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  1. 1. Nutrition Provide Support to meet Personal Care Needs CHCICS301A Updated by Jo Lewis BHS
  2. 2. What is nutrition? <ul><li>Nutrition = all processes by which the body utilises food and fluids for energy, growth and maintenance </li></ul><ul><li>At all stages of the lifespan, we need good nutrition, to resist illness, repair tissue, regulate body functions and provide energy </li></ul>
  3. 3. Characteristics of Nutrition
  4. 4. Nutritional requirements <ul><li>Nutritional requirements are considered in terms of essential and balanced nutrients (ie protein, fats, carbohydrates, vitamins etc), and energy (kilojoules) </li></ul><ul><li>Need foods from each of the basic food groups, in sufficient quantities (milk/dairy, meat/fish/eggs, fruit and veg, breads and cereals, fats, water) </li></ul>
  5. 5. How should nutrients be distributed ?? <ul><li>Traditional model = Healthy Diet Pyramid </li></ul><ul><li>Other distributions ie diet consisting of 60% carbohydrate, 20% protein, and 20% fat often thought appropriate </li></ul><ul><li>Current trend towards lower carbohydrate and higher protein intake </li></ul><ul><li>Important to eat a variety of foods each day </li></ul><ul><li>Energy requirements – don’t need as much energy in older age as there is little growth </li></ul>
  6. 7. Compare - Nutrient Requirements <ul><li>Younger adults (up to 65) </li></ul><ul><li>1 serve meat, fish, eggs, legumes = 60-75gm </li></ul><ul><ul><li>3 serves red meat </li></ul></ul><ul><ul><li>2 serves fish </li></ul></ul><ul><ul><li>1 serve chicken/pork </li></ul></ul><ul><ul><li>1 serve legumes </li></ul></ul><ul><li>2-3 serves diary foods </li></ul><ul><li>2-3 serves fruit </li></ul><ul><li>4-5 serves vegetables </li></ul><ul><li>5 or more serves bread & cereals </li></ul><ul><li>2 extras (indulgences) </li></ul><ul><li>5 or more cups of fluids </li></ul><ul><li>Frail older adults </li></ul><ul><li>2 serves meat, fish, eggs, legumes = 120-150gm/day </li></ul><ul><li>3-4 serves dairy foods </li></ul><ul><li>2-3 serves fruit </li></ul><ul><li>4-5 serves vegetables </li></ul><ul><li>5 or more serves bread & cereals </li></ul><ul><li>2 extras (indulgences) </li></ul><ul><li>5 or more cups of fluid-includes milk, soups as well as tea, coffee & other drinks </li></ul>
  7. 8. Nutrients <ul><li>The essential nutrients are: </li></ul><ul><li>Carbohydrates Water </li></ul><ul><li>Fibre Vitamins and minerals </li></ul><ul><li>Proteins Proteins </li></ul><ul><li>Lipids (fats) </li></ul><ul><li>Nutrients are the chemical substances in food that provide energy, build and maintain cells and regulate body processes </li></ul>
  8. 9. Carbohydrates <ul><li>Provide energy </li></ul><ul><li>Before being used are converted from food we’ve eaten into glucose </li></ul><ul><li>Also assist in metabolism of fat </li></ul><ul><li>Add bulk to intestinal contents aiding peristalsis </li></ul><ul><li>Found in vegetables, cereals and pastas, fruits, honey, milk </li></ul>
  9. 10. Proteins <ul><li>Compounds composed of amino acids </li></ul><ul><li>Proteins build and repair tissue, or supply energy </li></ul><ul><li>Major sources of protein are meat, fish, eggs, cheese, milk, poultry, lentils, legumes and nuts </li></ul>
  10. 11. Lipids <ul><li>Fat supplies energy and forms adipose tissue which supports and protects some organs </li></ul><ul><li>Adipose tissue also insulates the body to prevent heat loss and is a reserve store of fuel </li></ul><ul><li>Fats also supply the fat soluble vitamins A,D,E,K </li></ul><ul><li>Major food sources of fats are animal (meat, butter, oil, cream, egg yolk, cheese, fish oil) or vegetable (present in cocoa and oils like olive, safflower, peanut etc) </li></ul>
