NUTRITIONAL SUPPORT FOR ELDERLY PATIENTS 3
Nutrition in elderly patients has always been an issue because of anumber of reasons. For starters, quite a number of elderly patientsare diabetic hence they will be exempt from taking sugary andstarchy foods. In such a situation, the caregivers will have to findan alternative source of carbohydrates. Swallowing problems areanother hurdle in the nutrition program of elderly patients. The morethe severity, the more the elderly patient will experiencenutritional problems. Some of the swallowing difficulties may prevailfor a long duration and consequently, worsen the condition of theelderly patient. Every caregiver aims at achieving a good nutritionalstatus because it is a key determinant of mortality and morbidity inelderly patients. Many scholars have focused their energy on thenutritional status of elderly patients in order to find solutionsthat may avert possible mortality and morbidity.
Owing to the gravity of the issue, this research paper seeks toexplain the concepts surrounding nutrition in elderly patients byexploring scholarly sources. The paper also draws conclusions andgives recommendations in the end.
Factors influencing nutrition in Elderly Patients
Satietyand Satiation
According to Nieuwenhuizen et al (2009), personal factors are themajor determinants of successful nutrition in elderly patients. Thekey concept that governs nutrition in human beings is satiety.Satiety is a system of factors that influence voluntary nutrition.They include the digestive tract, the central nervous system, and thegut hormones. Nutrition in human beings is under the control of twoprimary physiological processes- Satiation and satiety.
Whilst satiation is the process that leads the person to stop eating,satiety is the function of the body that determines the intervalbetween two consecutive meals. The balance between satiation andsatiety is what will determine whether the nutritional status of aperson will be within the desired standards or it will need a littleadjustment. An imbalance between these two physiological processescould lead to either obesity or malnutrition. It is the duty of thecaregiver to ensure that the elderly patient makes a balance betweensatiation and satiety.
As a person grows older, the balance between satiation and satiety isoften lost. The situation is worsened when the elderly person becomessick. A hormone known as Cholecystokinin, responsible for suppressingappetite, is a key player in the satiety cascade. As a person growsolder, the hormone that suppresses appetite increases its activity.The overproduction Cholecystokinin in elderly patients is responsiblefor the nutritional problems that are prevalent in numerous cases.
The body overproduces the hormone because of the illness that isaffecting the elderly person, or for the simple reason that theperson is elderly and it is a normal occurrence in such people.According to Nieuwenhuizen et al (2009), older adults are moresensitive to Cholecystokinin that is produced by the endocrine cellsof the small intestines. The effects of satiation imbalance andCholecystokinin sensitivity are factors that most caregivers shouldconsider when recommending a nutrition program for elderly patients.
Anorexiaof age
The concept of the anorexia of aging, seeks to explain why olderpeople have nutrition dysfunctions. As a person grows older, theirenergy requirements and uptake reduce considerably. As men age from40 to 70 years old, their energy requirements may drop by 1300 kClper day while that of women is bound to reduce by an average of 600kCl/ day. The low energy requirements stem from the fact that olderpeople are less active, they mobility reduces, they sleep more often,and they rarely work. Lack of means to utilize energy produced by thebody implies older people will have a low intake of energy producingfoods, or any kind of food for that matter. The low energyrequirement explains why Sarcopenia is common in older people.Sarcopenia is the process by which the human body loses muscle weightdue to a low intake of food. Sarcopenia is therefore responsible forthe skinny look that many people assume once they grow old.
The energy requirements for elderly patients are lower in comparisonto those of their counterparts who are not sick. For a normal elderlyperson, the average drop in energy requirements is 1300 kCl/ a day.This figure could be higher considering that elderly patients havehigher rates of inactivity and immobility. The low energyrequirements for elderly patients could lead to complications due topoor nutrition.
Unlike their counterparts who can survive on a single meal in a day,an elderly patient will need proper nutrition in order to boost theimmunity of his or her body. The taste buds in older people alsoreduce with time, hence the reason they do not find most of the fooddelicious. It is therefore upon the caregiver to ensure that theelderly patient has enough motivation to have proper nutritiondespite the loss of appetite that is associated with sickness and lowenergy requirements.
