46

Part I Introduction to Nutrition Care in Older Adults

Poor Sitting Balance and Poor Neck Control

If a client has a tendency to fall forward from the waist with his or her head on the table while seated at the table in a regular dining room chair, several techniques are available to help maintain an upright position. First, the chair must be secure so that the client does not slide away from the table (Figure 4.2). If the resident’s hips are sliding forward in the seat of the chair, the head tends to lean back and the distance from plate to mouth increases and indepen- dence in eating becomes more difficult. The best position begins with the resident’s hips at a 90-degree angle at the back of the chair. A nonslip netting or other nonslip material on the seat of the chair helps prevent the client from sliding forward. Avoid multiple layers of cushions on the chair seat because this can result in the hips sliding forward.

A wedge cushion might be considered to position the hips back in a dining room chair. If all of these interventions are unsuccessful, then a seat belt may be considered for use on the chair during mealtime. Even though the seat belt would be used for positioning, it would still be considered a restraint under current regu- lations. Placement of the seat belt should allow the belt to come from under the chair and pass over the resi- dent’s hips, not waist, to help keep the hips at a 90-degree angle at the back of the chair (27).

Bed-Bound Clients

Occupational and physical therapists can be a great resource in evaluating the bed-bound client for posi- tioning interventions. If residents cannot sit in a chair, the following positioning tips can be used (27):

●

Raise the head of the bed to the fullest upright position.

●

Position a pillow behind the resident’s shoulder blades and neck so that the neck is slightly forward and the chin is tucked under.

● Keep the head in a midline position. ●

●

Maintain the head in an upright position to reduce the chances of aspiration.

Position the knees at a 90-degree flexion by adjusting the bed or by supporting the knees with pillows (additional pillows may be needed to maintain this position).

●

Reposition the resident frequently to prevent pres- sure ulcers.

Remember to raise the bedside table and position it close to the client. The table should be between waist and breast level to reduce the distance from plate to

mouth. Positioning is improved and a positive meal- time experience is promoted by close attention to (27):

●

clearing and cleaning the bedside table before serving the meal

● ● ●

placing all necessary items within reach, avoiding unpleasant smells

limiting distractions (eg, from visitors and loud televisions)

●

providing periodic supervision and assistance as needed

SUMMARY

Quality of life improves when nutritious meals that meet individual food preferences are served in a pleas- ant, friendly atmosphere that promotes socialization. With older adults, these approaches may be more bene- ficial than restricted therapeutic diets. Older adults benefit from an environment in which they are encour- aged to function at their highest physical and mental levels. Appropriate mealtime positioning promotes independence in eating. Monitoring for problems at mealtime and providing interventions can maximize the rehabilitation of eating-disabled clients. Issues related to independent dining in the older adult population can be complex and varied: “It can be difficult to provide each older adult with the assistance that they need because each person has different dis- abilities, appetite and food habits, and some, espe- cially those with dementia, find it difficult or even impossible to indicate their needs or preferences” (24). An individualized approach to the maintenance of independence with dining skills and preserving the social relations embedded within the act of dining can significantly impact older adult well-being and quality of life (3,18).

Figure 4.2 Incorrect Position