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Prep for Success- Digestion/Nutrition/Diabetes in the Older Adult Is old age a primary cause of digestive problems? Digestion of food and maintenance of nutrition are influenced to a small degree by age- related gastrointestinal changes and to a large degree by risk factors that commonly affect older adults. Although older adults can easily compensate for age-related changes in the digestive tract, they have more difficulty compensating for the many factors that interfere with their ability to obtain, prepare and enjoy food. Is a decline in OLFACTORY FUNCTION an age-related change? Olfactory dysfunction is termed hyposmia or anosmia and diminished sense of taste is called dysgeusia both sense of smell and taste decline w/ age affecting up to 60% of people aged 65 to 79 years and 80% of people aged 80 years and older. What may this decline be a marker for? Researches are exploring whether loss of olfactory sense is an early diagnostic indicator for dementia due to Alzheimer or Parkinson diseases b/c alterations to key brain regions of the olfactory system List other causes of impaired olfaction
- viral infections
- smoking
- chewing tobacco
- poor oral health
- periodontal disease
- chronic rhinosinusitis
- head trauma
- medications (diuretics and antidepressants) What does the ability to TASTE depend on? Ability to taste called gustatory function, depends primarily on receptor cells in the taste buds, which are located on the tongue, palate and tonsils Is a decline in TASTE an age-related change???? IDK Common taste disorders are head trauma, radiation, upper respiratory tract infections, medical conditions (diabetes, hypothyroidism) What may this decline be a marker for?
Recent studies indicate that gustatory function declines gradually in people w/ Alzheimer disease as the condition progresses TEETH AGE-RELATED changes Teeth: Less sensitive to stimuli, more susceptible to fractures Oral Mucosa: More susceptible to infections and ulcerations, dry mouth, cracked lips Altered chewing, swallowing, speaking
- tooth enamel becomes harder and more brittle
- dentin becomes fibrous
- the nerve chambers become shorter and narrower
FUNCTIONAL CONSEQUENCES:
- Less sentitice to stimuli
- More susceptible to fx SALIVA & ORAL MUCOSA AGE-RELATED changes
- Loss of elasticity
- Atrophy of epithelial cells
- Diminished blood supply to the connective tissue FUNCTIONAL CONSEQENCES:
- diminished muscle strength is an age-related neuromuscular change that can have a small effect on mastication and swallowing
- healthy older adults experience only minor changes in swallowing but are likely to develop symptomatic swallowing problems when risk factors are present
- More susceptible to infections and ulcerations List items that you can teach an older adult about dry mouth (p.388)
- Excessive dry mouth may be caused by medical conditions or medication effects and should be evaluated before symptomatic treatment is initiated
- The slowing of garlics emptying is age- related change that can lead to anorexia and inadequate energy intake. SMALL INTESTINE AGE-RELATED degenerative changes may affect immune function and absorption of nutrients such as folate calcium and vitamin b12 and D After chyme passes into the small intestine, liver, and pancreas converts the food substances into nutrients. A process of segmentation moves the chyme backward and forward, facilitating the digestion of food and the absorption of nutrients through the villi in the walls of the small intestine. After the nutrients as absorbed in the small intestine the chyme passes into the large intestine where water and electrolytes are absorbed and waste products are expelled LARGE INTESTINE AGE-RELATED changes
- Reduced secretion of mucus
- Decreased elasticity of the rectal wall Do not significantly affect motility of feces through the bowel, they may predispose the older person to constipation. The livers secretes bile which is essential for utilizing fats. Metabolizing and storing medications and nutrients. The liver has regenerative qualities LIVER AGE-RELATED changes
- Liver becomes smaller
- more fibrous
- blood flow to the liver decreases by approximately one third. Degenerative changes in the PANCREAS as we age can lead to increased susceptibility of older adults to the development of type 2 diabetes GALLBLADDER & BILLIARY TRACT AGE-RELATED changes
- Diminished bile acid synthesis
- widening of the common bile duct
- increased secretion of cholecystokinin, a peptide hormone that contracts the gallbaladder and relaxes the biliary sphincter These changes can lead to increased susceptibility of older adults to the development of cholelithiasis (gallstones)
What condition increases an older adult’s likelihood to have in adequate ORAL CARE? Dementia List CONSEQUENCES (adverse effects) of poor oral care:
- Malnutrition
- Dehydration
- Periodontal disease
- Respiratory infections (pneumonia and aspiration pneumonia)
- Joint infections
- Cardiovascular disease
- Poor glycemic control in diabetes
