Malnutrition of Elderly People in Nursing Homes

An Analysis of the Main Causes of Malnutrition among the Elderly and the Role of the Health Care Professionals in Addressing this Concern

Malnutrition of Elderly People in Nursing Homes

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Abstract
Background: Malnutrition is a pressing concern among populations. It is particularly a silent plague in
nursing homes and an issue that needs to be addressed. Malnutrition is found to be the cause of many different health conditions as well as an increase in the mortality and morbidity rate in such homes. However, the same remains to be an easily dismissed and unrecognized condition in such settings.

Aim: The main aim of this study is to create an assemblage of the most basic and most essential
information available in current studies regarding the malnutrition of the elderly people in nursing homes. It aims to collect and compile essential information such as the numerous causes of malnutrition among the elderly in order to serve as a simple and direct source of reference for nursing homes and their attending health care providers.

Methodology: This research was done through a systematic online journal search which used two
search engines, Google and Pubmedcentral. Five criteria served as the inclusion and exclusion factors in narrowing down the relevant results. After the gathering of results, a comparative study was made to derive the conclusions and the recommendations.

Conclusion: Malnutrition remains to be a highly unrecognized and unaddressed condition in nursing

homes. This is due to the usual notion that loss of appetite and weight loss is only common among the elderly, even more so in nursing homes. It has been found that physiological, psychological, social as well as environmental factors contribute greatly to this condition. Among the most prevalent factors found are Malnutrition of Elderly People in Nursing Homes | Dissertation Paper | Navarrete| Page2 depression and functional impairment. Intervention programs should be devised and implemented by nursing homes in order to address this issue. And the role of a health care professional enjoys great weight in the creation, evaluation and implementation of such measures to aid the elderly involved.

Tables of Contents and Figure Reference

Introduction Background Aim Definition of Terms Methodology Limitations of the Study

Findings and Critique

Summary of Prominent Themes and Findings in the Journals and Articles Gathered

Conclusions

Recommendations

Malnutrition of Elderly People in Nursing Homes

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Background
Malnutrition, in general, has been seen as one of the rampant concerns in the world today. In first world countries and emerging countries alike, the concern regarding malnutrition of the people are among the pressing concerns which public sectors and private sectors have been trying to curb for years. Malnutrition has been one of the causes of high mortality rate in the world; its face is one that is known in every nation. In a sense, it has been known around the world as a silent plague. The state of malnutrition has been long defined as a bodily state characterized by the lacking or deficiency, excess or imbalance of energy, and other nutrients in the body which is responsible for the many unpleasant manifestation in the body, health, function, skills and clinical outcome of a person (Stratton, 2003). Overnutrition and undernutrition are both types of malnutrition. The former is characterized by the excess of nutrients in the body, commonly caused by the large and uncontrolled consumption of food; while the latter is the under nourishment where a person is not able to meet the daily nourishment requirements most commonly due to the lack of intake of food. Among these two, it is undernutrition which is more rampant and is more alarming. Malnutrition is most common among children of tender ages and the elderly. Due to the unmet nutritional needs of the children starting from the womb of the mother until their birth and development to their tender years, children remain undernourished for years. On the other hand, the elderly are malnourished due to many reasons and their circumstances are more concerning than the first. The elderly are usually placed in nursing homes and hospitals where they are placed in a clinical and community setting. They Malnutrition of Elderly People in Nursing Homes | Dissertation Paper | Navarrete| Page4 are placed away from their families and are forced to adjust to new environments unlike children who remain in the care of their mothers, fathers or other immediate families. Certainly, the health concerns of the elderly in these cases are more needing of attention. Studies show that the nutrition of the elderly is a major problem in nursing homes. This has been evidenced by studies which show that up to eighty-five percent (85%) of the elderly living in nursing home are suffering from malnutrition (Rowe & Kahn, 1998). And such problems are often left unaddressed as they are often not diagnosed. These nutritional deficiencies in elderly homes are, in reality, frequently not recognized (Crogan, et al., 2008). This is due to the usual misconception that the elderly, as they age,

