Nutrition and Hydration

Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients.

Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities.

When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met.

Assessment tools such as the Lawton Instrumental Activities of Daily Living (IADL) Scale are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.

To prepare:

•Review this week’s media presentation, as well as Chapters 26 and 27 of the
Flaherty and Resnick text.

•Assess a patient using tools for inpatient and long-term patient care such as the Lawton (IADL) Scale.

•Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities.

Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.

•Consider the patient’s diet and whether they have any special dietary needs due to medical conditions such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc.

Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.

•Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).

Write a description of the patient assessment you performed using a tool for inpatient and long-term patient care such as the Lawton IADL Scale.

Explain whether nutrition and/or hydration might be impacted by the patient’s functional abilities.

Then, describe the patient’s diet and whether he or she has any special dietary needs due to medical conditions.

AIDress whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.

Finally, explain strategies for improving any nutrition issues that might present during the patient assessment.

Readings
•Flaherty, E., & Resnick, B. (Eds.). (2011). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (3rd ed.). New York, NY: American Geriatrics Society.
?Chapter 26, “Malnutrition” (pp. 195–202)

This chapter describes age-related changes that affect nutrition in older adults. It also examines nutrition screening and assessment, nutrition syndromes, nutritional interventions, and legal and ethical issues related to older adult nutrition.
?Chapter 27, “Eating and Feeding Problems” (pp. 203–206)

This chapter examines age-related changes that cause swallowing and feeding problems. It also examines strategies for assessing patients with swallowing and feeding problems.
•Holroyd-Leduc, J., & ReIDy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing Ltd.
?Chapter 11, “Keeping things moving: preventing and managing constipation” (pp. 140–154)

This chapter defines chronic constipation and describes strategies for diagnosing, preventing, treating, and managing constipation. It also examines pharmacological treatments, identifying adverse effects of these treatments, as well as contraindications.
•American Geriatrics Society. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Retrieved from http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf

This article examines three categories of medications that impact older adults: those that are potentially inappropriate and must be avoided, those that are potentially inappropriate and must be avoided in older adults with certain diseases, and those that must be used with caution.
•Chalé, A., Unanski, A. G., & Liang, R. Y. (2012). Nutrition initiatives in the context of population aging: Where does the United States stand? Journal of Nutrition in Gerontology & Geriatrics, 31(1), 1–15. Retrieved from the Walden Library databases.

This article examines existing nutrition-focused federal programs and nutrition initiatives for older adults. It also proposes a physician-based model of nutrition education for maximizing nutrition outcomes for older adults.
•Nutrition.gov. (2012). Life stages: Seniors. Retrieved from http://www.nutrition.gov/life-stages/seniors

This website provides links to resources related to nutrition for seniors. It focuses on nutritional concerns, health issues, and nutrition education.
•Plawecki, K., & Chapman-Novakofski, K. (2010). Bone health nutrition issues in aging. Nutrients, 2(11), 1086–1105. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257623/

This article describes the impact of osteoporosis on older adults. It then presents interventions for maintaining bone health as well as outcomes of each intervention