Yolande Brand, Ide-Marie Venter & Caryn Straker - The impact of nutrition on the quality of life
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Yolande Brand, Ide-Marie Venter & Caryn Straker - The impact of nutrition on the quality of life
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Yolande Brand, Ide-Marie Venter & Caryn Straker - The impact of nutrition on the quality of life
- 1. The impact of on Ide-Marie Venter: Dietician Caryn Straker: Dietician Yolandé Brand: OT
- 2. This morning before the conference…
- 3. Definition of functional status ADL’s are those activities or tasks that people undertake routinely in their every day life - which are required for independent living Functional status is determined by the ability to perform activities of daily living (ADL’s)
- 5. How do you measure quality of life?
- 6. FUNCTIONALITY 45 YEARS OF AGE TIME IN YEARS Quality of Life
- 7. Eden Alternative Domains of Well-Being CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 8. Being well-known; having personhood; individuality; wholeness; having a history IDENTITY “I am Suzie. Please call me by my first name and not my surname. I like to spend time with family and friends – especially my weekly catch up with ‘The Girls’ at the local coffee shop and Saturdays on the ‘Green’ for a friendly game of bowls. I love being outdoors and active – I used to walk to the local shop every morning for the days’ fresh fruit. I like to sleep late in the morning, and prefer to have a cup of very strong coffee with soya milk and one sugar when I wake up. I like classical music, reading and just being. I am happiest when my cat is on my lap.”
- 9. Liberty; self-governance; self-determination; immunity from the arbitrary exercise of authority; choice; freedom “I am a person in my own right, and can and want to make my own decisions about my life. I know what I want, how and when I want it. I do not like being told what to do, and will become grumpy if this is not respected.” Six months ago I chose to start with the ‘Cabbage-soup’ diet to lose a bit of my excess weight as my doctor said it will help with the pain in my knees due to OA.
- 10. MEANING Significance; heart; hope; value; purpose; reflection; “My life is full of meaning, which I derive from import; sacred my friendships, my pet, my books, being fully independent at the age of 75 and writing letters to my friends all over the world. I like to meet friends or going out for a good meal. Having to ask for help since my fall has been very difficult ”
- 11. CONNECTED State of being connected; alive; belonging; engaged; involved; not detached; connected to the past, present and future; connected to personal possessions; connected to place; connected to nature “I feel connected when people respect my privacy, connect with me on the things that are important to me, namely respect and dignity. I believe in the sacredness of the human spirit, and would like you to respect this at all times. My weekly visit to the ‘Green’ is very important to me – being with friends out in nature. ”
- 12. SECURITY Freedom from doubt, anxiety, or fear; safe, assured; having privacy, dignity, and respect “My security lies in being respected for and being well known by the staff for the individual who I am. I am strong minded, being in control of my own life gives me a sense of security. The staff at the Care Centre is aware of me being lactose intolerant and that makes me feel secure in not being presented with food that might make me ill. I do, however, struggle with constipation at the moment and I think it is due to the lack of my ‘daily’ fruit fix!’”
- 13. GROWTH Development; enrichment; unfolding; expanding; evolving “Before my fall, I was fully independent (even with the pain in my knees due to osteoarthritis). I want to regain my independence. I love cooking and experimenting with lactose free recipes, and would like to now and then make my favourite dishes in the kitchen for my friends.”
- 14. JOY Happiness; pleasure; delight; contentment; enjoyment “I am a happy person, I like to laugh and joke and tease. I love life, and get tremendous joy from my grandchildren, being in nature, eating lactose free cheesecake, a good film, my photographs, my music, and spending time with my friends. I also like to be alone most of the time reading, writing or listening to music.”
- 15. FUNCTIONALITY TIME IN YEARS Quality of Life
- 16. Quality of Life
- 17. Bone density Quality of Life Chronic diseases of lifestyle Muscle mass Gastro intestinal status Mental status Medical conditions Sensory changes
- 18. Bone density Quality of Life Chronic diseases of lifestyle Muscle mass Gastro intestinal status Mental status Medical conditions Sensory changes
- 19. Muscle Mass Activity/ exercise Nutrition • Kilojoules • Protein • Vit D, Calcium • Fluid Falls risk ADL • Bathing/ showering, toileting, dressing • Transferring • Eating Respiratory & cardiac function Instrumental ADL • Laundry, housekeeping • Shopping, errands • Food prep • Transport • Mobility
- 20. CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 21. Bone density Activity/ exercise Nutrition • Calcium, (Phosphate, Mg), vit.D, K Osteoporosis, fractures Mobility Instrumental ADL Muscle loss
- 22. CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 23. Chronic diseases of lifestyle e.g. obesity, CVD, Type 2 DM, hypertension Nutrition Kilojoules Refined carbs Saturated fat, cholesterol Sodium Fibre Antioxidants Exercise Smoking, stress, alcohol Short term Headaches, dizziness, fatigue. Long term Visual impairment, amputations, kidney disease, stroke, heart attack, dementia, disability, functional limitations.