require less food intake and that the loss of their appetite as well as the loss of some body weight is only normal. The major concern here is that these cases of malnutrition are actually often the common underlying cause of adverse clinical outcomes, but remain untreated (Crogan, et al., 2008). These kinds of setting still hold true despite the fact that many opportunities for both prevention and correction of the many factors contributing to the malnutrition of the elderly people are often easily available and recognizable (Crogan, et al., 2008). Malnutrition has many effects that are detrimental to the life of the elderly people. Studies show that not only does it affect the lifespan of the elderly, it also, in a sense, has a direct and adverse affect in the quality of life of even the community-dwelling type of elderly people in nursing homes (Feldblum, et al., 2007). It has been shown by studies that the undernourished elderly people in the nursing homes have stark longer periods of illness, and are subjected to longer hospital stays with a slower rate of recovery (Feldblum, et al., 2007). Increased mortality rates are seen among such elderly people and as such, are among the plagues which have become a pressing concern (Payette, et al., 1999). There are various recognizable causes of malnutrition in the nursing homes and studies about this specific subject matter but studies are left exploring few of such given material factors. Due to such circumstances, it is essential that these factors be amassed and analyzed together in order to come up with an intervention program which is applicable to the elderly homes and may, ideally, address all such concerns relating to the matter. The role of the health care professional regarding the malnutrition of the elderly as well as the factors Malnutrition of Elderly People in Nursing Homes which affect such malnutrition is weighted very lightly, when in fact, theirs is a role which is very material to the addressing of such concerns. Unlike children who are suffering from malnutrition, the elderly people in nursing homes do not have either of their parents, nor their immediate family to help them with such worries. Therefore, their well being, as well as the quality of their life is left at the mercy of their attending health care worker and the nursing home as a whole. The burden of addressing such matters is left at the shoulders of their health care providers. | Dissertation Paper | Navarrete| Page5

The main issue sought to be addressed in this study is the fact that, evidenced by adequate studies, all caregivers suffer from very low levels of knowledge as well as awareness of nutritional problems which the elderly in nursing homes suffer from (Chermesh, et al., 2011). Numerous studies have shown that caregivers are unaware of the many factors which contribute to the malnutrition of the elderly. This lack of knowledge and awareness forces the elderly to be subjected to lack of diagnosis, at times, wrong diagnosis and ultimately, with no refuge in addressing such concerns. The role of the health care provider in these situations is not one to be disregarded. In the nursing home setting, they are the only ones who can provide the elderly with the care and regard that they need. Their role in curbing this pressing concern is one which weighs heavily, in this sense, it is very important that they are well equipped with the information that they need in order to effectively provide such care to the elderly people who depend on them. Through such information, they will be able to ascertain the root of the problem in their own nursing homes and will be able to create unique intervention programs that will cater to the needs of the elderly people under their care. In summary, the author of this study seeks to gather the most essential, as well as the most basic of information available regarding this issue of malnutrition in order to aid nursing homes and the health care providers themselves to create an effective intervention program in hope of curbing the issue of malnutrition. Ultimately, with such intervention program, the well being, quality of life, and mortality rate of the elderly people in nursing homes may be improved.

Aim
Malnutrition of Elderly People in Nursing Homes | Dissertation Paper | Navarrete| Page6 The main aim of this study is to create an assemblage of the most basic and most essential information available in current studies regarding the malnutrition of the elderly people in nursing homes. It aims to collect and compile essential information such as the numerous causes of malnutrition among the elderly in order to serve as a simple and direct source of reference for nursing homes and their attending health care providers. As an after effect of such compilation, this study, through its conclusion and recommendation, aims to aid these said nursing homes and their health care providers in creating a cost effective intervention program which will be applied to their nursing homes in order to address the malnutrition of the elderly people under their care.

