Malnutrition in Geriatric Patient: A Neglected Problem? - Prepared and Presented by
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Malnutrition in Geriatric Patient: A
Neglected Problem?
Prepared and Presented by:
Ahmad Kobrosly, Registered nurse
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Outline
1. Old Age
2. The changes
3. Nutritional Requirements for Elderly
4. Difference between nutrients and
nutrition
5. Definition of malnutrition
6. Causes of malnutrition
7. Types of malnutrition
8. Related Factors
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Outline
9. Stages of Malnutrition
10. Factors affecting Malnutrition
11. Measuring Malnutrition
12. Malnutrition Prevention
13. Difference between Hunger and
Malnutrition
14. Malnutrition Diseases
15. The Nurse’s Role
16. Conclusion ” Advice of the Eldest
Person in the World”
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Old Age
Old age is accompanied by
great decrease in the body’s
physiological function, since
each body organ loses its
job gradually.
This stage is considered to
be of great importance from
the nutritional view since it
affects the natural
nutritional balance. For
example: woman, after the
age of forty, her ability to
burn fat decreases which
leads to obesity.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
The Changes
1. Decrease in muscle
weight and bones
and increase in the
amount of fat with
lack of motor
activity.
2. Loss of sense of
smell and taste; as
well as, teeth.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
3. Loss of vision and hearing.
4. Loss of appetite.
5. Depression, loneliness, and anxiety.
6. Memory Loss and/or confusion.
7. Constipation.
8. Risk for infection related to chronic
disease(diabetes, high blood pressure,
cardiovascular diseases).
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Nutritional Requirements for
Elderly.
1. Adequate calorie
intake essential for
carrying out activities.
2. Eating fresh
vegetables and fruits
rich of minerals that
aids in constipation,
and helps in digestion.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
3. The elderly patients’ need of proteins is
so similar to those who are younger (
proteins are available in milk, egg, milk,
and fish)
4. The elderly patients have problem in
burning sugar in great amounts because
of the decrease in activity level; from
here we find that the elderly’s need for
sugar decreases.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
5. Avoiding Fatty Diet in order to avoid cardiovascular disease. 6. Avoiding too much salt to prevent swelling and hypertension. 7. Avoiding drinking milk in large amount in an attempt to prevent indigestion. 8. Avoiding caffeine intake. 9. Drinking adequate amount of water. 10.Eating variety of food to provide the body with all the essential vitamins especially vitamin “A” ,“D” ,”B6” and “B12”. 10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
11. Eating food slowly and chewing it well in
case of teeth existence.
12. Distributing food among light meals of an
average of 4 meals per day minimum.
13. Having time for relaxation after eating food.
It should be mentioned that nutritional
guidance is essential for old people and it
should be in a polite and formal way to
make it easy for us to convince thee old
person for having a suitable nutritional
program.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalTHE DIFFERENCE BETWEEN NUTRIENTS
AND NUTRITION?
Definition of nutrients:
it is all what humans eat and
drink from animal or
vegetarian sources.
The definition of nutrition:
The process in which the
elderly gains the minerals,
vitamins… needed to keep
his life safe.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalThe definition of malnutrition:
Malnutrition isn’t the lack of nutrients
only, but also eating voraciously leads to
it as well.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalCauses of Malnutrition in The Elderly:
1. Malnutrition is due to
taking inappropriate
nutrients .
2. OR due to imbalances in
physiological mechanisms
(digestion, absorption,
distribution, and hydrolysis
deficit) which is evident in
old age.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalTypes of Malnutrition
1. Chronic malnutrition.
2. Severe malnutrition
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalRelated Factors:
I. General lack of nutrients and calories
II. Lack in specific kind of nutrients such as
proteins.
III. Weakness in the absorption of nutrients due
to several kinds of illnesses, especially
those related to the digestive system in
which there is decrease in digestive
secretions at old age.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalThe Stages of Malnutrition
1. Adaptation stage:
diagnosed by lab test.
There is no clear
symptoms of illness
for the body’s ability
to adapt; ability is
weak in old age.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital2. Storage exhaustion stage: it can be
diagnosed by some lab tests and body
measurements especially skin thickness.