- Increase risk of stroke and heart attack Is CONSTIPATION an age-related change? ( see above plus p. 363) Explain No, although age-related do not significantly affect motility of feces through the bowel, the may predispose the older person to constipation. PROPORTION OF TOTAL BODY WATER FROM WEIGHT Newborn Baby Older Adult 80% of newborn weight Less than half of older adult weight Go back and look at the bigger picture: Promoting Digestive and Nutritional Wellness in Older adults (p.367): What nursing assessments are needed: usual nutrient intake Oral health Usual eating patterns Risks that affect food preparation, intake, and enjoyment Measures of nutritional status What are the main age related changes? Less efficient chewing Decreased senses of smell and taste Decreased salvia production Slower motility Degenerative changes affecting digestion Daily intake: need fewer but higher quality calories What are the negative functional consequences: Difficulty procuring and preparing food Less enjoyment of food Less absorption of nutrients
Cardiovascular diseases (e.g., arrhythmias or myocardial infarction) • Respiratory diseases (e.g., chronic obstructive pulmonary disease) • Neurologic disorders (e.g., parkinsonism, cerebrovascular accident) • Metabolic disturbances (e.g., dehydration, electrolyte imbalances) • Musculoskeletal problems (e.g., osteoarthritis) • Transient ischemic attack • Vision impairments (e.g., cataracts, glaucoma, macular degeneration) • Cognitive impairments (e.g., dementia, confusion) • Psychosocial factors (e.g., depression, anxiety, agitation) POLYPHARMACY using 5 or more medications DEPRESSION depressed mood or loss of pleasure/ interest in activities COGNITIVE IMPAIRMENT person has trouble remembering, learning, concentrating PERSISTENT PAIN chronic pain- lasts for more than 3 hours From FRAIL Diabetes Document: Define A1C goals in older adults: Create a scenario of a frail elder with hyperglycemia (Glucose, S/S & nursing interventions). Create a scenario of a frail elder with hyperglycemia Glucose: >300 w/or w/o sx >200 w/ signs
S/sx: fruity smell, SOB, dry mouth, confusion, N/V, weakness nursing interventions: 1) insulin, oral hypoglycemics 2) assess for infection, abnormal dietary consumption, un-dx DM 3) call provider Create a scenario of a frail elder with hypoglycemia (Glucose, S/S & nursing interventions). Create a scenario of a frail elder with hypoglycemia (Glucose, S/S & nursing interventions). Glucose: <70 w/or w/o sx <100 w/ signs S/sx: inc HR, fatigue, pallor, “shakes”, anxiety, sweating nursing interventions: give 15g carbohydrate (e.g. 4oz fruit juice with 6 saltine crackers) Define DYSPHAGIA (p.371 & Try This article in Supplemental Resources on Moodle) is a swallowing disorder characterized by any or all of the following symptoms: Unsafe swallowing, residue remaining after swallowing Increased time to swallow Lack of coordination What does it increase the risk for?
- Frailty
- malnutrition
- Dehydration
- Functional decline
- Aspiration and aspiration pneumonia especially in those over 80 and older What are some SIGNS/SYMPTOMS of DYSPHAGIA?
- Unsafe swallowing
- residue remaining after swallowing
- increased time swallowing
- lack of coordination when swallowing
- drooling, coughing during meals,
- voice changes following meals,
- gurgling sounds in the throat,
- upper respiratory tract infection, wet lung sounds,
language pathologists, dietary professionals, primary care practitioners, and all levels of nursing staff. Speech–language pathologists are the health care professionals who usually assume primary responsibility for recommendations, but nurses are responsible for initiating the referrals in a timely manner and implementing interventions.
- Speech–language pathologists may recommend the following strategies: adaptive equipment, muscle-strengthening exercises, postural adjustments (e.g., chin-down or chin-tuck maneuver), swallow maneuvers, diet modification (e.g., altered viscosity, thickened liquids).
- Additional interventions include resting for 30 minutes before eating,
- sitting upright or with head of bed at 45°,
- allowing at least 30 minutes for eating or assisted feeding, alternating small amounts of solid and liquid foods, and minimizing distractions.
- Adjust rate and speed of oral intake, and offer food only after the previous mouthful has been swallowed. Why oral care? Good oral care is imperative for all patients with dysphagia to prevent consequences such as aspiration and aspiration pneumonia Do tube feedings prevent aspiration? Review Video at 20:47 minutes & 31: minutes = 11 MINUTES) No, they are risk factors for aspiration pneumonia QUALIFICATIONs for Hospice Benefit: GI Weight: unintentional weight loss despite treating with supplements and appetite stimulants, tube feedings and a serum albumin of <2.5 mg/dl Serum Labs: <2.5mg/dl If on Tube Feedings: they can qualify if they have 3 or more aspiration pneumonia in the past year Nausea, vomiting, and diarrhea (chronic) not treatable they have tried treating and are still symptomatic Want to remove the tube feeding, hospice well offer the support so that it is more comforting to remove the tube feedings when it happens Dysphagia without Tube Feedings and no plans to get one Pureed diet/ thickened liquids
History of aspiration (resp congestion, frequent coughing, gurgling or pneumonias) no plans for tube feeding even with weight loss or symptoms Look at the albumin and it will be low
