Nursing - Seniors Often Malnourished

Author

Seniors Often Malnourished - The Hidden Epidemic

Roman Bystrianyk

2005-05-18, 11:20 am

http://www.healthsentinel.com/org_n...ist_item&id=038

Roman Bystrianyk, "Seniors Often Malnourished - The Hidden Epidemic",
Health Sentinel, May 12, 2005,

Many of us picture senior citizens enjoying an idyllic retirement. We
visualize older adults spending time playing with grandchildren,
pursuing hobbies, or even trying new careers. We like to believe in a
vibrant and healthy time of life where people can enjoy their leisure
years after a lifetime of work.

Unfortunately, that simple and serene picture is not a reality for
many. The March issue of the American Journal of Nursing details what
is essentially a hidden epidemic in our senior citizens today -
malnourishment. According to the study, malnourishment is, in fact, a
greater threat to this population than obesity.

According to the study, "The Nutrition Screening Initiative [NSI], a
multidisciplinary coalition headed by the America Dietetic Association
and the American Academy of Family Physicians, estimates that 40% to
60% of hospitalized older adults are malnourished or at risk of
malnutrition; it also estimates that 40% to 85% of nursing home
residents suffer from malnutrition and that 20% to 60% of home care
patients are so afflicted."

There are many factors that contribute to malnutrition in seniors.
Seniors can have little or no appetite, problems with eating or
swallowing, inadequate servings, fewer than two meals a day, or
insufficient hot meals. Another risk factor for malnutrition is poor
dental health, which includes cavities, gum disease, and missing teeth.

Seniors can also suffer from xerostomia. Xerostomia is an abnormal
dryness of the mouth resulting from decreased secretion of saliva.
Antidepressants, antihypertensives, and bronchiodilators can contribute
to xerostomia.

Malnourished older adults are also prone to frailty. Once a person is
frail it can be the beginning of failing health. Frailty, was once
termed failure to thrive in older adults, is now considered a distinct
syndrome, a precursor to or a cause of disability. "Malnutrition has
been identified as one of the four causes of frailty. Others include
atherosclerosis, cognitive impairment, and sarcopenia (age related loss
of muscle mass). Frail older adults are more likely to die, be
hospitalized, or become disabled."

Hospitalization itself can be a factor in undernutrition. In one study
of elderly patients who had elective coronary artery bypass surgery
several factors were measured to determine their nutritional health.
The majority of patients before surgery had normal levels of albumin
(low levels can be used as a marker for malnutrition), transferrin (a
plasma protein that transports iron through the blood to the liver,
spleen and bone marrow), and Body Mass Index (BMI). Five days after
surgery, 85% of patients had a drop in albumin levels and 99% had a
drop in transferrin. Four to six weeks after surgery both these levels
were back to normal, however, BMI had decreased in 95% of the patients,
and "the more weight patients lost, the more likely they were to be
rehospitalized and report lower levels of physical health. These data
suggest that hospitalization of elderly patients can cause profound
changes in nutritional status that can remain into the unmonitored
post-discharge period."

Caregivers are sometimes inclined to employ the use of tube feeding as
a way to offset the eating difficulties associated with advanced
dementia in the elderly. However, a review of the evidence shows that
there is no data, "to support tube feeding of demented patients with
eating difficulties." According to the journal article, "hand
feeding is still considered the best intervention, and tube feeding
should only be started if the patient 'continues to decline in some
clinically meaningful way'; tube feeding in this population 'seldom
achieves the intended medical aims and ... rather than prevent
suffering ... can cause it.' "

According to a 2000 study supported by the Commonwealth Fund, "at
least a third of the 1.6 million nursing home residents in the United
States may suffer from malnutrition or dehydration, conditions that can
aggravate or cause more severe medical problems such as tooth decay,
broken bones, anemia, and low blood pressure-or in some cases even
death."

"Malnutrition, dehydration, and weight loss in nursing homes
constitute one of the largest silent epidemics in this country," said
Karen Davis, president of The Commonwealth Fund. "We can address this
problem by promoting changes in public policy, seeking creative
solutions from providers and professionals, undertaking further
research on key issues, and enforcing existing standards."