Symptoms of illness appear in this phase;
example :poor eye-sight due to lack in
vitamin “A” that distinguishes severe
malnutrition .
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Factors Affecting Malnutrition:
1. Diet.
2. The provision of nutrients in the society.
3. The production of nutrients and its storage.
4. The climate that affects the local production .
5. The physiological and health condition of the
human’s body.
6. The individual’s income.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
How To Measure Malnutrition
There are several ways to identify and measure
malnutrition:
1. Measuring the height, weight, arm’s parameters and
skin thickness.
2. Clinical signs and symptoms(example dehydration)
3. Lab findings.
4. X-ray examinations and others.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalMalnutrition Prevention
1. Close assessment
to detect changes
by a specialist.
2. Provide clean water
to prevent
gastrointestinal
infections.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital3. Nutritional assessment, observation and provision
of essential dietary requirements.
4. Prevention against illnesses that have dangerous
impact on the elderly’s life
( dehydration, hypertension, osteoporosis).
5. Family education and support, the provision of
guidance and health education.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital6. Eating vegetables and fruits rich with
vitamins and minerals.
7. Avoid smoking, alcohol intake and
carcinogenic food, e.g.: canned and
preserved food.
8. The prevention role that the nurse plays.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalThe Difference Between Hunger and
Malnutrition?
Hunger is a
biological alarm
people feel when
they lack energy
and perceive
emptiness of food
in their stomach.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalHowever, malnutrition is eating unhealthy food required to one’s health condition, thus leading ultimately to bodily imbalances ; for example not feeling thirsty due to weak signal in the center of thirst in the brain. 10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
Some Diseases That Result From
Malnutrition At Old Age:
1. Lack of vitamin “A”
which leads to poor eye
– sight .
2. Lack of iodine which
leads to
Hyperthyroidism.
3. Lack of iron and folic
acid that leads to
anemia.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital4. Lack of vitamin “C” which leads to gum
hemorrhage and there are studies showing
that the lack of vitamin “C” leads to
blindness.
5. Lack of vitamin “D” leads to osteoporosis
Lack of calcium in the blood leads to
contractions. To avoid such diseases ,
elderly should be exposed to sun light half
an hour per day and eat fish oil.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalThe Nurse’s Role
1. The nurse should stick
to the doctor’s
instructions.
2. It’s forbidden to
prepare the food in
the patient’s room, it
should be brought in
prepared already.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital3. The nurse should take into consideration the
cleanliness of the hands and the tools used:
spoons, forks, knives, and bowls…
4. Provide variety of food so that the patient won’t
lose his appetite.
5. Be close and next to the patient till he finishes
his meal.
6. A clean tray should be prepared on which there
are the necessary tools from plates knives, forks,
glass of water, and towel.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital7. Keep patient in a relaxing and comfortable
position.
8. Wash patient’s hands and mouth before and after
meals.
9. Never delay food distribution in order to keep the
food warm and fresh.
10. Make sure that this is the right diet for the
patient ( check patient’s, name, date, and type of
diet), plus that the food is suitable to the
patient’s health condition or state.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital11. Place the food near the patient's bed to make it
easier for him to reach it .
12. The nurse should document in the patient’s
medical record after he finishes his meal.
13. The nurse shouldn’t wake up the patient when
he is sleeping in order to feed him especially at
night.
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital14. In case of disability, the nurse must help
the patient in eating or help in putting the
food between his hands.
15. The nurse must explain for the patient and
identify for him the types/kinds of food
served especially if he was blind.
10/8/2009 Dar Al-Ajaza Al-Islamia HospitalThe Eldest Person in the world:
SARA CLARK, the American dean of the elderly in
the world and who is 118 years old, advised her
grandsons and daughters (and who are a lot surely)
of the following:
1. “Move a lot and take care that you walk daily
and leave your damned cars aside !
2. Laugh from the bottom of your heart.
3. Leave your worries aside to sleep calmly eight
hours each night!!
10/8/2009 Dar Al-Ajaza Al-Islamia Hospital10/8/2009 Dar Al-Ajaza Al-Islamia Hospital
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