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Running head: BETSY CASE STUDY

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BETSY CASE STUDY

Mature Adult Case Study

By June Saxton

7/30/2012

This case study is about Betsy, a 79 year old woman who lives with her 81 year husband who takes care of her. Two years ago she began to lose interest in shopping, cooking and sewing things that she used to enjoy. She has also lost interest in food and has lost 18 pounds in the past year. She now weighs 100 pounds. She is 51. Her husband prepares all their meals because they have no family support as they have no children. She does not appear to have any chewing or swallowing problems and only takes medication for her arthritis. A Mini-Mental State Examination revealed that she does have cognitive impairment. .

As Betsy aged, her body composition changed greatly from when she was 50 years old. Muscle Mass and strength decrease with age, the immune system weakens making it more difficult to fight off infection, posture deteriorates, the senses are dulled and salvia and gastric secretions decline (Edelstein & Sharlin, 2009). At 50, Betsy was able to walk farther and do more around the house; but at 79 because of joint problems she is more limited in her ability to get around. Also because her cognitive functions have decreased she may remember how to do some of the things that she used to enjoy doing like cooking and sewing.

One factor that may be affecting Betsys nutritional health status is dulled senses. Because the senses of taste and smell play key roles in the enjoyment of food, she may be experiencing a loss of appetite and the desire to consume a wide variety of foods. A decrease in physical activity and muscle mass also affects appetite because energy requirements decrease. Loss of cognitive function can also affect food intact and appetite. It may alter the ability to feed oneself, impair movement and affect memory. Depending on what medication that Betsy is taking for her arthritis, it could also affect her appetite, cause dry mouth, and alter taste sensation, diarrhea or constipation (Edelstein & Sharlin, 2009).

Another factor that could affect Betsys nutritional health status is economic hardship. Income can affect the quality and quantity of food that Elders are able to purchase. The fact that Betsy and her husband have no family support and are living alone also puts them at nutritional risk because depression, loneliness and anxiety also may result in decreased appetite.

Betsys current energy and nutrient needs can be determined by using the Interactive DRI Healthcare Professionals. This showed that even based on her current height and weight her calorie need at age 40 was 1628 and at 79 is 1359 (USDA, 2006). Her BMI is 18.9 which puts her at the low end of the normal weight range (Edelstein & Sharlin, 2009). Her total carbohydrate, fiber and fat also decreased but her protein needs remained the same. Most of her micronutrient needs remained the same except Vitamin D, Vitamin B6, iron and sodium needs were increased and calcium was decreased (USDA, 2006).

At her age, Betsy is at a higher risk for cardiovascular disease and osteoporosis. If Betsy had cardiovascular disease, I would recommend that she reduce her consumption of saturated and trans-fats, increase her folate consumption by eating more high fiber fortified cereals, fruit and leafy green vegetables. To decrease her risk of osteoporosis and the associated bone fractures, I would recommend a varied diet, consuming, low-fat dairy products and calcium and vitamin D fortified foods. Both of these diseases benefit from physical activity and weight-bearing exercise. It would be great if Betsy could get some of her exercise outdoors (Edelstein & Sharlin, 2009).

Nutrition benefits that are available for Betsy if she were to live in a senior center would be the availability of staff to help support her husband in the preparation of meals, shopping and possibility a dining room where they would have social interaction with other seniors. They should provide nourishing, well-balance, palatable meals that meet daily nutritional and special dietary needs. They would probably not be as lonely or depressed because they would be in a setting where they would have other seniors to interact with and her husband would not be as frustrated. Thus possibly helping increase their appetites. Also they would probably have activities that they could do to improve their social interaction. They would not have to worry about finances because the facility could handle all of that for them or provide assistance with it. Many senior facilities also provide exercise programs to assure that seniors are able to maintain their range of motion and their mobility (CANHR, 2008). These benefits must be weighed against possible loss of autonomy, government regulations, restrictions on activities and congregate living. The quality of care and staffing must also be considered (Mueller, Hook and Fleming, 2004). Because safety is the main reason that senior care is offered (Mueller, Hook and Fleming, 2004) and I believe that safety is not an issue at this time, I would not recommend it.

The ethical concerns that are affect the nutritional aspect of Betsys personal rights is surrogate decision making because her husband is the one who prepares her meals and may be limited in his ability to provide well-balanced meals by his lack of nutritional knowledge and cooking ability. She doesnt appear to be able to provide informed consent and her decision making capacity appears to be impaired (Mueller, Hook and Fleming, 2004). Therefore, we only have her husbands assessment to go by.

This presents a challenge because if her husband is not able to communicate with Betsy to find out why she might not be eating or if he is unaware of her preferences, the problem of her losing weight and not getting adequate nutrition will continue and possibly even become worse.

As a nutrition professional, I would try and communicate with Betsy to find out why she doesnt want to eat and what she likes to eat. If that fails, I will try and find out from her husband what her food preferences are and get a 3 day food intake from him to help me determine where she is lacking in nutrients. I would also recommend that her husband look into Meals on Wheels to help him provide at least one balanced meal a day and possibly look into classes that may be offered in nutrition and health though a senior recreation center.

Betsys case is difficult and an elderly person like a child cannot be forced to eat. All that can be done is to try and find out why she does not want to eat and do all that can be done to make her meals and mealtimes as pleasant and enjoyable as possible. Betsy may be choosing not to eat because she consciously or unconsciously feels that her quality of life is not what she wants it to be or because she feels out of control of her life and feels that only place that she has control is with food (Thomas, 2009).

References

CANHR. (2008).Nursing home care standards. Retrieved from http://www.canhr.org/factsheets/nh_fs/html/fs_CareStandards.html

Edelstein, S., & Sharlin, J. (2009).Life cycle nutrition, an evidence-based approach. Jones and Barlett.

Mueller, P.S., Hook, C.C., & Fleming, K. (2004). Ethical issues in geriatrics: A guide for clinicians. Mayo Clinic Proceedings, 79(4), 554562, Retrieved from http://ehis.ebscohost.com.lib.kaplan.edu/eds/pdfviewer/pdfviewer?sid=711a1f4c-ec8e-43a9-8e96-bf6112626848%40sessionmgr13&vid=3&hid=8

Thomas, D. (2009). Anorexia: Aetiology, epidemiology and management in older people.American Psychological Association,Drugs and Aging(26/7), 557-579. doi: doi:10.2165/11316360-000000000-00000 retrieved fromhttp://ehis.ebscohost.com.lib.kaplan.edu/eds/pdfviewer/pdfviewer?sid=153e7faf-e475-42dd-8b19-878ae4d5c952%40sessionmgr114&vid=7&hid=116

USDA. (2006).Interactive dri for healthcare professionals. Retrieved from http://fnic.nal.usda.gov/fnic/interactiveDRI