- 24. Sensory Changes: Hearing Nutrition • Vit B12 • Vit D • Antioxidants Falls risk Instrumental ADL Mood & cognition Medications • Aspirin • Antibiotics Malnutrition risk Risk of isolation
- 25. GIT complaints: Constipation & Diverticular Disease Nutrition • Fibre & Fluid • Fruit & veg Dietary supplements Falls risk Mood & cognition ↑ Malnutrition risk Activity ↓ Colonic motility ↑Laxatives Medications Medical conditions ADL Instrumental ADL
- 26. CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 27. Medical conditions e.g. pulmonary disease, osteoarthritis, disability after stroke, infections Instrumental ADL ADL Falls risk Mood Nutrition Pulmonary Disease *Prot & iron, Vit C, fluid, electrolytes Osteoarthritis Optimal E, nutrients Nutrition will vary for each condition
- 28. CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 29. Mood ↑ Malnutrition risk Falls risk Decreased appetite ADL Instrumental ADL Weight loss Fatigue ↓Nutrition • Vit B12, B1, B3 • Glucose • Tryptophan • Selenium
- 30. CONNECTED SECURITY GROWTH MEANING JOY IDENTITY AUTONOMY
- 31. Dementia ↑ Nutrition • Saturated fats • Trans fatty acids • ? Iron & copper • ? Aluminium ↓ Nutrition • ? Antioxidants • ? Omega 3 fatty acids ↑ Malnutrition risk Falls risk Medical conditions • High cholesterol • Obesity • High homocysteine levels ADL Instrumental ADL
- 32. Muscle mass Quality of Life Bone density MEANING Chronic diseases of lifestyle Gastro intestinal status Mental status Medical conditions Sensory changes CONNECTED SECURITY GROWTH JOY IDENTITY AUTONOMY
- 33. Any question?
Editor's Notes
- Vra vir groep hoe sal hulle voel as…. En lees elke punt uit…. Gee tyd om in te sink… Ek lees gewoonlik nie alles deur nie – en respond dan op hul verbale/non-verbale reaksie en negatiewe emosies.
- Net met die opskrif: ek vra gewoonlik wat het mense vanoggend gedoen en skryf dit op die flipchart – ek soek al die ADL’s – opgestaan, koffie gedrink, aangetrek, gestort ens ens. Tandeborsel skryf ek aan die regterkant van die papier sodat ek dit in stappe kan opbreek – vra vir die groep om elke stap te noem. Ek skryf dit dan ook so neer. Ek vra of enige iemand beplan het hoe hul oggend gaan verloop, en fokus daarop dat die take deel van ‘n routine is, en partykeer automaties gebeur. Ek eindig dan met die prentjies – check dat almal als genoem het.
- Lees…..
- Vra vir groep hoe sal hulle voel as…. En lees elke punt uit…. Gee tyd om in te sink… Ek lees gewoonlik nie alles deur nie – en respond dan op hul verbale/non-verbale reaksie en negatiewe emosies.
- Ek vra met prentjie 1 of hope geld in jou bankrekening jou beter sal laat voel al kan jy nie jouself help nie (toilet toe vat…) Prentjie 2 – geleerdheid Prentjie 3 – duurste kar Eindig met feit dat kwaliteit van lewe bepaal word deur onafhanklikheid in ADL’s
- Verduidelik – seker ek hoef nie aan jou te verduidelik nie…
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- Read the description Ask the audience to share What gives you your identity What makes you different from others Where and with who can they relax and just be What is important to you CLICK: Read Andrew’s description
- The next domain is Autonomy – what does it mean to you when you hear AUTONOMY? Get responses from audience. CLICK: Eden Alternative describes it as (read description) For Andrew his autonomy comes down to CLICK: read … In the current old age homes what are the likelyhood that Andrew will be labled as DIFFICULT? CLICK:
- What gives real meaning to your life? Big things but also small things? (Wait for responses) CLICK: What is really important to you and also for you? What is your purpose? What makes you feel you are worth something? Andrew says … CLICK: read ….. We have already referred to the people is our lives CLICK:
- Connection with others is essential to all of us. Read description …… CLICK: Andrew feels connected when people …. Read Should Rayne not be allowed to have his dogs around him, will he feel that he belongs, will it feel like home to him? Ask a attendee of 2 - What makes you feel connected? What items in your home connects you to your past? CLICK:
- SECURITY – when we think about security especially in SA, some of the first things that usually comes to mind are A gate? An alarm system? A Guard? Keys? Eden Alternative describes SECURITY as CLICK: Read: Freedom from doubt, anxiety, or fear. Safe , assured, having privacy, dignity and respect. Ask audience: Help me to identify a few things that gives dignity to a resident living in a care centre (frail care)? Get responses …. The following domain is in general not seen as a normal part of the last phase of some ones life. … CLICK: Here is what contributes to Andrews ’ s sense of security CLICK:
- Principle 9 in the Eden Alternative Philosophy states ‘Human growth should never be separated from Human life’ We all have the capacity to learn and grow till the last day of our existence. CLICK: Allow audience to read for themselves … Clearly Andrews curiosity and hunger for information is big. CLICK:
- The last domain might be the simplest of them all. CLICK: JOY, pleasure, delight, happiness Ask the audience: What are the small things that gives you joy in your life? Wait for responses CLICK:
- If we look at this slide again; we’ll see that unfortunately we cannot change anything about the time in years which is one of the factors affecting QOL, BUT we can definitely manage the aging process and we can definitely manage our functional ability with proper nutrition, exercise and social wellness.
