Nutrition Difficulties

        Observe your care recipient closely for difficulty in eating, chewing, or swallowing. The difficulty may be caused by the muscles or nerves not working properly anymore or by the care recipient forgetting how to do it. Difficulty in swallowing is called dysphasia. Two issues are the most important if a care recipient has dysphasia: positioning and thickened fluids. The care recipient should be positioned upright as much as possible, not leaning forward or backward. Fluids should be thickened since a liquid is difficult to control and swallow in its normal state. When it is thickened, it is easier to swallow. There are different consistencies that may be ordered, such as nectar, honey, or pudding. There are several commercial powders you can buy to thicken fluids and there are prepared products you can purchase. The care recipient may need foods that are easier to chew and swallow. He/she may need more supervision with eating so direction can be provided by the caregiver.

Age related factors that influence adequate dietary intake:

• Loss of appetite;
• Reduced sense of taste;
• Loss of dentation;
• Denture problems;
• Dehydration;
• Malnutrition;
• Severe weight loss;
• Severe weight gain

Situational factors:

• Ileostomies;
• Dysphagia;
• Confusion;
• Medications;
• Depression;
• Grief;
• Immobility;
• Medical problems.

Aspects of personal care worker care:

• Socialization;
• Atmosphere;
• Presentation of food;
• Variety of seasonings;
• Oral inspection and hygiene;
• Denture care;
• Adequate fluid intake using a variety of fluids;
• Comfort foods;
• Thickened liquids;
• Liberalized diets – comfort foods;
• Adequate Hydration.

Ensuring Adequate Hydration in the Elderly

        According to the Journal of the American Geriatrics Society, dehydration is the most common fluid and electrolyte disorder in the elderly with a prevalence of 20-40%.The elderly are at a high risk for dehydration related to a decreased sense of thirst, fear of being incontinent, swallow difficulties and gastrointestinal disorders just to name a few. Fluid intake reduces as the aging process takes place. Dehydration in the elderly is associated with a higher complication rate and must be regularly monitored. Standard follow-up from nursing and dietary paired with client education on strategies to maintain adequate hydration levels are essential to preserve optimal hydration in the elderly population. The importance of adequate hydration among the elderly cannot be stressed enough. There are several ways to ensure adequate fluids are being consumed by our elderly clients:

• Keep a full and fresh water pitcher at the bedside table.
• Ensure the water pitcher and a cup is within the client’s reach.
• Incorporate foods high in water content (e.g. popsicles, gelatin and watermelon) in daily activities.
• Make drinks more appealing by using lemonade pitchers and glasses, cocktail decorations or a fruit garnish.
• Take a proactive approach when administering fluids. Hand the clients a drink as opposed to asking if they want a drink.
• Identify clients at high risk for dehydration and place a symbol (e.g. a picture of a water droplet) in the client’s rooms to remind family or client to encourage fluid consumption.
• Provide a variety of sugar-free flavored beverages, such as Crystal Light, to help increase palatability and assist with hydration.
• Have the Dietitian re-evaluate the clients on fluid restrictions. He/she can make recommendations, if appropriate, to liberalize the restriction.
• Provide client education about the importance of adequate hydration.

Monitoring Hydration Status and Recognizing Dehydration

        On a daily basis, most people get enough fluid through normal drinking behavior, such as drinking with meals and snacks. However, thirst isn’t always a reliable gauge of hydration status, especially in children and older adults. A better barometer is the color of the urine. For most healthy individuals, clear or light-colored urine suggests adequate hydration, whereas a dark yellow or amber color usually signals dehydration, although certain medicines and vitamins may cause the color of the urine to change, making this test unreliable. Infrequent urination and low urine volume can also suggest inadequate hydration.

        Mild dehydration can affect physical and mental performance and contribute to unpleasant physical symptoms like headaches and muscle cramps. The early signs of dehydration can be non-specific, usually involving fatigue, headache and confusion. Oral rehydration is usually all that is required. But because severe dehydration can be life threatening, medical help should be sought quickly if there is any concern about someone needing more aggressive fluid supplementation. However, severe dehydration can be life threatening.

        Because dehydration can develop quickly under some conditions, it’s important to recognize the following signs of dehydration in others and act quickly to help them cool down and rehydrate.

Signs of Dehydration

• Increased thirst
• Dry or sticky mouth
• Light-headedness or headache
• Fatigue
• Impaired mental focus
• Low urine output
• Inability to produce tears
• Dry skin

Measuring intake and output.

• Intake – oral and food;
• Output