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Nutrition and Older Adults: Issues among Community and Long-Term Care Residents. Jean Helps, RD 1 and Christina Lengyel PhD, RD 2 1 Clinical Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Services

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nutrition and older adults issues among community and long term care residents

Nutrition and Older Adults: Issues among Community and Long-Term Care Residents

Jean Helps, RD1 and Christina Lengyel PhD, RD2

1Clinical Nutrition Manager, Long Term Care Sector, WRHA Nutrition and Food Services

2Assistant Professor, Human Nutritional Sciences, Faculty of Human Ecology,

University of Manitoba

outline
Outline
  • Canadian Demographics
  • Factors affecting Nutritional Intake
  • Long–Term Care Setting
  • Rural and Urban Communities
  • Nutritional Guidelines and Recommendations
  • Take Home Messages
slide7

Osteoporsis

Malabsorption

Syndromes

Diabetes

Celiac Disease

Palliative Care

Pressure

Ulcers

Superbugs

Congestive

Heart

Failure

GERD

ALS

Obesity

Renal Disease

Nutrition Issues For Older Adults

Falls

Malnutrition

Anemia

Constipation

Parkinson’s

Disease

Alcohol

Abuse

Stroke

Pneumonia

Dementia

System Issues

Multiple

Sclerosis

COPD

Dysphagia

Family Related

Issues

Mental Illness

Cancer

Osteoarthritis

nutrition and quality of life
Nutrition and Quality of Life
  • Healthy food choices positively influence the quality of life of older adults.
  • Older adults are at risk for inadequate dietary intakes which may lead to:
    • Poor nutritional status
    • Decreased quality of life
    • Functional disability
    • Increased health care costs
    • Greater risk for morbidity and mortality
factors affecting nutrition status
Factors Affecting Nutrition Status
  • Physiological
    • Declining digestion and absorption
    • Reduced sensory perception
      • visual, olfactory, taste acuity, thirst
    • Anorexia of Aging
  • Physical
    • Chewing and swallowing difficulty
    • Affects on body systems
      • Integumentary (skin), renal, musculoskeletal, cardiovascular
factors affecting nutrition status cont d
Factors Affecting Nutrition Status (cont’d)
  • Psychological
    • Depression
    • Loneliness
    • Dementia
    • Food likes/dislikes
  • Social and Economical
    • Poverty
    • Transportation availability
    • Lack of knowledge of nutrition
    • Inadequate cooking knowledge (men)
    • ↓ Social support
factors affecting nutrition status cont d1
Factors Affecting Nutrition Status (cont’d)
  • Cultural beliefs
    • Provision of culturally appropriate food and setting are both important

(Wu and Barker, 2008)

  • Others
    • Medical conditions
    • Prescribed diets
    • Medication side effects
malnutrition
Malnutrition
  • Inappropriate amount of, or quality of nutrients comprising a healthy diet are not consumed for an extended period of time

Undernutrition:

  • Often thought to be a problem of third world countries
  • Inadequate consumption, poor absorption, or excessive loss of nutrients

Overnutrition:

  • Excessive intake of specific nutrients
prevalence of malnutrition in the elderly
Prevalence of Malnutrition in the Elderly

Hospitalized Patients:

  • 32% to 50%

Long Term Care:

  • 5% to 85% (Average= 30%)
causes of malnutrition organizational
Causes of Malnutrition- Organizational
  • Failure to help residents eat or recognize malnutrition
  • Importance of nutrition not realized
  • Absence of Dietitian
  • Lack of staff, lack of communication, inadequate training and education
  • Monotonous diet, inappropriate diet or mealtime environment
  • Inappropriate medication prescribing

(Cowan et al., 2004)

liberalization of the diet prescription
Liberalization of the Diet Prescription

Therapeutic diets may contribute to malnutrition through restriction of:

  • preferred food & beverages
  • components in food which promote intake (e.g., salt)
  • Culturally significant foods

