nursing.elitecme.com Page 71 Complete Your CE Test Online - Click Here ● ● Increase fiber intake in the form of raw fruits and vegetables and whole-grains to avoid constipation. ● ● Eat whole grains as much as possible for long-lasting energy and stable levels of insulin. ● ● Check food labels for hidden sugars. For example, fast foods, canned soups and vegetables, and frozen dinners may have added sugar. ● ● Purchase fresh or frozen vegetables and low-carbohydrate or sugar- free options for products such as bread, pasta and ice cream. ● ● Eat a variety of foods to keep meals appetizing and interesting. ● ● Do not rush through meals. Enjoy mealtimes. Nursing consideration: Vitamins D and B12 and calcium are the only nutrients that are routinely considered as supplements for older adults [9]. Caution adults that any and all supplements (including vitamins, minerals, weight loss products, and herbal preparations) that they are, or are considering taking, must be reported to their healthcare providers. Such items can adversely interact with prescription drugs or with each other. Such items may also build to toxic levels in the body. Vitamin D is necessary to maintain bone mineralization and adequate levels of serum calcium. Without adequate intake of vitamin D, older adults are prone to poor bone mineralization, and osteomalacia. Lack of vitamin D has also been linked to some serious diseases such as dementia, prostate cancer, hypertension, and even cardiac disease. The modified MyPlate for Older Adults recommends an approximately 600 IU/day supplement of vitamin D in addition to three diary servings per day [9,18]. Nursing consideration: Adequate intake of vitamin D is an important factor in reducing the risk of falls in older adults. Good food sources of vitamin D include fish and fish oils, fortified milk, egg yolks and beef liver [9]. Another good source of vitamin D is exposure to the sun. Individuals that are homebound are at greatest risk for vitamin D deficiency. Calcium is also essential for the maintenance of bone mineral density and bone health. The recommendation for calcium intake is 1,200 mg per day for adults over 50 years of age. Note that inadequate calcium and vitamin D may lead to osteoporosis. Inadequate calcium also increases the risk for periodontal disease [9]. Vitamin B12 is necessary for appropriate cell division and to maintain the myelin sheaths of the central nervous system. United States dietary guidelines recommend that adults over the age of 50 eat fortified foods or take a vitamin B12 supplement because, with aging, there is decreased absorption of this vitamin linked to atrophic gastritis and altered gastric pH [9]. Assessment tip: Remember that older adults should not simply add vitamins to their diet. Any additions of vitamins, minerals or other supplements should be under the supervision of health care professionals. Fat-soluble vitamins, such as D, E, K and A are stored in the body and not excreted the way water-soluble vitamins are. Taking large amounts of fat-soluble vitamins could lead to toxic levels and adverse effects [9]. Nursing consideration: Alcohol ingestion can have an impact on nutrition, especially for deficiencies of thiamin, riboflavin, foliate and vitamin B6 because alcohol can inhibit nutrient absorption, irritate the stomach and affect metabolism [9]. In cases of significant alcohol use, alcohol may actually be ingested in place of or in preference to food, thus further compounding its negative effects. In summary, a nutritional assessment is critical to identifying problems and correcting them in the older adult. Nurses must evaluate nutritional status carefully, taking into consideration not only the types and quantities of food being ingested, but the social and economic factors that influence nutrition as well. Pharmacology assessment and the older adult Mrs. Burns is 80 years old. Her physician prescribed Benicar, 20 mg daily, for hypertension. During a routine checkup, her blood pressure was still significantly elevated. When questioned, Mrs. Burns admitted that she only takes the Benicar four times a week instead of daily. She says she does this to save money and to “make the pills last longer.” Mr. Lord is 70 years old, has had epilepsy for many years, and takes Dilantin to control his condition. He recently had a seizure, the first he has had in many years. During a thorough evaluation, it was discovered that Mr. Lord recently began to take ginseng, an herbal supplement, to “increase my energy.” He said, “My daughter takes it and says it really helps her. I know it can’t hurt me because it’s ‘natural’ and not really medicine.” What neither Mr. Lord nor his daughter realized is that ginseng and Dilantin interact, and that ginseng reduces the effectiveness of Dilantin [17,19]. The preceding scenarios illustrate two common problems with medication adherence among the older adults. Financial concerns may cause an older adult to take less of his or her medication than prescribed in an attempt to, as Mrs. Burns says, “make the pills last longer.” Sometimes it may be difficult to make trips to the pharmacy, especially if the older adult’s physical or mental health makes driving impossible. Another issue which impacts medication compliance with increasing frequency is the addition of herbs or other supplements to medication regimens without the knowledge or consent of health care providers. Many people believe that non-prescription agents such as aspirin, herbal supplements, vitamins and minerals are harmless and can be taken without medical supervision. They do not realize that these agents can interact with prescription drugs and cause adverse effects. They also fail to realize that these agents may be harmful by themselves as well. When conducting a pharmacological assessment of the older adult, start by determining what prescription medications they are taking. Reconcile the list of medications and make sure you have the most current information. Find out how much the patient and, if appropriate, a family member, knows about the patient’s medication regimen. Important questions to ask include [9,10]: ● ● What are the names of the medications you are taking? ● ● When do you take your medications? Do you take your medications with food or something to drink? What kinds of food and drinks do you take with your medication? ● ● What kinds of side effects occur when you take your medicine? If side effects take place, what do you do about them? ● ● Do you have insurance that covers some of the cost of your medicine? Do you ever have trouble affording the cost of your medicine? ● ● Have them show you their medications, if possible. If you feel there is some discrepancy you may want to count the pills in the bottle to see if they may be taking too many or none at all. Inquire about the other medications they are taking that have not been prescribed by their provider such as: over-the-counter (OTC) medications; herbal supplements; illicit drugs (such as meth or marijuana); or medications “borrowed” from family or friends. Explain that non- prescription drugs and prescription drugs can interact and cause harmful side effects. Emphasize that they should not take other medicines without the knowledge and approval of their healthcare providers. Nursing consideration: Provide simply written instructions regarding what medications the patient is taking, the actions/effects of the drug, when and how to take them, common side effects, and what to do if side effects occur. If necessary, a family member, friend, or caretaker should be involved to assist the patient in adhering with their medication regimen. Be sure instructions are written in terms and language that patients and families or caretakers can understand. The body’s ability to metabolize drugs and use them effectively decreases with age. Here are some body changes that influence the effectiveness of medication in the older adult [9,14,17]: ● ● Body water content: As the body ages, there is as much as a 15 percent decrease in water content, and an increase in body fat. The extra fat means that the effects of fat-soluble drugs may be increased, and the reduction in water content means that water- soluble drugs can exist in more concentrated amounts.