42


Part I Introduction to Nutrition Care in Older Adults


to promote a calm and focused emotional state to max- imize independence (4). Cognitive Deficits


Cognitive deficits such as those resulting from dementia and cerebrovascular accidents (CVAs) can be very chal- lenging and can significantly impact eating abilities. Frequently observed problem mealtime behaviors asso- ciated with cognitive deficits include slow pace of eating, distractibility, and ineffective use of utensils (6). Those with dementia have impaired depth perception (for example, the person placing a cup on the plate instead of next to the plate) and spatial orientation. Other problems associated with dementia include ide- ational apraxia, which is the inability to use an object properly because the person has lost the ability to discern the object’s purpose. Delayed response to cues and sensory input is also a factor in dementia. Persons in end-stage dementia may have as much as a 90-second response delay (7). Allowing adequate response time and following a prompt hierarchy can be effective interventions.


Older adults with dementia may not recall that they have just eaten a meal. Offering second servings or snacks may help decrease stress in these situations. In addition, meal presentation may be visually confus- ing or overwhelming for the person suffering from dementia (6). Some older adults may not be able to remain seated at the table for an entire meal. Providing foods such as sandwiches and finger foods that can be carried and eaten on the go and allowing residents to change location or ambulate while eating (if safe to do so) may increase intake.


Paranoia can also be a component of some types


of dementia. A person experiencing paranoia may think their food is being poisoned (19). Providing canned and packaged foods that the person can witness being prepared may help. Once distracted, the older adult with dementia may not recall that he or she has eaten some of their meal and may believe they are being pre- sented with someone else’s half-eaten meal. Removing the plate and reserving the meal may help (7).


Finger-Food Diet


When an older adult is not able to or refuses to eat with utensils, a diet consisting of foods that can be easily eaten without utensils—and with limited risk of spill- ing—can be utilized, provided no other diet texture modifications are required (eg, pureed diet) and any other therapeutic diet requirements are followed (eg, diabetic restrictions and sodium restrictions) (20). In some instances, those on a mechanical soft diet may be able to handle some finger foods, but this requires


close supervision and monitoring. There are products available to assist in creating pureed foods that may be eaten with the fingers. Such a diet can meet the Reference Daily Intake (RDI) for older adults as defined by the National Research Council. Foods that are small and difficult to pick up (eg, peas or rice) and foods that are slippery (eg, noodles in sauce or canned fruits in syrup) should be avoided. Foods that may become choking hazards if chewing or swallowing is impaired (eg, raw carrots, whole hot dogs) should also be avoided. Such foods may be cut into bite-size pieces (fruit cocktail size) if appropriate. Many foods can be modified to comply with a finger-foods diet, including soups served in mugs or meat served in a pita or tortilla. A wide variety of foods can be made into a sandwich. (See Table 4.1 on pages 48–49.)


Decreased Sensation of Taste


and Smell Dementia and the effects of aging can also result in decreased perception of or sensation for taste and smell. Enhancing flavor by increasing the amount of extracts, herbs, or spices called for in recipes or by adding fla- vorings such as bacon, cheese, or maple may increase intake as well as enjoyment in eating (19). Increasing aroma by directing the smell of cooking foods into the dining room and by lifting a cover from the plate just before it is served can help increase appetite. “A group of older adult men and women living in a retirement home ate more food and improved their immune func- tion when several foods at each meal were enhanced with one of the following: meat, cheese, or maple fla- voring” (19). See Box 4.2 for interventions for address- ing cognitive deficits.