- We will now focus specifically on how nutrition can impact on QOL. We need sufficient nutrients in sufficient quantities for our body and mind to function optimally – so if we eat too little or too much of certain foods it has negative consequences on our health- in ALL stages of life. However malnutrition rates in the older population is alarmingly high -varies between 20—85% in long term care facilities - due to SO many factors: physiological; social, financial, staff ignorance, systems not being followed…the list goes on; AND as the world aging population increases; the total number op people who are malnourished increases. The factors that we will now focus on are all consequences of MALnutrition, or at least where nutrition plays a role and how that impact on QOL. The sad reality is that all these factors caused by malnutrition again increases a persons risk for malnutrition; so it ends up working in a viscous circle.
- Many older people do NOT consume sufficient nutrients causes loss of muscle mass –muscle wastage; a loss of bone density On the other hand over and improper nutrition can cause chronic diseases of lifestyle which can hugely impact QOL Statistics show that 80% of older adults have at least one chronic condition; unfortunately these conditions may lead to pain and functional disability which may result in a lower quality of life. There is also many other medical conditions where nutrition plays a role in the onset or management of the condition We see a lot of GI and sensory changes impacting QOL And lastly we will touch on nutrition and mental status and how that can impact QOL. As mentioned the dark encompassing cloud of malnutrition is part of the cause of all these factors; BUT all these factors could again increase the risk of malnutrition.
- We will now focus on each of these factors mentioned
- As people age their body composition change; the amount of muscles decrease and the fat volume increase –sarcopenia; the reason for this is mostly because older people are less active, do less sport and exercise. So if you do not use muscle –you will lose muscle –and with that you lose strength and function Adequate nutrition is needed for synthesis and maintenance of muscle. Unfortunately we often see that older people do not consume sufficient tot E; the list of reasons for this is endless, but most often it is due to A lack of appetite, mouth issues (dentures/loss teeth/dry mouth/swallowing diff), but the biggest contributing factor is depression….something which is very common amongst older people. The reason for a lack of protein is often because the mouth conditions just mentioned that makes it difficult to chew especially red meat, but also chicken and if your resident does not like a very soft or pureed diet and if your CM is not creative or allowed to replace protein options for eg. to serve fish, cheese or beans in the place of red meats we often see that protein intake levels might be low. so those 2 nutrients specifically needed for muscle synthesis and maintenance are often consumed inadequately. III. Vit D levels are also often low, because few foods are naturally good sources and in SA few of our foods are fortified with Vit D, because government/manufacturers assume we get enough sunlight for our bodies to make sufficient Vit D; but how often does our frail elderly come into direct sunlight…? Many of them never..and we need about 1-2 hours per week (ideally 15-20 mins per day) It also does wonders for mood! Vit D def =associated with loss of lower leg muscle mass, strength (muscle contractions), and impaired balance which could increase a person’s fall risk -it also helps to absorb Ca which we all know is needed for strong bones; but is also needed for muscle contractions; so if both = you do not only have an falls risk, but increased risk for fractures! Which is one of the biggest reasons why people end up in frail care. The fact that they will be immobile for many weeks causes even further loss of muscle mass and usually with this goes varying levels of depression. Ca is often low in older people, because many have reduced lactase enzymes which causes indigestion with dairy consumption. IV. Then Dehydration is also a common problem amongst older people as they have a diminished sense of thirst; less water storage capacity due to the decreased muscle mass as that is partly where the body stores water + a lot of people find it difficult to go to the toilet so they want to save on trips to the toilet by drinking less fluid. Another factor is staff ignorance in that if a staff member is not aware of the consequences of dehydration they might not necessarily spend time +effort to ensure residents consume enough; and then also a lack of systems to ensure proper hydration. confusion, postural hypotension falls risk We also see that individuals find it more difficult to function independently in society for e.g.: Indiv who were able to lift their own wet laundry out of the washing machine and hang it on lines; who were able to vacuum under beds, carry their own shopping bags and walk far distances in malls/parking lots or to or fro from shops; or walk or drive to visit friends, do their hobbies are just not strong enough to do that. I want you all to put your hands on your legs and stand up..can you feel how much those muscles have to work to lift your 60/80kg’s off the chair; so we see that residents become too weak to transfer themselves into a bath; onto a toilet, from the bed into a chair; doing their own hair with arms lifted or even being able to feed themselves. And this has a serious impact on quality of life… Furthermore the heart and lung functions are compromised with less muscle and light chest infection can easily become a severe pneumonia or bronchitis. I will spend more time on nutrition and the pulmonary system at a later stage.
