Page 69 Complete Your CE Test Online - Click Here ● ● Patient complains that there is always a feeling of something “stuck” in the throat. ● ● Swelling of the jaw or mouth that changes the way dentures fit. ● ● Pain in the ear or when chewing or swallowing. ● ● Changes in the patient’s voice. Assessment tip: When inspecting the mouth and oral cavity, make sure that extra light is available to allow good visualization of the tongue, buccal mucosa, lips, teeth, and gums [15]. It is important to be aware of risk factors for the development of oral issues. Diseases or other factors that can cause oral problems will affect the patient’s ability to consume food and maintain proper nutrition. Issues and factors that increase the risk for oral issues include [9,14]: ● ● Diseases such as cancer, HIV/AIDS, diabetes mellitus, stroke, dementia, renal failure, or viruses such as herpes simplex. ● ● Deficiencies of vitamins including B6, B12, folic acid, C, K, A, and niacin. ● ● Changes that accompany aging such as: thinning tooth enamel; lines and/or cracks in teeth; thinner and smoother mucosa that loses elasticity; and a decrease production of saliva. ● ● Facial droop following an ischemic stroke that can cause dysphagia. Assessment tip: After inspecting the mouth and oral cavity, palpate the lymph nodes in the neck. Lymph nodes should be small, smooth, round and painless. Tenderness may indicate infection. Enlarged, fixed, and/ or hard lymph nodes require further evaluation as this may indicate a serious problem, such as a malignancy. Also observe the neck for any lesions, moles or bulging areas [4]. Nursing consideration: Another important risk factor for oral problems (and corresponding nutritional problems) is financial issues. Older adults living on a fixed and/or inadequate income may not have the money to schedule regular dental visits, or purchase dentures and oral hygiene products. Persons with financial problems should be referred to local dental practices that offer services at reduced rates. They should also be helped to identify stores where dental supplies may be purchased at minimal costs (such as dollar stores). Transportation may also be an issue. Find out whether patients have access to public transportation or if they have family members or friends who are able to help them get to dental visits and purchase oral hygiene supplies. Remember that assessment of the oral cavity and mouth involves much more than physical assessment techniques. Finances, mental acuity, transportation and family/friend assistance play important parts in good dental hygiene. Taste assessment After the age of 70, some adults begin to experience a reduced sense of taste, called hypogeusia. The ability to perceive the tastes of salt and sweet are usually the most affected. Taste buds are located on the tongue, epiglottis, larynx and the first third of the esophagus [9]. In addition to the normal changes of aging, many factors contribute to a diminished sense of taste. These include poor dental hygiene, broken teeth or dentures, and dry mouth. There are also quite a few medications that adversely affect taste. These include [9,17]: ● ● Antibiotics. ● ● Anti-cancer drugs. ● ● Anticholenergics ● ● Antidepressants. ● ● Antihistamines. ● ● Antihypertensives. ● ● Cholesterol-lowering drugs (e.g., statins). ● ● CNS stimulants. ● ● Decongestants. ● ● Drugs used to treat Parkinson’s disease. ● ● Lithium. ● ● Muscle relaxants. ● ● Thyroid medications. ● ● Tricyclic antidepressants. Nursing consideration: Not every drug in the preceding classification necessarily alters taste. Be sure to determine which medications patients are taking and check to see whether these drugs are having an impact on the sense of taste. Sometimes the sense of taste can be affected by the environment in which a patient eats. Older adults who live alone may not be as interested in preparing or eating meals as they may once have been. Encourage patients to eat in a comfortable, relaxed surrounding as much as possible and to take the time to enjoy a meal. Help patients to select foods that are easy to prepare, nutritious, and that they enjoy. Assessing the sense of smell Problems with the sense of smell (olfactory) are quite common (even more common than problems with taste) in older adults. In fact, about half of adults over the age of 60 experience alterations in their sense of smell [9]. The medical term for reduced sense of smell is hyposmia [9]. A lack of the sense of smell can be dangerous. The inability to smell smoke, gas or spoiled food can lead to illness or death. If severe enough, hyposmia can reduce appetite to the point that the older adult becomes malnourished [9]. EBP alert! Research shows that nearly 50% of all adults over the age of 60 have changes in their sense of smell [9]. Thus it is important that nurses and other healthcare providers carefully assess the sense of smell and be aware that changes in this sense can have an impact on nutrition (i.e. the inability to smell food can affect appetite and nutritional intake) as well as safety (e.g., the inability to smell smoke or gas in the home can result in a dangerous situation. There are a number of factors that contribute to hyposmia. These include age-related changes, such as reduction in the number of sensory cells, injury to the olfactory mucosa, or alterations to the structure of the upper airway hypothalamus and olfactory tract [9]. Other factors include nasal congestion, smoking, and drug use [14]. Sometimes nurses and physicians simply assume that a decreased sense of smell is due to a person’s age. But it could also be the result of damage to the olfactory nerve (Cranial Nerve I). It is important to assess the function of this nerve by first checking to be sure that both nostrils are patent and unobstructed. Then ask the patients to close their eyes. Occlude one nostril and place a familiar, strong-smelling substance (such as coffee/ coffee beans, peppermint or orange peel) under the nose and ask them to identify it. Then do the same thing with the other nostril. The patients should be able to identify each smell correctly. If olfactory nerve damage is suggested, the patient will need further evaluation [14]. Assessment tip: Be sure that you use scents with which patients are familiar. They can’t identify a scent if they have never smelled it before. Body composition in the older adult There are a number of changes in body composition in the older adult that can have an impact on nutrition and overall health. One such change is the loss of lean muscle mass that occurs with aging. The loss is due to a reduction in physical activity, hormone production and alterations in nutrition. If caloric intake continues at the rate consumed at a younger adult, the older adult will gain weight in the form of fat, not muscle [9]. Loss of muscle mass is associated with a reduction in strength and endurance and an increased risk for falls. Research indicates that even a ten percent loss of muscle mass is linked to increased mortality in older adults [9]. Other body changes that directly or indirectly influence body composition include [9,14]: ● ● Loss of bone mineral density, which increases the risk for osteoporosis in both men and women. Loss of bone density increases the risk of fractures as well as the risk of falls.