Prompt Hierarchy


Following a prompt hierarchy allows staff intervention to compensate for lost abilities (21). “Feeding tech- niques other than spoon feeding—including verbal and nonverbal prompts and physical guiding—can support the older adult’s participation in independent dining even when independence is no longer possible” (6). The prompt hierarchy breaks intervention down into individual types of cueing, beginning with the least invasive cue and progressing to physical assistance only when necessary. As mentioned previously, staff can create dependence for dining in as little as two days by doing the task for the person (7). Using the least invasive cue is vital to maintaining independence, as detailed in Box 4.3.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156  |  Page 157  |  Page 158  |  Page 159  |  Page 160  |  Page 161  |  Page 162  |  Page 163  |  Page 164  |  Page 165  |  Page 166  |  Page 167  |  Page 168  |  Page 169  |  Page 170  |  Page 171  |  Page 172  |  Page 173  |  Page 174  |  Page 175  |  Page 176  |  Page 177  |  Page 178  |  Page 179  |  Page 180  |  Page 181  |  Page 182  |  Page 183  |  Page 184  |  Page 185  |  Page 186  |  Page 187  |  Page 188  |  Page 189  |  Page 190  |  Page 191  |  Page 192  |  Page 193  |  Page 194  |  Page 195  |  Page 196  |  Page 197  |  Page 198  |  Page 199  |  Page 200  |  Page 201  |  Page 202  |  Page 203  |  Page 204  |  Page 205  |  Page 206  |  Page 207  |  Page 208  |  Page 209  |  Page 210  |  Page 211  |  Page 212  |  Page 213  |  Page 214  |  Page 215  |  Page 216  |  Page 217  |  Page 218  |  Page 219  |  Page 220  |  Page 221  |  Page 222  |  Page 223  |  Page 224  |  Page 225  |  Page 226  |  Page 227  |  Page 228  |  Page 229  |  Page 230  |  Page 231  |  Page 232  |  Page 233  |  Page 234  |  Page 235  |  Page 236  |  Page 237  |  Page 238  |  Page 239  |  Page 240  |  Page 241  |  Page 242  |  Page 243  |  Page 244  |  Page 245  |  Page 246  |  Page 247  |  Page 248  |  Page 249  |  Page 250  |  Page 251  |  Page 252  |  Page 253  |  Page 254  |  Page 255  |  Page 256  |  Page 257  |  Page 258  |  Page 259  |  Page 260  |  Page 261  |  Page 262  |  Page 263  |  Page 264  |  Page 265  |  Page 266  |  Page 267  |  Page 268  |  Page 269  |  Page 270  |  Page 271  |  Page 272  |  Page 273  |  Page 274  |  Page 275  |  Page 276  |  Page 277  |  Page 278  |  Page 279  |  Page 280  |  Page 281  |  Page 282  |  Page 283  |  Page 284  |  Page 285  |  Page 286  |  Page 287  |  Page 288  |  Page 289  |  Page 290  |  Page 291  |  Page 292  |  Page 293  |  Page 294  |  Page 295  |  Page 296  |  Page 297  |  Page 298  |  Page 299  |  Page 300  |  Page 301  |  Page 302  |  Page 303  |  Page 304  |  Page 305  |  Page 306  |  Page 307  |  Page 308  |  Page 309  |  Page 310  |  Page 311  |  Page 312  |  Page 313  |  Page 314  |  Page 315  |  Page 316  |  Page 317  |  Page 318  |  Page 319  |  Page 320  |  Page 321  |  Page 322  |  Page 323  |  Page 324  |  Page 325  |  Page 326  |  Page 327  |  Page 328  |  Page 329  |  Page 330  |  Page 331  |  Page 332  |  Page 333  |  Page 334  |  Page 335  |  Page 336  |  Page 337  |  Page 338  |  Page 339  |  Page 340  |  Page 341  |  Page 342  |  Page 343  |  Page 344  |  Page 345  |  Page 346  |  Page 347  |  Page 348  |  Page 349  |  Page 350  |  Page 351  |  Page 352  |  Page 353  |  Page 354  |  Page 355  |  Page 356  |  Page 357  |  Page 358  |  Page 359  |  Page 360  |  Page 361  |  Page 362  |  Page 363  |  Page 364  |  Page 365  |  Page 366  |  Page 367  |  Page 368  |  Page 369  |  Page 370  |  Page 371  |  Page 372  |  Page 373  |  Page 374  |  Page 375  |  Page 376  |  Page 377  |  Page 378  |  Page 379  |  Page 380  |  Page 381  |  Page 382  |  Page 383  |  Page 384  |  Page 385  |  Page 386  |  Page 387  |  Page 388  |  Page 389  |  Page 390  |  Page 391  |  Page 392  |  Page 393  |  Page 394  |  Page 395  |  Page 396  |  Page 397  |  Page 398  |  Page 399  |  Page 400  |  Page 401  |  Page 402  |  Page 403  |  Page 404  |  Page 405  |  Page 406  |  Page 407  |  Page 408  |  Page 409  |  Page 410  |  Page 411  |  Page 412  |  Page 413  |  Page 414  |  Page 415