Caring for an Older Relative in My Home

1. Caring for an Older Relative in My Home Consumer and Family Sciences Department of Foods & Nutrition Dorothy Morré, PhD Laura Palmer, MS, RD Purdue University is an Equal Opportunity/Equal Access institution.

2. Objectives • Explore the demographicsof aging. • Learn how to identify signs ofinability to live independently. • Consider benefits andchallenges of living with family. • Explore challenges presented to caregiver. • Understand the nutritional needs of an older adult in your home. • Identify changes in the body that affect nutrition in older adults.

3. People Are Living Longer • 1900, 4% older than 65 • 1990, 12.6% older than 65 • 2010, first of baby boomer generation turns 65 • 2030, 20% of all U.S. residents will be over 65; their care will require about half of all health-care expenditures • Greatest increase is those 85 and older, a 200% increase since 1960 Perron & Robinson., 1998. Archives of Am. Acad. Orthop. Surg., 2:1-8

4. Dependency Generally Increases with Age “Dependency” is defined as a lack of independence or self-sufficiency. • Among those older than 70, two of five (8.5 million) need help with one or more daily activities. • By 2030, about 21 million older individuals with activity limitations may need help.

5. Signs of Inability to Live Independently • Requires assistance in performing basic activities of daily living. • Fails to eat regularly or adequately. • Needs assistance in eating. • Weight loss greater than 10 pounds during past 6 months. • Restricted to wheelchair or bed. • Home shows signs of neglect.

6. Mobility Is the Key for Independence Mobility (how well the person can move about) is an important factor for someone who lives alone. • Problems result from lower body disabilities. • If a person is immobile, it is nearly impossible to remainindependent.

7. Assessing Dependency: Activities of Daily Living • Bathing • Dressing • Toileting • Transferring • Continence • Feeding

8. Identify signs of inability to live independently Activities of Daily Living Activity Needs no help Needs some help Unable to do ( 2 pts. each) (1 pt. each) (0 pts each) 1. Bathing Dressing Toileting Transferring Continence Feeding Total score ___ ____ ____ 0 Scoring: Total the number of points. The lower the score, the more dependent the older adult is. Scores are only for individuals. It is useful to see the score comparison over time. Adapted from Katz et al., The Gerontologist. 10:20-30

9. Assessing Dependency: Instrumental Activities of Daily Living • Telephone • Grocery shopping • Preparing meals • Housework • Laundry • Medications • Finances

10. Additional signs of inability to live independently Instrumental Activities of Daily Living Scoring: Total the number of points. The lower the score, the more dependent the older adult is. Scores are only for individuals. It is useful to see the score comparison over time. Modified from Lawton, M.P. & Brody, E.M. (1969). The Gerontologist, 9, 179-186 

11. What May an Older Relative Give Up to Live in Your Home? • Independence • Leaving a familiar neighborhood of friends and peers, leading to a feeling of isolation • Self-reliance – their attempts to contributemay be rejected • Role reversal – parents become childlike as their child becomes parentlike

12. Why Might It Be Important to Live in Your Home? • Familiar surroundings • Feeling of security • Eases the “season of loss”

13. Why Might It Be Important to Live in Your Home? • Contributes to socialization • Aids in meeting nutritional needs • Active families may motivate them toremain or become physically active

14. Who Provides the Help? Majority rely on family Family members provide about 80% of necessary care for older adults. Source: U.S. Agency for Healthcare Research and Quality. Long-term Care Users Range in Age and Most Do Not Live in Nursing Homes. http://www.nfcacares.org/who_are_family_caregivers/care_giving_statstics.cfm

15. Who Provides the Help? Twenty percent of middle-aged households include at least one elderly relative who cannot be left alone. Many of these households also include children and even grandchildren. Source: Federal Agency for Healthcare Research and Quality. Elderly/Long-term care. http://www.ahrq.gov/research/feb00/0200ra18.htm

16. Family Can Be a Good Support System However, the picture is not always a “bunch of roses”

17. How many of you are caring for an older relative in your home? More than one older relative? If you are not currently caring for an older relative, chances are that you will at some time during your lifetime. How many are caring for an older relative and children at the same time in your home?