* A balanced approach is needed in assessment

combating malnutrition dining room set up for residents with dementia
Combating Malnutrition – Dining Room Set-up for Residents with Dementia
  • Simplify the environment
  • Simplify the food – Provision of too many foods at one time leads to over-stimulation, agitation and reduced intake
  • Communicate
  • Provide flexible care
    • Self-feeding if possible (i.e., finger foods)
nutrition based interventions
Nutrition Based Interventions
  • Oral Nutritional Supplements
  • Changes to the meal pattern:
    • Protein, energy enriched foods
    • Small, frequent meals (i.e., between meal snacks)
    • Individualizing the meal pattern to accommodate social and cultural preferences
prevalence of malnutrition
Prevalence of Malnutrition

Undernutrition:

  • 5% to 20% prevalence of malnutrition
  • ~40% are at risk of malnutrition

Overnutrition:

  • Increasing in all age groups
  • 25% obesity among adults 65+ and older
baby boomer and nutrition study
Baby Boomer and Nutrition Study
  • 10 focus groups conducted in rural and urban Manitoba communities
  • 8-12 participants/group recruited by MAFRI GO Team Representatives in specified areas
  • All participants completed a focus group questionnaire
  • Moderator facilitated the sessions for a 2 hour period
preliminary key findings
Preliminary Key Findings
  • Distrust in nutrition labeling
  • Misleading advertising on packaging
  • Importance of locally grown foods, their availability in local markets and supporting the local economy
  • Portion control on packages
  • Costs associated with healthier products
  • Environmental concerns
  • More nutrition education needed
  • Importance of flavor, texture, taste and variety in food products
reading food labels
Reading Food Labels
  • Compare the Nutrition Facts Table on food labels to choose products that contain less fat, saturated fat, trans fat, sugar and sodium.
  • The calories and nutrients listed are for the specific amount of food found at the top of the Nutrition Facts Table.

(http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/educat/info-nutri-label-etiquet-eng.php)

dietary fibre
Dietary Fibre
  • Increase dietary fibre intake to 21 g/day for women and 30 g/day for men (51+ years)
  • Replace refined cereals and flour products with whole grain foods
  • Increase fibre slowly to prevent excessive bloating, cramping, flatulence and diarrhea
  • Drink adequate amount of fluids
  • Examples: oat bran, psyllium, legumes, fruits, vegetables, wheat bran, flax seeds
fluid intake
Fluid Intake

Dietary Reference Intake (DRIs) (51+ years)

  • Females: 2.7 L/day total water (2.2 L = 9 cups total beverages)
  • Males: 3.7 L/day total water (3.0 L = 13 cups total beverages)
  • NOTE: these values may be difficult to achieve for older adults due to reduced food intake. Aim for 6-8 cups per day.
vitamins and minerals
Vitamins and Minerals
  • Vitamin D
    • Current DRI’s are:
      • Males and Females 51-70 years: 10 ug (400 IU)
      • Males and Females 70 +years: 15 ug (600 IU)
    • Canada’s Food Guide recommends an additional daily vitamin D supplement of 10 ug (400 IU) for everyone over the age of 50
    • New research is demonstrating a need for increasing vitamin D requirements for older adults
canada s physical activity guide to healthy active living for older adults
Canada’s Physical Activity Guide to Healthy Active Living for Older Adults

(www.phac-aspc.gc.ca/pau-uap/paguide/older/index.html)

take home messages
Take Home Messages
  • Nutrition is one of the major determinants of healthy aging
  • Individualized care
    • Ensuring effects of aging are considered
  • High quality diet is important across the lifespan
  • Consume a variety of nutrient dense foods from the four food groups
  • Nutrient supplementation with low-dose multivitamin and mineral supplements can be useful in achieving recommended intake levels
  • Enjoy your meals!
resources
Resources
  • Dietitians of Canada
    • www.dietitians.ca
  • Eating Well with Canada’s Food Guide
    • www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
  • Canada’s Physical Activity Guide for Older Adults
    • www.phac-aspc.gc.ca/pau-uap/fitness/pdf/guide_older_e.pdf
  • Nutrition Labelling
    • www.healthcanada.gc.ca/nutritionlabelling
  • Alzheimer Society of Canada
    • www.alzheimer.ca/english/care/dailyliving-mealtime.htm
slide38

“If we knew what it was we were doing, it would not be called research, would it?”

Albert Einstein