the body resist infection Encourages faster healing from surgery or pressure ulcers Good Nutrition is Important! Maintains stronger muscle and bone mass Increases energy level Contributes to improved outcomes from medical treatment May shorten hospitalizations The registered dietitian is responsible for nutrition assessment and care plans, but you our our nurses and care partners are are the ones that make it happen!!! Together we can make a difference. 7

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