Geriatric Nutrition: How Dietitians can make a positive impact on our

aging population Meridith Paterson, MS, RDN,CSG, LDN

patersonmm@upmc.edu West Virginia Academy of Nutrition and

Dietetics

Learning Objectives

• Recognize the challenges of the aging population and the direct impact on nutrition outcomes.

• Understand the role the dietitian in improving not only nutrition but quality of life as well.

• Understanding the importance of learning each individual’s needs and wishes and not a one size fits all approach.

• Learning Codes: 4190, 5100, 5430

Challenges of the aging population….

Aging Population

• Between 2012 and 2050, the United States will experience considerable growth in its older population (65 years and older).

• From 43.1 million (2012) to 83.7 million (2050)

• Baby Boomers are a significant contributing factor to the increase in the older population.

Ortman, Jennifer M., Victoria A. Velkoff, and Howard Hogan. An Aging Nation: The Older Population in the United States, Current Population Reports, P25-1140. U.S. Census Bureau, Washington, DC. 2014.

Challenges Facing the Elderly

• Physical Changes

• Cognitive Changes

• Environmental Changes

• Financial Changes

Physical Changes

• Common changes noted: – Vision Impairment

– Hearing Impairment

– Taste Bud changes

– Sense of smell

– Sleep Disturbances

– Oral Changes (tooth loss, dentures, implants)

(May also have physical changes related to medical condition/ disease process)

Cognitive Changes

• “Slowing down”

• Forgetfulness

• Memory may be effected related to dementia, depression, delirium and other medical conditions.

Oral Care

• Approximately 25% of those 65 years and older have no natural teeth.

• Diet and nutrition intervention for older adults with compromised oral integrity must target individual needs based on current diseases and disabilities.

• Dietetics practitioners must address oral health as part of nutrition diet and screening, assessment, intervention, and monitoring of older adults.

• Position of the Academy of Nutrition and Dietetics: Oral health and Nutrition. 2013;113(5).

Environmental Changes

• No longer to be able to maintain their home

• Moved to new environment (Apartment, move in with a family member, SNF, PCH)

• May require giving up driver’s license

• Giving up independent activities (cooking, shopping, going to church, etc.)

Financial Changes

• May have went from two incomes to one income due to death of spouse or partner.

• Income may not cover current expenses (utilities, food, medicine, car, etc.)

• Increase cost of prescriptions

Direct impact on Nutrition

• Food insecurity

• Isolation

• Depression

• Chronic diseases

• Dependent of others- decrease in independence

• Oral hygiene (ill fitting dentures, mouth sores, thrush)

Other areas to consider

• Education Level (Can they read?)

• Evaluate the basics:

Do they have a working kitchen that is accessible to them? Do they have support (family/ friend/ church) to help? Can they manage their finances?

The role of the Dietitian…

Role of the RDN

• To look at the entire picture when it comes to nutrition

• Think outside the box

• Look at each person individually and nutrition plan should not be a one size fits all approach.

EOL Nutrition Issues

Dietitian's Role

• Active role in educating and advocating for our patients. Dietitians are part of the palliative/ hospice team.

• The dietitian should talk with the patient and/or family member about wishes prior to a crisis. Be Proactive!

• Schedule family meetings to discuss what the patient would want so that everyone is on the same page.

• The goal is to provide an opportunity for patient to discuss his/ her wishes and to provide comfort and dignity at the end of life by honoring what they would want.

To Feed or Not to Feed?

• Dietitian to educate patient and/or caregiver on palliative and/or EOL nutrition related issues and provide support.

• Tube feedings, IV hydration, MBS studies

• Issues surrounding feeding at the EOL.

• The “waiver” to go against what is recommended- is this valuable to complete?

Dietitian’s Role

• Liberalize diet ( this can be difficult for family members- diabetics)

• Assess for constipation which may be related to pain medication, decrease mobility, inadequate fluid intake

• Medications which may have negative effect (i.e. vitamins/ minerals may increase GI distress) recommend to discontinue any unnecessary medications

EOL Strategies

• Offer comfort/ pleasure foods (encouraging family members to provide favorite foods)

• Assess oral hygiene (for the demented patient cleaning their mouth before and after meals)

• Offering smaller portions

• Offering one food at a time

• Monitoring for pain and constipation

Conclusion

“To make a difference in someone’s life, you don’t have to be brilliant, rich, beautiful, or perfect. You just have to care.”

Mandy Hale

Questions???