Page 344 - Nutrition Essentials for Nursing Practice

332 U N I T 2 Nutrition in Health Promotion

(Bernstein and Munoz, 2012). Loss of appetite is a key predictor of malnutrition in older
adults (Bernstein and Munoz, 2012).

Functional Limitations

Instrumental Aging causes a progressive decline in physical function that is related to a decrease in muscle
Activities of Daily mass and strength (Villareal, Apovian, Kushner, and Klein, 2005). In community-dwelling
Living (IADL) elderly, sarcopenic obesity is independently associated with functional instrumental activities
Limitations: difficulty of daily living disability (Baumgartner et al., 2004). In 2009, the percentage of Medicare
performing (or unable enrollees age 65 years and older with a functional limitation (previously called disability) was
to perform for a health 42% (Federal Interagency Forum on Aging-Related Statistics, 2012). Twelve percent of this
reason) one or more population had one or more instrumental activities of daily living (IADL) limitations
of the following tasks: without any activities of daily living (ADL) limitations, and almost 18% had difficulty with
using the telephone, one to two ADL. Diseases that increase the risk of functional limitations include cerebrovas-
light housework, heavy cular accident, diabetes, ischemic heart disease, and arthritis (Bernstein and Munoz, 2012).
housework, meal prepa-
ration, shopping, or Social Isolation
managing money.
Eating alone is a risk factor for poor nutritional status among older adults; therefore, efforts
Activities of Daily should be made to eat with friends and relatives whenever possible. Other potential op-
Living (ADL) tions are the federally funded nutrition programs—congregate meals and Meals on Wheels.
Limitations: difficulty These programs are designed to provide low-cost, nutritious, hot meals; education about
performing (or unable food and nutrition; opportunities for socialization and recreation; and information on other
to perform for a health health and social assistance programs. The congregate meal program provides a hot, bal-
reason) one or more anced, midday meal and the opportunity to socialize in senior citizen centers and other
of the following tasks: public or private facilities. Those who choose to pay may do so; otherwise, the meal is free.
bathing, dressing, Meals on Wheels is a home-delivered meal program for elderly persons who are unable to
eating, getting in/out get to congregate meal centers because they live in an isolated area or have a chronic ill-
of chairs, walking, or ness or physical limitations. Usually, a hot meal is served at midday and a bagged lunch is
using the toilet. included to be used as the evening meal. Modified diets, such as carbohydrate-controlled
diets and low-sodium diets, are provided as needed.

Polypharmacy

Both prescription and over-the-counter drugs have the potential to affect and be affected
by nutritional status. Sometimes, drug–nutrient interactions are the intended actions of
the drug, such as the effect of warfarin on vitamin K status. At other times, alterations in
nutrient intake, metabolism, or excretion may be an unwanted side effect of drug therapy.
Although well-nourished individuals on short-term drug therapy may easily withstand the
negative effects of drug–nutrient interactions, people who are malnourished or those on
long-term drug regimens may experience significant nutrient deficiencies and decreased
tolerance to drug therapy.

The elderly are at risk for developing drug-induced nutrient deficiencies because
they have more chronic illnesses, are often on long-term drug therapy, and polypharmacy
increases with age. In a study by Heuberger and Caudell (2011), the prevalence of poly-
pharmacy in participants (average age 75.5 years) was 43%, with 51.5% of those participants
using five or more medications. Polypharmacy was associated with poorer nutritional status.
Overall, as the number of medications used increased, the intake of

■ Fiber decreased
■ Cholesterol, carbohydrates, and sodium increased
■ Fat-soluble vitamins, B vitamins, and minerals decreased