Nutritional Support for Elderly Patients

Aug 17, 2020 in Medicine Essay

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The number of the older population has soared over the years and is likely to increase further in the future. Leslie and Hankey (2015) explain that since this segment of people is growing at supersonic speed, it will soon outnumber the young population. As a result, the problem of nutrition among the elderly patients will become more massive than it is now. In fact, malnutrition is not only a cause but also a consequence of ill health among such patients (McLeod & Wilkinson, 2008). Nutritional support for the elderly people entails the provision of care for older patients at risk of malnutrition or the malnourished individuals (Haute Autorite de Sante, 2007). The elderly patients are more likely to face malnutrition because of their age, the disease process, and effects of therapy they receive from care institutions. Additionally, their physiology is unique, and it negatively impacts nutrition. This essay discusses nutritional support for the elderly patients by defining such concepts as the population of the elderly in need of nutritional support, the physiological and risk factors that predispose nutritional support, and the nutritional requirements.

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Prevalence of the Elderly Patients in Need of Nutritional Support

Old age is accompanied by many health challenges such as poor nutrition. In Western nations, the percentage of people over the age of 65 years is increasing. In Sweden, 1.8 million (19 percent of the total population) people are old and by 2060, the percentage is anticipated to grow to 25 (Soderstrom, 2013). Since age is a risk factor for malnutrition, there is no doubt that nutrition of elderly will pose challenges in the future. This group of people requires nutritional support to mitigate the possible issues. Such approach means that institutions that provide care for the older patients should be equipped in order to provide nutritional care for the malnourished or at-risk individuals.

It is hard to identify the exact population statistics of the elderly in need of nutritional support because there are conflicting findings of various research results. Nevertheless, the fact remains that many are affected by malnutrition. According to Soderstrom (2013), in a data set that comprised of 4,500 people above the age of 65 years, the mean prevalence of malnutrition was found to be 23 percent and another 43 percent were at risk. The elderly in the hospital institutions account for 30 to 70 percent followed by the ones in institutionalized care (15 to 38 percent), with those at home taking the lowest proportion of 4 to 10 percent (Haute Autorite de Sante, 2007). On the other hand, Soderstrom (2013) states that malnutrition in rehabilitation centers stood at 51 percent, and hospitals accounted for 39 percent followed by nursing homes (14 percent) and finally the community (six percent). However, the findings show that a huge number of the elderly patients require nutritional support.

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Risk Factors Predisposing Elderly Patients to Nutritional Support

The elderly patients face many risks of malnutrition because of the impending circumstances. The increase in age results in the subsequent growth in the probability of poor nutritional status. Such tendency exists because old age is accompanied by a decrease in the natural drive to eat and drink, leading to anorexia of aging (Burgos et al., 2012; Soderstrom, 2013). Furthermore, energy expenditure in the elderly reduces immensely with years. Although the physiological changes related to nutrition are normal, they predispose this group of people to malnutrition secondary to their reduced food intake. Therefore, age is a risk factor that impacts nutritional status of the elderly patients, and thus the need for nutritional support arises.

Overall, the health conditions of the older patients affect their nutritional situation in a negative manner. According to McLeod and Wilkinson (2008), gastrointestinal, chronic respiratory, kidney, and liver diseases increase the risk of poor nutrition. Haute Autorite de Sante (2007) reiterates that malnutrition accompanies such health conditions as depression and dementia. The stress associated with diseases like cancer, HIV/AIDS, and many others is capable of making the elderly individuals lose appetite. Similarly, these conditions are likely to impact the digestive system, resulting in anorexia. Therefore, such people should receive nutritional support to uphold and restore their healthy nutritional status.

Moreover, the care that the elderly patients receive from healthcare facilities is also a risk factor for poor nutrition. The side effects of most drugs given to these patients are sufficient to cause undernutrition. Drug therapy negatively impacts elderly patients through the overwhelming side effects as a result of polypharmacy (Soderstrom, 2013). Some of the side effects that may affect their nutritional status include nausea and vomiting, diarrhea, constipation, reduced appetite, confusion, and taste and smell alterations among others. As a result, elderly patients who are prescribed therapy that affect nutrition should also receive nutritional support.

Physiological Changes Explaining Why Elderly Patients Need Nutritional Support

When individuals age, several changes occur in the gastrointestinal system that impacts the status of nutrition. Gastrointestinal motility reduces proportionally to aging resulting in adverse effects on the digestive system. For instance, reduced intestinal motility leads to constipation and fecal impaction, which are common in aged people (Woodmansey, 2007). According to Woodmansey (2007), the reduction in fecal weight associated with aging occurs after the decline in the excretion of bacterial matter and most importantly because of slow gut transit time. These conditions substantially impact the elderly patients nutrition, which guarantees them nutritional support.

