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Age Related Changes in Nutritional Requirements Age related changes in body composition and homeostasis regulation may also affect the nutritional needs of older people. The reliability of available data is further limited by the complex interactions between various age related changes and the impact of these changes on nutrient requirements. For example if iron absorption is impaired because of age related gastric changes, any resultant detriment effects may be offset by the age related increase in iron stores. Calories The energy producing potential of food is measured in units called calories. Caloric requirements are determined by various factors, including gender, usual level of physical activity, health illness state, and height, weight, and body build, energy requirements gradually decrease throughout adulthood, primarily as a result of reductions in activity and metabolism. Additional changes in the older body, such as decreases in muscular efficiency and lean body tissue, further reduce the need for calories. Nutritional guideline generally recommend a gradual reduction in calories beginning around the age of 40 to 50 years. Surveys of the nutritional status of older adults indicate that caloric intake is often deficient, especially in older women. One study found that 37 % of men and 40 % of women aged 65 to 98 years reported a caloric intake of less than to thirds the Recommended Dietary Allowance (Ryan et al., 1992). Moreover, older adults require higher-quality calories to meet their nutrient needs. Thus, nutritional deficiencies will occur unless a reduced caloric intake is accompanied by an increased intake of foods with high nutritional value and a concomitant decrease in the intake of foods containing little or no nutrients. Protein Protein provides the essential components for new tissue growth in te human body. Research on the impact of age related changes in protein requirements is incloncusive. However, researchers have identified certain age related changes that may influence protein requirements, including 1. Decreased lean body mass, muscle tissue, and total body protei 2. decreased plasma albumin and total body albumin levels

3. decreased glomerular filtration rates with a concomitant decrease in protein tolerance. Further research is needed to determine the specific impact, if any of these age related changes on protein requirements. Older adults should consume a minimum daily protein intake of about 1 g/kg of body weight (Bidlack and Wang, 1995). The protein needs of older adults will usually be met if approximately 12 % to 15 % of the daily caloric intake is derived from protein. Carbohydrates and Fiber Carbohydrates provide an essential source of energy and fiber. Without an adequate intake of carbohydrates, energy will be derived from fat and protein, causing an increase in serum cholesterol and triglyceride levels and a depletion water, electrolytes, and amino acids. In recent years, fiber as received much attention, primarily for its role in disease prevention, as an essential food component. Soluble fibers, found in oats and pectin, are beneficial in lowering serum cholesterol levels and improving glucose tolerance in diabetics. Insoluble fibers, fund in most grins and many vegetables, are important for maintaining good bowel function and for preventing constipation. For the average American, intake of fiber is 10 to 20 g/day, which is less than half the amount recommended by the National Cancer Institute. Dietary guidelines suggest a daily intake of five or more servings of fruits and vegetables, with at least 55% of the total calories consumed derived from complex carbohydrates. Fats The primary function of fat are to assist in temperature regulation, to provide a reserve source of energy, to facilitate the absorption of fat soluble vitamins, an to reduce acid secretion and muscular activity of the stomach. Fats are also useful in providing a feeling of satiety and improving the taste of foods. Adults in most industrialized societies consume far more calories in fats than is healthy or necessary. Because excessive fat intake is associated with harmful effects, such as hyperlipidemia, fat should constitute no more than 10 % to 30% of a persons daily caloric intake. Those fats that are consumed should be polyunsaturated and monounsaturated fatty acids, rather than cholesterol and saturated fats. Vitamins Vitamins are essential for almost all metabolic processes. Vitamin deficiencies in older adults are associated with many factors. Because older adults need fewer calories, if the

quantity of the calories is reduced without a corresponding increase in the quality of the food consumed, a deficiency of essential nutrients will occur. Older adults are more likely to have vitamin deficiencies because of other conditions, such as medication effects and alcohol use, that interfere with absorption and utilization. The vitamins most commonly found to be deficient, based on blood level measurements in older adults, are niacin, thiamine, riboflavin, and vitamins B6, C, and D. Minerals Minerals, like vitamins, are required for all metabolic processes. With the expectation of zinc and calcium, healthy, nonmedicated, older adults derive adequate amounts of most minerals from foods. Although iron deficiency is cited as a common nutritional problem of older adults, studies of iron intake have failed to support any widespread dietary deficiencies. Iron deficiency anemia in older adults is more often related to chronic disease and blood loss from pathologic conditions than to low dietary intake iron (Cohen and Crawford, 1992). Much of the literature suggests that older adults, particularly older women, should consume 1200 to 1600 mg of calcium/day. Base on the evidence: 1. calcium deficiency is one of the most common nutrient deficiencies among older people, and it is more pronounced in older women than older men. 2. calcium absorption gradually decreases with increasing age, in women, this is

compounded by postmenopausal estrogen deficiency. 3. in older adults, regulation of calcium balance is less efficient, and adaptation to lower calcium intake is impaired. 4. increased calcium intake is an important preventive measure for age related conditions, such as osteoporosis and hypertension. Although there is much support for calcium intake is not without risks, and the

ingestion of more than 2500 mg of calcium/day may be detrimental. In particular, risks are linked to the use of calcium supplements (Yen, 1997). Hypercalmia, impaired renal function, and an increased risk of kidney stones have been associated with calcium carbonate. Additionally, the ingestion of calcium carbonate with meals may interfere with the absorption of iron, zinc, magnesium, and phosphorus. Water

