Elderly Care Services/ Malnutrition Problems

As we age, there tends to be a general decline in health. A big reason for this is malnutrition.

Oxford Dictionary's definition for malnutrition states: malnutrition is a lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat.

As we get older, it gets harder to cook, plan and prepare meals, harder to chew and swallow, and harder to drive out to the grocery store on a regular basis for fresh food. Some of these things can be difficult to monitor in our loved ones. Nestle has developed a Mini-Nutritional Assessment Tool that can be used to determine whether you or someone you know is at a nutritional risk.

Screening:

A) Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing, or swallowing difficulties?

• 0= severe decrease in food intake
• 1= moderate decrease in food intake
• 2= no decrease in food intake

B) Weight loss during the last 3 months

• 0= weight loss greater than 3 kg (6.6lbs)
• 1= does not know
• 2= weight loss between 1 kg and 3 kg (2.2 and 6.6 lbs)
• 3= no weight loss

C) Mobility

• 0= bed or chair bound
• 1= able to get out of bed/ chair but does not go out
• 2= goes out

D) Has suffered psychological stress or acute disease in the last 3 months?

• 0= yes
• 2= no

E) Neuropsychological Problems

• 0= severe dementia or depression
• 1= mild dementia
• 2= no psychological problems

F1) Body Mass Index (BMI) (weight in kg)/ (height in meters)2 

• 0= BMI less than 19
• 1= BMI 19 to less than 21
• 2= BMI 21 to less than 23
• 3= BMI 23 or greater

If BMI is not available, replace question F1 with question F2. 

Do not answer question F2 if Question F1 is already completed.

F2) Calf Circumference (CC) in cm

• 0= CC less than 31
• 3= CC 31 or greater

Screening Score (max 14 points):

• 12-14- Normal nutritional status
• 8-11- At risk of malnutrition
• 0-7- Malnourished

 Ref. Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA® ) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009; 13:782-788. ® Société des Produits Nestlé, S.A., Vevey, Switzerland, Trademark Owners © Nestlé, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com

What can you do to help combat nutritional risk?

First off, you will want to talk to a doctor or nurse to make sure there are no other health complications. Then, you will want to look at some in-home health care options. At Home Comfort Care, we offer aides to come in and plan and prepare meals, as well as grocery shopping- we can even take you with us! We offer companionship- sometimes just having someone else to eat with or talk to can help increase appetite! We keep daily journals and carefully monitor those we are in care of for any signs of change. We can also help with bathing, dressing, housework, and transportation. We understand the challenges of age and we like to help promote as much independence as possible with our services. Our rates are hard to beat, and we even have a live-in care service provided. Call or e-mail us today to set up a free consultation with Jenny!

-Carrie 801-529-7170; homecomfortcareutah@gmail.com

Feeding Tips for Alzheimer's and Dementia:

My grandmother passed away due to Alzheimer’s. I was her caregiver for the last five years of her life and I was able to witness the progression of the disease and I know how emotionally and physically draining it can be. It is so important to have a good family support system but to also know when to ask for help to eliminate some of the caregiving burnout. Meal time can be one of the most frustrating and difficult times for those with Alzheimer’s disease. Knowing some proper feeding techniques and tricks could help make this process a lot easier for you and your loved one.

The Hand over Hand Technique:

Place your loved one’s hand over your hand as you are guiding the spoon to their mouth. Vision loss and impairment is very common in those with dementia and this helps them to feel the spoon coming and to know when to open their mouth. You can also use this technique to help them with bathing, brushing their teeth, walking, etc. It will help them to be more involved in their daily routine and more comfortable if you allow them to feel what you are doing.

Choosing proper textures:

Along with chewing, swallowing becomes increasingly difficult as the Alzheimer’s becomes more advanced. It is important to be attentive and to know what textures are easy for them to handle and always note any changes in eating behavior. In the last stages of my grandmother’s life she would eat very little. She had an extremely hard time swallowing so we would look for ways to give her more calories without the food being too thick for her to swallow. We would serve her Greek yogurt as it is high in protein and thin up the texture by adding apple juice or ensure to help it go down easier. We also would add rice cereal to the yogurt to help add more calories. Pureed foods and smoothies are another great way to help create easy to swallow foods. However, they may prefer mashed, or chopped. Be creative and learn what works best for the individual as it will change over time.

 Keep track of how much they are eating as some medications may change desires in appetites. It is common for those with Alzheimer’s to eat less and less until they are at the point of eating very little as the disease progresses, and this is not a painful way to die. However, always note changes in appetite and weight and consult with their doctor or nurse to help address any concerns.

Keep It Simple:

In order to help avoid confusion, serve food one item at a time on a plain colored plate. Patterns may get confused with food. The color red has also been linked to increasing appetite, so a plain, red plate may be your best way to go. Place foods directly in front of them and keep it in their direct line of sight. Tunnel vision is common in those with dementia and bringing something to their mouth from the side may startle them. It is also a good practice to be in their direct line of sight when you first come to them instead of coming in from the side.

The best thing to do in working with those with dementia is to be loving, patient and supportive. Try visuals to help communicate. Avoid asking questions and avoid negative words such as “don’t.” Go through picture albums of when they were younger. Try listening to music. My grandmother remembered tunes and words to songs long after she lost the ability to speak. It is not easy to watch the progression of the disease but it is important to keep trying and learning new ways of adapting to changes. Let me know in the comments below what you have found that works for you.

 -Carrie