Nutrition and hydration in the elderly.
Today we list the reasons why elderly are at risk for dehydration
and try to understand how risk factors and changes affect nutritional status.
Why are the elderly are at risk for poor nutrition and inadequate hydration?
There are many possibilities from any of the given factors like chronic diseases they may have, sensory loss that comes along with becoming elderly, eating dependency, dementia, depression, many medications, and also changes in GI functions such as dental problems, constipation, or changes in absorption of nutrients.
There's also a decrease in metabolic rate, decrease in cardiovascular function, a decrease in renal function, also in neurological function, and decreased energy expenditure.
So how do these risk factors and changes affect nutritional status?
There's a decreased interest in food due to decreased sense of taste and smell, inability to chew food related to poor dentition, decreased absorption of vitamin D and calcium, there's an increased prevalence of lactose intolerance among the elderly, cognitive issues that affect meal intake and are interested in food, and a need for fewer calories due to decreased metabolic rate and a decreased energy expenditure.
What are some interventions to prevent inadequate nutrition?
That would be liberalize the diets, make sure the resident doesn't have low cholesterol, low fat, low sodium type diets, make sure they maybe just get a general regular diet. Fewer restrictions can often equal increased intakes, provide texture modified diet if it's needed, recommend multivitamin, and also supplement on nutrition if it's needed.
Also provide lactose free milk if they're lactose intolerant, evaluate the need for setup or queuing, feeding, etc. related changes in cognition, and then provide nutrient dense foods that limit empty calorie foods to prevent unwanted weight gain.
How does dehydration occur?
It occurs when you lose more fluid than you take in and your body doesn't have enough water and other fluids to carry out its normal functions. Water is often the overlooked essential nutrient. We must have water for maintaining blood volume, for regulating body temperature, for transporting nutrients to body cells, for maintaining moist mucus membranes and tissues, for cushioning the joints, and it also protects the body's organs.
It's also needed in that digestive process, also to carry waste products out of the body and to rebuild cells. Conditions that can increase the risk of dehydration would be fever, infection, confusion, or dementia, constipation, diarrhea, vomiting or draining wounds.
Other conditions would be elevated environmental temperatures, medications, especially diuretics, inability to drink by oneself, high protein diet, or dysphagia.
The signs of dehydration would be rapid weight loss, dry or sunken eyes, dry mouth or mucus membranes, changes in mental status, fever, vomiting. Other signs would be concentrated urine or decreased urine volume, dizziness, or an increased combativeness or confusion.
So, interventions to prevent dehydration also include know how much fluid each resident needs, usually that's 30 milliliters per kilogram of weight. You can see on the slide 100 pound person needs about 5 and a half cups of fluid a day, or 250 pound person needs about 14 cups per day.
And then there's additional fluid needed with diarrhea, vomiting, and fever. Also, offer the resident fluids frequently throughout the day, such as at med passes before and after personal care. Provide early morning beverage carts, provide midday hydration carts, or even evening beverage carts.
Offer extra fluids on meal trays, offer ice chips, ice cream, fruit ices, soups, gelatin, and other foods that have a high fluid content. Monitor your at-risk patients for physical signs of dehydration, refer them to speech and language if patient appears to have any kind of difficulty swallowing.
Recommend any adaptive equipment for eating and drinking if that's appropriate and would help. Report signs or symptoms of dehydration to the nursing staff, and then care plan any resident at risk for dehydration.
And simply keep water pitcher where the resident can reach it. Of course, there aren't fluid restrictions, you'd want to adjust that. But when a resident, you're going to be offering them water, make sure you take a direct approach.
Instead of here, Margaret, would you like a sip of water, say here, Margaret, take a few sips of water.
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