Community Care Resources - Nutrition

Nutrition 

As older adults age, their nutritional requirements change.

Why is it important?

  • 34% of older Canadians are at nutritional risk, and women more so (1)
  • Older adults are at risk for under-nutrition due to dietary, economic, psychosocial, and physiological factors (2)

Common Causes

  • Increased sedentary lifestyle  and lowered metabolic rate (5)
  • Increased deficiency in key vitamins and minerals; a reduced sense of taste and smell; difficulty chewing or swallowing; a restricted diet for a health condition; eating alone; loss of appetite; and medications (5)
  • Chronic conditions or disability may affect ability to cook (2)
  • Poor oral hygiene (2)

Key Considerations

  • Advise to follow Canada’s Food Guide
  • Discuss any concerns with serving sizes, dietary restrictions, Nutrition Facts table
  • Assess for vitamin/mineral deficiencies with attention vitamin B6, B12, D, calcium and iron (3)
  • Screen for obesity: calculate Body Mass Index•
  • Develop a healthy eating plan- consider budget limitations, refer to a dietician, community programs for meal preparation (e.g. safe cooking practices) and meal planning

Consult the following for patient handout information:

References

1. Dieticians of Canada. (2013). Online nutrition screening tool helps older adults identify if they
    have risk factors leading to poor nutrition
. Retrieved March 12, 2014 

2. DiMaria-Ghalili, R. (2012). Nutrition in the Elderly, Nursing Standard of Practice Protocol: Nutrition in Aging.
    Retrieved March 12, 2014 from:
    http://consultgerirn.org/topics/nutrition_in_the_elderly/want_to_know_more

3. EatRight Ontario. (2014). Seniors Nutrition. Retrieved March 12, 2014 from:
    http://www.eatrightontario.ca/en/Articles/Seniors-nutrition/Older-adults-eating-well.aspx#.UyBs6BbnL7I

4. Health Canada. (2007). Food and Nutrition: What is a Food Guide Serving? Retrieved March 12, 2014 from:
    http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/serving-portion-eng.php

5. University of Rochester Medical Center. (2014).  Nutrition Needs in Older Adults.
    Retrieved March 12, 2014 from:
    http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2321

Hydration

Dehydration occurs when an individual’s body loses more water than it takes in. The body will not have enough fluids to
carry out normal functions.

Why is it important?

  • Older adults are vulnerable to shifts in water balance- in both over hydration and dehydration
  • Dehydration can result in serious problems:
    • heat injury
    • cerebral edema
    • seizures
    • low blood volume shock
    • dizziness/fainting and risk of falls
    • kidney failure
    • constipation
    • coma
    • death (2) (3)

Common Causes

  • Age-related changes in body composition resulting in depletion of total body water (4)
  • Decreased renal function (4)
  • Thirst sense becomes less accurate (4)
  • Poor tolerance for hot weather (4)
  • Intense vomiting and diarrhea (3)
  • Vigorous exercise and not drinking enough water
  • Inadequate nutrition intake
  • Increased urination

Key Considerations

  • Risk factors: 85+, female, dementia,  multiple chronic diseases, medications, fever, dehydration history, use of diuretics (water pills) (4)
  • Parkinson’s disease or stroke may cause swallowing difficulties leading to decreased fluid consumption (1)
  • Signs of dehydration: little or no urination, sunken eyes, skin lacking elasticity and resilience when pinched, low blood pressure, a heart rate faster than normal, reduced blood flow to the extremities, dry mouth,  dizziness/sudden confusion, weakness (3) (1)
  • To confirm diagnosis, consider blood tests (electrolytes, kidney function) and urinalysis (3)
  • Treatment usually involves replacing lost fluids and electrolytes as oral rehydration
  • In life threatening emergency situations provide intravenous (3)
  • Identify medications that may be causing water loss (1)
  • Eat Right Ontario recommends: women 9 cups (250ml per cup) a day and men 12 cups (2)
  • Certain liquids, such as fruit juices, coffee, or carbonated drinks can make diarrhea worse (3)

References

1.  Alberta Caregiver College. (2014). Support for Caregivers of Older Adults: Hydration.
     Retrieved February 20, 2014 from:
     http://www.caregivercollege.org/scoa/?Hydration.html

2.  Dieticians of Canada. (2014). Facts on Fluids- How to Stay Hydrated. Retrieved February 19, 2014 from:
     http://www.eatrightontario.ca/en/Articles/Water/Facts-on-Fluids---How-to-stay-hydrated#.UwYiMRbnL7I

3.  MAYO CLINIC. (2014).  Diseases and Conditions: Dehydration. Retrieved February 19, 2014 from:
     http://www.mayoclinic.org/diseases-conditions/dehydration/basics/definition/con-20030056

4.  Mentes, J. (2012).  Hydration Management. Nursing Standard of Practice Protocol: Managing Oral Hydration.
     Retrieved February 19, 2014 from:
     http://consultgerirn.org/topics/hydration_management/want_to_know_more#item_2