NutritionProvide Support to meet

Personal Care NeedsCHCICS301A

Updated by Jo Lewis BHS

What is nutrition?

Nutrition Nutrition = all processes by = all processes by which the body utilises food and which the body utilises food and fluids for fluids for energy, growth energy, growth and and maintenancemaintenance

At At all stagesall stages of the lifespan, we of the lifespan, we need good nutrition, to resist need good nutrition, to resist illness, repair tissue, regulate body illness, repair tissue, regulate body functions and provide energyfunctions and provide energy

Characteristics of Nutrition

Hair Smooth & glossy Dull, dry or brittle

Nails Firm, pink nail bed andnail

Brittle, ridged or spoonshaped, pale nail bed

Skin Healthy color, goodskin turgor

Unhealthy color, poorturgor, dry and scaly,lots of bruises

Mouth Firm gums, red-pinkmucous membranes

Spongy or bleedinggums, pale mucousmembranes, swollenor smooth tongue

Eyes Bright and clear, red-pink rims, no discharge

Dull, pale rims

Muscles Firm, good tone Wasted, lack of tone

Limbs Straight Bowed arms or legs

Nutritional requirements

Nutritional requirements are Nutritional requirements are considered in terms of considered in terms of essential and essential and balanced nutrientsbalanced nutrients (ie protein, fats, (ie protein, fats, carbohydrates, vitamins etc), and carbohydrates, vitamins etc), and energyenergy (kilojoules) (kilojoules)

Need foods from Need foods from eacheach of the basic of the basic food groups, in food groups, in sufficient quantities sufficient quantities (milk/dairy, meat/fish/eggs, fruit and (milk/dairy, meat/fish/eggs, fruit and veg, breads and cereals, fats, water)veg, breads and cereals, fats, water)

How should nutrients be distributed ??

Traditional model = Healthy Diet PyramidTraditional model = Healthy Diet Pyramid Other distributions ie diet consisting of Other distributions ie diet consisting of

60% carbohydrate, 20% protein, and 20% 60% carbohydrate, 20% protein, and 20% fat often thought appropriatefat often thought appropriate

Current trend towards lower carbohydrate Current trend towards lower carbohydrate and higher protein intake and higher protein intake

Important to eat a Important to eat a variety of foods each variety of foods each dayday

Energy requirements – don’t need as Energy requirements – don’t need as much energy in older age as there is little much energy in older age as there is little growthgrowth

Compare - Nutrient Requirements

Younger adults Younger adults (up to (up to 65)65)

1 serve meat, fish, eggs, 1 serve meat, fish, eggs, legumes = 60-75gmlegumes = 60-75gm 3 serves red meat3 serves red meat 2 serves fish2 serves fish 1 serve chicken/pork1 serve chicken/pork 1 serve legumes1 serve legumes

2-3 serves diary foods2-3 serves diary foods 2-3 serves fruit2-3 serves fruit 4-5 serves vegetables4-5 serves vegetables 5 or more serves bread & 5 or more serves bread &

cerealscereals 2 extras (indulgences)2 extras (indulgences) 5 or more cups of fluids5 or more cups of fluids

Frail older adultsFrail older adults 2 serves meat, fish, eggs, 2 serves meat, fish, eggs,

legumes = legumes = 120-150gm/day120-150gm/day

3-4 serves dairy foods3-4 serves dairy foods 2-3 serves fruit2-3 serves fruit 4-5 serves vegetables4-5 serves vegetables 5 or more serves bread & 5 or more serves bread &

cerealscereals 2 extras (indulgences)2 extras (indulgences) 5 or more cups of fluid-5 or more cups of fluid-

includes milk, soups as includes milk, soups as well as tea, coffee & other well as tea, coffee & other drinksdrinks

Nutrients

The essential nutrients are:The essential nutrients are:CarbohydratesCarbohydrates Water Water

FibreFibre Vitamins and Vitamins and mineralsminerals

ProteinsProteins Proteins Proteins

Lipids (fats)Lipids (fats)

Nutrients are the chemical Nutrients are the chemical substances in food that provide substances in food that provide energy, build and maintain cells energy, build and maintain cells and regulate body processesand regulate body processes

Carbohydrates

Provide energyProvide energy Before being used are converted Before being used are converted

from food we’ve eaten into from food we’ve eaten into glucoseglucose

Also assist in metabolism of fatAlso assist in metabolism of fat Add bulk to intestinal contents Add bulk to intestinal contents

aiding aiding peristalsisperistalsis Found in vegetables, cereals and Found in vegetables, cereals and

pastas, fruits, honey, milkpastas, fruits, honey, milk

Proteins

Compounds composed of amino Compounds composed of amino acidsacids

Proteins build and repair tissue, or Proteins build and repair tissue, or supply energysupply energy

Major sources of protein are meat, Major sources of protein are meat, fish, eggs, cheese, milk, poultry, fish, eggs, cheese, milk, poultry, lentils, legumes and nutslentils, legumes and nuts

