Transcript Offer and provide assistance with meals EAT FIRST

PRESENTER: EBONY CRAMERI
Accredited Practising Dietitian
What is dehydration?
 Dehydration occurs when the amount of fluid
consumed is less than the amount that is lost.
Dehydration in aged care settings is a common and
dangerous problem.
The role of Hydration in the body
 Carries nutrients
 Regulates body temperature
 Removes wastes
Inadequate Hydration
Inadequate hydration is associated with many adverse
consequences including:
 poor oral health
 poor skin integrity
 Constipation
 urinary tract infection
 confusion & cognitive impairment which can lead to
increased risk of falls and reduced quality of life
 electrolyte imbalances
 Reduced food intake and an increased risk of malnutrition
Why is dehydration common in the
aged care setting?
Dehydration can happen very quickly, often less than 8 hours.
Residents are at an increased risk of dehydration due to the
following:
 Poor oral intake and appetite
 Refusal of fluid
 Diminished sense of thirst despite having normal fluid
requirements
 Inadequate staffing to assist residents who have total or
partial dependence on staff for fluid intake
 Medicines such as diuretics
Continued ….. Why is dehydration
common in the aged care setting?
 Residents actively limiting intake to reduce need to go to the
toilet often due to fear of incontinence (restricting fluids does not
reduce urinary incontinence.
 Swallowing difficulties or oral disorders making it difficult to drink
 Vomiting/ diarrhoea
 Limited range of fluids offered
 Poorly controlled diabetes
 Inability to hold/manage a cup & limited access to assistive
devices to aid in drinking eg/ a 2 handle cup
 Dislike of thickened fluids
Dehydration in Summer AND Winter
 Many people are aware of the risks of dehydration in the
summer months however winter also poses a significant risk
to residents hydrations due to:
- heating in rooms
- illnesses such as the flu/fever and respiratory illnesses
that require an increased fluid intake
Signs of Dehydration
 Dry mouth and tongue
 Cracked lips
 Dark urine and small output
 Reduced sweat in the armpits
 Recent alteration in consciousness , confusion & irritability
Remember residents may not complain of thirst, especially if
their cognition is impaired.
Fluid Requirements
Older People have similar fluid needs compared with young
adults.
Minimum fluid intake for most residents is between 1600ml2000ml per day, more may be required if the resident has
increased fluid requirements. Common conditions that require
increased fluid intake include :
 Wounds
 Fever
 Hot weather
What counts as fluid?
Any food or beverage that is liquid at room temperature. This
includes:
FOODS:
ALL BEVERAGES such as:
Soup
Jelly
Custard
Ice Cream
Yoghurt
Porridge
Tea
Coffee
Milk
High protein drinks such as
Sustagen
Cordial
Soft Drinks
Juice
How much fluid in standard
foods and beverages?
½ cup custard = 100ml
Coffee cup of fluid = 150ml fluid
fluid Juice glass = 120ml fluid
200g carton yoghurt = 180ml fluid
½ cup sago/tapioca pudding = 80ml fluid
Fruit juice Tetra Pak of fluid = 250ml fluid
¾ cup thick soup = 150ml fluids
½ cup jelly = 100ml
Plastic feeder glass of fluid = 200ml fluid
2 scoops ice-cream = 70ml fluid
Practical Tips to Increase Residents
Fluid Intake
1. Monitor
Observe, record and monitor consumption of fluids
2. Identify residents at high risk if dehydration
What does your facility currently do?
3. ACT
3. ACT
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Fluid rounds at meals and in between
Small quantities of fluid frequently
Encourage a full glass of fluid to be consumed with medicines
Have a fluid station available during all activity and therapy sessions.
Offer fluids every time a resident is assisted to the toilet
Have a fluid plan for nights
Offer high fluid foods at mid meal snacks
Have a wide variety of beverage flavours available to prevent flavour
fatigue
 Increase variety of flavour of water by adding lemon, lime, cordial
 Introduce special drinks for days of the week eg/ milkshake Monday.
