STRATEGIES TO MANAGE WEIGHT LOSS AND WEIGHT GAIN

Transcription

1 STRATEGIES TO MANAGE WEIGHT LOSS AND WEIGHT GAIN Tena Alonzo, Co-Director Palliative Care for Advanced Dementia & Lori Eddings, RD Clinical Nutrition Manager, Beatitudes Campus Objectives: Identify the challenges associated with weight gain and weight loss for elders. Describe effective approaches for health weight gain for elders. Describe effective approaches for healthy weight loss for elders. DISCLOSURE Tena Alonzo and Lori Eddings, RD do not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and or provider(s) of commercial services discussed in the presentation. The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 57

2 Slide 1 Strategies to Manage Weight Loss and Gain Tena Alonzo, MA Lori Eddings, RD Slide 2 Learning Objectives Identify the challenges associated with weight gain and weight loss for elders. Describe effective approaches for healthy weight gain for elders. Describe effective approaches for healthy weight loss for elders. Slide 3 The Anorexia of Aging The decline in appetite and food intake common in elders. (Morley JE and Silver AJ Neurobiol Aging) Physiological changes Social and psychological changes The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 58

3 Slide 4 Physiological Changes Body Weight Weight decline Undernutrition Body Composition Increase body fat, decrease lean tissue Regulation of Water Decrease in thirst Sense of Taste and Smell Slide 5 Physiological Changes Oral Health and Dysphagia The Aging Gut Reduced satiety sensitivity Hormones and Neurotransmitters Cytokines Vitamin and Mineral Deficiencies Vitamin D, Calcium, Vitamin B12, and Folate Slide 6 Physiological Changes Chronic Illness Dementia Cancer Diabetes Osteoporosis COPD Heart Disease Obesity Acute Illness Unrecognized Pain The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 59

4 Slide 7 Medications Refer to Handout Over and Under Medicating Specific Types of Medications Weight Loss: not recommended Weight Gain: no improvement in long-term outcomes or quality of life (Sloan PD, et al J Am Med Dir Assoc.) Slide 8 MatGens (Mature Generations) GI Generation ( ) Silent Generation ( ) Baby Boomer Generation ( ) Focus on choice and flexibility Healthy, tasty foods Diversity (Morrison Senior Dining 2007) Slide 9 Dementia DEMENTIA TRIGGERED PROGRESSIVE CHANGES IN EATING Moderate Dementia Advanced Dementia Level 1: Independent Meal set up only-feeds self. Level 2: Independent with cueing Needs to be reminded to eat/redirected back to the food. Food may be offered on the run. Level 3: Cueing with assistance Needs verbal and hand over hand cueing to stay focused on eating. Level 4: Total assist with eating Opens mouth readily and takes 100% of meal. May experience some swallowing difficulties. Level 5: Total assist with eating Needs ~ 90 minutes to eat and takes ~ 30% of most meals. THE GREAT MYTH THE ACTUAL TRUTH The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 60

5 Slide 10 Effective Approaches for Weight Gain for Persons with Dementia Make COMFORT the goal of the dining experience Recognize and treat pain Liberalize all diets even if conventional medical wisdom would indicate otherwise (JADA 2005) Offer snacks continuously Use flavor enhancers Adopt an individual routine for dining Attend to the Milieu Slide 11 Depression Depression is one of the most important treatable causes of weight loss in the community (Morley and Kraenzle JAGS) Losing the Motivation to Eat -Loss of social network -Social Isolation -Loss of physical function -Sensory loss Slide 12 Barriers to Treating Depression Elders can be reluctant to acknowledge symptoms of depression or seek treatment Depression is under recognized and therefore may go untreated Dialogue with elders Ask the difficult questions The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 61

6 Slide 13 Effective Approaches for Weight Gain Assessment should include the following: (Evans C Permamente J.) 1. Medical Evaluation of underlying causes of weight loss including cardiac, gastrointestinal, respiratory, renal, recurrent infections and dentition concerns 2. Functional status including ability to shop, plan, prepare meals and feed self 3. Review current use of medications Slide 14 Effective Approaches for Weight Gain Treat co-morbidities that contribute to weight loss including depression Begin an ongoing dialogue with the elder regarding food intake and weight loss Suggest eliminating dietary restrictions Suggest the use of flavor enhancers. Encourage the social aspects of dining Offer resources to address the challenges of functional decline Slide 15 Effective Weight Loss Strategies Lack of Parameters to Treat Obese Elders Treatment Goals for Obese Elders Weight maintenance Improve physical function if possible Honor quality of life (Villareal DT, Apovian CM, Kushner RF, et al Am J Clin Nutr.) The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 62

7 Slide 16 Review Consider all the challenges with the elders that can effect weight. Physiological, Psychological, and Social Focus on a multifactorial approach to address weight loss. Evaluate if intended weight loss will benefit quality of life of the elder. Slide 17 Community Resources Senior Helpline/Area Agency on Aging Telephone # (602) Resource Guide Online -Senior Centers -Delivered meals -Assistance in home Senior Companion Program Telephone # (602) Companionship in home Slide 18 Nutrition Resources Mini Nutritional Assessment (MNA) 6 or 18 questions validated Simplified Nutritional Assessment Questionnaire (SNAQ) Predicts appetite The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 63

8 Slide 19 Contact Info Tena Alonzo, MA Lori Eddings, RD The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of the 64