Nutrition Promotion: Nurses Play a Crucial Role of Malnutrition Prevention in the Elderly

“Thousands of people are starving in the midst of plenty from want of attention to the ways which alone make it possible for them to take food” (Murray, 2006, p. 18). “Frail older adults are particularly vulnerable to both developing malnutrition and succumbing to its consequences, which are significant in this group “(Booth, 2005, p.26). The enjoyable aspects of eating diminish as people age. The causes for this may be the result of illnesses, age-related changes, social, psychological, and economic factors. All of these issues lead to the inadequate consumption of food or malnutrition in older adults. According to Association of Community Health Councils for England, malnourished patients are more likely to experience complications and die in spite of medical advances. Since malnutrition can lead to severe health outcomes and reduce healing in older adults, nurses should educate them about a healthy diet and adapt strategies to encourage their food intake to decrease the risk of malnutrition in elderly. In order to control the problem in the community and hospital settings, the nurse may implement several strategies: use the Malnutrition Universal Screening Tool, implement protected mealtimes, and work to restore appetite in older adults.
Nutrition is a basic human need, which does not always get fulfilled and is taken for granted. “The latest national statistics reveal that three percent of older men and six percent of older women in the community are underweight, rising to 16 percent and 15 percent in care homes” (Holmes, 2006, p. 50). Up to forty percent of the elderly admitted to the hospital are malnourished. At first look, the data appears to show a small percentage, but it represents a significant number of people. The concept of malnutrition is related to improper and inadequate consumption of food. Practice shows that underweight adults usually have a history of decreased appetite, inadequate dentition,
electrolyte imbalance, dry skin, bruising, weakness and fatigue. A Nutritional Survey in 1998 found that the average seventy-five year old had only 15 natural teeth. Lactose intolerance, lack of ability to prepare a meal, or viewing cooking for one as a waste of time may be contributing factors to the malnourishment in older adults. In the hospitals, undernutrition is often unrecognized and, as a result, goes untreated. A lack of emphasis on nutrition may lead to failure to recognize actual nutritional needs or identify those with low nutritional intake. It is the nurse’s responsibility to recognize malnutrition and minimize the chances of its occurrence.
One strategy that nurses can use is Malnutrition Universal Tool (MUST). MUST is an easy-to use screening tool that helps to identify people who are at nutritional risk. The tool uses five steps. In step one, height and weight are measured to calculate BMI (Body Mass Index); in the second step the percentage of unplanned weight loss is noted; in the third step, establishment of acute disease is performed; in the steps four and five the score calculations are done. Based on the score from step four, the management guidelines are developed. Usage of this particular screening tool by a nurse during a routine assessment might minimize the chance of overlooking of malnutrition among elderly population. It may also “help to tailor health promotion advice to individuals to improve overall health and quality of life” (Neno, 2006, p. 65).
In the hospitals, nurses might also implement protected mealtimes. The key principles of this strategy lie in the avoidance of unnecessary interruption by the nurses or supportive staff during the meal hours in the hospitals, creation of a quiet and relaxed atmosphere, providing environment appropriate for eating, and emphasizing the
importance of mealtimes to nursing staff and relatives of the patient. An unwelcoming hospital atmosphere, lack of food choice, and social isolation might diminish the elderly’s appetite as well. The consultation of a hostess might be required in order to create the relaxed and welcoming environment for eating. In order for this strategy to be successful a collaborative approach to the strategy is required.
Due to physiological changes that take place in older adults, loss of appetite is unavoidable. Restoring appetite and promoting salivation in older adults is one of the strategies that help to minimize the risk of undernutrition. “The mechanisms regulating appetite in the elderly are complex and vulnerable to a host of pathologic processes, making anorexia a challenging clinical entity to manage” (Noll, 2004, p. 27). A variety of approaches are used to restore and stimulate the appetite in the elderly. Encouraging social dining, using herbs for seasoning and lemon to enhance flavor, and sucking on ice cubes help to enhance the taste qualities of the meal. According to Noll, medications can also be used to promote appetite and weight gain. Megestrol acetate, for example, is a progesterone agent that may work through alterations in central nervous system neurotransmitters or through suppression of cytokine production and adding fat mass out of proportion to muscle mass. In addition, chronic and acute medical problems can contribute to poor appetite and need to be stabilized whenever possible.