High-calorie, nutrient-rich supplements are a good way to aid people
who are not capable or unwilling to eat. The NSI states that
improvement in body weight and survival has been shown in patients
receiving oral supplements. One study of illness related to
malnutrition in older adults concluded that, "oral nutritional
supplements have a greater role than dietary advice in the improvement
of body weight and energy intake."

SOURCE: American Journal of Nursing, March 2005

mac1

2005-05-18, 11:20 am

As a layperson I would like to submit a recent observation regarding my
father's malnourishment which supports the findings of this article.

My 80 yr. old dad was recently diagnosed as having senile dementia. As he
was confused, hallucinating and becoming increasing frail with each passing
day. His wife alerted me about his failing condition. I immediately, booked
a flight and made plans to look after him.

I was surprised to learn that much of his diet was comprised of fast food.
Therefore, I immediately changed his diet. All meals became home cooked and
nutritionally balanced. I also made sure his fluid intake was increased to
the point of having him drink something every couple of hours.

The results were: that within 24 hrs. his hallucinations were reduced to
having only one (and it was brief). Thereafter, the remainder of the week
his mind became sharp and clear with zero hallucinations. It was amazing to
see the transformation occur so quickly.

Because of his age his was automatically diagnosed as having senile
dementia...it never occurred to the doctors that his diet and dehydration
may be cause of his confusion and hallucinations. Dad was simply
malnourished and dehydrated.

Therefore, since I live out-of-state, my solution was to contact and begin
the "Meals on Wheels" program for him. This way I can insure malnutrition
will not occur again.

Rich

2005-05-18, 11:20 am

"mac1" <mac1@nospam.com> wrote in message
news:g64ie.14501$7A2.12210@bignews6.bellsouth.net...
> As a layperson I would like to submit a recent observation regarding my
> father's malnourishment which supports the findings of this article.
>
> My 80 yr. old dad was recently diagnosed as having senile dementia. As he
> was confused, hallucinating and becoming increasing frail with each
> passing
> day. His wife alerted me about his failing condition. I immediately,
> booked
> a flight and made plans to look after him.
>
> I was surprised to learn that much of his diet was comprised of fast food.
> Therefore, I immediately changed his diet. All meals became home cooked
> and
> nutritionally balanced. I also made sure his fluid intake was increased to
> the point of having him drink something every couple of hours.
>
> The results were: that within 24 hrs. his hallucinations were reduced to
> having only one (and it was brief). Thereafter, the remainder of the week
> his mind became sharp and clear with zero hallucinations. It was amazing
> to
> see the transformation occur so quickly.
>
> Because of his age his was automatically diagnosed as having senile
> dementia...it never occurred to the doctors that his diet and dehydration
> may be cause of his confusion and hallucinations. Dad was simply
> malnourished and dehydrated.
>
> Therefore, since I live out-of-state, my solution was to contact and begin
> the "Meals on Wheels" program for him. This way I can insure malnutrition
> will not occur again.

Meals on Wheels is one of my favorite social services. Besides providing
seniors with improved nutrition, it provides a mechanism by which elders who
live alone are visited at least once each day, so that if they are ill or
injured, appropriate intervention can be initiated.

--Rich

2005-05-18, 11:20 am

mac1 wrote:
> As a layperson I would like to submit a recent observation regarding
my
> father's malnourishment which supports the findings of this article.
>
> My 80 yr. old dad was recently diagnosed as having senile dementia.
As he
> was confused, hallucinating and becoming increasing frail with each
passing
> day. His wife alerted me about his failing condition. I immediately,
booked
> a flight and made plans to look after him.
>
> I was surprised to learn that much of his diet was comprised of fast
food.
> Therefore, I immediately changed his diet. All meals became home
cooked and
> nutritionally balanced. I also made sure his fluid intake was
increased to
> the point of having him drink something every couple of hours.
>
> The results were: that within 24 hrs. his hallucinations were reduced
to
> having only one (and it was brief). Thereafter, the remainder of the
week
> his mind became sharp and clear with zero hallucinations. It was
amazing to
> see the transformation occur so quickly.
>
> Because of his age his was automatically diagnosed as having senile
> dementia...it never occurred to the doctors that his diet and
dehydration
> may be cause of his confusion and hallucinations. Dad was simply
> malnourished and dehydrated.
>
> Therefore, since I live out-of-state, my solution was to contact and
begin
> the "Meals on Wheels" program for him. This way I can insure
malnutrition
> will not occur again.