 Ask residents to drink rather than asking if they are thirsty
(remember diminished sense of thirst)
Malnutrition:
The skeleton in the nursing home
closet
What is Malnutrition?
 Malnutrition is a state in which a deficiency of
nutrients such as energy, protein, vitamins and
minerals causes measurable adverse effects on
body composition, function or clinical outcome
 Malnutrition is both a cause and consequence
of ill health
 Malnutrition increases a patients vulnerability
to disease
How Common is Malnutrition in
Residential Aged Care Facilities?
 Studies have shown the prevalence of
malnutrition in residential aged care
facilities to be between 40%-70%
 Malnutrition is largely under recognised
and under diagnosed resulting in a
continual decline in nutritional status
Effects of aging on nutrition
Which resident is malnourished?
Which resident is malnourished?
They all could potentially be malnourished or at risk of
malnutrition!
Body weight and appearance alone is not an accurate
predictor of nutritional status.
Malnutrition can occur in residents who are normal,
overweight or obese - not just those with an obvious wasted
appearance!
Signs & Symptons of Malnutrition
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Loss of appetite
Decreased food intake
Unintentional weight loss
Loss of lean body mass
Decreased functional capacity
Nausea/ vomiting
Constipation and/or diahorrea
Malnutrition Results from…
1. Decreased Intake
2. Increased Requirements
3. Malabsorption/Nutrient
Losses
Poor appetite
Infection
GI diseases
Needing assistance with
meals
Post- surgical
Bowel resection
Lack of access to food
Would healing
Wounds/ drains
Dysphagia
Pressure ulcers
Alcohol Dependence
Cancer
Depression
Trauma
Other factors that may lead to
malnutrition
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Disease
Delirium & Dementia
Medication- changing smell, taste, SE’s such as diahorrea
Surgery
Vomiting
Fistula losses
Burns
Drug abuse
Long hospital admissions
Effects of Malnutrition
 Increased infection rate
 Increased risk of complications- pressure areas/ulcers, sepsis, falls,
declining mental health
 Decreases response and/or tolerance to treatment
 Decreases quality of life
 Decreases life expectancy
 Negatively effects treatment outcomes
ALL EQUAL POOR PATIENT OUTCOMES
&
INCREASED HEALTHCARE COSTS!
Pressure Areas & Ulcers
 People with malnutrition are twice as likely to develop a
pressure ulcer compared to well nourished patients
 Patients with infections often have poor appetites,
resulting in lower nutritional intake
 Patients with pressure areas, ulcers and wounds have
higher protein and energy needs in order to promote
wound healing
 Refer to Dietitian as early as possible for nutrition
intervention
Texture Modified Diets
 Residents can be at risk of malnutrition when on a texture
modified diet
 Residents usually require assistance with feeding- if not being
assisted this can lead to reduced intake
 Residence may need prompting and encouragement to eat if
they are having difficulties swallowing
 Pureed diet can lack variety & be visually unappealing
 Ensure patients are upright during feeding and for at least
30minutes post feeding
 It is important that food is offered to residents at EVERY meal,
even if you personally find the food to be unappealing.
How to improve nutrition via meals
 Encourage patients to:
- Drink nutritious drinks such as HP/HE supplement, milk,
juice, cordial before other drinks such as water, tea, coffee
How to improve nutrition via meals
 Encourage patients to:
- Encourage residents to eat meat and dairy desserts before
vegetables
EAT FIRST
- Eat small frequent meals
- Give residents plenty of time to eat their meal
- If you notice a resident is enjoying a particular food- provide them
with extras of that food
- Make eating easier by setting the resident up for meals
- Offer and provide assistance with meals
What else can you do?
 Screen patients using a
screening tool such as
Malnutrition Screening Tool
(MST) to screen patients on
admission and throughout their
residency
What else can you do?
 Refer patients to a Dietitian who:
- have pressure areas, ulcers or wounds
- have experienced unexplained weight loss
- are not eating at meal times
 Monitor weight loss over six month period & identify
residents who have lost > 5% total body weight over 6
months
 Offer and provide assistance with feeding