Water is such commonly available and tasteless substance that it is often overlooked as a nutritional requirement. However, it is essential for all metabolic activities and must be consumed in adequate amounts for proper physiologic performance. The functions of water include regulating body temperature, maintaining a suitable metabolic environment, diluting water soluble medications, and facilitating renal and bowel excretion. Potential consequences of reduced body water include decreased efficiency of thermoregulation, increased susceptibility to dehydration, and increased

concentrations of water soluble medications in the body. Throughout life, the proportion of total body weight gradually decreases. Whereas water constitutes about 80% of a newborn infants weight, is represents 60%of a younger adults weight, and about 50% or less of an older adults weight. This decrease in total body water is associated with a loss of lean body mass and is influenced by gender and degree of leanness, with women and obese people having a lower percentage of body water than men and lean, muscular people. In older adults, total body water may be further diminished by poor fluid intake secondary to age related factors, such as diminished thirst sensation. It is recommended that older adults consume 1500 to 2000 ml of noncaffeinated fluid daily to maintain adequate hydration.

Miller, C.A. (1995). Nursing care of olders adults : Theory and practice. Philadelpia : JB Lippincott. Lippincott, Philadelphia

NURSING CARE Nursing Assessment Behavioral Cues Assess Oral Comfort and Chewing ability There arent soreness and bleeding in her mouth. She has toothless (just 3 teeth in front) so make problem chewing food. Assess Dental habits and attitudes toward dental care She is rare to seek dental, but she brush teeth regularly. Assess nutrient needs She has gastritis since 3 years ago. She have no allergy. Assess food procurement patterns

She get grocery shopping easily. There is no problem Assess food preparation and consumption patterns She lives with 2 grandchildren, daughter and son in law. They can help her to eat and prepare meals. Behavioral Cues to Nutrition and Digestion - Assess Eating patterns She eats irregularly and she like acid and hot foods. - Assess the Eating Environment The environment is good and enjoy for her Physical Examination - Examination of the oral cavity Lips: pink but dark, without fissures Teeth: toothless Gums: pink but dark, no bleeding. Mucous Membranes: pink, dry, without ulcer, bleeding, or inflammation Tongue: pink, moist - Examination of the abdomen Abdomen: symmetrical, bowel sounds: 20 seconds apart. She said pain in stomach and have diarrhea Rectum and Stool: skin around anus is red and scratched Fesses: moist, yellow. Frequency 7 x/day. Nursing Diagnose No. Data 1. Do: Patient look thin Problem Impaired Etiology adverse effects on Diagnose Impaired less than nutrition: body related

DS: patient said that she nutrition: have irregular eating and less feeling weak body requirements 2. DO: DS: patients said in a statement on his stomach pain 3. DO: fesses is liquid Ds: patient said that she have x/day) diarrhea (BAB:7 Diarrhea Acute pain

than GI

requirements

to adverse effects on GI inflammati Acute pain associated on of the with inflammation of gastric mucosa Diarrhea associated with GI disorders or disorders adverse effects of or adverse laxatives GI effects of the gastric mucosa

laxatives 4. Do: patients with dry Risks lack of volume mouth and lips DS: fluid Risks lack of fluid with

loss due to associated

diarrhea is volume loss due to not normal diarrhea is not normal

5.

Do: skin in the anal area The red and scratched Ds:

risk often defecation

The

risk

of damage

of damage to the integrity of the skin

to the integrity of the skin associated with often defecation

Nursing Intervention No. Diagnose 1. Impaired nutrition: less than body requirements related to adverse effects on GI 2. Acute pain associated with inflammation of the gastric mucosa Result Criteria After nursing actions 1 x 24 hours the patient's problem is resolved with the criteria: BB increased patient Patients are not faint Patient's pain is reduced Intervention Give IV fluids based on the program, to maintain fluid and electrolyte balance. When the patient can tolerate feeding by mouth, give a soft diet are included in one patient's food choices. Start feeding with a slow return Provide smaller meals more often, to reduce the amount of gastric secretions that cause irritation Help the patient identify specific foods that cause stomach maslaah, and hilagkan these foods from the diet of patients. Give antacids and other drugs that direspkan, according to the program and note the response of the patient. Assess the patient to ensure that leaks, or liquid stools was not due to faecal impaction. Provide prescription

3.

Diarrhea associated with GI disorders or adverse effects of laxatives

After nursing actions 1 x 24 hours the patient's problem is resolved with the criteria:

4.

6.

Risks lack of fluid feces not diluted antidiarrheal. make sure associated with No diarrhea pseudomembranous colitis volume loss due to The mouth and lips have been ruled out before diarrhea is not normal are not dry administering the drug skin in the anal because the drug causes the area is not red and patient at risk for toxic The risk of damage scratched megacolon. to the integrity of the Encourage high-fiber diet. skin associated with Educate to avoid spicy and often defecation acidic foods. Monitor the frequency and characteristics of defecation Monitor intake and output. Replace haluaran excessive fluids through an IV or by mouth according to program Assess the abdomen for the presence of distension and bowel sounds Weigh the patient's body weight per day, and assess vital signs. Evaluation of serum electrolyte levels, BUN, creatinine, and hematocrit. Provide appropriate electrolyte supplementation program. If dirogramkan potassium via IV infusion rate should not exceed 10 mEq / hour and the patient should be associated with continuous cardiac monitor. Monitor the patient whether there is arrhythmia Help the patient perform hygiene after defecation. Help the patient to change soiled clothing. Encourage good hand washing. Apply ointment as prescribed moisture prevention.

Jaime L. Stockslager .2007. edisi 2. Asuhan keperawatan Geriatri. EGC : jakarta