Nutrition and Hydration
HOW NUTRITION AND FLUID NEEDS CHANGE WITH AGE
Food and nutritional needs change as a person gets older and older. The need for a lot of calories decreases when a person gets older. These needs were highest when the person was an infant, a teen, and when they were pregnant or breast-feeding their baby.
Old patients and residents need the least calories of all age groups. They do not burn calories and food as quickly as they did when they were younger and more active. This doesn't mean, however, that the elderly do not need a good diet. Older patients do need a good diet just like the other age groups. They need the same amount of vitamins, minerals and protein that they needed when they were younger. They need even more vitamins, minerals and protein when they are sick or have a pressure ulcer. They also need fiber to prevent constipation. Breads, cereals, fruits and vegetables have fiber.
The older age group is at risk for a poor diet for many reasons. Although some older people may gain weight from eating too much, most older people are at risk for losing weight. They may lose weight without wanting to. This loss of weight can cause them to be weak and ill.
A good diet must have all four food groups. The four food groups are:
The appetite and the digestive process also slow down as the human body ages. Old adults do not feel as hungry as they did when they were young. Also, when they eat meals they feel full and they may not want to eat another meal for a long time. They may even skip a meal. Old adults often do better with small snacks during the day rather than large meals three times a day.
Old adults may also lose their sense of taste and smell. Half of the taste buds are lost by the age of 60. Sweet and salty taste is lost first. Sour taste lasts the longest. Men lose their taste more often and sooner than women. These losses make many elderly people less interested in food than they were in the past. They do not enjoy the food as much because they do not taste it and they may not be able to smell the apple pie baking in the oven. Many older people will over salt their food to taste it.
Human beings are also more apt to eat when they see something that looks good to eat. Older adults, who lose their eyesight, are not able to see the food. They may be not interested in eating when they cannot see what they are eating. They will also have trouble feeding themselves if they have poor vision. If the patient or resident has eyeglasses, they should be worn during their meals.
Some other old people may not be able to safely drink liquids unless they are thick. They may choke with water, juice and other thin fluids like tea or coffee. Nursing assistants are often asked by nurses to give the patient water and fluids that are made as thick as honey. These thick fluids help provide fluids to patients who have trouble swallowing.
Aging people may also not be able to use a spoon or a fork. They may be too confused to know how to feed themselves. Their lack of ability to eat or drink often makes it necessary to go to an assisted living facility or a nursing home so that they can be helped with eating, a basic ADL. It is the nursing assistant that most often provides the necessary food and fluids to these patients and residents
Other things that can decrease the amount and kinds of food and fluids that an elderly person will eat are:
Older people at home and in a hospital or nursing home are at risk for poor nutrition. They will lose weight and have malnutrition if they do NOT get a good diet. They will also be dehydrated if they do not get enough fluids. They will get weak, less able to fight off an infection or illness. When people have malnutrition and dehydration, they are:
They may also have dry skin. The human body needs a good diet and fluids in order to work properly. If the diet is poor, the body will not work the way it should. If a person eats too much they will get fat and obese. It is also important to make sure that a person is not getting obese. These people may have to decrease the amount and kinds of food they eat and they may also have to exercise in order to burn off extra calories and fat.
The human body is made mostly of water. Water makes up about 2/3 of the body's weight. Water is needed to control the temperature of the body, to keep all body cells alive and to keep the blood flowing. This water is given to the body in some foods and by drinking fluids, such as tea, water, juice and coffee. As a person gets older, the amount of water that is found in the body gets smaller.
People will become dehydrated when they drink or consume less fluid than the body needs to perform its functions. When a person is dehydrated, the whole body is affected. Older patients and residents may not get enough fluid for a number of reasons. They may:
A doctor may limit fluids for a person with a heart or kidney disease. If fluids are not limited for a heart or kidney disease, the patient or resident should consume at least 1,500 cc of fluid each day. It is better if they can get 2,000 cc a day.
If a person is not taking in enough fluid, they may have:
THINGS YOU CAN DO TO PREVENT NUTRITION AND HYDRATION PROBLEMS
Some of the things that nursing assistants can do to help the patient or resident get a good diet and enough fluids are:
Other health care workers also play a role in nutrition and hydration.
Nurses. Nurses, doctors and some other members of the healthcare team assess patients for their risk of malnutrition when they are admitted and during the course of their stay in the hospital or nursing home.
Dietitian. The dietitian assesses the patient's nutrition status. They plan nutritional care with the doctor and other members of the health care team.
Laboratory workers. These health care team members may process blood and urine samples to make sure that the patient or resident is well nourished.
Activity coordinators. Activity coordinators often plan events like a cook out, a special meal or an afternoon tea time to promote healthy eating, hydration and socialization.
Occupational therapists. Occupational therapists work with patients and residents so they can be independent with their activities of daily living (ADLs), including eating. They often find special plates, cups, forks, etc. so person that has a disability can still feed themselves.
Speech therapists. Speech therapists assess patients with a swallowing problem. They recommend ways that patients with a swallowing problem can eat and drink safely.
Like most other care, nursing assistants and others who care for the old adult must make sure that their patients and residents get a good diet and enough fluids. We must meet these needs every day and each time we talk with or have contact with a patient or resident. Older adults have special nutrition and hydration needs. If you would like to learn more about feeding a patient or resident, take the course "Feeding Residents and Patients"
Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.
Eliopoulos, Charlotte. (1995). Manual of Gerontologic Nursing. St.
Louis: Mosby –Year Book Inc.
University of Iowa Gerontological Nursing Interventions Research Center. (1998). Hydration Management. University of Iowa.
Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.
Zembrzuski, Cora. (2000). Nutrition and hydration. Best Practices in Nursing Care to Older Adults. New York: The Hartford Institute for Geriatric Nursing. Sept.; 2 (2).
Copyright © 2010 Alene Burke
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