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SE C T I O N NIN E - M E E T IN G T H E NU T RI T I O N A L N E E DS O F SE NI O RS

This section deals with nutrition and diet. The Home Care Assistant will learn about the food guide pyramid, dietary guidelines, servings, special diets, eating practices and factors which influence nutrition, particularly as they relate to seniors. This information will enable Home Care Assistants to provide nutritional services to clients such as meal planning, food preparation and food shopping. Nutrition Nutrition is a process in which food material is taken into the body and utilized. Foods that are great sources of nutrition are called nutrients. There are six different types of nutrients:

carbohydrates; fats; proteins; vitamins; minerals; and, water.

Nutrients are vital to health because they:

give energy; promote growth; help repair body tissues; and, regulate body functions.

People need energy for all activities, including sleeping. The energy used is called calories. A calorie is a measure of the energy content in food. The more calories a person consumes, the grater the amount of energy he/she will have. Dietary Guidelines Dietary guidelines were established to improve health and reduce the risk of disease, especially high blood pressure, heart disease, stroke, type 2 diabetes and cancer. There are seven guidelines for improving health and preventing disease:

Eat a variety of foods to get all the nutrients needed. Balance the food eaten with physical activity to reduce or maintain weight and to reduce the chances

of developing diseases. Include a lot of grains, fruits and vegetables in the diet, as they provide vitamins, minerals and fiber.

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Choose a diet low in fat, saturated fat and cholesterol. Limit sugars in the diet, as they have no other nutrients and can keep healthier foods out of the diet.

Sugars can also cause tooth decay. Choose a diet with moderate amounts of salt to help reduce the risk of high blood pressure. Drink alcohol in moderation. i.e. two drinks per day for men and one drink per day for women.

Alcohol supplies calories but few or no nutrients. Food Guide Pyramid The Food Guide Pyramid is an outline of what should be eaten each day for optimum health. It is a general guide that enables people to select foods according to their individual tastes and, at the same time, ensure that their nutritional needs are being met. There are five major food groups emphasized in the Food Guide Pyramid:

milk, yogurt and cheese meat, poultry, fish, dried beans, eggs and nuts vegetables fruit bread, cereal, rice and pasta

There are three levels in the Food Guide Pyramid: Top Level The top level is the small section at the tip of the pyramid, which contains fats, oils and sweets. These foods provide calories, little nutrition and should be eaten sparingly. Examples of food in this category are desserts, candy, soft drinks, sugar, butter, margarine, dressings and oils. Middle L evel The middle level is the center section of the pyramid and it divides into two food groups:

those which come mostly from animals. They provide protein, calcium, iron and zinc. Examples of food in this category are yogurt, cheese, meat, poultry, fish, beans, eggs and nuts; and,

those which come mostly from plants, vegetables and fruits. They are rich in vitamins, minerals and

fiber.

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Bottom Level The bottom level is the base of the pyramid, which contains foods that come from grain. Examples of food in this category are bread, cereal, rice and pasta. The pyramid food guide ensures the adequate intake of essential nutrients. Food Servings A healthy diet should include foods from each level. The amount of food needed each day depends on a number of factors:

age; body size; activity level; gender; pregnancy; and, breast feeding.

The Food Guide Pyramid recommends the following number of servings per day for each food group:

Food G roup No. of Servings/Day One Serving Size

Milk, Yogurt Cheese

2 - 3 ¾ cup yogurt 1 cup milk I piece hard cheese I1”L 1”L R”N or ;ust under 2 oP. 2 cheese slices

Meat, Poultry, Fish, Dry Beans & Eggs

2 - 3 2O3 oz. of cooked lean meat, poultry or fish ½ cup of cooked dry beans The following are equivalent to 1 oz. of meat:

o 1 egg o 1/3 cup nuts o 2 tablespoons of peanut butter

Vegetables

3 - 5 1 cup of raw, leafy vegetables ½ cup of other vegetables O cooked, frozen or raw ¾ cup vegetable juice

Fruit

2 - 4 1 medium apple, orange or banana ½ cup chopped, cooked, canned or frozen fruit ¾ cup fruit juice (6 oz.)