Definition of Terms

Elderly People in Nursing Homes This term, as applied in this study, is used as an umbrella term for all elderly people embraced in this designation. Most of the studies used as a reference in this study made no significant or substantial distinctions among the elderly in nursing homes. This term embraces elderly people of various ages, most qualified by the age of sixty-five (65) and above as well as those suffering and not suffering from pathological or non-pathological conditions alike.

Functional Status This is characterized by functional impairment of all kinds and gravity. Functional status, as used in this study, ranges from the most common such as poor eye sight up to the graver conditions such as dysphagia or impairment of oral functions which relates best to malnutrition and food intake.

Health Care Providers and Health Care Professionals This term includes, but are not limited to, individuals employed and tasked to provide care and aid to the elderly people while they are admitted to nursing homes. This term includes caregivers, health care assistants, nurses, nursing assistants and all similar kinds of such employment.

Malnutrition of Elderly People in Nursing Homes

Inadequate Food Intake This term is used to depict the lack or deficiency in proper food consumption as well as related hydration deficits experienced by the elderly people in nursing homes caused by many different factors.

Intervention Program This is described as programs and procedures created and used by institutions to address, prevent, and correct an existing wrong which is detrimental to the health, life, and well being of an individual under their care.

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Malnutrition This is formally defined as a bodily state experienced by individuals which is characterized by the inadequacy or stark deficit, the overload or lack of: energy, as well other nutrients needed in the body which is responsible for the various adverse effects to the health, function, skills and clinical outcome of a person (Stratton, 2003). This term has been used loosely in many of the references used in this study and usually used interchangeably with under nutrition which mainly describes the inadequacy and lack of nutrients which is usually manifested by the undesired weight loss and lack of energy of the individual.

Nursing Homes This term is used in its general sense. Nursing homes are institutions and places tasked in the care and supervision of the elderly. No significant distinctions have been made between ordinary nursing homes and nursing homes which provide high level medical facilities and treatment for ill elderly people.

Nutritional Deficiencies This term is defined as the lack of nutrition experienced by the individual wherein an individual is unable to meet his bodys daily nutritional needs. This inadequacy is usually caused by the lack of food intake.

Oral Problems This is an umbrella term used by all such oral problems conceivable. In includes concerns Malnutrition of Elderly People in Nursing Homes as grave as dysphagia and concerns as trivial mere dental problems. | Dissertation Paper | Navarrete| Page8

Methodology
An organized search of science journals, articles and reference text has been used to meet the data requirements of this study. Through the use of a systematic search, the author was able to gather thirteen sources which were specifically and essentially related to the subject matter of this study. Internet search or online search has been the main scheme of data gathering. Websites such as Google (www.google.com) and Pubmedcentral (http://www.ncbi.nlm.nih.gov/pmc/) have been used to search related journals and articles used in this study. The search engine, Google, was used to search for complementary references while Pubmedcentral was used as the main source of references. The author had the original idea of basing the study on malnutrition. This is due to the recognition of the author of the fact that malnutrition is a pressing concern and there are many aspects which may become an interest of study. The first search was effected using the simple keyword malnutrition. This search in Google yielded hundreds of pages of related results. This prompted the author to another brainstorming in order to narrow down the field of study to more specific grounds. Since the author is a trainee in the health care department, the author listed three topics of interest relating to the main subject matter of malnutrition. First topic is the malnutrition of patients admitted in for a substantial length of time in hospitals. The second topic is the malnutrition of children and third is the malnutrition of the elderly. Through a comparative search of all three topics, the author found that the first two topics were too broad and the topics were woven too tightly and therefore, could not be taken separately and specifically. The third topic was found to be more of interest but was still too broad. Malnutrition of Elderly People in Nursing Homes The third search was effected through the use of Pubmedcentral. The keywords used was the topic itself which were malnutrition, elderly and elderly people. With each addition of keywords, the search results yielded results of two hundred fifty-three (253), two hundred thirty-three (233) and two hundred ten (210). Undeniably, this was still a large number of results and the study still lack specificity. The author analyzed the results in order to find recurring themes. One of the most rampant themes involved the admission and care of the elderly people in nursing homes. This, the, became the final topic of interest for the study. | Dissertation Paper | Navarrete| Page9