In addition, aging also affects the oral cavity and other functional elements that form a part of the digestive system. The sense of taste and smell diminish with age, which explains why most of the elderly people have less appetite for food than other individuals in society (Burgos et al., 2012). The masticatory function also weakens because of the loss of muscle mass, the probable loss of teeth, and swallowing difficulties (Woodmansey, 2007). Such issues result in the consumption of restricted and nutritionally imbalanced diets. Additionally, effects of aging in the stomach limit macronutrient intake. Atrophic gastritis occurs with aging, resulting in hypochlorhydria that leads to reduced absorption of nutrients such as vitamin B2, ferrous, and calcium (Woodmansey, 2007). In brief, the effects of aging in the oral cavity and other parts of the digestive system are enough to impact nutritional status of the elderly.

Furthermore, aging influences renal function that in turn affects nutrition among the elderly individuals. The kidneys responsiveness to antidiuretic hormone decreases with age, predisposing the aged patients to dehydration (Chernoff, 2013). The effect of this hormone reduction is detrimental to the fluid mass. Such decrease impairs thirst drive, which reduces the probability of the elderly to refill the lost fluids orally. Ahmed and Haboubi (2010) explain that renal impairment affects not only vitamin D metabolism but also its levels in the body. Such condition may be among some of the reasons why the elderly have high rates of osteoporosis. Due to the fact that renal function impairment impacts nutrition among the elderly, these individuals require nutritional support.

Elderly Nutritional Requirements

Like many other people, the elderly individuals require both micronutrients and macronutrients; however, the amount may vary. According to Ahmed and Haboubi (2010), 0.8 g of protein per kilogram body weight is the daily recommended dietary allowance (RDA) in adults regardless of age. This amount is necessary for the prevention of progressive lean body mass losses. Ahmed and Haboubi (2010) further argues that evidence has asserted that taking proteins above the RDA requirements (around 1.5g/kg body weight) normalizes blood pressure and improves elderly muscle mass, functions, strength, wound healing, and immune defense mechanisms. However, proteins should not be taken excessively because of their negative impact on human health. Furthermore, the elderly need calorie rich foods. Although their energy requirements vary, the amount of the caloric foods is more or less the same compared to other people. Therefore, they should ensure they take adequate starch-containing foods such as cereals and bread.

Regarding the micronutrient requirements, adults should ensure not only adequate but also proper intake of required nutrients. For example, vitamin D is needed for calcium absorption (Ahmed & Haboubi, 2010). This vitamin is obtained from oral intake of food or through the action of sunlight on the human skin (Chernoff, 2013). However, its acquisition in adults through sunlight is limited because of the thinning of the skin. Therefore, the elderly should take food rich in vitamin D or take its supplements in case of undernutrition. Moreover, the elderly are faced with the problem of osteoporosis. Hence, the need to increase their calcium intake so as to limit bone demineralization arises. Apart from calcium supplements, milk and dairy products are rich in this nutrient.

Other vitamins are also necessary for good health of the elderly patients. For instance, vitamin C plays an important role in the body that includes promotion of wound healing, both the formation and maintenance of body tissues, and the promotion anti-oxidation functions that aid in protecting the body against toxins (The Dairy Council, n.d.). Although vitamin C requirements for the elderly is the same as for young adults, the elderly intake is mostly suboptimal. As a result, people above the age of 65 years should be in a position to increase the intake of foods such as fruits and vegetables that are rich in vitamin C. Other vitamins like A and E are vital for a better and healthy body. The Dairy Council (n.d.) ascertains that the intake of anti-oxidizing vitamins and selenium reduces the risk of deadly cancers, heart conditions, and cataracts.

However, the elderly should not just limit themselves to vitamin C alone. The intake of folate, vitamin B12, and iron are of great importance to their bodies. Both vitamin B2 and folate are necessary for various functions such as healthy nerve function and cell division (The Dairy Council, n.d.). Prevention of deficiency of these nutrients is good for health of the elderly patients because their inadequate intake is mostly associated with elevated risks of heart diseases, dementia, and cancer. Lack of these essential nutrients can worsen the disease process among the elderly patients. Inadequate dietary intake or malabsorption of the nutrients due to either digestive problems or side effects of medications among patients can also impact nutritional status. The elderly also need iron for the formation of hemoglobin, a molecule in the red blood cells responsible for oxygen transportation. The Dairy Council (n.d.) explains that dietary iron requirements for the female elderly are less than for the young adults because of the cessation of menstruation; but in males, the requirements are more or less the same. Iron deficiency leads to anemia, which can worsen the disease condition of the old patients.

Conclusion and Recommendations

The elderly population is increasing, and it may soon reach the level of the young population. The biggest challenge in this group of people is nutrition because of the risk factors. Elderly patients have nutrition problems because of the effects of aging, the disease processes, and the side effects of therapy they receive in care facilities. Aging affects the oral cavity and other parts of the digestive system, which impairs nutrition. Furthermore, the energy requirements for these individuals is lower as well as their appetite for food. Just like many other people, the elderly need to take a balanced diet with all food nutrients ranging from micronutrients to macronutrients.

This essay recommends screening the elderly patients for nutritional challenges to correct the malnutrition problem early enough. All care providers should know that this population is at risk of malnutrition, and nutrition should be a priority in care provision among other aspects. Elderly patients found in need of nutritional support should be given proper nutrient supplementation through appropriate channels such as oral, enteral, or parenteral feeding.

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