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Food G roup No. of Servings/Day One Serving Size

Bread, Cereal, Rice &

Pasta

8 - 11 1 slice of bread, bagel, bun or pita bread

1 oz. ready to eat cereal ½ cup cooked cereal, rice or pasta

Fats, Oils & Sugar

Use sparingly Limit fat to 30%

of calories

Some things to keep in mind when making food choices are:

Grain Products…………….Choose whole grain and enriched products more often. degetaBles and Xruits…….. Choose dark green and orange vegetables and orange fruit more often. Milk Products……………..choose leaner meats, poultry and fish as well as dried peas, Beans and

lentils more often. Common Types of Diets Omnivorous Diet An omnivorous diet is one in which both animal and vegetable foods are eaten. Most people are omnivorous. This type of diet is the easiest one to maintain because there are no restrictions. Carnivorous Diet A carnivorous diet is one that contains animal meat. Advantages of a carnivorous diet:

It is high in protein, which is beneficial for growth and tissue repair. It provides iron.

Disadvantages of a carnivorous diet:

It contains hardly any fiber, which increases the risk of colon diseases. The high fat types of meat increase the risk of cancer, atherosclerosis (hardening of the arteries), heart

disease, and other problems. It is low in vitamins and minerals and thus requires Vitamins B, C, E and minerals (which can be

found in the vegetable foods).

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Vegetarian Diet A vegetarian diet is a diet in which no animal products such as red meat, poultry, fish and shellfish are eaten. However, it may include dairy products and eggs.

Advantages of a vegetarian diet:

Vegetarians generally have lower blood pressure and weight than people who eat meat. The incidence of hypertension, obesity, high cholesterol, atherosclerosis, heart disease, cancer and

osteoporosis are all reduced with a vegetarian diet. The high fiber and lower fat in the vegetarian diet help keep cholesterol levels down. The incidence of digestive tract diseases is minimal. The vitamin and mineral content in vegetables is high.

Disadvantages of a vegetarian diet:

There are potential problems for reduced iron and vitamin B12 intake; and, There is generally a higher incidence of anemia than there is in the average population.

Lacto-Ovo-Vegetarian Diet A lacto-ovo-vegetarian diet is the most common of the vegetarian diets. It does not include meat but does use the products of chickens and cows (e.g. egg and milk products). Usually the vegetable foods are the largest part of this diet, which consists mainly of fruits, vegetables, grains, legumes, nuts, and seeds. Vegan Diet This is the strict (or pure) form of vegetarianism. In the vegan diet, no animal products are consumed, only fruits, vegetables, legumes, grains, nuts, and seeds. Eggs, cheese, yogurt, ice cream, butter and other milk products are also avoided. _either will “vegans” use animal products in any other aspects of their lives. There is a potential for nutrient deficiencies in the vegan diet. The main one is Vitamin B12 but iron and calcium may also be low. Protein levels may be satisfactory if the person is very conscious of protein intake and complementing food. Vitamin A may be low unless high amounts of orange, yellow, and green vegetables are consumed. Vitamin D is often low but this deficiency can be helped by sunshine. Zinc may also be low unless seeds and nuts are consumed regularly.

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Raw Food Diet A raw food diet consists primarily of unprocessed and uncooked food and is potentially very healthy. The belief is that heating food destroys enzymes and diminishes nutritional value. The diet utilizes organically grown fresh vegetables and fruit, seeds, nuts, grains, beans, nuts, dried fruit, seaweed, and purified water. All stimulants, chemicals, and alcoholic beverages are avoided. Advantages of a raw food diet:

It can potentially be very healthy as it provides good nutrients. It provides increased energy. There is an improvement in the appearance of the skin. It aids digestion. It can reduce the risk of heart disease. It can promote weight loss.

Disadvantages of a raw food diet:

It is usually low in protein, calcium and iron. Some people (depending on their previous diet) go through a detoxification process when they start

the diet, which could cause: o headaches; o nausea; and, o cravings.

The raw food diet is not recommended for:

people at risk for osteoporosis (decreased bone mass and porous bones); people with anemia (deficiency in red blood cells); children; and, pregnant or nursing women.

