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The Nutrition Community of Practice (CoP) was a network of health professionals and caregivers that promoted the importance of food and nutrition for healthy aging, and shared research and best practices in nutrition care for older adults across the care continuum. The CoP was committed to supporting knowledge exchange between members of various disciplines, developing relevant resources and organizing quarterly webinars.

Diet, Nutrition & Weight Control programs evaluate an individual‘s nutritional history and dietary intake to develop a plan which ensures that the person‘s nutritional needs are met. Weight control programs may also help individuals who have an eating disorder or a weight control problem achieve a more healthful body weight and develop a lifestyle that allows them to maintain that weight.  The southeasthealthline website provides links to services.

Nutrition 

As older adults age, their nutritional requirements change.

Why is it important?

  • 34% of older Canadians are at nutritional risk, and women more so (1)
  • Older adults are at risk for under-nutrition due to dietary, economic, psychosocial, and physiological factors (2)

Common Causes

  • Increased sedentary lifestyle  and lowered metabolic rate (5)
  • Increased deficiency in key vitamins and minerals; a reduced sense of taste and smell; difficulty chewing or swallowing; a restricted diet for a health condition; eating alone; loss of appetite; and medications (5)
  • Chronic conditions or disability may affect ability to cook (2)
  • Poor oral hygiene (2)

Key Considerations

  • Advise to follow Canada’s Food Guide
  • Discuss any concerns with serving sizes, dietary restrictions, Nutrition Facts table
  • Assess for vitamin/mineral deficiencies with attention vitamin B6, B12, D, calcium and iron (3)
  • Screen for obesity: calculate Body Mass Index•
  • Develop a healthy eating plan- consider budget limitations, refer to a dietician, community programs for meal preparation (e.g. safe cooking practices) and meal planning

Consult the following for patient handout information:

References

1. Dieticians of Canada. (2013). Online nutrition screening tool helps older adults identify if they
    have risk factors leading to poor nutrition
. Retrieved March 12, 2014 

2. DiMaria-Ghalili, R. (2012). Nutrition in the Elderly, Nursing Standard of Practice Protocol: Nutrition in Aging.
    Retrieved March 12, 2014 from:
    http://consultgerirn.org/topics/nutrition_in_the_elderly/want_to_know_more

3. EatRight Ontario. (2014). Seniors Nutrition. Retrieved March 12, 2014 from:
    http://www.eatrightontario.ca/en/Articles/Seniors-nutrition/Older-adults-eating-well.aspx#.UyBs6BbnL7I

4. Health Canada. (2007). Food and Nutrition: What is a Food Guide Serving? Retrieved March 12, 2014 from:
    http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/serving-portion-eng.php

5. University of Rochester Medical Center. (2014).  Nutrition Needs in Older Adults.
    Retrieved March 12, 2014 from:
    http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2321

Hydration

Dehydration occurs when an individual’s body loses more water than it takes in. The body will not have enough fluids to
carry out normal functions.

Why is it important?

  • Older adults are vulnerable to shifts in water balance- in both over hydration and dehydration
  • Dehydration can result in serious problems:
    • heat injury
    • cerebral edema
    • seizures
    • low blood volume shock
    • dizziness/fainting and risk of falls
    • kidney failure
    • constipation
    • coma
    • death (2) (3)

Common Causes

  • Age-related changes in body composition resulting in depletion of total body water (4)
  • Decreased renal function (4)
  • Thirst sense becomes less accurate (4)
  • Poor tolerance for hot weather (4)
  • Intense vomiting and diarrhea (3)
  • Vigorous exercise and not drinking enough water
  • Inadequate nutrition intake
  • Increased urination

Key Considerations

  • Risk factors: 85+, female, dementia,  multiple chronic diseases, medications, fever, dehydration history, use of diuretics (water pills) (4)
  • Parkinson’s disease or stroke may cause swallowing difficulties leading to decreased fluid consumption (1)
  • Signs of dehydration: little or no urination, sunken eyes, skin lacking elasticity and resilience when pinched, low blood pressure, a heart rate faster than normal, reduced blood flow to the extremities, dry mouth,  dizziness/sudden confusion, weakness (3) (1)
  • To confirm diagnosis, consider blood tests (electrolytes, kidney function) and urinalysis (3)
  • Treatment usually involves replacing lost fluids and electrolytes as oral rehydration
  • In life threatening emergency situations provide intravenous (3)
  • Identify medications that may be causing water loss (1)
  • Eat Right Ontario recommends: women 9 cups (250ml per cup) a day and men 12 cups (2)
  • Certain liquids, such as fruit juices, coffee, or carbonated drinks can make diarrhea worse (3)

References

  1. Alberta Caregiver College. (2014). Support for Caregivers of Older Adults: Hydration. Retrieved February 20, 2014 from:
    http://caregivercollege.ca/mod/tab/view.php?id=108