18. The “Sandwich Generation” This term refers to people who are caring for their aging parents while supporting their own children. G E N E R A T I O N S A N D W I C H

19. What Challenges May the Family Face? • Decision during time of active career • Loss of job • Resentful children • Additional expenses

20. What Challenges May the Caregiver Face? • Caregiving can be stressful • Responsibilities can be overwhelming • Caregivers must be sure to take care of their own health • Preparing meals may become more difficult.

21. Nutrition for Older Adults Changes that affect nutrition as we age… • Senses • Body structure • Specific nutrient needs

22. Sensory Changes Loss of smell • Experiment with fresh herbs and unusual spices • Focus on “eye appeal”

23. More Sensory Changes Loss of taste • Altered by medications • Can lead to loss of appetite

24. Structural Changes • Reduced muscle mass and strength • Reduced organ function • Decrease in weight

25. More Structural Changes • Loss of bone density • Loss of teeth Dense bone vs. porous bone

26. Nutritional Needs Change with Age Total energy requirements decline Older adults need to eat less to maintain the same body weight because of reduced muscle mass and less daily activity.

27. Nutritional Needs Change with Age Daily requirements for most vitamins and minerals do not decrease with age Older adults need a nutrient-dense diet, which may be supplemented with a daily multivitamin.

28. The Energy Nutrients • Carbohydrates • Protein • Fat

29. The Energy Nutrients Carbohydrates • Grains are especially good for older adults • Full of fiber (bulk) • Provide energy, vitamins, and minerals • When buying carbohydrates, look for “whole-grain” as the first ingredient

30. The Energy Nutrients Protein How can older adults get enough protein? • Include a protein food source at each meal • If chewing is difficult, chop meat well • If tolerated, include dairy products

31. The Energy Nutrients Fat • Solid fats vs. oils • Eating less fat is often beneficial because it lowers the risk of chronic heart disease, cancer, and obesity

32. The Daily Diet • Fluids • Calcium • Fiber Increase:

33. The Daily Diet Fluids Function: • Reduce stress on kidneys • Reduce constipation • Ensure adequate blood volume • Help carry medicine to proper places in the body

34. The Daily Diet Water • Take regular breaks throughout the day to drink a glass of water • Have fluids with your meal; try soups and juices • Keep a water container available at all times

35. The Daily Diet Calcium Calcium is the most abundant mineral in the body • Strengthens bones and teeth • Reduces risk of fractures from falls

36. Specific Nutrient Needs Show me the calcium Make dairy choices at every meal • Sources: • Yogurt • Milk • Cheese • Fortified whole grains • Calcium-fortified orange juice

37. Specific Nutrient Needs Fiber The part of the plant that cannot be digested • Lowers blood cholesterol • Reduces constipation

38. Specific Nutrient Needs Fiber boosters • Whole grain bread and flour • Brown rice • Fruits and vegetables • Legumes and peanut butter • High-fiber cereal * Add additional fiber to food by sprinkling on some bran

39. Variety: Spice Up Life • More than 40 nutrients required daily • Increased importance of nutrient density and variety

40. Opportunities to Include a Variety of Foods • Provide breakfast foods for lunch or dinner • Include a snack between meals • Encourage small, frequent meals

41. Additional Tips for Increasing Food Consumption • Taste and smell • Texture and consistency • Social dining

42. Factors to Consider when Preparing Meals for Older Adults • Does your family member have difficultywith chewing? • Is your family member on a restricted diet? • What is the activity level of your adult relative? • Do they take medications?

43. Summary • Dependency increases • with age • Two ways to assess • dependency are: • ― Activities of Daily Living • ― Instrumental Activities of Daily Living • Older relatives experience benefits and • challenges when living in home of family. • Changes in the body affect nutrition in older • adults. • Nutritional needs change because of • declining total energy requirements.

44. Assessing the Daily Diet of an Older Adult Was Today a Good Nutrition Day?