Special Diets Special diets (also called therapeutic diets) are usually prescribed by a Physician for people who have certain diseases or medical conditions. They are different from the “regular” diet. People may be put on special diets because they:

have diabetes; have kidney, gallbladder, liver, stomach or intestinal disease;

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have difficulty swallowing (dysphagia); have allergies; have excess weight; have to reduce their salt (sodium) level; have been injured or are recovering from surgery; have to reduce their cholesterol and/or fat level; and, have constipation or diarrhea problems.

Home Care Assistants should be aware that different diets exist because they will inevitably have clients who are on special diets. The intent of this section is to provide an overview of the more common diets and not go into a detailed listing of individual foods that can and cannot be eaten. Clients on special diets should possess written documentation/pamphlets about their diets. Home Care Assistants, who are involved in food preparation, meal planning andGor shopping, should refer to the client:s documentationG pamphlets for the diet details. The following table outlines some of the more common diets, a brief description of the diet and the conditions/ diseases they are prescribed for.

Diet Descr iption Condition/Diseases

Diabetic Diet

A diabetic diet helps to manage the amount of sugar in the blood. It does this by:

controlling the amount of carbohydrates eaten

ingesting a certain amount of carbohydrates every day at the same time each day, as determined by a physician. A dietician develops a diet, especially for the individual.

Diet is prescribed for people who have Diabetes Mellitus (a chronic disease caused by a lack of insulin) .

Insulin is injected into the body on a regular basis by the individual who has diabetes.

Low Fat/ Cholesterol

Low Fat/Cholesterol diets limit the amount of fat and cholesterol by:

eating foods which are low in fat such as fruit, vegetables, grains, nuts & low fat dairy products

cooking without using fat (Cholesterol is a waxy, fat-like material used by the body to produce hormones & other vital chemicals.)

Diet is prescribed for people who have:

heart disease gallbladder disease fat digestion disorders liver disease

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Diet Descr iption Condition/Diseases

Restricted Sodium/ Low Salt Diet

Sodium restricted diets are diets wherein salt and sodium are restricted. (Salt is 40% sodium)

Low Sodium Diet contains 2000 O 3000 mg. per day of sodium. A small amount of salt may be used when cooking but cannot be added to the plate.

Medium Sodium Diet contains no more than 1000 mg. of sodium per day. Food is cooked without salt & high sodium foods are not included in the diet.

Strict Sodium Diet contains no more than 500 mg. of sodium per day. Food limits are: o 1 egg per day o no more than 4 ounces of meat per day o only fresh vegetables are permitted o no more than 2 cups of milk per day

Foods to avoid include canned, deli, pickled, cheese, meats/meat alternatives, packaged foods, soups, seasonings, sauces & salad dressings.

Diet is prescribed for people who have: o heart disease

kidney disease liver disease hypertension (high blood pressure)

fluid retention

High Protein

High protein diets build, repair & maintain body tissues and is found in foods such as meat, poultry, fish, eggs, dairy products, tofu & beans.

Diet is prescribed for people who have:

a high fever an infection burns some liver diseases

Low Protein

Low protein diets are designed to reduce the amount of nitrogen and ammonia in the body. A doctor determines the amount of protein that can be consumed.

Diet is prescribed for people who have:

kidney disease toxic bowel (poisonous bowel)

High Iron

High iron diets include foods which have high iron content such as meat, fish, poultry & seafood. (Iron is an important mineral in the body)

Diet is prescribed for people who: have inadequate dietary intake have decreased intestinal absorption

have blood loss are elderly are adolescent are menstruating are pregnant

High Calorie High calorie diets provide 4000 calories per day. Calories are attained by eating three full meals a day plus between meal snacks.

Diet is prescribed for people who: are underweight have thyroid problems

Low Calorie

Low calorie diets provide less than the minimum daily requirements, which are:

1600 for seniors & sedentary women 2200 for children, teenage girls, active women & sedentary men

2800 for teenage boys, active men & very active women

Diet is prescribed for people who need to lose weight.

