Page 70 Complete Your CE Test Online - Click Here ● ● Decrease in both the size and number of gastric glands and mucous membranes and reduction in gastric acid production can lead to atrophic gastritis (irritation of the stomach due to atrophy). ● ● Decrease in gastric acid production results in a decrease in the acidity of the stomach. Since iron and vitamin B12 need an acid environment for proper absorption, this lack of acidity can inhibit the absorption of both of these substances, leading to anemia. ● ● Peristalsis in the intestines slows as an adult ages. If this is compounded by a lack of fluid and fiber intake, lack of exercise or chronic illnesses, constipation can and often does occur. ● ● Aging diminishes thirst drive. Because of this, the fluid intake of older adults is often inadequate. Compounded by the aging kidney’s inability to efficiently concentrate urine, this lack of fluid intake often leads to dehydration in older adult patients. If older adult patients experience vomiting and/or diarrhea, excessive sweating, or excessive urination due to diuretic therapy, they must be carefully monitored for signs and symptoms of dehydration and hyponatremia. Such symptoms include dry skin, poor skin turgor, dark-colored urine, headache, dizziness, dry mucous membranes, increased heart rate and respirations, alerted levels of consciousness and confusion. ● ● Wrinkled skin results from loss of elasticity and turgor. Skin gradually thins and loses density, making it more susceptible to bruising and tears. ● ● Older adults often experience vision changes that compromise their sight. These changes include cataracts, glaucoma, and macular degeneration as well as a generalized deterioration of vision. Such changes can make it difficult, and unpleasant, for them to shop, prepare food and, at times, eat. This is also a risk factor for falls, especially on shiny floors, and during driving, especially at nighttime. Reduced vision may make it necessary for someone to transport older adults to the grocery store, and help them to purchase food and even prepare it. Collaboration with case management or licensed medical social workers can assist nurses in locating community resources to assist with these issues. Assessment tip: Older adults are often afraid of being urine incontinent. Because of this fear, patients may limit their fluid intake, which further increases the risk for dehydration. Nursing consideration: Incontinence is embarrassing and, for some people, even shameful. Be alert to the possibility that older adults may severely limit their fluid intake to avoid incontinence. Nurses must help older adults to realize that they need to stay hydrated and that lack of fluid intake can adversely affect their health. Intervene appropriately. Teach adults to limit fluid intake after supper to help avoid night incontinence but to have an adequate fluid intake during the day. Teach bladder training techniques as appropriate. Socioeconomic impact on nutrition It is important that socioeconomic factors be included as part of the nutritional assessment of the older adult patient. Nutritional intake is closely linked to socialization. Where we eat, how we eat, and with whom we eat can have as much of an impact as what we eat. When assessing the social aspects of nutrition, consider the following issues [9,10,11]: ● ● With whom does the older adult eat? If older adults eat with others, is it in a home setting or long-term care setting such as assisted living? If they eat with others, is the atmosphere congenial? For example, if older adults are living with adult children, are they made to feel welcome and a part of the family’s social interactions? If they eat in a long-term setting, in what type of an environment are meals served? Is the environment conducive to enjoying a meal? ● ● If the older adult lives alone, is there easy access to a grocery store? Does the older adult drive or is it necessary for them to find transportation? Is the older adult aware of public transportation options and how to access them? If needed, is the older adult aware of options such as “Meals on Wheels” or other similar community services? ● ● If older adults have access to a grocery store, are they physically capable of shopping and carrying bags of groceries or is help needed? If help is needed, who is available to provide help? Does the older adult have the visual acuity to read and understand food product labels and prices? Do they have the mental acuity to make appropriate food choices? Another important aspect of nutritional assessment is the financial impact of food purchases [9]: ● ● Do the older adults have enough money to purchase healthy foods? If not, they may purchase whatever “fits” within the budget, even if such foods are not recommended for a healthy diet. For example, do they purchase microwave dinners that are high in sodium because they are cheap and easy to prepare, even though sodium intake may need to be limited? ● ● Do the older adults need help managing money? They may have adequate financial resources, but are unable to live within their budgets due to uncertainty over prices or decreasing mental acuity. Does the older adult have anyone to help them manage money? What family or community resources are available to assist with money management? If there is not enough money to purchase food, the older adult needs to be referred to agencies that may be able to help or to make referrals. Possible sources are veterans’ associations, area agencies on aging, church groups, and/or government assistance agencies. Nursing consideration: Always include socioeconomic evaluation as part of physical assessment. These areas influence every aspect of health. Also note that women are twice as likely as men to live in poverty [9]. Nutritional requirements Nutritional requirements for older adults correlate with the physical changes that accompany aging. Older adults have generally decreased caloric needs due to decreased physical activity. However, the need for vitamins and minerals does not decrease. In fact, based on food intake, there may actually be a need for vitamin supplements [9]. The U.S. Department of Agriculture has published nutritional guidelines called MyPlate for Older Adults, which replaces the Modified MyPyramid for Older Adults. These guidelines promote physical activity as well as provide healthy eating recommendations [18]. Recommendations from the MyPlate for Older Adults include teaching your patients to [18]: ● ● Add flavor to foods using spices and herbs instead of salt. ● ● When shopping for packaged foods, look for low-sodium options. ● ● Add sliced fruits and vegetables to meals and snacks. Nursing consideration: Chopping and slicing foods may be a problem for some older adults. In these cases, tell patients to look for pre-sliced fruits and vegetables when shopping for groceries [18]. ● ● If medications are affecting your appetite and make you less likely to eat, ask your doctor to suggest other medication options. ● ● Drink three cups of fat-free or low-fat milk throughout the day. Nursing consideration: If patients cannot tolerate milk suggest that they try to eat small amount of yogurt, hard cheese, or lactose-free foods [18]. ● ● Drink water instead of sugary drinks. ● ● Eat foods fortified with vitamin B12 such as fortified cereals. ● ● Maintain a healthy body weight. ● ● Engage in at least 2 ½ hours of moderate-intensity physical activity every week. A good plan is to be active at least three days per week. Nursing consideration: All adults should consult with their healthcare providers before beginning an exercise regimen to make sure that they are fit enough to engage in weekly fitness programs. Tabloski (2009) identifies the following healthy eating tips for older adults [9]: ● ● Reduce sodium intake to help reduce/prevent water retention and hypertension. ● ● Enjoy good fats such as olive oil, salmon, and walnuts, and other products with monosaturated fats while avoiding trans fats.