A key role for gerontological nurses is helping their patients with their nutritional needs. This care can include things such as helping patients make healthy food selections based on their likes and dislikes, connecting them with dental services and reviewing good dental care.
The major reason for nutritional issues in older adults is teeth or lack of them, or the inability to use teeth, or infection in teeth that may cause food to taste bad, said Tara A. Cortes, PhD, RN, FAAN, executive director of The Hartford Institute for Geriatric Nursing and a professor of geriatric nursing at the NYU College of Nursing. The fact that we dont have any coverage for dental care for older adults is a huge problem. Medicare doesnt cover dental care, so many people as they age stop going to the dentist because it is too expensive. I think the primary reason for malnutrition in older adults is poor mouth hygiene.
Another barrier to proper nutrition can be lack of information about quality food. Pamela Z. Cacchione, PhD, CRNP, BC, FAAN, president-elect of the Gerontological Advanced Practice Nurses Association and an associate professor of geropsychiatric nursing at the University of Pensylvania School of Nursing in Philadelphia, recommends providing presentations and tips to patients on how they can work within their budgets and dietary restrictions.
We have a lot of pictorial graphics we use with them as far as what to eat and what not to eat, Cacchione said. We have a presentation where we show them foods to avoid, which include high-sodium processed foods such as fried meals, cheese, salty and sugary snacks and canned meats or vegetables. In the presenation, Cacchione said, patients also learn about low- and high-sodium spices and seasonings. She also recommends providing reading aides to help patients review materials,
We have worksheets we do with them on how to read labels, and sometimes we provide them with magnifying glasses so they can read, Cacchione said.
Nurses also can encourage patients to drink more water, said Lisa Byrd, PhD, RN, FNP-BC, GNP-BC, a gerontologist and president of the GAPNA. Byrd said some elderly individuals are reluctant to do so because they will urinate more, but increased water consumption can help keep patients hydrated and decrease recession of the gums.
Two issues nurses should regularly check are weight loss and lack of interest in food, which can be caused by not being hungry or an inabilty to feed oneself.
Sometimes they cant cut it, yet alone chew it, Cortes said. Some of it may be a matter of what they can physically do.
Nurses also advise asking the same questions every time they see a patient.
Ask them what they eat everyday, Cortes said. Getting an accounting of the food that they eat on that particular day is very helpful. You run into problems if the patient has dementia, so you need to rely on their caregiver to do an assessment. Think of the caregivers and their family as part of the healthcare team. Find out if they can eat. Do they have dentures? Have they seen a dentist? Do they have loose teeth? Can they cut their meat? Do that with the caregiver present and then work on a plan of care.
Nurses also can help patients stay on their nutritional plans by not getting caught up in rigid nutritional restrictions as people get older, particularly in the nursing home population, Cacchione said.
We set people up for weight loss, which will then have a negative impact on their health, Cacchione said. I think having common sense parameters for people in long-term care, in particular, is needed. And maybe not being so strict on high-fat diets, or low-fat diets or low-salt diets so that they dont restrict their nutritional intake too much. Its the quality of life sometimes more than quantity.