Geriatric Nursing: Nutrition and Fluid Balance Sandy Mishkin, RN, BC, MSN, MEd ©2008

Caloric Intake Many factors determine how many calories an individual uses: Activity Gender Body size Age Body temperature Emotional status Environmental temperature The caloric needs of an individual decrease with age. In addition, the basal metabolic rate (the rate at which the body uses calories) also decreases due to a reduction in lean tissue and muscle mass as adipose tissue increases. Disease processes also affect an individual’s caloric needs. Some conditions limit physical activity, such as arthritis, and reduce caloric requirements while other conditions, such as infections, increase the body’s caloric needs. For the elderly person, it is desirable to choose foods that are high in nutritional value yet relatively low in calories.

Factors Affecting Nutrition in the Elderly Chronic health problems Alcoholism Sensory changes Pain Medications Difficulty chewing, swallowing, or digesting Malabsorption Cost of food Difficulty getting transportation Challenge obtaining a variety of foods Depression Loneliness Lack of motivation In 2002, the Nutrition Screening Initiative determined the following data on malnutrition in the elderly (Wold, 2008, p.108): 20%-60% for elderly in the community 40%-60% for hospitalized elderly 40%-85% for elderly residing in skilled nursing facilities

Nutrients Carbohydrates Proteins Fats Vitamins Minerals Water Sugars & starches Emphasis on complex form for the elderly Usually foods with other nutrients Proteins Need might increase in the elderly Fats Limit to 25%-30% of daily intake Vitamins Deficiencies in D, B12, B6 Toxic symptoms from the fat-soluble vitamins: A, D, E, K Minerals Calcium Iron Water Dehydration The recommended daily allowance (RDA) is the national standard for determining the nutritional adequacy of an individual’s diet. The food pyramid is a guide for measuring the balance of the diet (text, p.81). It has been modified several times over the years; the current form, called MyPyramid, was developed in 2005. You can go to www.mypyramidtracker.gov for more information on nutrition as well as worksheets to use with your patients. 55% to 60% of daily calories ought to come from carbohydrates. The fiber in complex carbohydrates is particularly important to maintain normal levels of cholesterol and improve colon health. Proteins are made of amino acids and are necessary for tissue repair and healing. Avoid proteins with a high saturated fat content that contribute to high cholesterol. Fats are incorporated into lipoproteins, such as high density lipoproteins (HDL), low density lipoproteins (LDL), and very low density lipoproteins (VLDL), mostly triglycerides. HDL is found in unsaturated fats, that is, non-meat sources, and is the healthiest form of lipoprotein. Vitamins are organic compounds necessary for a diversity of metabolic and physiologic processes. Vitamins are fat-soluble or water-soluble. Vitamin D deficiency is fairly common in the elderly and can contribute to osteoporosis. Vitamin B12 deficiency can lead to alterations in sensation, balance, and memory. A deficiency of vitamin B6 are associated with neurologic and immunologic problems. Vitamin E contributes to immune function. Minerals are inorganic elements. Low calcium levels (hypocalcemia) can reduce bone density while high levels (hypercalcemia) can cause confusion, abdominal or muscle pain, weakness, and anorexia (loss of appetite). Low iron levels contribute to anemia, whose symptoms include fatigue, exertional dyspnea, tachycardia, palpitations, headache, insomnia, vertigo, pallor (especially notable in the mucous membranes), and cool extremities. Two types of anemia seen in older adults are iron deficiency anemia and pernicious anemia. Iron deficiency anemia results from inadequate intake of iron while pernicious anemia is caused by inadequate intrinsic factor leading to poor absorption of B12, necessary for red blood cell maturation in the bone marrow. Older adults generally have less intracellular and interstitial fluid and are at high risk for dehydration. It is essential to maintain fluid balance in the elder, with equal amounts of fluid taken in and eliminated. 2000ml to 3000ml of fluid is the normal range for most adults.

Malnutrition Approximately one-third of the elderly are at risk for malnutrition Numerous factors impact nutritional intake Long-term care facilities Community Nutritional and metabolic changes most commonly observed in the skin, mucous membranes, hair, and nails.

The Importance of Good Nutrition Extremely significant to maintain skin integrity and prevent skin breakdown

References Wold, G. (2004). Basic geriatric nursing (3rd ed.). St. Louis: Mosby. Wold, G. (2008). Basic geriatric nursing (4th ed.). St. Louis: Mosby.