  11. 12. Water & Fibre <ul><li>Water obtained from food and fluid’s we eat and drink as a result of metabolism </li></ul><ul><li>Necessary for digestion, absorption and metabolism of food, to produce secretions, and maintain body fluids </li></ul><ul><li>Fibre is fibrous part of foods not digested or absorbed </li></ul><ul><li>Excreted in stool (BA) , and provides bulk </li></ul><ul><li>Thought to help in prevention of some disorders constipation, diverticular disease, gallstones, intestinal ca </li></ul>
  12. 13. Vitamins & Minerals <ul><li>Vitamins generally obtained from food we eat </li></ul><ul><li>Essential for metabolic function - either fat or water soluble </li></ul><ul><li>Minerals important in metabolism, maintenance of BP, cardiac function, and regulation of body processes ( homeostasis ) </li></ul>
  13. 14. Vitamin D <ul><li>Essential to maintain strong, healthy bones & assist prevention of fractures, along with calcium </li></ul><ul><li>In Australia 68-86% of elderly in Res. Care have low Vit D levels </li></ul><ul><li>Residents require 1-3hrs sun exposure (face & hands) every week – if unable, require supplements </li></ul><ul><li>Vitamin D is diminished by sunscreen </li></ul><ul><li>Cannot be obtained through glass </li></ul>
  14. 15. Who is at risk for poor nutritional status? <ul><li>Physically inactive </li></ul><ul><li>Alcohol, drug or nicotine dependent </li></ul><ul><li>Pregnant or breastfeeding </li></ul><ul><li>Elderly </li></ul><ul><li>People unaware of nutritional principles </li></ul><ul><li>Strict vegetarians/vegans, or following ‘fad’ diets </li></ul><ul><li>People experiencing certain physical or emotional disorders </li></ul>
  15. 16. What influences individual eating patterns? <ul><li>Availability of food </li></ul><ul><li>Economic status </li></ul><ul><li>External influences, such as the family or advertising </li></ul><ul><li>Food fads and fallacies </li></ul><ul><li>Beliefs, values, religious and cultural heritage </li></ul>
  16. 17. <ul><li>Social and emotional aspects of food </li></ul><ul><li>Physical status – including allergies, food intolerance, difficulty chewing or swallowing, medical or surgical disorders which interfere with digestion, absorption or cause loss of nutrients, level of mobility and independence </li></ul><ul><li>Psychologic status – anxiety, depression </li></ul>
  17. 18. How is nutritional status assessed? <ul><li>Nutritional history </li></ul><ul><li>Clinical signs </li></ul><ul><li>Height/weight tables </li></ul><ul><li>Calculation of body mass index </li></ul><ul><li>Laboratory values </li></ul><ul><li>Other measurements, ie skinfold testing </li></ul>
  18. 19. Effects of poor nutrition and hydration <ul><li>Loss of strength for daily activities </li></ul><ul><li>Reduced mobility and independence </li></ul><ul><li>Risk of falls </li></ul><ul><li>Increased fatigue </li></ul><ul><li>Increased risk of illness and infection </li></ul><ul><li>Increased risk of pressure areas/ulcers </li></ul><ul><li>Poor wound healing or recovery from illness </li></ul><ul><li>Constipation </li></ul><ul><li>Confusion and sensory changes/loss </li></ul>
  19. 20. What affects nutritional status of older people? <ul><li>Physiologic and physical changes – loss of teeth, loss of smell and taste, decreased saliva, decreased peristalsis, reduction in appetite, reduced dexterity </li></ul><ul><li>Social changes – loneliness, depression </li></ul><ul><li>Perceptions of food </li></ul><ul><li>Availability of food – changes in ability to shop, prepare and eat food, low income </li></ul><ul><li>Medication interactions </li></ul>
  20. 21. Malnutrition <ul><li>Consequence of continued poor nutrition – defective in either quantity or quality </li></ul><ul><li>Is not a specific term – could refer to either over- or under- nutrition </li></ul><ul><li>Malnourishment usually termed to mean that intake and utilisation of nutrients is reduced, in relation to body requirements </li></ul>
