This document discusses nutrition in elderly adults and the role of nurses. It describes a patient who has lost 10 pounds and is at risk of malnutrition due to factors like decreased activity and mild dementia. The nurse's role is to assess the patient's nutritional status using tools like the Mini Nutritional Assessment and develop interventions. These may include encouraging exercise, ensuring social eating environments, and monitoring lab values to guide increasing calorie, protein and nutrient intake through the diet and supplements. The goal is to maintain the patient's nutrition, health, and quality of life.

1. Running head: ELDER ADULT NUTRITION 1
Elder Adult Nutrition: How a Nurse Can Help
Laura Nealon
Binghamton University

2. ELDER ADULT NUTRITION 2
Elder Adult Nutrition: How a Nurse Can Help
When an elderly patient is exhibiting signs of malnutrition it’s often the nurse who steps
in to assess, evaluate, and make interventions on behalf of their patients to maintain or improve
their nutritional status, which is vital role considering that as many as 50% of nursing home
residents are malnourished (Biggs, 2007) . When I first met, assessed, and watched my patient
eat breakfast I thought that she was a low risk for malnutrition, until I looked at her chart and
saw that she’s lost over 10 Lbs. since her admission in February this past year. My patient was
admitted seven months ago after she suffered a small ischemic stroke to the left hemisphere and
the subsequent onset of mild-hemi paresis, dementia, and an unsteady gait. On the Mini
Nutritional Assessment (MNA) assessment tool she scored a 20, which puts her a risk for
malnutrition, and the Biggs’ Elderly Self Care Assessment Tool of Water and Food Intake
(BESCAT) she did well except for her recent weight loss and her No Added Salt and ground
protein diet. According to her she eats according to the food intake requirements on the test and
said that, “Food still tastes good, I like to eat it” in response to one of the questions. Though
she’s overweight (BMI 26.7), some studies indicate that being overweight is less of an indicator
or morbidity in the elderly and that it can be beneficial in the case of infection when the energy
demands of the body increase (Biggs, 2007).
One of the possible reasons for her risk for malnutrition could be due to a reduction in
lean muscle mass due to her relative inactivity slow walking speed, and her unsteady gait(Biggs,
2007),. Since she is less active and a fall risk she spends most of her time sitting, even though
she goes to exercise activities, she not participating in as much weight bearing exercise which
puts her at risk for a further decrease in lean muscle mass, a slowing of her metabolic rate, an
increase in fat, and sarcopenia (Amella and DiMaria-Ghalili, 2005)

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Dementia could be another factor in her weight loss, she has mild short and some long
term memory loss that may make it harder for her to recall what she’s eaten and more likely to
forget to eat or forget to ask for food when she’s hungry. Dementia can negatively affect
nutrition intake over the course of the disease and it’s important that patients be regularly
assessed and prompted when eating in order to maintain adequate intake (Biggs, 2007).
Decreased thirst perception could be another potential issue with this patient, according
to her answer during the BESCAT she drinks water when she’s thirsty but she seems more
inclined to only drink when it’s put in front of her. It’s also possible that she is not thirsty as
often as a younger person might be due to diminished thirst perception or possible medications
that could cause dry mouth (Biggs, 2007).
Decline in sensory acuity and taste and smell could also be a potential problem for her.
Changes in taste is common as we age, much if this is due to a decline in our sense of smell as
we age, about half of people over the age of 80 had a reduced sense of smell (Biggs, 2007). A
decrease in smell can affect intake as well as taste, if a person can’t smell the food coming out of
the kitchen it will suppress the physiologic hunger reaction (Biggs, 2007).
Impaired dentition could be a potential problem since oral care can be easily overlooked.
Most of her original teeth are intact, but if she were to lose additional teeth or become edentulous
it can affect her ability to chew food adequately or result in a modified diet that is less appealing
and therefore less likely to be consumed (Biggs, 2007).
As a nursing intervention, further increasing her resistance exercises activities or
ambulating with her up and down the hallway 2x a shift would help to maintain lean muscle
mass and increase her energy expenditure, putting her at a lower risk for falls and
increase/maintain her appetite and metabolism (Gulanick and Myers, 2014).