A fourth search was done through Google which yielded a lesser number of fives pages of related results, with two specifically relevant results. The first website was the Mini Nutritional Assessment site (http://www.mna-elderly.com/), a website dedicated to the optimal nutritional assessment of the elderly and the Stuurgroep Ondervoeding, a Dutch website literally meaning Steering Malnutrition (http://stuurgroepondervoeding.nl). Both sites provided an ample amount of reference articles which were not found in Pubmedcentral. The articles gathered thereon were also used in this study. Five criteria were used in this study in order to narrow down the number of references needed for an effective comparative study and assemblage. The following criteria were used: scope of the study, methodology, relevance with the recurring themes, time of study and the recommendations. The scope of the study was among the important considerations in narrowing down the results. The author recognized that the subject matter of this study was very specific and in turn, required a very specific scope of study. It was essential for the science journals to have nursing homes as their main site of study in order to relate it to the topic of interest. This first criterion narrowed the references slimly. The second criterion was the methodology. Most of the journals acquired had mixed methodologies and the author felt that such would only complicate the studies. Articles which used an ample amount of literary review and an actual field research were preferred. The third criterion was the relevance of recurring themes. There were four recurring themes in most of the studies. These themes were considered to narrow the remaining articles further. The fourth crtiterion was the time of study. This was an essential requirement since the author wanted only the most relevant results which were applicable in the present time. Journals and studies which were done and published a decade ago, around the year 2000, were eliminated. The author considered the possibility that some of the findings found on such studies may have already been debunked by the more recent studies and will only confuse the study. The last criterion was the recommendations in the science journals and research studies. The studies with more comprehensive recommendations compared to the others were taken in order to aid the author with coming up with an adequate compilation of such recommendations which will meet the aim of the | Dissertation Paper | Navarrete| Page10 Malnutrition of Elderly People in Nursing Homes

study which is to aid nursing homes and health care professionals in creating a cost effective intervention program in addressing the malnutrition of the elderly. Through such criteria, the author was able to narrow down the results to a final count of fourteen (14) references. Three (3) of which were reference texts and the remaining ten (10) being scientific journals and research studies.

Limitations of the Study

The character of this study being a dissertation study, the author was limited to the review of literature already available in the field. There was no room for testing such theories and results which were already pre-existing at the time. However limitation, this did not operate as a bar to the study from meeting its original aim and endeavour. This was due to the fact that the stark consistency and reliability of the findings found in the science journals and reference texts were enough to produce adequate information to support the study.

Malnutrition of Elderly People in Nursing Homes

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Findings and Critique

Chart 1.0 Summary of Prominent Themes and Findings in the Journals and Articles Gathered
(The complete publishing information of the following journals, articles and references may be found in the Bibliography section of this paper)

Title and Theme of the Study

Author/s

Country of Origin

Category of the Literature

Strengths and Weaknesses of the Reference (Applicable to Journals and Research Papers)

Main Findings and Prominent Themes

Improving Nutrition Care for Nursing Home Residents Using the INRx Process

Neva L. Crogan, PhD, APRN, BC, FNGNA, Ceanne Alvine, PhD, RN, and Alice Pasvogel, PhD, RN

Arizona, United States Of America

Research Journal

The systematic procedures applied to the research as well as the length of time dedicated to the study are among its strengths. The decision of the authors to include a comparison group in their study was also proven helpful in the crafting of their recommendations. The limitations of the study include (but are not limited to) the small number of participants, the study being limited to only two nursing homes in Arizona. Another limitation is the mode of selection in terms of the participants. Due to the nature of the research as a feasibility study, the researchers opted to hand pick their participants instead of randomly selecting. This, in a way, may have affected the result in a small potential of having bias.