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- Just as for maintaining muscle mass; residents need to do exercise to maintain optimal bone density. Weight bearing exercise in any form; whatever the resident can manage will help; but residents need to be informed and reminded of this as for a lot of them any form of activity might be difficult. Careworkers also needs to know how important it is and how they can help for e.g. to assist a resident to walk to the dining room no matter how long it takes rather than to just put someone in a wheelchair –which might look like a faster and safer option. From a nutritional perspective Calcium, phosph + Mg are needed for optimal bone density. Vit D (which we have discussed is often low due to lack of direct sun exposure) helps Ca absorbtion; prevents it’s excretion together with Vit K which also helps to get Ca into the bones iso being deposited in the veins that might increase risk for attack, stroke; vasc dementia Good sourced of Vit K is green vegetables and residents often exclude these because they prefer the sweeter veg; also most of them are gasformic (brocc, peas, beans, cabbage); plus a lot of residents wrongly belief that they have to exclude these when on blood thining medication. So with a lack of activity and the nutritional factors mentioned older people have an increased risk of osteoporosis and with that a chance of fracturing bones. While recovering from a fracture the resident’s mobility will be compromised, and this leads to increased bone resorption (furhter loss of bone density) + the muscle loss as already discussed Instrumental ADL’s…
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- Overeating and improper nutrition over a long period of time can lead to chronic diseases of lifestyle like obesity, CVD, T2DM and hypertension. From a nutrition perspective too much kJ, refined carbohydrates and bad fats like saturated fat and cholesterol, too much salt and a lack of fibre and antiox may be part of the causes. I think we are all familiar with Lifestyle factors that increase risk like lack of exercise, smoking, but they find that we underestimate alcohol use and stress levels of older people. [constant worries about their finance, future, functionality, health, worries about their children’s financial/marital/work problems] The short term impact from these chr diseases on QOL is headaches, dizziness and fatigue. Long term impacts are visual impairment, amputations, …all these factor’s impact I think are self explanatory. Good food plus the social side of dining definitely adds quality to my life! But they find that catering staff who are not well trained provide unpalatable and over-restrictive diets to these specific residents. We will often see that where the full diet will be chick pie & gravy, roast potatoes and glazed carrots the diabetic and cardiac diets will get plain steamed chicken, potatoes and carrots which contribute to the residents consuming less food which increase the risk for malnutrition or residents not wanting to be compliant and switching back to normal diets which is not good for their condition and thus in both ways are not good for quality of life.
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- Medical conditions on their own can impact on quality of life and if these conditions are not managed properly even more so. Conditions we see often among older people are pulmonary disease, osteoartritis, and disability after stroke +infections Optimal nutrition can prevent many pulmonary conditions in that it plays a role in lung structure, elasticity, function, endurance + lung immune defence mechanisms. If prot and Fe levels =HbO-carrying capacity is sub-optimal prot pulm edema with witch lungs cannot function well surfactant synth collapse alveoli Vit C- supporting connective lung tissue Airway mucus consist of water, electr so if a resident is dehydrated there would not be sufficient mucous for proper lung function. If we look at osteoarthr a resident should consume an optimal diet high in anti-ox to prevent disease infection and also not be overweight as that would put extra workload on joints. Disabilities following from conditions will impact functionality and mood; both have been discussed. Malnourished individuals are more susceptible to get infections, to get it in a more severe degree and to take a longer period to recover.
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- “Well-being is a much larger idea than either quality of life or customer satisfaction. It is based on a holistic understanding of human needs and capacities. Well-being is elusive, highly subjective, and the most valuable of all human possessions.” Dr. Bill Thomas, What Are Old People For The Eden Alternative have identified 7 domains of Well-Being. Connectedness Meaning Autonomy Identity Joy Growth Security CLICK: these domains are interlinked and connected. CLICK: To help us get our heads around these domains, Andrew shared with us some the things contributing to his Well- being. Lets look at each domain. CLICK:
- As dementia develops – have impact on ability to carry out certain activities: