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Bernstein ch18 pp_tx Bernstein ch18 pp_tx Presentation Transcript

  • Nutrition Support forthe Older AdultChapter 18
  • Indications for Nutrition Support• The provision of nutrients needed to optimizehealth and nutritional status that cannot beachieved through basic diet alone.• Enteral nutrition– Provided by mouth or tube• Parenteral nutrition– The intravenous provision of nutrients via acentral or peripheral vein
  • Indications for Nutrition SupportNutritional Support for the Older AdultData from A.S.P.E.N. Nutrition Support CoreCurriculum. 2nd ed. Silver Spring, MD:American Society for Parenteral and EnteralNutrition; 1993.
  • Indications for Nutrition Support• Oral Supplements– Commonly used to increase calorie and proteinintake– Other uses and contraindications– Disease-specific supplements are available– Can play a significant role in the prevention ofmalnutrition
  • Indications for Nutrition Support• Oral Supplements
  • Indications for Nutrition Support• Oral Supplements– Consider acceptability factor– Evaluate nutritional status regularly– Screen for appropriateness of supplements
  • Enteral Nutrition Support• Step after all oral nutrition support optionshave been exhausted• Used in individuals who are unable toconsume nutrients by mouth– Short term– Long term
  • Enteral Nutrition Support• Enteral Feeding Formulas– Many types of formulas available– Standard formulas• Likely to meet nutrition needs• Isotonic–Decrease risk of diarrhea–Less costly• 1,500 calories/day provides RDA for vitaminsand minerals
  • Enteral Nutrition Support• Enteral Feeding Formulas– Fiber• Integral component of enteral feedings• Control blood glucose• Control lipid levels• Aid with constipation– Prebiotics• Natural occurring fibers• Support normal intestinal flora
  • Enteral Nutrition Support• Enteral Feeding Formulas– Disease-specific formulas• Diabetic formulas• Acute and chronic kidney disease• High-protein formulas• Pulmonary formulas• Partially hydrolyzed formulas• Immune-enhancing formulas
  • Enteral Nutrition Support• Enteral Feeding Delivery and Access Devices– Nasogastric feeding– Nasoduodenal– Nasojejunal feedings– Percutaneous endoscopic gastrostomy (PEG)– Long-term jejunal feedings
  • Enteral Nutrition Support• Enteral Feeding Delivery and Access Devices– Formula delivery• Pump• Bolus• Gravity drip
  • Enteral Nutrition Support• Complications with Enteral Nutrition Support– Gastrointestinal• Nausea• Vomiting• Diarrhea• Constipation• Increased residuals
  • Enteral Nutrition Support• Complications with Enteral Nutrition Support– Infectious• Improper handling techniques• Microbial contamination– Metabolic complications• Changes in formula may be needed to correct– Manual complications• Dislodging or clogging of the tube• Skin irritations
  • Parenteral Nutrition• Used when enteral feeding is not an option• Managed by a health care team• Vascular access route• Limited in the amount of amino acids anddextrose– Supplement with micronutrients and fluids asneeded
  • Parenteral Nutrition• Calculating TPN Calories– Free amino acids• 4 calories per gram– Dextrose monohydrate• 3.4 calories per gram– Lipids• 2 in 1 TPN are 10% lipid–1.1 calorie/mL• 3 in 1 TPN are 20% lipid–2 calories/mL
  • Parenteral Nutrition• Medications reviewed– TPN additives based on patient needs
  • Home Nutrition Support• Home Health organizations• Home enteral nutrition– Multiple considerations for home enteral regimen– Ensure adequate monitoring• Home parenteral nutrition– Used for impairment of the small bowel thatdecrease ability to absorb and metabolizenutrients
  • Ethics and Nutrition Support• Controversies with regards to end-of-life care– Ethical debates• Provision of TPN and IV fluids may actuallyworsen the dying experience– Cost-effectiveness• Many insurance companies will not providecoverage for TPN in end-of-life situations– Medical necessity– Cultural and religious beliefs
  • Ethics and Nutrition Support• Controversies with regards to end-of-life care– Medical necessity• TPN can increase risk of infectious andmetabolic complications– Cultural and religious beliefs• Various views
  • Ethics and Nutrition Support• Advanced directives– Legally binding documents that explain anindividual’s desires regarding life-savingtreatments in the event that he or she would bedeemed unable to make a decision– Have a support staff to help families make aninformed decision
  • Conclusion• Nutrition support in the geriatric populationwill continue to grow more complex• Biological needs, as well as emotional andsocial needs, must be considered to provideoptimal patient care