The National Institute on aging reports that undernourishment can increase the likelihood of infections, poor wound healing, pressure sores, immune deficiency, anemia, and abnormally low blood pressure (hypo-tension). Dehydration can also lead to problems such as constipation, urinary tract infections, renal disease, pneumonia, hypo-tension, and delirium. In addition, lack of adequate nutrition and fluids can negatively impact the person’s mood, behavior, and physical functioning as dementia progresses (“National Institute on Aging | The Leader in Aging Research,” n.d.).
One specific observation made while working within a long term care facility is that many of the clients (especially those with dementia and Alzheimer’s) do not consume much of their provided meal. One could identify a number of reasons as to why this may occur, but one in particular could be limited staff available to assist.
The American Dietetic Association has conducted research indicating up to 85% of residents in long term care facilities are undernourished. Another statistic from the ADA states as many as 60% of these patients may also be suffering from dehydration (“Individualized Nutrition Approaches for Adults in Health Care Communities,” n.d.). Just because they are elderly does not mean they do not require adequate amounts of macro and micro nutrients for basic survival.
Attending the lunch session, I asked my preceptor if I could sit and help two clients both exhibiting dysphasia and severely contractured limbs, rendering them helpless. Upon sitting down, one of the nurses said to me, “Good luck with those two.” I wasn’t sure what to make of her comment but assumed it to be that I may encounter some challenges attempting to provide care to these two women.
Both lunch plates were fully pureed mechanical diet with some chicken, peas, potatoes as well as thickened liquids and applesauce. Approximately 40 minutes later, and a lot patience, both had consumed 80-85% of their meal most of their liquids and all of their applesauce. The same nurse walked back by, stopped and said, “Wow! They must have been really hungry today.” Since the patient is unable to advocate for themselves, how would we know were we to not at least exhaust all efforts in attempting to provide them much needed nourishment?
Within this same facility, some patients have a tray brought to the room – often times left there while they lay in bed. An hour or so later, someone from the kitchen comes to collect trays, the client is still sleeping so the tray is picked up and the person obtains no nutrition. Cachexia is defined as weakening or wasting of the body due to severe chronic illness. Could this failure to assist these people in consumption of provided food be causing them to become cachexicin addition to any other illness they may be enduring?
Health care expenses are monitored at every level. The demands on nurses and aids have and may continue to increase. Adding more staff to assist with the feeding of patients during the lunch hour is probably not feasible. However, during that hour, many facilities have numerous “other” workers throughout; kitchen help, administrators, maintenance, etc who could be educated on assisting those incapable of feeding themselves. This could be a Quality Improvement initiative within an institution to bring various levels of the organization back to what matters, the patient better identified as, the customer
Individualized Nutrition Approaches for Adults in Health Care Communities. (n.d.). Retrieved from http://www.eatrightpro.org/resource/practice/position-and-practice-papers/position-papers/individualized-nutrition-approaches-for-older-adults
National Institute on Aging | The Leader in Aging Research. (n.d.). Retrieved from https://www.nia.nih.gov/alzheimers/features/promoting-successful-eating-long-term-care-relationships-residents-are-key