Malnutrition in the elderly is a common problem, which often goes undiagnosed and undertreated. Implementation of easy to use Malnutrition Universal Screening Tool during the routine examination, protected mealtimes at the hospital settings and restoring appetite in older adults by encouraging social dining, enhancing flavor of food, and
administering medication by a nurse may decrease and in the end eliminate the occurrence of malnutrition in elderly.
Intervention # 1
Nurses need to use Malnutrition Universal Screening Tool (MUST) to identify the elderly who are at nutritional risk.
Disadvantage # 1
Discrimination to use the screening tools at the assessments by the nurses or any other healthcare professionals at any particular clinic or hospital. Nutritional screening is not a mandatory requirement. According to Neno (2006), nutrition is rarely included in older people’s screening programs. Therefore, MUST tool often fails to identify the malnourished patients due to lack of usage by healthcare professionals.
Disadvantage # 2
Lack of education and training for medical and nursing staff on the purpose of usage the screening tools and its result’s interpretations. “Although, the nurses are ideally placed to carry out such screening, research has indicated that they do not make the same interpretations of nutritional status as dietitians” (Holmes, 2000, p.44). It is obvious that inadequately read results by the nurse might be the reason for failure to identify the malnourished patient.
Intervention #2
Restoring appetite and improving salivation in older adults through encouraging social dining, using herbs for seasoning to enhance flavor, and sucking on ice cubes to help to enhance the taste qualities of the meal is the one of the strategy that is useful in minimizing the risk of undernutrition in older adults.
Disadvantage #1
The economic and social status of older adults might be the barriers to the promotion of adequate food consumption in older adults. According to Neno (2006), older adults diminish the consumption of food to one time a day with the purpose to save some money; shopping may become difficult as out-of-town shopping centers replace local shops, perhaps increasing expenditure and, in turn, restricting availability of fresh foods (eg fruit, vegetables), particularly for those with physical disabilities or restricted transport. All of the factors, mentioned above, interfere with the major goal as to restore the appetite in the elderly.
Disadvantage #2
The aging population is susceptible to developing the dry mouth due to the physiologic changes (xerostomia). Saliva lubricates and protects the mouth from microbial infections and plays a critical role in daily oral functions. Without adequate amounts of saliva, normal oral functions are compromised and, as a result, quality of life may be negatively affected. According to the Journal of Royal Society for the Health Promotion, there are a lot of products available on the market to manage the dry mouth; however, it is pointed out that the products, which promote salivation do not last for a long time.
References
Booth, J (2005) Implementing a best practice statement in nutrition for frail older people: part 2. Gerontological Care and Practice. 17(1), 22-25. Retrieved April 11, 2007, from Expanded Academic ASAP database.
Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 21, (3), 50-54. Retrieved January 10, 2008, from Expanded Academic ASAP database.
Holmes, S. (2000). Nutritional screening and older adults. Nursing Standard 15, (2), 42-44. Retrieved May 8, 2008 from Expanded Academic ASAP database.
Matear, D. (2005). Effectiveness of saliva substitute products in the treatment of dry mouth in the elderly. The Journal of the Royal Society for the Promotion of Health 125 (1), (35-41), Retrieved May 8, 2008, from expanded Academic ASAP database.
Murray, C. (2006). Improving nutrition for older people. Journal of Nursing Older People, 18 (6), (18-22). Retrieved April 11, 2007, from Expanded Academic ASAP database.
Neno, R. & Neno, M. (2006). Promoting a healthy diet for older people in the community. Journal of Nursing Standard, 20(29), 59-66. Retrieved April 11, 2007, from Expanded Academic ASAP database.
Noll, D. (2004). Restoring appetite in the elderly. Journal of Clinical Geriatrics, 12(2), 27-32. Retrieved April 28, 2007 from Directory of Open Access Journals database.