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Nursing interventions involving prompting and encouraging to eat, offering her a
selection of beverages and snacks that she’s stated she likes, and reminding her that she can have
ice cream verbally to see if she would like it as a snack could help improve her intake. Offering
foods that they prefer can increase caloric intake (Biggs, 2007)
Since she does not like eating alone it would be important for the nurse to make sure that
she’s eating in a comfortable and social environment like the dining room (Ackley, 2011), that
she’s seated with her preferred dining companions, and if possible it would also be a benefit if a
nurse or aid engaged with her during a meal to ask her questions (not while she’s chewing or
swallowing but throughout the meal). Patients are more likely to eat in a positive socially
supporting environment that is free from loud noises or unpleasant smells (Gulanick and Myers,
2014).
Since she’s had some decrease in weight, but is not weighed regularly it would be
important for the nurse to regularly asses her nutritional status by administering regular MNA
assessments, accurately measure her weight and height, and make sure that her meal intake is
being measured properly. Regularly assessing a patient’s nutritional status allows nurses and
staff to identify malnutrition and intercede (Ackley, 2011).
Establishing long and short term goals with her, like finishing her Ensure or adding an
extra glass of milk in the afternoon for added protein, are appropriate methods to increase her
intake of calories and nutrients. It may be beneficial to write these goals down where she can see
them so that she’s regularly reminded of them. Since improving her intake, nutrition, and
exercise habits are ongoing processes having short and long terms goals provide tangible rewards
for the patient (Gulanick and Myers, 2014).

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Lab values can be good indicators of overall health, nutrition, and disease status.
Albumin and pre-albumin are indicators of protein depletion with pre-albumin being a better
indicator because of its shorter half-life which would reflect acute problems, my patient had a
low albumin score of 2.8 G/dL (Normal 3.4-5.0 G/dL) which would indicate a decrease in
protein production and tell the nurse that she should increase her protein intake and monitor her
for signs of edema. There were no pre-albumin lab values available. Her white blood cell count
(WBC) was normal, but her red blood cell (RBC) and hemoglobin (Hg) counts were low with
her RBC being 3.99 (Normal 4.0-5.2) which is low but only just so and something the nurse
should keep an eye on for future labs. Her Hg was low 11.0 g/dL (Normal 12.2-15.5) which
would indicate that he oxygen carrying capacity of her RBC’s is slightly diminished and that the
nurse should monitor her Pule O2 saturation regularly and make sure that she is getting enough
folate, B12, and iron in her diet. There were no labs on her Thyroid Stimulating Hormone level.
Vitamin B12 labs were also not available but a low B12 could result in a lower WBC and RBC
blood count, paresthesia, and possibly a reversible dementia, all of which would indicate a need
for vitamin B12 supplementation. Her Blood Urea Nitrogen labs were normal indicating good
hydration (Porth, 2007). Her Serum Glucose levels were normal indicating adequate production
and absorption of insulin (Porth, 2007). Most of her electrolytes were normal, including her
potassium and sodium, but her calcium level was slightly low at 7.8 mG/dL (Normal 8.5-10.0
mG/dL) indicating a calcium deficiency and would tell the nurse to increase her calcium intake
and monitor her future blood work. Her Vitamin D hydroxy was also low at 20.7 (normal 30.0-
100.0) and indicates a vitamin D deficiency that should also be increased and monitored. Both D
and Calcium can be taken as a cholecalciferol supplement, of which she’s been prescribed.

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References
Ackley, B. J., & Ladwig, G. B. (2011). In Clark S., Jones C. J. (Eds.), Nursing diagnoses
handbook (Ninth ed.). St. Louis. MO: Mosby.
Amella, E., & DiMaria-Ghalili, R. A. (2005). Nutrition in older adults: Intervention and
assessment can help curb the growing threat of malnutrition. American Journal of Nursing,
105(3), 40.
Biggs, A. J. (2007). Nutritional considerations. In Linton, A., Lach, H., Matteson &
McDonnell's Gerontological nursing: Concepts and practice. (pp. 169-192). St Louis:
Elsevier.
Gulanick, M., & Myers, J. M. (2014). Nursing care plans: Diagnoses, interventions, and
outcomes (8th ed.). Philadelphia, PA: Elesvier/Mosby.