Interdisciplinary Nutritional Management and Care for Older Adults: An Evidence-Based Practical Guide for Nurses (Perspectives in Nursing Management and Care for Older Adults)

« This open access book aims to primarily support nurses as leaders and champions of multimodal, Interdisciplinary nutrition care for older adults. A structured approach to fundamentals of nutrition care across Interdisciplinary settings is combined with additional short chapters about special topics in geriatric nutrition. The book is designed to provide highly accessible information on evidence-based management and care for older adults, with a focus on practical guidance and advice across acute, rehabilitation, and primary and secondary malnutrition prevention settings.The cost of malnutrition in England alone has been estimated to be p1s19.6 billion per year, or more than 15% of the total public expenditure on health and social care. ^65 years). The importance and benefit of specialised nutrition care, delivered by experts in field, is well established for those with complex nutrition care needs. However, despite the substantial adverse impact of malnutrition on patient and healthcare outcomes, specialised management of this condition is often under-resourced, overlooked and under-prioritised by both older adults and their treating teams. As an alternative, timely, efficient, and effective supportive nutrition care opportunities may be appropriately implemented by nurses and non-specialist Interdisciplinary healthcare team members, working together with nutrition specialists and the older adults they care for. Practical, low-risk opportunities should be considered across nutrition screening, assessment, intervention, and monitoring domains for many patients with, or at risk of malnutrition. Whilst a variety of team members may contribute to supportive nutrition care, the nursing profession provide a clear focal point. Nurses across diverse settings provide the backbone for Interdisciplinary teamwork and essential patient care. The nursing profession should consequently be considered best placed to administer Interdisciplinary, multimodal nutrition care, wherever specialist nutrition care referrals are unlikely to add value or are simply not available. As such, the book is a valuable resource for all healthcare providers dedicated to working with older patients to improve nutrition care.»--Quatrième de couverture Foreword Acknowledgements Contents Part I: Nutritional Care in Geriatrics 1: Overview of Nutrition Care in Geriatrics and Orthogeriatrics 1.1 Defining Malnutrition 1.2 Nutrition Care in Older Adults: A Complex and Necessary Challenge 1.3 Malnutrition: A Truly Wicked Problem 1.4 Building the Rationale for Integrated Nutrition Care 1.5 Managing the Wicked Nutrition Problems with a SIMPLE Approach (or Other Tailored Models) 1.5.1 Keep It SIMPLE When Appropriate 1.5.2 A SIMPLE Case Example 1.5.2.1 S—Screen for Malnutrition 1.5.2.2 I—Interdisciplinary Assessment 1.5.2.3 M—Make the Diagnosis (es) 1.5.2.4 P—Plan with the Older Adult 1.5.2.5 L—Implement Interventions 1.5.2.6 E—Evaluate Ongoing Care Requirements 1.6 Bringing It All Together: Integrated Nutrition Care Across the Four Pillars of (Ortho) Geriatric Care 1.7 Summary: Finishing Off with a List of New Questions References Recommended Reading 2: Nutritional Requirements in Geriatrics 2.1 Nutritional Recommendations for Older Adults, Geriatric and Orthogeriatric Patients 2.2 Nutritional Recommendations for Older Adults 2.2.1 Energy Requirement and Recommended Intake 2.2.2 Protein Requirement and Recommended Intake 2.2.3 Micronutrients and Dietary Fibers 2.3 Nutritional Risk Factors in Older Adults 2.4 Estimating Intake in Older Adults 2.5 Nutritional Status of Older Adults, Geriatric and Orthogeriatric Patients 2.6 Summary References Recommended Reading 3: Nutritional Assessment, Diagnosis, and Treatment in Geriatrics 3.1 The Nutrition Care Process 3.2 Nutritional Screening/Risk Detection 3.3 Nutritional Assessment and Diagnosis 3.3.1 Nutrition Impact