The main themes of the study were the causes of malnutrition in nursing homes in the country as well as preventive measures to avert the incidence of malnutrition. The paper also explored the role of the health care professionals in charge as well as the role of dining assistant as factors to the addressing of such concerns.

Successful Aging

Rowe, J. And Kahn, R.

New York, United States of America

Reference Text

Under-nutrition in the nursing home: prevalence, consequences,

Abbasi, AA and Rudman, D.

Wisconsin, Milwaukee

Research Journal

Although the study was conducted in 1994 when references for this very specific study was scarce, the authors

The main themes of this research include the introduction of

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Malnutrition of Elderly People in Nursing Homes

causes and prevention

were able to gather enough sources in their review in order to serve as the foundation of their study.

the significance of malnutrition of the elderly in the nursing homes in many different clinical outcomes as well as the recognition that this issue is most often overlooked by researchers who are trying to assess the health and well being of the elderly. As for its conclusion and recommendation , this research explored the often missed opportunities in addressing and preventing this pressing concern.

Nutrition in Aging rd 3 Edition

5

Schlenker, ED

New York, United States of America

Reference Text

Another highlight of this study is the

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Malnutrition of Elderly People in Nursing Homes

Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status

Ilana Feldblum , Larisa German, Hana Castel, Il ana HarmanBoehm,N atalya Bilenko, Miruna Eisinger, Drora Fraser, a nd Danit R Shahar

Science Journal

What served as the main limitation of this study was the sample. The authors of this study had admitted that the study was pressed for time and that the samples used in the study were handpicked through certain criteria instead of using a randomized system of selection. In a sense, this may have limited the scope of the study and may not be reflective of the reality of the situation which the authors were trying to derive at.

The main point of this study is that several unseen factors play into the malnutrition and undernutrition of the elderly which remain undetected due to the lack of proper screening and assessment by their respective health care providers.

recognition of the fact that malnutrition and undernutrition is one of the factors responsible for the heightened rate of morbidity and mortality rate in nursing homes.
6

Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial

Kristel A N D Nijs, PhD fellow,1 Cee s de Graaf, profe ssor,1 Frans J Kok,profess or,1 and Wija A van Staveren, pr ofessor emeritus1

Wageningen, Netherlands

Science Journal

The strength of this research study is the use of a simplified and very systematic methodology which helped the researchers gather data rather quickly. On the other hand, due to such simplicity the researchers were unable to discount the possibility that some of the research participants may not be fitting of the criteria which they seek for their sample population.

The main point of this study is the advantage of using family style meals in averting malnutrition in the elderly people admitted in nursing homes.

Senescent Swallowing: Impact, Strategies and Interventions

Denise Ney, PhD, RD, Jennifer Weiss, MD, Amy Kind, MD, and JoAnne Robbins, PhD

Madison, United States of America

Science Journal

The strength of this study is its specificity in the effect of functional impairment in the nutrition of the elderly. The weakness of this research, however, lies in its untested theories that remain to be subject to actual application.

The prevalence of dysphagia in adults and its impact on nutrition and hydration.

Reference Text

Assessment and management of nutrition in older people and its importance to health

Tanvir Ahmed and Nadim Haboubi

Wales, United Kingdom

Science Journal

The weakness of this study is the fact that it has dismissed the possibility of malnutrition among the elderly who are not suffering from any diseases.

The main finding unique to this study is the stress on pathological and nonpathological factors which greatly affect the health and well

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Malnutrition of Elderly People in Nursing Homes

Disease Related Malnutrition: an Evidence Based Approach to Treatment

Stratton, RJ

being of the elderly.

