Page 212 - Nutrition Counseling and Education Skills: A Guide for Professionals

homes tend to be more impaired functionally and may need assistance with eating. Malnutrition affects about
two of every five elderly nursing home residents. Several assessment tools are available to perform nutritional
and dysphagia screening.29,34

A primary nutrition focus in long-term care facilities is the risk reduction of pressure ulcers and other
wound healing issues by providing adequate calories and nutrients under the direction of a registered
dietitian.35 The Academy of Nutrition and Dietetics has an active practice group of specialized members that
focus on this area of geriatric expertise and have published standards of practice for their field.32

Achieving and maintaining optimal nutritional status of the older population is the primary goal for
nutrition counselors. A few counseling recommendations are found in Table 9-2. Nutrition counselors should
be aware of local and government community programs to access for older adults. Food assistance programs
and food pantry systems are often available. Government programs may provide meals at little or no cost in a
social setting such as community or recreational centers, senior citizen centers, and churches. Home-delivered
meals are another common resource in many communities.

Changes in resting energy expenditure and decreased levels of physical activity require assessment of caloric
needs to achieve and maintain healthy body weight.

Smaller meals and portions require increased nutrient density.

Sensory changes of taste, smell, hearing, and vision may influence appetite and food choices by making food
less appealing.

Drug–nutrient interactions need to be assessed due to higher risk of multiple medication and over-the-
counter supplement use.

Denture problems, difficulty swallowing, or chewing impairment may restrict foods selected or eaten.

Social isolation, loneliness, and bereavement due to loss of spouse decrease interest in cooking and eating.

Income may be limited or fixed while healthcare and other expenses increase, resulting in food insecurity
and economic problems.

Physical disability and cognitive impairments (depression and dementia) may make shopping and cooking
difficult.

Lack of physical activity decreases muscle mass, which can affect mobility and strength.

Physiologic changes in digestion and absorption increase with age.

Table 9-2 ■ Counseling Awareness Issues in Older Adults

Managing Chronic Diet-Related Diseases

As people live longer, they often are diagnosed with a chronic disease condition. Examples of diet-related
chronic diseases may include diabetes mellitus, elevated blood cholesterol (dyslipidemia), osteoporosis, cancer,
heart (cardiovascular) disease, high blood pressure, or kidney disease. Many adults may have more than one
chronic disease to address and integrate within their lifestyle. Diabetes, hypertension, and hyperlipidemia
commonly occur in a cluster along with obesity. This combination of metabolic disorders is referred to as

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