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Diet Descr iption Condition/Diseases

Bland

Bland diets consist of foods that are low in roughage & are without strong seasonings or condiments.

Diet is prescribed for people who have:

ulcers gallbladder disorders intestinal disorders undergone abdominal surgery

High Fiber

High fiber diets consist of foods that increase the amount of residue in the colon, which helps the bowels move. High roughage foods include vegetables, fruit, & whole grain cereals. (The colon is the lower 6 O 8 feet of the bowel.)

Diet is prescribed for people who have:

constipation colon disorders

Low Residue

Low residue diets consist of foods that leave little residue in the colon. The diet includes such foods as refined bread/crackers/cereal; cottage cheese; strained & cooked vegetables; eggs (not fried); canned fruits. Fresh vegetables & fruits are to be avoided. (Refined refers to a process wherein machinery has been used to remove the high fiber bits from the grain.)

Diet is prescribed for people who have:

diseases of the colon diarrhea

Soft

Soft food diets consist of semi-solid foods,. which are easily digested such as liquids, eggs (not fried), shredded meat, fish & poultry, mild cheeses, cooked cereal, fruit & vegetables. Sometimes the food needs to be pureed (blended)

Diet is prescribed for people who have:

difficulty chewing gastrointestinal disorders (stomach & bowel disorders)

Liquid

Liquid diets consist of foods which are liquid at room temperature or that melt at body temperature. Foods consist of custards; eggnog, strained soup, strained fruit &vegetable juices; milk, creamed cereals, plain ice cream & sherbet.

Diet is prescribed for people who have:

been on a clear diet after surgery

stomach irritations fever nausea vomiting

Clear Liquid

Clear liquid diets consist of water, tea & coffee (without milk or cream), gelatin (jello), clear fruit juices (apple, grape, cranberry), broth, hard candy, sugar & popsicles.

Diet is prescribed for people who have:

have undergone surgery have an acute illness are nauseas are vomiting

Nutr itional Needs of Seniors Nutritional needs change with age. A basic understanding of these changes can help Home Care Assistants avoid nutritional snags, which are common in seniors, and ensure they get sufficient nutrients to be healthy.

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A nutritional diet for seniors provides foods which:

have a high level of nutrition (as recommended in the Food Guide Pyramid); have an appropriate number of calories (a minimum of 1600 calories per day); can be eaten in small amounts; can be digested easily; can be chewed and swallowed without difficulty; provide some fat to help fight disease; and, can be tolerated by existing diseases and/or conditions.

Impacts of Aging on the Nutr itional H ealth of Seniors As people age, some changes take place which may impact the nutritional health of seniors:

Their energy levels decline so they do not require as much food to maintain their weight. Their needs for certain nutrients increase because their digestion and absorption functions are not as

efficient. (e.g. calcium, Vitamin D, Vitamins B-12 & B-6 and folic acid) They drink less liquid Because they don:t feel thirsty and Because they want to reduce the effects of

incontinency. Their appetites decrease. The digestive process slows down. Their taste and smell senses decline. Many develop chewing and swallowing problems. Their ability to shop and prepare meals may be affected.

Warning Signs That Seniors A re Not Getting Proper Nutrition Home Care Assistants need to be alert for indicators that seniors may not be getting enough nutrition. Some things to watch for are:

sudden weight loss (more than 5% of body weight in one month or 10% in six months); weight gain; nausea; vomiting; chronic illness; no appetite; weakness; dizziness; and, fainting.

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Reasons Why Seniors Might Not Be Getting Proper Nutrition There are a number of reasons why seniors may not be getting the proper nutrition. The more common reasons are due to:

changes in taste and smell, wherein the desire to eat is reduced; constipation, wherein food moves slowly through the digestive tract or insufficient fruits and

vegetables are consumed; diseases (e.g. heart, diabetes, high blood pressure), wherein they find it hard to adapt to the

restrictions of therapeutic diets; medicationsC wherein the Body:s aBility to aBsorB nutrients and eLcrete minerals are affectedC low amount of physical exercise; wherein energy levels are reduced and the appetite is not stimulated; mobility problems, wherein they may have difficulty preparing meals or shopping; and, loneliness and depression, wherein they are not interested in eating.

