Nutritional Support for Elder Patients

Nutrition is a critical health determinant of elderly patients. Over the years, the importance of nutrition has been recognized in various morbid conditions like cancer, dementia in individuals over the age of 65 years and heart diseases. However, there is no regularly accepted meaning of malnutrition in the elderly persons. Some common indicators include abnormal mass index (BMI), decrease in dietary intake, specific vitamin deficiencies and involuntary weight loss (Donini, Savina & Cannella, 2003). Health statistics indicate that elderly patients have a higher risk for undernourishment than the adult population. That is, about 2% to 16% of older people in a community are nutritionally lacking calories and proteins. Moreover, with the addition of vitamin and mineral deficiencies, malnutrition in elderly patients in a particular community can be estimated to reach about 35%. It is also estimated that 20% to 65% of hospitalized elderly patients are suffering from nutritional deficiencies while prevalence of under-nutrition in a durable care facilities is approximately 30% to 60%. Most of the time, malnutrition in older patients is underdiagnosed. The reason is that sometimes health practitioners may instantly not recognize weight loss in elderly patients and use it as a morbid symptom of malnutrition. It is because sometimes weight loss is associated with muscle mass reduction at old age. Besides, elderly patients with obesity have their protein under nutrition overlooked during diagnosis.

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In the article Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake by Nieuwenhuizen, Weenen & Hetherington, it is clear that the greatest threat to health and wellbeing of elderly patients is malnutrition. The article draws its statistics from the National Health and Nutrition Survey which has shown an involuntary weight loss in the older population and it is associated with high mortality rate of the more elderly population. That is malnutrition in older population is related to high risk of depression, infection and death. The authors also state that the leading causes of involuntary weigh loss in elderly patients are cardiac disorders, cancer, lower socioeconomic status, gastrointestinal diseases and functional disability. Besides, the article states that depression is the leading cause of involuntary weight loss among elder patients by 58% (Nieuwenhuizen,Weenen,Rigby,& Hetherington,2010).

While the article attributes depression as the primary cause of weight loss in older patients, it further acknowledges the physiological influence on malnutrition in elderly patient. The first important factor of physiology is its influence on the nutritional intake of the ageing patients. That is dietary intake is governed by complex interactions of senses, the central nervous system, digestive tract and gut hormones which are involved in the satiety cascade. The ideas underlying the satiety cascade is that nutritional intake in humans is regulated by two major physiological processes. They include satiation, which leads an individual to stop eating and satiety which, controls the intervals with which an individual consumes two successive meals. Hence, the balances between the two processes determine and also affect the energy balance. Moreover, food yield individual's satiation and satiety upsets due to a series of anticipatory processes such as palatability, cognitive process, for instance, expectations towards food, pre-absorptive process like gastric distension and filling. Finally is the post-absorptive sensory like hormones and nutrients circulation process (Nieuwenhuizen,Weenen,Rigby,& Hetherington,2010).

In the article Nutrition and aging, Wells & Dumbrell,2006,the authors fathom that functional disabilities like impaired vision, poor dentition, dementia, psychological problems like depression also, do influence feeding behavior of elderly patients. For instance, patients with dementia are likely to lose appetite due to depression. They can also forget to eat appropriately in regard to substances of foods he or she is required to take. Hence, loss of taste is common features of aging due to the functional changes in the taste bud, medications, diseases associated with aging and environmental exposure. Moreover, intact senses of smell and taste are fundamental for cephalic stage of digestion which involves increasing salivary, intestinal, gastric and pancreatic secretions. Unfortunately, older adults have lower salivary response rate and higher dissatisfaction rate of food due to dry mouth during chewing thus losing taste for food (Wells & Dumbrell, 2006).

Wells and Dumbrell are also convinced that the physical state of food to be consumed by an elderly patient can influence his or her nutrition intake. The physical state of the food can be liquid or solid. However, the effect may vary depending on the type of food presented before the patient. One of the variable factors is related to mouth wetness which may shift to food being accepted after when the mouth is dry. Mouth wetness of elderly patient is simulated by acidity and cold. Hence, changes in salivary glands makes older individuals to feel thirsty than younger adults. Therefore, drinks that instigate saliva production are most likely to quench thirst, therefore, they are consumed in large quantities (Wells & Dumbrell, 2006).

Social Isolation

Human as social being love to eat in groups. When elderly patients are left to eat alone, the end result is low energy consumption. It is because eating alone reduces food consumption and the quality of diet in elderly patients. More importantly, it is the male patients living alone who are most likely to suffer from under-nutrition than their female counterparts. Also, loss of social contact leads to loneliness thus depression which causes poor eating behavior (Nieuwenhuizen,Weenen,Rigby,& Hetherington,2010).