Lipids

Fat supplies energy and forms Fat supplies energy and forms adipose adipose tissuetissue which supports and protects some which supports and protects some organsorgans

Adipose tissue also insulates the body to Adipose tissue also insulates the body to prevent heat loss and is a reserve store of prevent heat loss and is a reserve store of fuelfuel

Fats also supply the fat soluble vitamins Fats also supply the fat soluble vitamins A,D,E,KA,D,E,K

Major food sources of fats are animal Major food sources of fats are animal (meat, butter, oil, cream, egg yolk, cheese, (meat, butter, oil, cream, egg yolk, cheese, fish oil) or vegetable (present in cocoa and fish oil) or vegetable (present in cocoa and oils like olive, safflower, peanut etc)oils like olive, safflower, peanut etc)

Water & Fibre

WaterWater obtained from food and fluid’s we obtained from food and fluid’s we eat and drink as a result of metabolismeat and drink as a result of metabolism

Necessary for digestion, absorption and Necessary for digestion, absorption and metabolism of food, to produce metabolism of food, to produce secretions, and maintain body fluidssecretions, and maintain body fluids

FibreFibre is fibrous part of foods not is fibrous part of foods not digested or absorbeddigested or absorbed

Excreted in Excreted in stool (BA)stool (BA), and provides bulk, and provides bulk Thought to help in prevention of some Thought to help in prevention of some

disorders constipation, diverticular disorders constipation, diverticular disease, gallstones, intestinal cadisease, gallstones, intestinal ca

Vitamins & Minerals

Vitamins generally obtained from Vitamins generally obtained from food we eatfood we eat

Essential for metabolic function - Essential for metabolic function - either fat or water solubleeither fat or water soluble

Minerals important in metabolism, Minerals important in metabolism, maintenance of BP, cardiac maintenance of BP, cardiac function, and regulation of body function, and regulation of body processes (processes (homeostasishomeostasis))

Vitamin D

Essential to maintain strong, healthy Essential to maintain strong, healthy bones & assist prevention of fractures, bones & assist prevention of fractures, along with calciumalong with calcium

In Australia 68-86% of elderly in Res. In Australia 68-86% of elderly in Res. Care have low Vit D levelsCare have low Vit D levels

Residents require 1-3hrs sun exposure Residents require 1-3hrs sun exposure (face & hands) every week – if unable, (face & hands) every week – if unable, require supplementsrequire supplements

Vitamin D is diminished by sunscreenVitamin D is diminished by sunscreen Cannot be obtained through glassCannot be obtained through glass

Who is at risk for poor nutritional status?

Physically inactivePhysically inactive Alcohol, drug or nicotine dependentAlcohol, drug or nicotine dependent Pregnant or breastfeedingPregnant or breastfeeding ElderlyElderly People unaware of nutritional People unaware of nutritional

principlesprinciples Strict vegetarians/vegans, or Strict vegetarians/vegans, or

following ‘fad’ dietsfollowing ‘fad’ diets People experiencing certain physical People experiencing certain physical

or emotional disordersor emotional disorders

What influences individual eating patterns?

Availability of foodAvailability of food Economic statusEconomic status External influences, such as the External influences, such as the

family or advertisingfamily or advertising Food fads and fallaciesFood fads and fallacies Beliefs, values, religious and Beliefs, values, religious and

cultural heritagecultural heritage

Social and emotional aspects of foodSocial and emotional aspects of food Physical status – including allergies, Physical status – including allergies,

food intolerance, difficulty chewing food intolerance, difficulty chewing or swallowing, medical or surgical or swallowing, medical or surgical disorders which interfere with disorders which interfere with digestion, absorption or cause loss digestion, absorption or cause loss of nutrients, level of mobility and of nutrients, level of mobility and independenceindependence

Psychologic status – anxiety, Psychologic status – anxiety, depressiondepression

How is nutritional status assessed?

Nutritional historyNutritional history Clinical signsClinical signs Height/weight tablesHeight/weight tables Calculation of body mass indexCalculation of body mass index Laboratory valuesLaboratory values Other measurements, ie skinfold Other measurements, ie skinfold

testingtesting

Effects of poor nutrition and hydration

Loss of strength for daily activitiesLoss of strength for daily activities Reduced mobility and independenceReduced mobility and independence Risk of fallsRisk of falls Increased fatigueIncreased fatigue Increased risk of illness and infectionIncreased risk of illness and infection Increased risk of pressure areas/ulcersIncreased risk of pressure areas/ulcers Poor wound healing or recovery from Poor wound healing or recovery from

illnessillness ConstipationConstipation Confusion and sensory changes/lossConfusion and sensory changes/loss

What affects nutritional status of older people?

