Ms. E is 81 years old and lives in public housing. Due to her age, she is experiencing esophageal dysphagia, which is the reason she feels food stuck in her throat. Esophageal dysphagia is a neuromuscular dysfunction where swallowed material stops moving in the esophagus. This condition is commonly associated with senility. Since she has difficulty swallowing she prefers to eat very soft food and seldom eats meat. Adding a thickener to her foods and cutting the meat into small pieces or pureeing her food will make it easier to swallow.
Due to her age and failing health she is not able to walk to the market like she used to. Because of her inability to go to the market and swallowing issues her food intake has reduced. This has led to her weight loss and also decreased energy levels.
Nutrition in older adults is affected by a variety of medical, psychological, social and lifestyle factors. Older adults living in poverty often lack the resources to purchase the quality and quantity of food that they require for adequate nutrition and money budgeted for groceries may take a back seat to the cost of utilities, medication and health care.
This is because their annual incomes are usually less than $12,000 and their diet is more likely to include refined grains, refined sugar, processed foods, and starchy vegetables. As an older adult, eating alone is also a factor that can have a negative effect on her nutrition. Ms. E could find a meal program for seniors by contacting her local senior center, attend an adult day-care center or invite friends, family and neighbors to share meals with her.
Eating with others will improve her appetite and increase the amount of food she is eating. Older adults were also found to have energy intakes only 83% of what is recommended; this is due to inadequate housing. Ms. Es apartment offers limited storage space for fresh food so she is forced to purchase canned foods, but is not able to walk to the store.
Nutrient requirements in advanced age are influenced by changes in composition, function, and chronic diseases and are often complicated by associated malnutrition and weight loss. Aging adults tend to eat fewer calories, due to changes in the appetite control center of the hypothalamus and activity levels. This decrease in caloric intake can lead to deficient levels of vitamins and minerals. Some common vitamin deficiencies could be calcium, vitamin D, magnesium, vitamin C, and vitamin B. From a nutritional standpoint unintentional weight loss in older adults is a major concern. However, unintentional weight loss is common in adults age 70 and older, who may not eat enough to meet their energy needs. A slow metabolism may also cause Ms. E. to eat less than she once did and there is an increase in the hormone that causes fullness, so hunger is not as strong. According to the nutrition experts at Tufts University adults over 70 years of age should follow a modification of the food guide pyramid. Ms. E can take a vitamin or mineral supplement after she gets her individual assessment by her PC (primary care). This is because individuals in her age group who use single nutrient supplements in addition to multivitamins, and mineral supplements are more at risk for exceeding the upper limit for one or more nutrients or precipitating dangerous interactions.
Miss E has been experiencing a decline in her health and nutritional status that has led to loss of muscle mass and feeling tired. She wonders if she should take supplements to give her more energy, but a simple change in diet and daily exercise can make her feel more energetic. For most older adults, walking is a safe form of endurance exercise that supports cardiovascular health, weight management, and independent living (Schlenker, & Roth 2011). Miss E should also avoid the foods high in sodium and limit daily intake to 2300 mg or less to avoid unwanted fluid retention or rise in blood pressure (Schlenker, & Roth 2011). By cooking using fresh ingredients she can reduce the amount of sodium in her diet. Additionally, Miss E should consider making extra food each time cooks to ensure she was ready to eat meals stored in the fridge for the days that she does not feel like cooking so she does not just eat cereal and milk.
Because Miss E is battling weight loss, I would recommend a diet plan with 35% of total calories from healthy fats to help prevent additional weight loss. Healthy fats can come from foods such as fish and nuts. People of any age should obtain 45% to 65% of their total energy from carbohydrates from sources such as sweet potatoes, oatmeal, rice, and beans. These food choices are also high other important vitamins and minerals that are essential to health as the body ages. Protein preserves muscle mass, supports optimum immune function, and maintains body tissues and clinicians recommend an intake of 1.0 g/kg for persons older than age 70 (Schlenker, & Roth 2011). Miss E should consider adding Vitamin D to her diet because her lack of sun exposure prevents the body from synthesizing Vitamin D on its own. Potassium and calcium are also important minerals for the aging population and both can be obtained from the diet. However, it is important to note that calcium can be taken as a supplement but potassium should only come from food sources. The AI for calcium is 1200 mg for those ages 51 and older and that amount can be obtained by consuming fluid milk, fortified soy milk, and fortified yogurt that may all also have added vitamin D.