Mentaland Emotional problems
It so happens that some of the elderly patients are lonely because ofthe little affection and attention that they receive from familymembers and close friends. In the modern society set up, most peopleprefer to send their older relative to institutionalized care centersbecause of the numerous job commitments that restrict them. Elderlypatients receiving care from strangers could feel a little lonely andneglected. This type of mental state has a negative impact on thenutritional status of the elderly patient. Social isolation in theinstitution of care could also have a negative impact on thenutritional state of the elderly patient. Human beings are socialanimals and therefore interactions with other human beings are partof the basic needs. Elderly patients who suffer from diseases thatmake them unable to interact with other patients are prone tonutritional dysfunction.
Some of the elderly patients also suffer from a functional disabilitysuch as poor cognition, ingestion, and impaired visions. Dementia andamnesia have been recorded to be among the leading causes ofinconsistencies in feeding behavior among elderly patients. Apartfrom leading to depression and psychological problems, elderlypatients often forget basic parts of their life, such as feeding orend up consuming inappropriate amounts and types of food. Inaddition, these psychological diseases also lead to loss of appetite,which in turn leads to poor nutritional status. Caregivers should paymore attention to elderly patients suffering from psychologicalproblems because they are more prone to poor nutritional tendencies.
Effects of poor nutrition on Elderly patients
Protein-energy malnutrition
Deficiencies in protein and energy will lead to a weaker immuneresponse system (Chandra, 2008). Protein-energy malnutrition willcause a reduction in size and weight of the thymus. The thymus is apart of the peripheral immune system that controls numerousneurological and immunity functions. PEM (protein-energymalnutrition) leads to a decrease in the number of lymphocytes in thebody of the elderly patient. A smaller number of lymphocytes lead todelayed hypersensitivity reactions. PEM also impairs the rate ofmaturity of T-lymphocyte cells that a crucial part of the body’sdefense mechanism. With a weakened immune system, the elderly patientwill be prone to opportunistic infections such as the common flu,fungal infections, and staphylococcal infections. Treating thesediseases may also take long, and sometimes could be the cause ofmortality.
Poornutrition also leads to general body weakness. An elderly patientexperiencing nutrition problems will fail to do simple tasks such aswalking, sitting upright, and interacting with his family andfriends. The patient will be confined to his bed for the better partof the day, something that could lead to more cases of depression.General body weakness will also increase the dependence of theelderly patient on his caregiver and make him vulnerable to abuse andother forms of neglect. General body weakness is also a majorcontributor to morbidity in elderly patients. In addition toaffecting the body’s ability to fight infections, general bodyweakness also affects basic physiological functions such as excretionand homeostasis.
Conclusion and Recommendations
Foodsupplements are a good way of maintaining the level of nutrients inelderly patients who have problems in their nutrition. Thisrecommendation is especially appropriate for those patients who haveswallowing problems. Increasing the portion size of every servingwill increase the food intake of elderly patients. Thisrecommendation is helpful, especially when serving the patient’sfavorite meal. However, for it to work, the caregiver will have tomotivate the elderly patient to ensure that he finishes his serving.Research shows that soups are more satiating than solid foods.Although soups lack the nutrients that are found in most solid foods,they will create the appetite to ingest more food.
Meal fortification is another recommendation for elderly patients whohave lost their appetite. For instance, the caregiver can add sauceto a meal. The sauce functions to create desire in eating. Fortifiedfatty foods can be used in place of proteins and carbohydrates.Research has shown that fortified fats are more palatable whencompared to fortified proteins and carbohydrates. Increasing thevariety of food can also help to increase intake as opposed toserving monotonous food to elderly patients. Trying out new cuisinesand introducing them to new kinds of food will help revive theirinterest in consuming food.
In conclusion, nutrition problems in elderly patients are a leadingcause of morbidity and mortality. Among the effects of poor nutritionin elderly patients are reduced levels of body immunity and generalbody weakness. Causes of poor nutrition stem from mental to personal.They include psychological problems such as depression, sensitivityto hormones that suppress appetite, swallowing problems, and lowenergy requirements. Caregivers should ensure that elderly patientsmaintain a proper nutritional status in order for them to recuperate.They can motivate elderly patients to consume more food by increasingthe variety and the size of the portion in every serving. Showingaffection and care to this group of patients will go a long way inrestoring their appetite.
Reference
Chandra, R. K. (2008). Nutrition and the immune system: anintroduction. The American journal of clinical nutrition,66(2), 460S-463S.