10

Malnutrition and Nutrition-Therapy: Our Neglected Responsibility

Irit Chermesh, Lubos Sobotka, Co rina Hartman, an d Rmy Meier

Israel, Czech Republic, And Switzerland

Science Journal

The weakness of this study is virtually the same with this dissertation paper in the sense that it relied solely on researches and pre published text.

The main point of this study is the alarming low levels of knowledge and awareness among health care providers concerning the causes and preventive measures relating to the malnutrition of the elderly. It stressed the role of such health care professionals in curbing this concern.

11

Prevention of Unintentional Weight Loss in Nursing Home Residents: A Controlled Trial of Feeding Assistance

Sandra F. Simmons, Ph.D., Emm ett Keeler, Ph.D., Xiaoh ui Zhuo, M. Phil, Kelly A. Hickey, BA, Hui-wen Sato, MA, and John F. Schnelle, Ph.D

United States of America

Science Journal

The strength of this study lies in the system of its methodology and the length of time dedicated to the study. The presence of the control group in the study surely gave a better ground for the basis of the results.

Similar to the earlier science journal, this study recognizes the role of the health care professional in preventing and addressing this health concern among the elderly. It suggested not only feeding assistance, but also a larger involvement of the health care professionals in the health and well being of their patients in order to ensure their adequate nutrition and timely | Dissertation Paper | Navarrete| Page15 Malnutrition of Elderly People in Nursing Homes

assessment.
12

Malnutrition in the Elderly: An Unrecognized Health Issue

Danielle Maher, Student Nurse and Carol Eliadi EdD, JD, APRN, Mas sachusetts College of Pharmacy and Health Sciences Worcester MA

United States of America

Science Journal

The recommendations found in the study are the strongest point of this research.

This study stressed the common mistake of health care institutions and their health care professionals alike in dismissing and not properly recognizing the malnutrition of the elderly people which operates as a kind of a silent plague that needs to be immediately addressed.

13

Weight loss and mortality among free-living frail elders: a prospective study.

Payette H, Coulomb e C, Boutier V, GrayDonald K.

Science Journal

The premise of this research was very simple but the same enjoyed a great weight of background and basis for the conclusions derived there from.

This study stresses the relation between the increased mortality and morbidity rate of the elderly people admitted in nursing homes to their malnutrition and inadequate food intake.

Malnutrition is a health concern which is widely recognized around the world. In every nation, the face of malnutrition is easily seen and identified. In both manifestations, which are of under nutrition and over nutrition, nations around the world are exerting efforts in order to curtail and to prevent the same. In fact, this is a well recognized field of concern, resulting to it being a well recognized topic of interest in numerous studies and movements. As a result, several factors which contribute to this condition,

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Malnutrition of Elderly People in Nursing Homes

Theme 1: Malnutrition as a Silent Plague in Nursing Homes: A Pressing Concern

including but not limited to, physical, social, mental and psychological factors have already been identified (Maher, et al., 2011). However, the usual population of interest are among the younger members of the population, when in reality, malnutrition is just as rampant in the elderly. Studies show that such dismissal and disregard of malnutrition among the elderly people owes to the fact that the usual notion is that malnutrition is not a pressing concern as weight loss and decline of energy is only normal among the aging population (Chermesh, et al., 2011). This is among the common mistakes of health care providers tasked with the care and aid of the elderly people, most commonly admitted in nursing homes. In fact, such lack of awareness is reflected in studies showing that in reality, one of the major unrecognized problems in nursing homes is the adequate nutrition of the elderly people as evidenced by the fact that up to eightyfive percent (85%) of the elders admitted thereon are suffering from malnutrition (Rowe & Kahn, 1998). Not only is malnutrition unrecognized and unaddressed, more often than not, it is also frequently misdiagnosed by health care providers (Maher, et al., 2011). This had contributed to the rising number of malnourished elderly people in nursing homes since there was less preventive measure applied to the actual problem. This is a pressing concern as malnutrition operates as a silent plague which haunts the four walls of nursing homes in nations around the world. The fact that the levels of knowledge and awareness of such concerns is low among caregivers (Chermesh, et al., 2011) only aggravates the matter since there is very little effort exerted by such responsible people in curtailing the concern. Malnutrition is not a trivial matter. It directly affects the well being of the elderly people concerned. Studies show that not only is it a simple health issue, the fact is that it greatly contributes to the heightened mortality rate among the elderly people in nursing homes (Ney, et al., 2010). Such studies show that the elderly who are better nourished enjoy longer life spans compared to those who are not receiving the same amount of nourishment. The malnutrition of the elderly also operates as a trigger to many different medical concerns, pathological and non-pathological alike (Ahmed, et al., 2010). This contributes to a graver concern of sickness and lower quality of life among the elderly. | Dissertation Paper | Navarrete| Page17 Malnutrition of Elderly People in Nursing Homes