  2. Dieticians of Canada. (2014). Facts on Fluids- How to Stay Hydrated. Retrieved February 19, 2014 from: 
    http://www.eatrightontario.ca/en/Articles/Water/Facts-on-Fluids---How-to-stay-hydrated#.UwYiMRbnL7I

  3. MAYO CLINIC. (2014).  Diseases and Conditions: Dehydration. Retrieved February 19, 2014 from: 
    http://www.mayoclinic.org/diseases-conditions/dehydration/basics/definition/con-20030056

  4. Mentes, J. (2012).  Hydration Management. Nursing Standard of Practice Protocol: Managing Oral Hydration. Retrieved February 19, 2014 from: 
    http://consultgerirn.org/topics/hydration_management/want_to_know_more#item_2

Nutrition

As we age, our nutritional needs change (1). Eating a nutrition-packed diet can help older adults feel their best and stay healthy (1). Giving your body the nutrition it needs by eating healthy can help prevent or manage diseases like type 2 diabetes and heart disease (2).

Healthy eating for older adults is…

  • eating a variety of vegetables and fruits
  • eating whole grain products like brown rice, oats, quinoa etc.
  • eating healthy fats such as those found in nuts, seeds, avocados and fish
  • eating healthy portion sizes – older adults generally require fewer calories
  • limiting or eliminating foods high in unhealthy fats, sugar and salt such as cakes, cookies, doughnuts, fast foods, soft drinks etc.
  • drinking plenty of water to stay hydrated
  • making sure important nutrient needs are met – Vitamin B6, Vitamin B12, Vitamin D, Calcium, Iron and fiber
  • a supplement can help make sure the body gets the nutrients it needs; talk to the doctor to find out which one is right for the person you are caring for (1)(2)(3)(4).

Common problems

A lack of key vitamins and minerals in the diet can occur from a combination of factors:

  • side effects of medications can lessen appetite, cause nausea, make food taste differently, or prevent absorption of vitamins and minerals 
  • limited income and lack of transportation may affect  access to quality food and the number of meals per day (5)
  • chronic conditions or disability can limit movement needed to cook 
  • Chewing problems (6).

Things to consider

  • Some signs that your loved one may not be reaching their nutritional goals include a decreased appetite, weight changes, no longer able to cook or shop, taking lots of medication or not having enough money to buy food (1). If you notice these signs, ask your loved one to speak with their doctor (1).
  • Use Canada's Food Guides to help make healthy choices.
  • Call Telehealth Ontario toll-free at 1 866 797 0000 and speak to a registered dietitian about healthy eating.

Hydration

Drinking liquids throughout the day is especially important for older adults (7). Fluid is needed for your body to function well; if the body doesn’t get enough fluid it can become dehydrated (2). Dehydration can lead to dizziness, fainting, confusion, constipation, low blood pressure and increase the chance of a fall (2)(7).

Things to consider

  • The signs of dehydration include: thirst, low blood pressure, increased heart rate, dry lips and mouth, dizziness/confusion (7).
  • The amount of fluids you need depends on your age, gender and level of physical activity (7). Certain circumstances – like illness, exercising, hot/humid weather, staying in heated buildings – require more fluid intake (7).
  • Drink frequently throughout the day instead of drinking large amounts in one sitting (7).
  • Your fluid intake can include water and a variety of foods containing high amounts of water like fresh fruit and vegetables (7).

 References

(1)  Dietitians of Canada. (2018). Older Adults eating well.  Retrieved from http://www.unlockfood.ca/en/Articles/Seniors-nutrition/Older-adults-eating-well

(2)  HealthLinkBC (2016). Healthy eating and healthy aging for adults. Retrieved fromhttps://www.healthlinkbc.ca/healthlinkbc-files/healthy-eating-adults

(3)  Government of Canada. (2015). What is healthy eating? Retrieved from https://www.canada.ca/en/health-canada/services/tips-healthy-eating/what-is-healthy-eating.html

(4)  Wolfram, T. (2018). Special nutrient needs of older adults. Retrieved from https://www.eatright.org/health/wellness/healthy-aging/special-nutrient-needs-of-older-adults

(5)  Health in Aging. (2018). Nutrition – Unique to older adults. Retrieved from http://www.healthinaging.org/aging-and-health-a-to-z/topic:nutrition/info:unique-to-older-adults/

(6)  Dietitians of Canada. (2018). Managing chewing problems. Retrieved from http://www.unlockfood.ca/en/Articles/Dental-health/Managing-Chewing-Problems.aspx

(7)  Dietitians of Canada. (2018). Facts on fluids - How to stay hydrated. Retrieved from http://www.unlockfood.ca/en/Articles/Water/Facts-on-Fluids-How-to-stay-hydrated.aspx

This handout provides dietary guidelines for adults with diabetes and chronic kidney disease . 3 Pages.

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