Physiologic and physical changes – loss Physiologic and physical changes – loss of teeth, loss of smell and taste, of teeth, loss of smell and taste, decreased saliva, decreased peristalsis, decreased saliva, decreased peristalsis, reduction in appetite, reduced dexterityreduction in appetite, reduced dexterity

Social changes – loneliness, depressionSocial changes – loneliness, depression Perceptions of foodPerceptions of food Availability of food – changes in ability Availability of food – changes in ability

to shop, prepare and eat food, low to shop, prepare and eat food, low incomeincome

Medication interactionsMedication interactions

Malnutrition

Consequence of continued poor Consequence of continued poor nutrition – defective in either nutrition – defective in either quantity or qualityquantity or quality

Is not a specific term – Is not a specific term – couldcould refer refer to either over- or under- nutritionto either over- or under- nutrition

Malnourishment usually termed to Malnourishment usually termed to mean that intake and utilisation of mean that intake and utilisation of nutrients is nutrients is reduced,reduced, in relation to in relation to body requirementsbody requirements

Who is at risk for malnutrition?

Clients experiencing increased Clients experiencing increased metabolic demands, or extensive metabolic demands, or extensive loss of nutrients – infection, burns, loss of nutrients – infection, burns, vomiting, physical trauma, major vomiting, physical trauma, major wounds, prolonged feverwounds, prolonged fever

Clients not consuming oral Clients not consuming oral food/fluids for more than a few daysfood/fluids for more than a few days

BMI less than 20, or recent loss of BMI less than 20, or recent loss of 10% of usual body weight10% of usual body weight

Alcohol or drug dependentAlcohol or drug dependent Clients on medications which work Clients on medications which work

against or block nutrientsagainst or block nutrients Clients with deficient ability to Clients with deficient ability to

utilise nutrients, ie Crohn’s diseaseutilise nutrients, ie Crohn’s disease

NB – need early identification of NB – need early identification of those at riskthose at risk

Common in older patientsCommon in older patients Worse with illness - CVA, Worse with illness - CVA, MND, MS, MND, MS,

PDPD Poor nutrition increases risk of:Poor nutrition increases risk of:

Pressure soresPressure sores Delayed healingDelayed healing Prolonged recoveryProlonged recovery Psychological response to illnessPsychological response to illness

Obesity

Excess of body fat, r/t either Excess of body fat, r/t either excessive kJ intake, or inadequate excessive kJ intake, or inadequate energy expenditure, or bothenergy expenditure, or both

Serious consequences = Serious consequences = cardiovascular disease, breathing cardiovascular disease, breathing difficulties, hypertension, diabetes difficulties, hypertension, diabetes mellitus, gallbladder disease, mellitus, gallbladder disease, mobility problems, reproductive mobility problems, reproductive problemsproblems

Psychosocial problemsPsychosocial problems

Treatment of Obesity

Supervised regulation of food Supervised regulation of food intakeintake

ExerciseExercise Behaviour modificationBehaviour modification ?? Medication - appetite ?? Medication - appetite

suppressants or fat-blockerssuppressants or fat-blockers Surgical intervention for morbid Surgical intervention for morbid

obesity, ie gastric bandingobesity, ie gastric banding

Bariatric

Bariatric – defined as BMI greater Bariatric – defined as BMI greater than 30than 30

Their weight far exceeds the Their weight far exceeds the recommended guidelinesrecommended guidelines

Body size restricts – mobility, health, Body size restricts – mobility, health, access to available servicesaccess to available services

Their weight increases risk of further Their weight increases risk of further health complications & deathhealth complications & death

Causes numerous care challengesCauses numerous care challenges

Dietary Guidelines for Older Australians

Enjoy a wide variety of nutritious foodsEnjoy a wide variety of nutritious foods Keep active to maintain muscle Keep active to maintain muscle

strength and a healthy body weightstrength and a healthy body weight Eat at least three meals per dayEat at least three meals per day Care for your food: prepare and store it Care for your food: prepare and store it

correctlycorrectly Eat plenty of vegetables (including Eat plenty of vegetables (including

legumes) and fruitlegumes) and fruit Eat plenty of cereals, breads and pastasEat plenty of cereals, breads and pastas

Eat a diet low in saturated fatEat a diet low in saturated fat Drink adequate amounts of water Drink adequate amounts of water

and/or other fluidsand/or other fluids If you drink alcohol, limit your If you drink alcohol, limit your

intakeintake Choose foods low in salt and use Choose foods low in salt and use

salt sparinglysalt sparingly Include foods high in calciumInclude foods high in calcium Use added sugars in moderationUse added sugars in moderation

Developed by National Health and Medical Research Council 1999Developed by National Health and Medical Research Council 1999

Activity – What about Molly?

BreakfastBreakfast Cornflakes, milk & Cornflakes, milk &

sugarsugar 1 slice white toast, 1 slice white toast,

butter, jambutter, jam White teaWhite tea

Morning teaMorning tea White tea, sweet White tea, sweet

biscuitbiscuit

LunchLunch Roast lamb, potato, Roast lamb, potato,

pumpkin, peas, gravypumpkin, peas, gravy Rice pudding, white teaRice pudding, white tea

Afternoon teaAfternoon tea White tea & cakeWhite tea & cake

TeaTea SoupSoup Ham sandwichHam sandwich Peaches & creamPeaches & cream

SupperSupper Milk & MiloMilk & Milo Sweet biscuitSweet biscuit