Due to such circumstances, it is very important that the causes of such malnutrition be identified and well recognized in order to suppress this silent plague.

Theme 2: Most Prominent Causes of Malnutrition of the Elderly in Nursing Homes

Numerous factors are found to contribute to the malnutrition of the elderly in nursing homes. This chapter provides a list of the most common and most prevalent among these causes and factors.

Appetite Change and Poor Appetite

Appetite change is among the many factors attributable to the under nourishment of the elderly admitted in nursing homes. Several factors come into play regarding the appetite change. According to studies, with increasing age also comes the inevitable decline of appetite which results to the equal decline of food consumption (Ahmed, et al., 2010). Due to such loss of appetite, the elderly find it less and less needed to eat and consume the proper amounts of food to sustain ones health. According to studies, older people are less hungry during the day compared to their younger counterparts. They also become easily fuller and actually feel fuller even before consuming their meals. | Dissertation Paper | Navarrete| Page18 Malnutrition of Elderly People in Nursing Homes As a result, elderly people consume smaller meals during the day, and eat more slowly. They opt to have fewer snacks between meals and are comparably more easily satisfied with the smaller portions of food that they consume as compared to the portions that younger people generally consume within the day (Ahmed, et al., 2010). Evidently poor appetite and loss of it is a very important risk factor which should be addressed early on as it contributes to the great under nourishment of elderly people (Feldblum, et al., 2007).

Medical Oriented and Non-Pathological Factors

Medical oriented and non-pathological factors contribute greatly to the malnutrition of the elderly. The following factors are among the most rampant related factors to such under nutrition. Loss of swallowing function brought by Dysphagia, can have devastating health implications

A. Oral Problems
The oral cavity, qualified by the teeth and the tongue, serves as the main point of entry for the food people consume everyday. The process of eating starts in the oral cavity, accompanied by the nasal cavity, through the contribution of aroma to complete the sensation of taste and eating. Where oral problems as well as nasal problems are present, an individual is expected to lose not only their appetite, but the actual ability to eat. One of the most common conditions falling under this category is the loss of swallowing function. This is a condition brought by dysphagia, where the swallowing is hindered by the dysfunction of the muscles. Dysphagia is a very common condition among the elderly and can have devastating health implications. Such implications include dehydration, malnutrition, and other similar effects due to the inability to commence consumption of fluid and the normal fluid intake (Ney, et al., 2010)..

B. Depression
Studies show that another cause of malnutrition among the elderly is depression (Crogan, et al., 2008) The overall incidence of depression in the elderly is approximately 10% (Schlenker, 1998). This depression may be brought about by several factors that remain unrecognized for a long period of time. Depression is actually one of the prominent conditions that the elderly suffer from as they adjust in their admittance in the nursing homes. The aging residents of the nursing home are faced with several adjustments, not only do they suffer from physical deterioration but they are also subjected to loss of independence, privacy, their family, their spouses, and an environment that they | Dissertation Paper | Navarrete| Page19 Malnutrition of Elderly People in Nursing Homes