Factors Contributing to Poor Nutrition in Seniors Good eating habits and proper nutrition are essential for healthy aging. As seniors age, their nutritional needs change which may cause them to become malnourished. Poor nourishment may also:

worsen the impact of chronic diseases; lower resistance to infection; and, slow the healing process.

Some factors, which contribute to the poor nutritional health of seniors are:

decreased mobility; illness; swallowing and chewing problems; loss of appetite; medications; dentures that don:t fit properlyC loneliness; and, depression.

Dehydration Seniors often don:t drink enough Because they do not feel thirsty andGor they are trying to offset the unwanted effects of incontinency. If they don:t drink enough liquids Iat least f cups per dayN or if they are putting out a lot of urine, they may become dehydrated. Illness and medication may also lead to dehydration.

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Signs And Symptoms Of Dehydration

headache; fatigue; muscle weakness or cramps; dry mouth and tongue; dry skin; cracked lips; sunken eyes; lethargy nausea; vomiting; diarrhea; dark and strong smelling urine; weigh loss; low blood pressure; fast heart beat; confusion; lightheadedness; and, disorientation.

Dehydration can cause serious problems such as electrolyte imbalance and can even result in death. Therefore, it is important that Home Care Assistants ensure their clients are drinking enough and keep alert for signs of dehydration. This condition is easily treatable, which enables seniors to return to their normal life -- the key is to prevent dehydration from occurring in the first place.

Dysphagia

Dysphagia means having difficulty swallowing, which can have detrimental repercussions for seniors because they:

may not be able to get enough food and fluids to maintain good nutrition and hydration; and, are susceptible to aspiration (inhaling food or fluid into the lungs).

Seniors with dysphagia are placed on diets wherein food thickness is regulated to adapt to the individual:s needs. Since Home Care Assistants may be asked to prepare food for clients with dysphagia, they should know about the various diets and methods of food preparation:

Minced Diet, wherein all food is chopped up into little pieces for easier swallowing or chewing.

Pureed Diet, wherein all food is put through a blender until it reaches the consistency of baby food.

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Thickeners, wherein thickeners such as tapioca, flour, instant potato flakes or a commercial thickener is added to hot or cold fluids to reach the desired consistency level.

Liquid Supplements, wherein nutritional drinks and liquid supplements (e.g. Ensure) are used as

extra nutrition for those who are not getting enough nutrients.

Tube feedings, wherein food is delivered right into the person:s stomach via a tuBe, which is either inserted through the nose for short-term feeding or is inserted directly into the stomach for long-term or permanent use.

Signs and Symptoms of Dysphagia in Seniors

difficulty swallowing; breathing in food while swallowing; food spilling out at corners of the mouth; getting food pocketed within the cheeks of the mouth; getting food stuck; coughing during or after swallowing; choking or breathing saliva into lungs while swallowing; regurgitating food after meals; (Regurgitation is the backward flow of food from the stomach to the

mouth.) regurgitating liquid through nose; weight loss; and, weak or harsh voice after eating.

T ips for Getting Seniors to Eat Proper ly

If they wear dentures, have them consult with a denturist to determine if they fit properly and are in good shape.

If they have their own teeth, have them consult with a dentist to determine if they have enough teeth and there are no cavities, as these factors can: o affect chewing; o affect nutrition; o give food a strange taste.

If they have trouble chewing, provide foods that are minced, soft and well cooked.

Give small meals several times a day instead of giving three larger ones.

Cater to their food choices O ensure they are within the guidelines of any prescribed diet.

Add any herbs and spices they like to improve the flavor of food.

Present food in an appealing manner.

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Dine in a pleasant area.

Set a nice table.

Eat with them, to make it a social event.

Use regular dishes and regular cutlery, as opposed to plastic or paper ones. Use linen napkins instead of paper ones.