Symptoms 3.3.2 Nutritional Diagnosis 3.3.3 Etiologic Criteria 3.3.4 Estimating Requirements 3.3.5 Nutritional Diagnosis 3.4 The Nutrition Plan and Care Required 3.4.1 Nursing Care Required for Nutritional Therapy 3.5 Action and Monitoring 3.6 Evaluation and Adjustment of Nutrition Plan 3.7 Discharge from Hospital or Handover to Another Caretaker 3.8 End of Nutritional Therapy 3.9 Ethical Considerations 3.10 Summary References Recommended Reading 4: Malnutrition Prevention 4.1 Malnutrition and Its Risk Factors 4.2 Impact of Malnutrition on Older Adults, Healthcare Systems and the Community 4.3 General Nutritional Care and Prevention of Malnutrition 4.4 The Role of Physical Activity and Training in Malnutrition Prevention 4.5 Opportunities for Nurses and Other Healthcare Providers to Prevent Malnutrition 4.6 Additionally, Good to Know 4.7 Limits of Preventing Malnutrition 4.8 Implementation of Malnutrition Interventions References Recommended Reading Training Courses (Selection) 5: Nutrition Support in Older Adults 5.1 Nutrition Support in Older Adults: A Hard Edge Best Balanced by Shared Decision-Making, Informed Consent, and Ethical Insight 5.2 Applying a Systematic Approach to Nutrition Support in Older Adults 5.3 Protein- and Energy-Dense and/or Fortified Foods, Fluids, and Menus 5.4 Oral Nutrition Supplements 5.5 Artificial Tube Feeding 5.5.1 Enteral Nutrition 5.5.1.1 Feeding Tube Types 5.5.1.2 Tube Placement 5.5.1.3 Tube Considerations and Care Requirements 5.5.1.4 Checking Placement 5.5.1.5 Flushing Tubes 5.5.1.6 Feeding Regimens and Modality 5.5.1.7 Formula Handling and Management 5.5.2 Parenteral Nutrition (PN) 5.6 Preventing and/or Managing Nutrition Support Complications 5.6.1 Medications 5.6.2 Aspiration 5.6.3 Gastrointestinal Upset 5.6.4 Delayed Gastric Emptying or Gastroparesis 5.6.5 Hyperglycemia 5.6.6 Refeeding Syndrome 5.7 Summary References Recommended Reading 6: Supporting Nutrition Care in Older Adults: An Essential Component of ‘Best Practice’ Nursing 6.1 What Is ‘Best Practice’ Nursing Nutrition Care? 6.2 Leading Supportive Nutrition Care for Older Adults with or at Risk of Malnutrition: An Example of Best Practice in Nursing Care References Recommended Reading 7: Preventing and Managing Hydration and Dehydration in Older People 7.1 Geriatric Orthopaedic Patients 7.2 Hydration in Geriatrics 7.2.1 Recommendations for Older Adults 7.2.2 Age-Related Changes Associated with Hydration 7.3 Dehydration and Other Hydration Disturbances 7.3.1 Screening and Assessment of Dehydration 7.3.1.1 Assessing Low-Intake Dehydration 7.3.1.2 Assessing Volume Depletion 7.3.2 Prevention and Treatment of Dehydration 7.3.2.1 Low-Intake Dehydration 7.3.2.2 Volume Depletion 7.3.3 Fluid Overload 7.3.4 Electrolyte Imbalances 7.4 Hospitalisation After Fall 7.4.1 Arriving at the Emergency Department 7.4.2 Preoperation Nursing at the Ward 7.4.3 Post-operation Nursing at the Ward 7.4.4 Best Practice at the Ward 7.5 Summary References Recommended Reading 8: Untangling Malnutrition, Physical Dysfunction, Sarcopenia, Frailty and Cachexia in Ageing 8.1 Preface 8.2 Definitions, Diagnosis, Prevalence and Relevance 8.2.1 Malnutrition 8.2.2 Low Muscle Mass, Physical Dysfunction and Sarcopenia 8.2.3 Frailty 8.2.4 Cachexia 8.3 Nutritional Treatment and Management Approaches 8.4 Key Levels to Implement Change 8.5 Conclusion References Recommended Videos 9: Bone Health, Fragility and Fractures 9.1 Introduction 9.1.1 Bone 9.1.2 Normal Bone Metabolism 9.1.3 Peak Bone Mass (PBM) 9.2 Nutrients and Bone Health 9.2.1 Calcium 9.2.2 Vitamin D 9.2.3 Vitamin K 9.2.4 Protein 9.2.5 Other Nutrients 9.3 Other Factors Influencing Bone Health 9.4 Osteoporosis 9.4.1 Risk Factors for Osteoporosis 9.5 Fragility, Fractures and Falls 9.5.1 Frailty, Falls and Bone Health Assessment 9.5.1.1 Frailty Assessment 9.5.1.2 Falls Risk Assessment 9.5.1.3 Bone Health Assessment 9.6 Supporting Those with Frailty, Fragility, Fractures and Osteoporosis 9.6.1 Lifestyle Advice to Improve Bone Health 9.6.2 Supplementation and Medications 9.6.3 