  21. 22. Who is at risk for malnutrition? <ul><li>Clients experiencing increased metabolic demands, or extensive loss of nutrients – infection, burns, vomiting, physical trauma, major wounds, prolonged fever </li></ul><ul><li>Clients not consuming oral food/fluids for more than a few days </li></ul><ul><li>BMI less than 20, or recent loss of 10% of usual body weight </li></ul>
  22. 23. <ul><li>Alcohol or drug dependent </li></ul><ul><li>Clients on medications which work against or block nutrients </li></ul><ul><li>Clients with deficient ability to utilise nutrients, ie Crohn’s disease </li></ul><ul><li>NB – need early identification of those at risk </li></ul>
  23. 24. <ul><li>Common in older patients </li></ul><ul><li>Worse with illness - CVA, MND, MS, PD </li></ul><ul><li>Poor nutrition increases risk of: </li></ul><ul><ul><li>Pressure sores </li></ul></ul><ul><ul><li>Delayed healing </li></ul></ul><ul><ul><li>Prolonged recovery </li></ul></ul><ul><ul><li>Psychological response to illness </li></ul></ul>
  24. 25. Obesity <ul><li>Excess of body fat, r/t either excessive kJ intake, or inadequate energy expenditure, or both </li></ul><ul><li>Serious consequences = cardiovascular disease, breathing difficulties, hypertension, diabetes mellitus, gallbladder disease, mobility problems, reproductive problems </li></ul><ul><li>Psychosocial problems </li></ul>
  25. 26. Treatment of Obesity <ul><li>Supervised regulation of food intake </li></ul><ul><li>Exercise </li></ul><ul><li>Behaviour modification </li></ul><ul><li>?? Medication - appetite suppressants or fat-blockers </li></ul><ul><li>Surgical intervention for morbid obesity, ie gastric banding </li></ul>
  26. 27. Bariatric <ul><li>Bariatric – defined as BMI greater than 30 </li></ul><ul><li>Their weight far exceeds the recommended guidelines </li></ul><ul><li>Body size restricts – mobility, health, access to available services </li></ul><ul><li>Their weight increases risk of further health complications & death </li></ul><ul><li>Causes numerous care challenges </li></ul>
  27. 28. Dietary Guidelines for Older Australians <ul><li>Enjoy a wide variety of nutritious foods </li></ul><ul><li>Keep active to maintain muscle strength and a healthy body weight </li></ul><ul><li>Eat at least three meals per day </li></ul><ul><li>Care for your food: prepare and store it correctly </li></ul><ul><li>Eat plenty of vegetables (including legumes) and fruit </li></ul><ul><li>Eat plenty of cereals, breads and pastas </li></ul>
  28. 29. <ul><li>Eat a diet low in saturated fat </li></ul><ul><li>Drink adequate amounts of water and/or other fluids </li></ul><ul><li>If you drink alcohol, limit your intake </li></ul><ul><li>Choose foods low in salt and use salt sparingly </li></ul><ul><li>Include foods high in calcium </li></ul><ul><li>Use added sugars in moderation </li></ul><ul><li>Developed by National Health and Medical Research Council 1999 </li></ul>
  29. 30. Activity – What about Molly? <ul><li>Breakfast </li></ul><ul><ul><li>Cornflakes, milk & sugar </li></ul></ul><ul><ul><li>1 slice white toast, butter, jam </li></ul></ul><ul><ul><li>White tea </li></ul></ul><ul><li>Morning tea </li></ul><ul><ul><li>White tea, sweet biscuit </li></ul></ul><ul><li>Lunch </li></ul><ul><ul><li>Roast lamb, potato, pumpkin, peas, gravy </li></ul></ul><ul><ul><li>Rice pudding, white tea </li></ul></ul><ul><li>Afternoon tea </li></ul><ul><li>White tea & cake </li></ul><ul><li>Tea </li></ul><ul><li>Soup </li></ul><ul><li>Ham sandwich </li></ul><ul><li>Peaches & cream </li></ul><ul><li>Supper </li></ul><ul><li>Milk & Milo </li></ul><ul><li>Sweet biscuit </li></ul>