Factors Which Influence Nutr ition in Seniors The food seniors eat is often influenced by factors gained over a lifetime and include those born into and those acquired through living. If Home Care Assistants know the factors which guide the eating habits of seniors, then Home Care Assistants are better armed to help seniors eat nutritionally. Some of these factors are:

Personal Choice

The likes and dislikes that Seniors have for certain foods often got their origin in infancy and were modified throughout life, as they were exposed to different foods. Allergies also have an impact on food choices.

Appetite Many seniors do not have an appetite or a desire for food and drink because of:

illness; medication; decreased ability to taste and smell; anxiety; pain; depression; and/or, not feeling hungry.

F inances

A lot of seniors have limited income, which reflects on the types, quality and amount of food they purchase. Often they buy carbohydrates, which are cheaper than protein, vegetables and fruit. Consequently, their nutritional needs are negatively affected.

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Culture

Culture is learned behaviors, which are common to certain ethnic groups. It influences food choices, dietary practices and food preparation. Examples of Cultural Food Choices o sushi is poplar in Japan; o organ meats are popular in England; o low fat and high sodium dishes are popular in China; o high fat and starchy foods are popular in Poland; o pasta is popular in Italy; o fish is popular in the Scandinavian countries; o rice is popular in the Philippines; o beans and rice are popular in Mexico; and, o beef is not eaten in India;

Religion

Xood preferences can also Be Based on an individual:s religious Beliefs. Hhen it comes to following the food guidelines of their faith, some people are very strict, while others semi-conform or do not conform at all. Whatever the religious practices are, it is important that Home Care Assistants respect them. The best way to find out their practices is to ask the clients or their families directly.

Some eating practices of different religions are outlined below.

o Roman Catholic

- Some do not eat meat on Fridays. - Meat is not eaten on Ash Wednesday and Good Friday - Fasting is required at least one hour before receiving communion.

o Islam (Muslim)

- Pork and pork products are forbidden. - Alcohol is forbidden except for medical purposes.

o Greek Orthodox Church

- Fast on Wednesdays, Fridays & Lent. (Lent is 40 weekdays from Ash Wednesday until Easter observed by Christians as a season of fasting and penitence in preparation for Easter.)

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o Judaism

- Foods must be kosher. (Kosher refers to the proper methods of food preparation & the dietary laws governing its consumption.)

- Foods that are allowed: -- all fruits & vegetables -- meat from kosher animals (e.g. cows, goats & sheep) -- meat from kosher fowl (e.g. chicken, ducks & geese) -- fish that have scales & fins (e.g. tuna, salmon, carp & sardines) -- milk products & eggs from kosher animals & fowl

- Foods that are not allowed: -- shellfish -- pork -- blood

- Some practices of Judaism -- Milk & milk products cannot be eaten with or immediately after eating meat. -- Kosher and non kosher foods cannot be prepared using the same utensils. -- Breads, cake, cookies, noodles & alcoholic drinks cannot be consumed during Passover

(Passover is a Jewish religious festival, which is celebrated according to the Jewish Calendar ( corresponding to March - April).

o Mormon

- Alcohol, coffee and tea are not permitted. - Meat is not to be eaten very often, but it is still permitted.

o Christian Scientist

- Alcohol and coffee are not permitted.

o Baptist

- Some groups forbid alcohol, tea and coffee.

o Seventh Day Adventist

- Coffee, tea and alcohol are not permitted. - Drinks containing caffeine are prohibited. - Some groups forbid the consumption of meat.

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Summary Food and water are basic human needs, as the nutrients they supply are essential to maintaining life. When insufficient nutrients are ingested, repercussions occur in the body such as poor health, infections, chronic diseases and ineffective healing. Therefore, it is important that an appropriate diet is followed and that good eating habits are practiced. The Food Guide Pyramid provides details on what should be eaten each day to maintain health. Regular diets and therapeutic diets are extracted from these food choices -- the regular diet to maintain healthy eating; and therapeutic diets to meet the needs of certain diseases and medical conditions. Since factors such as physical and emotional problems, food preferences, appetite, culture, religion and finances can affect eating habits, it is important to keep alert for signs of nutritional deficiencies. By being aware of them and taking corrective action, Home Care Assistants can assist their clients in attaining or maintaining healthy eating practices and thus improve their quality of life.