Money factor

Elderly patients who have limited funds do suffer from malnutrition than those who have enough money. It is because, with less money one purchases less food and it also influences the quality of food choice.

Despite the article Older adults and patients in need of nutritional support, giving a general reasons for malnutrition in elderly patients, the article does not state that nutritional problems is always gradual and hard to detect. It also does not mention that a patients history and medical examinations can be helpful in identifying malnutrition risks. That is, sometimes patients can present nonspecific symptoms. In that, he or she can report reduced appetite, alteration in taste sensation from regular bowel habits and reduced energy. Therefore, clinical features that suggest undernourishment are fragile skin, low body weight, recurrent infections, impaired wound healing and wasted muscles. Also, even though clinical judgment is a sufficient way to diagnose malnutrition, it is imperative to note that not every elderly patient who is malnourished will always be thin. Hence, objective classification of patients does assist in clinical decision making. Most important is the use of a reliable and validated nutrition screening tool (Donini, Savina, & Cannella,2003).

Current practices to improve nutritional intake in malnourished older adults

Dietary advice and meal fortification

As stated in the article Older adults and patients in need of nutritional support, dietary advice is often recommended as the first stage of nutritional intervention. It is because meal fortification do improve energy and protein intake in hospitalised elderly patients. Though the approach is taunted as a way of increasing energy intake, nutrients such as fibres are easily compromised. Also, in most cases, many clinicians do not keep a record on dietary advice (Nieuwenhuizen,Weenen,Rigby & Hetherington,2010).

Variety

Both articles have not mentioned the importance of variety food nutrition as a malnutrition measure. They have overlooked the fact that older people have a weak response to dietary monotony, it best explains why they are at risk to consume diets that are nutritionally inadequate, therefore, the trending multinational concepts in the health sector is the subjection of elderly patients to variety of diets to instigate cravings for particular foods. The concept helps in maintaining optimal nutritional balance in elderly patients (Donini, Savina & Cannella, 2003).

Enteral Feeding

According to the article, strategies to improve nutrition in older people, doctors can employ enteral nutrition as a diet method by a tube to the gastrointestinal tract. Such feeding method is considered for those patients who cannot feed in a normal way. Tube feeding is delivered through health professionals who have been trained in nutrition support and the practice is coordinated by a multi-displinary team. The team includes dietitians, community pharmacist and a nurse. Such team will provide both guidance and monitoring. They will also recommend when to stop enteral feeding. Moreover, some situation may require Food First approach which can be a sufficient method to correct malnutrition in elderly patients. However for those patients whom first-line dietary methods are not sufficient then oral nutrition supplements is considered together with Food First approach (Prescription foods, 2016).

Oral Nutritional Supplements

Oral nutrition supplements are liquids containing macro and micronutrients. They are nutritionally complete. They are also more effective when patients are offered different flavors and with varying temperatures. It is recommended that oral nutrition is given to patients between meals and it is even more efficient if they are administered in small doses as medicines. More importantly, they do not serve as food replacement but as supplement. Just like other reviews, both articles conquer that oral supplements are not health hazards to the elderly patients. They agree that supplements are useful measures for increasing energy, micronutrient intake and protein when combines appropriately with other nutrition support strategies (Payette, Boutier, Coulombe & Gray-Donald,2002).

Having studied both the articles, I think it is important to have proper nutrition diet for the elderly patient because first, the physiological system is beyond their control. That is, they cannot practice proper dieting by themselves because a physiological force is hindering them from doing so. For instance, at old age, they are bound to lack appetite or even a craving for a particular food. Also, they tend to feel less hungry than younger adults hence the presumption that they do not eat food. Moreover, because older people get less hungry, they tend to feed less hence, smaller amount of nutrient intakes which eventually affect their health. Therefore, by putting elderly patients under a proper nutrient support, they will be at less risk from malnutrition or may heal from under nutrition. Most importantly, through nutritional support, they are bound to escape from the side effects of wrong dietary measures. I also recommend that for such nutritional programs to be effective, these patients should be encouraged to eat by encouraging their family members to visit during mealtimes. Also, medical staff should not undermine a patients food preference during such program. The program should fit within the patient preference to provide a stepping stone for moving from malnutrition risks. Finally, because elderly patients have multiple comorbidities that do contribute to nutritional comprise and such contributing factors are complex, it is also imperative that nutritional assessment is done carefully for a successful diagnosis of under...