Food For Thought Special Nutritional Considerations for the Elderly Population Living in Institutional Settings CAPT Glen Revere, MS, RDN, CDE (Ret.) August 9, 2018 1
Magnified Medical Issues Certain medical conditions may be exacerbated related to nutritional issues. New onset disorders may develop as well. 2
Often Encountered Health Issues Affecting Meals Diabetes Meal/snack composition Weight Heart Disease Dietary fat modification Weight Hypertension Sodium Hydration Parkinson s Disease Antioxidants vs. dairy Abdominal Issues Pain Bloating Constipation Malabsorption Ability to Self-Feed Insufficient nutrition 3
Just Keep Hanging In There I may be a little slow, but I still have a smile. 4
A Healthy Meal Should Include: Lean Protein Lean meats Seafood Eggs Beans Fruits and Vegetables Think orange, red, green and purple Whole Grains Brown rice Whole wheat pasta Low-Fat Dairy Milk and its alternatives 5
The Basic Idea 6
Balance and Variety It goes a long way in a life. 7
Special Nutrient Needs Bones Muscles Calcium & Vitamin D Vitamins B12 & B6 Energy metabolism Red blood cells Fiber Digestion improvement Prevention of T2D and HD Potassium Metabolism Muscles Nerves Hydration Water Know Your Fats Heart disease Circulation issues 8
Bones, Teeth, Muscles and More Calcium Essential for the formation and regeneration of bone tissue and teeth Plays role in healthy functioning of muscles, nerves and coagulation of blood Milk products are good sources of calcium. Vitamin D Regulates metabolism of calcium and phosphorus Sunlight stimulates body to produce vitamin D Milk products, egg yolks and wheat germ are good sources of vitamin D. 9
Think RBCs, Energy and Electrolytes Vitamin B12 Plays role in formation of cells, production of hemoglobin and functioning of nervous system Vitamin B12 is found in meats and dairy products. Vitamin B6 Participates in metabolism of proteins and amino acids, formation of red blood cells, other cells and hormones Helps regulate body s balance of sodium and potassium Vitamin B6 is found in egg yolks, meats, liver, kidneys, fish, milk products, whole grains, yeasts and dried fruits and vegetables. 10
Dietary Fiber Complex carbohydrate that is not digested and found in fruits and vegetables Helps balance absorption of sugars in intestine, aids in digestion and increases meal satiety Food manufacturing processes often remove wanted fiber Good sources of fiber = whole grain breads, brown rice, whole grain rice (avoid white bread and white rice when possible) and dried kidney and pinto beans 14g For healthy adults, USDA recommends 14 grams for every 1,000 calories consumed 11
Potassium: Balance in Metabolism Has a role in metabolism of carbohydrates and proteins Maintains cellular balance, particularly in functioning of muscles and nerves Often lost due to medication regimens Foods rich in potassium: Green vegetables, fresh fruits, meats, dairy products, legumes, nuts, seeds 12
Water: Transportation and Metabolism Water is the body s most important nutrient, as it is involved in every bodily function Ideally makes up 70 to 75% of total body weight Helps maintain body temperature, metabolize body fat, aids digestion, lubricates and cushions organs, transports nutrients and flushes toxins Many elders have fluid restrictions and should be carefully monitored, as symptoms of dehydration are sometimes slow to manifest and misinterpreted 13
Dietary Fat Important source of energy (calories) Slows down digestion and absorption of sugar Facilitates absorption of vitamins A, D, E and K 2 Saturated fats = primarily of animal origin Unsaturated fats = primarily of vegetable origin, but includes fish oils Too much dietary fat can contribute to heart disease, arteriosclerosis, stroke, etc. 14
Barriers to Good Nutrition 15
Inherent Institutional Challenges to Good Nutrition Budgetary, including staffing Kitchen design/production capabilities Meal delivery system Meal setting Food availability from vendors Staff/physician/family communication system Nutritional assessment procedures 16
Personal Factors That Can Affect Older People s Nutritional Status Decreased taste, smell, sight Loss of appetite Chewing and swallowing difficulties Lack of mobility decreased activity, ability to feed oneself, etc. Eating habits/preferences/comfort foods Therapeutic diets Dementia Depression, isolation, worries about finances, family, etc. Medicines 17
Time to Discuss What to Do Group Problem-Solving Activity 18
Barriers to Proper Nutrition Institutional Budgetary, including staffing Kitchen design/capabilities Meal delivery system and meal setting Patient mobility Patient-Oriented Therapeutic diets Eating habits/preferences Comfort foods Depression Families Medicines Physical issues, e.g., self-feeding, digestion, dental 19
Questions? Thank you for your time! Developed by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy. 11SOW-MPQHF-WY-B2-18-56 20