It goes to show a couple of important things.

1) Food, nutrition, vitamins, etc. are sooooo damned important to
physical and mental health that it isn't even funny.

2) Doctors know nothing about the importance of nutrition and are
virtually guaranteed to not be able to spot the results of malnutrition
even when it jumps up and bites them on the XXX. They simply do not
have the training.

There is no excuse for the medical mainstream to be so damned focused
on pharmaceuticals and surgery when simply doing a straight-forward
nutritional assessment would resolve many, if not, most health issues.

TC

PeterB

2005-05-18, 11:20 am

mac1 wrote:
> As a layperson I would like to submit a recent observation regarding
my
> father's malnourishment which supports the findings of this article.
>
> My 80 yr. old dad was recently diagnosed as having senile dementia.
As he
> was confused, hallucinating and becoming increasing frail with each
passing
> day. His wife alerted me about his failing condition. I immediately,
booked
> a flight and made plans to look after him.
>
> I was surprised to learn that much of his diet was comprised of fast
food.
> Therefore, I immediately changed his diet. All meals became home
cooked and
> nutritionally balanced. I also made sure his fluid intake was
increased to
> the point of having him drink something every couple of hours.
>
> The results were: that within 24 hrs. his hallucinations were reduced
to
> having only one (and it was brief). Thereafter, the remainder of the
week
> his mind became sharp and clear with zero hallucinations. It was
amazing to
> see the transformation occur so quickly.
>
> Because of his age his was automatically diagnosed as having senile
> dementia...it never occurred to the doctors that his diet and
dehydration
> may be cause of his confusion and hallucinations. Dad was simply
> malnourished and dehydrated.
>
> Therefore, since I live out-of-state, my solution was to contact and
begin
> the "Meals on Wheels" program for him. This way I can insure
malnutrition
> will not occur again.

Congrats on turning your dad's health around. Proper diet at that age
is so important. I'm not so sure, though, that "meals on wheels" can
single-handedly address an elderly person's nutritional needs. An
important portion of the article is the observation that "oral
nutritional supplements have a greater role than dietary advice in the
improvement of body weight and energy intake," perhaps especially for
the elderly. So be sure your dad gets a good whole food multi-vitamin.

PeterB

beni

2005-05-18, 11:20 am

what is this "Meals on wheels" program?
we in Israel dont have such a thing, but it seems interesting.
thanks. beni.

Mark Thorson

2005-05-18, 11:20 am

mac1 wrote:

> Because of his age his was automatically diagnosed as having senile
> dementia...it never occurred to the doctors that his diet and dehydration
> may be cause of his confusion and hallucinations. Dad was simply
> malnourished and dehydrated.

Note that a common vitamin deficiency among seniors is B-12.
Unlike the other vitamins, B-12 has a very complex absorption
mechanism, and if anything goes wrong you don't get enough.

Fortunately, it is stored in the liver and you don't need much of it.
One shot of B-12 completely bypasses the complex absorption
mechanism and lasts for years.

Don't know if this caused your dad's dementia, but lack of B-12
can cause neurological problems.

PeterB

2005-05-18, 11:20 am

beni wrote:
> what is this "Meals on wheels" program?
> we in Israel dont have such a thing, but it seems interesting.
> thanks. beni.

It's a non-profit org. whose volunteers deliver cooked foods to the
elderly and disabled.

mac1

2005-05-18, 11:20 am

"PeterB" <pkm@mytrashmail.com> wrote in message
news:1116274361.338140.247820@z14g2000cwz.googlegroups.com...
>
> beni wrote:
>
> It's a non-profit org. whose volunteers deliver cooked foods to the
> elderly and disabled.
>

Another wonder component of this program is that when you enroll in the
program, you are asked a series of questions regarding any special medical
needs regarding the individual being fed (such as: are they diabetic, do
they take coumadin ect.) Therefore the menu/meals are tailored to the
specific needs of the person by a nutritionist.

Rich

2005-05-18, 11:20 am

"mac1" <mac1@nospam.com> wrote in message
news:tu7ie.26462$0i3.14100@bignews3.bellsouth.net...
>
> "PeterB" <pkm@mytrashmail.com> wrote in message
> news:1116274361.338140.247820@z14g2000cwz.googlegroups.com...
>
> Another wonder component of this program is that when you enroll in the
> program, you are asked a series of questions regarding any special medical
> needs regarding the individual being fed (such as: are they diabetic, do
> they take coumadin ect.) Therefore the menu/meals are tailored to the
> specific needs of the person by a nutritionist.
>

And yes, Mr Lagergren, the old folks usually get 8oz of milk with every
meal.