Education, Training and Sociopolitical Action 9.6.3.1 Coordinated Care Opportunities to Optimise Bone Health, Fragility and Fractures in Older Adults Example 1: Orthogeriatric Services Care Example 2: Fracture Liaison Services Example 3: Fracture Liaison Nurses Example 4: Audit and Feedback 9.6.3.2 End-of-Life Care 9.7 Summary References Further Reading 10: Increasing Patient Motivation and Adherence to Nutritional Care: The Importance to Overcome Psychological Barriers 10.1 Introduction 10.2 The Relationship Between Older Adults and Food as a First Step Toward Overcoming Psychological Barriers 10.2.1 Age: Younger and Older Adults 10.2.2 Biological Sex: Older Male and Female 10.2.3 Personal Health 10.2.3.1 Physical Health 10.2.3.2 Mental Health 10.2.4 Lifestyle Choices 10.2.5 Social Environment and Conditioning 10.3 The Older Adult Perspective and the Quality of Nutritional Care 10.3.1 The Role of Caregivers and Community 10.4 The Effectiveness of Multidisciplinary Nutritional Care to Increase Patient Motivation 10.5 Summary References Recommended Reading 11: How to Sustain and Spread Nutritional Care Improvements 11.1 Getting Started 11.1.1 Definitions 11.2 Case Example: Improving Nutrition Care in Hospital 11.2.1 Initial Implementation and Considering Sustainability from the Beginning 11.2.2 Strategies for Sustainability and Spread 11.3 Tools for Sustainability and Spread 11.3.1 Sustainability Tools 11.4 Monitoring and Evaluation 11.5 Barriers and Facilitators 11.6 Considering Equity 11.7 Summary References Recommended Reading 12: Delivering Interprofessional Education to Embed Interdisciplinary Collaboration in Effective Nutritional Care 12.1 Introduction 12.2 The Role of Interdisciplinary Teams 12.3 Nutrition Education and Interdisciplinary Team Collaboration 12.4 Approaches to Interprofessional Education for Nutritional Care 12.4.1 Curriculum 12.4.2 Delivery 12.5 Interdisciplinary Collaboration for Nutritional Care in Action 12.6 Summary References Recommended Reading Part II: Special Topics in Geriatric Nutrition: Editorial: Specialised Versus Supportive Nutritional Care in Ageing: A Conundrum 1.1 Summary 13: Multidisciplinary Nutrition Care: Benefitting Patients with Malnutrition Across Healthcare Sectors 13.1 Malnutrition, Assessment, and Screening 13.2 Multidisciplinary Roles in Malnutrition Care 13.2.1 Dietitian Role 13.2.2 Physician Role 13.2.3 Role of the Speech-Language Pathologist 13.2.4 Other Health Professionals 13.2.5 The Nursing Role in Malnutrition 13.2.6 Management and Healthcare Leaders 13.3 Multidisciplinary Models of Malnutrition Care 13.4 Standards and Policy Promote Multidisciplinary Malnutrition Care 13.5 Examples of Multidisciplinary Malnutrition Care 13.6 Summary References Recommended Reading 14: Physical Activity, Exercise, and Physical Rehabilitation 14.1 Importance of Physical Activity in Older Adults 14.2 Recommendations for Physical Activity 14.3 Benefits of Physical Activity 14.4 Nutrition Status and Physical, Functional, Exercise, and Rehabilitation Outcomes 14.5 Combined Nutrition Physical Activity/Exercise Interventions 14.6 Physical Rehabilitation 14.7 Enhancing Physical Activity Level Among Older People 14.8 Summary References Recommended Reading 15: Pressure Injury Prevention and Management 15.1 Pressure Injuries 15.2 The Aetiology of Pressure Injuries 15.3 The Link Between Malnutrition and Pressure Injuries 15.4 Prevention and Management of PIs with a Focus on Nutrition Care 15.5 Summary References Recommended Reading 16: Obesity and Health in Older Adults 16.1 Definition and Epidemiology 16.2 Changes in Body Composition with Ageing 16.3 Causes of Obesity 16.3.1 Health Consequences of Obesity 16.3.2 Obesity Paradox: Protective in Older Adults and Patient Population 16.4 Is Targeted Weight Loss Appropriate in Older Adults? 