Geriatric Nutrition: How Dietitians can make a positive impact on our aging population

Transcription

1 Geriatric Nutrition: How Dietitians can make a positive impact on our aging population Meridith Paterson, MS, RDN,CSG, LDN patersonmm@upmc.edu West Virginia Academy of Nutrition and Dietetics

2 Learning Objectives Recognize the challenges of the aging population and the direct impact on nutrition outcomes. Understand the role the dietitian in improving not only nutrition but quality of life as well. Understanding the importance of learning each individual s needs and wishes and not a one size fits all approach. Learning Codes: 4190, 5100, 5430

3 Challenges of the aging population.

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5 Aging Population Between 2012 and 2050, the United States will experience considerable growth in its older population (65 years and older). From 43.1 million (2012) to 83.7 million (2050) Baby Boomers are a significant contributing factor to the increase in the older population. Ortman, Jennifer M., Victoria A. Velkoff, and Howard Hogan. An Aging Nation: The Older Population in the United States, Current Population Reports, P U.S. Census Bureau, Washington, DC

6 Challenges Facing the Elderly Physical Changes Cognitive Changes Environmental Changes Financial Changes

7 Physical Changes Common changes noted: Vision Impairment Hearing Impairment Taste Bud changes Sense of smell Sleep Disturbances Oral Changes (tooth loss, dentures, implants) (May also have physical changes related to medical condition/ disease process)

8 Cognitive Changes Slowing down Forgetfulness Memory may be effected related to dementia, depression, delirium and other medical conditions.

9 Oral Care Approximately 25% of those 65 years and older have no natural teeth. Diet and nutrition intervention for older adults with compromised oral integrity must target individual needs based on current diseases and disabilities. Dietetics practitioners must address oral health as part of nutrition diet and screening, assessment, intervention, and monitoring of older adults. Position of the Academy of Nutrition and Dietetics: Oral health and Nutrition. 2013;113(5).

10 Environmental Changes No longer to be able to maintain their home Moved to new environment (Apartment, move in with a family member, SNF, PCH) May require giving up driver s license Giving up independent activities (cooking, shopping, going to church, etc.)

11 Financial Changes May have went from two incomes to one income due to death of spouse or partner. Income may not cover current expenses (utilities, food, medicine, car, etc.) Increase cost of prescriptions

12 Direct impact on Nutrition Food insecurity Isolation Depression Chronic diseases Dependent of others- decrease in independence Oral hygiene (ill fitting dentures, mouth sores, thrush)

13 Other areas to consider Education Level (Can they read?) Evaluate the basics: Do they have a working kitchen that is accessible to them? Do they have support (family/ friend/ church) to help? Can they manage their finances?

14 The role of the Dietitian

15 Role of the RDN To look at the entire picture when it comes to nutrition Think outside the box Look at each person individually and nutrition plan should not be a one size fits all approach.

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17 EOL Nutrition Issues

18 Dietitian's Role Active role in educating and advocating for our patients. Dietitians are part of the palliative/ hospice team.

19 The dietitian should talk with the patient and/or family member about wishes prior to a crisis. Be Proactive! Schedule family meetings to discuss what the patient would want so that everyone is on the same page. The goal is to provide an opportunity for patient to discuss his/ her wishes and to provide comfort and dignity at the end of life by honoring what they would want.

20 To Feed or Not to Feed? Dietitian to educate patient and/or caregiver on palliative and/or EOL nutrition related issues and provide support. Tube feedings, IV hydration, MBS studies Issues surrounding feeding at the EOL. The waiver to go against what is recommended- is this valuable to complete?

21 Dietitian s Role Liberalize diet ( this can be difficult for family members- diabetics) Assess for constipation which may be related to pain medication, decrease mobility, inadequate fluid intake Medications which may have negative effect (i.e. vitamins/ minerals may increase GI distress) recommend to discontinue any unnecessary medications

22 EOL Strategies Offer comfort/ pleasure foods (encouraging family members to provide favorite foods) Assess oral hygiene (for the demented patient cleaning their mouth before and after meals) Offering smaller portions Offering one food at a time Monitoring for pain and constipation

23 Conclusion To make a difference in someone s life, you don t have to be brilliant, rich, beautiful, or perfect. You just have to care. Mandy Hale

24 Questions???