--Rich

Starlight

2005-05-18, 11:20 am

On Mon, 16 May 2005 16:38:06 -0400, "mac1" <mac1@nospam.com> wrote:

>
>"PeterB" <pkm@mytrashmail.com> wrote in message
>news:1116274361.338140.247820@z14g2000cwz.googlegroups.com...
>
>Another wonder component of this program is that when you enroll in the
>program, you are asked a series of questions regarding any special medical
>needs regarding the individual being fed (such as: are they diabetic, do
>they take coumadin ect.) Therefore the menu/meals are tailored to the
>specific needs of the person by a nutritionist.
>

Not always.

Unfortunately some of the programs feed so many that
they are unable to provide specific foods/meals. Those in our area
seem to offer too much salt, starch and sugar, which isn't good for
diabetics or others with health problems. They don't make changes
for people on Coumadin, renal diets, etc.. It's up to the patient to
eat what they're permitted and skip what isn't in their diet.
You're lucky that your programs are so streamlined.

Becky

mac1

2005-05-18, 11:20 am

"Starlight" <homehealth_rnDELETE@yahoo.com> wrote in message
news:dtdi81l9r14v5mjgn2vqi6ggd3rqg12d9l@4ax.com...
> On Mon, 16 May 2005 16:38:06 -0400, "mac1" <mac1@nospam.com> wrote:
>
>
> Not always.

Unfortunately some of the programs feed so many that
> they are unable to provide specific foods/meals. Those in our area
> seem to offer too much salt, starch and sugar, which isn't good for
> diabetics or others with health problems. They don't make changes
> for people on Coumadin, renal diets, etc.. It's up to the patient to
> eat what they're permitted and skip what isn't in their diet.
> You're lucky that your programs are so streamlined.
>
> Becky

Yes, I feel very fortunate indeed.
My suggestion (to those who are financially able) is to support your local
Meals on Wheels Program. Perhaps then, more locals throughout the country
can offer meals tailored specifically to elderly needs.

PeterB

2005-05-18, 11:20 am

mac1

2005-05-18, 11:20 am

mac1

2005-05-18, 6:01 pm

PeterB

2005-05-18, 6:01 pm

mac1 wrote:
> As a layperson I would like to submit a recent observation regarding
my
> father's malnourishment which supports the findings of this article.
>
> My 80 yr. old dad was recently diagnosed as having senile dementia.
As he
> was confused, hallucinating and becoming increasing frail with each
passing
> day. His wife alerted me about his failing condition. I immediately,
booked
> a flight and made plans to look after him.
>
> I was surprised to learn that much of his diet was comprised of fast
food.
> Therefore, I immediately changed his diet. All meals became home
cooked and
> nutritionally balanced. I also made sure his fluid intake was
increased to
> the point of having him drink something every couple of hours.
>
> The results were: that within 24 hrs. his hallucinations were reduced
to
> having only one (and it was brief). Thereafter, the remainder of the
week
> his mind became sharp and clear with zero hallucinations. It was
amazing to
> see the transformation occur so quickly.
>
> Because of his age his was automatically diagnosed as having senile
> dementia...it never occurred to the doctors that his diet and
dehydration
> may be cause of his confusion and hallucinations. Dad was simply
> malnourished and dehydrated.
>
> Therefore, since I live out-of-state, my solution was to contact and
begin
> the "Meals on Wheels" program for him. This way I can insure
malnutrition
> will not occur again.

Congrats on turning your dad's health around. Proper diet at that age
is so important. I'm not so sure, though, that "meals on wheels" can
single-handedly address an elderly person's nutritional needs. An
important portion of the article is the observation that "oral
nutritional supplements have a greater role than dietary advice in the
improvement of body weight and energy intake," perhaps especially for
the elderly. So be sure your dad gets a good whole food multi-vitamin.

PeterB

beni

2005-05-18, 6:01 pm

what is this "Meals on wheels" program?
we in Israel dont have such a thing, but it seems interesting.
thanks. beni.

Starlight

2005-05-18, 6:01 pm