16.4.1 Summary References Recommended Reading 17: The Nutritional System 17.1 Introduction 17.2 Hormones Produced by White Adipocytes 17.3 The Adipose Organ 17.4 Browning of the Adipose Organ as a Therapy for Obesity and Related Diseases 17.5 The Physiology of the Mammary Gland Confirms the Plasticity of the Adipose Organ 17.6 The Obese Adipose Organ 17.6.1 Summary References Further Reading 18: Oropharyngeal Dysphagia in Older Patients 18.1 Oropharyngeal Dysphagia: Prevalence and Consequences 18.2 Causes of Oropharyngeal Dysphagia 18.3 Screening and Diagnosis of Oropharyngeal Dysphagia 18.3.1 Screening 18.3.2 Assessment 18.3.3 Oropharyngeal Dysphagia Diagnosis 18.4 Interventions for Oropharyngeal Dysphagia 18.5 Maximising Adequate Nutrition, Hydration and Diet Choices 18.6 Dietary Modifications 18.7 Oral Hygiene and Health 18.7.1 Swallowing Strategies and Manoeuvres 18.7.2 Opportunities for Interdisciplinary Management of Dysphagia 18.7.3 Summary References Suggested Further Reading 19: Nutrition and Delirium 19.1 What Is Delirium? 19.2 Who Is at Risk? 19.3 What Can Be Done to Prevent and Manage Delirium? 19.4 The Role of Enteral Feeding 19.5 Post-Hospital Support 19.5.1 Summary and Main Points References Recommended Reading 20: Food-Drug Interaction in Older Adults 20.1 Introduction 20.2 Food and Herbal Product Interaction with Drugs 20.2.1 Common Foods 20.2.2 Herbal Products 20.3 Effects of Drugs on Nutrition Status 20.3.1 Drugs Likely to Negatively Influence Nutritional Intake/Status 20.4 Drugs Likely to Increase Body Weight 20.4.1 Conclusion References Recommended Reading 21: End of Life, Food, and Water: Ethical Standards of Care 21.1 Background 21.2 Factors Associated with Nutritional Vulnerability 21.3 Malnutrition: A Commonly Identified Precursor to the End of Life 21.3.1 Nutrition at the End of Life 21.4 Artificial Nutrition and Hydration (ANH) 21.5 Voluntary Stopping Eating and Drinking (VSED) 21.6 Stopping Oral Nutrition for Incapable Patients 21.7 Conclusions and Take-Home Points References Recommended Reading This open access book aims to primarily support nurses as leaders and champions of multimodal, Interdisciplinary nutrition care for older adults. A structured approach to fundamentals of nutrition care across Interdisciplinary settings is combined with additional short chapters about special topics in geriatric nutrition. The book is designed to provide highly accessible information on evidence-based management and care for older adults, with a focus on practical guidance and advice across acute, rehabilitation, and primary and secondary malnutrition prevention settings. The cost of malnutrition in England alone has been estimated to be 119.6 billion per year, or more than 15% of the total public expenditure on health and social care. ^65 years). The importance and benefit of specialised nutrition care, delivered by experts in field, is well established for those with complex nutrition care needs. However, despite the substantial adverse impact of malnutrition on patient and healthcare outcomes, specialised management of this condition is often under-resourced, overlooked and under-prioritised by both older adults and their treating teams. As an alternative, timely, efficient, and effective supportive nutrition care opportunities may be appropriately implemented by nurses and non-specialist Interdisciplinary healthcare team members, working together with nutrition specialists and the older adults they care for. Practical, low-risk opportunities should be considered across nutrition screening, assessment, intervention, and monitoring domains for many patients with, or at risk of malnutrition. Whilst a variety of team members may contribute to supportive nutrition care, the nursing profession provide a clear focal point. Nurses across diverse settings provide the backbone for Interdisciplinary teamwork and essential patient care. The nursing profession should consequently be considered best placed to administer Interdisciplinary, multimodal nutrition care, wherever specialist nutrition care referrals are unlikely to add value or are simply not available. As such, the book is a valuable resource for all healthcare providers dedicated to working with older patients to improve nutrition care