are comfortable with. These several factors directly affect their well being and result to a high prevalence of loneliness and later on, depression (Nij, et al., 2006). The relationship between depression and malnutrition goes both ways. Studies have recognized the fact that depression results to loss of appetite and results to malnutrition. On the other end of the spectrum, it has been found that inadequate food intake and the subsequent nutritional deficiencies can actually lead to the development of depression (Crogan, et al., 2008) It is is the most common cause of unintentional weight loss recognized by studies. In reality, depression in the elderly is a frequent phenomenon but the same is very treatable. The only predicament in this department is that is often under-recognized and in turn, under-treated. Due to the lack of such identification and recognition, more elderly people suffer from depression and continue to suffer a lower quality of life (Feldblum, et al., 2007).

C. Medical Problems
Another contributive factor in malnutrition is the medical problems that people become more susceptible to as they age. Pathological factors become more common with age since the immune system of the body is no longer in its best working condition when a person reaches old adult age. This is, however, not to say that such causes are not treatable as these usual conditions found in the elderly are usually detected at an early stage and may be treated by several methods of treatment (Ahmed, et al., 2010). However, the fact remains that these conditions have great impact on ones nutrition as they age. One of the direct effects of such diseases and medical conditions are the weakening of the body of the patient. As such, it is accompanied by loss of appetite and difficulty in eating. Due to such losses and impairment, the elderly person is unable to meet his daily nutritionional needs. In the same vein, another effect of such conditions is the fact that most patients are subjected to certain diets the moment they are found to be suffering from such conditions. It is the fact that | Dissertation Paper | Navarrete| Page20 Malnutrition of Elderly People in Nursing Homes

restrictive diets come with these conditions that contribute to the malnutrition (Ahmed, et al., 2010). These restrictive diets serve as a factor which increases the risk of malnutrition (Maher et al., 2011) because of two reasons. One is that they are no longer able to receive all the nutritional requirements and two, is that they are not allowed to eat what they prefer.

D. Inability to Feed Oneself Effectively

Studies show that a persons aging is greatly linked with a decline in a number of physiological functions that can affect the nutritional status of the aging adult (Ahmed, et al., 2010). Difficulty feeding oneself owing to several factors also serves as a hindrance in the elderly peoples meeting of their daily nutritional needs which results in malnutrition (Crogan, et al., 2008). Such factors include poor hand to mouth coordination, poor vision, and the weakened state of the body all of which are common manifestations of old age (Crogran, et al., 2008). Functional disabilities greatly affect ones way of life and the many daily routines that one used to do with ease such as feeding oneself (Feldblum, et al., 2007). With such impairment in functional status, the elderly person easily dismisses eating as a task and no longer enjoys the same. Due to such circumstances, their food consumption declines. This makes them unable to meet the nutrition which their body requires in order to function properly and be in its best condition to function and combat diseases and other similar conditions. This ultimately | Dissertation Paper | Navarrete| Page21 Malnutrition of Elderly People in Nursing Homes

heightens the weakness and lethargy that they experience every single day. This turns into a vicious cycle until the elderly person becomes severely undernourished.

Environmental Factors

Last among the factors found in the studies are such other factors embraced in the mantle of environmental factors.

The elderly are subjected to several adjustments as they move out of their homes and are admitted to such nursing homes. Certainly, the change in environment will not sit well right way. Studies show that many perceive the common environment within nursing homes to be not conducive to eating due to several factors. Such factors include the noisy community dining room and the unsupportive dining room staff if they choose to actually eat in such places, or the unappealing meals served on individually prepared trays served in their bedrooms and preferences in food among others. In most nursing homes, the community dining area is just as unappealing as the meals ndividually served on trays in a nonstimulating environment (Nijs, et al., 2006). Other similar factors are social isolation, poor social support, and the like, serving as major risk factors for malnutrition (Feldblum, et al., 2007).

Theme 3: Preventive and Responsive Measures

Several preventive and responsive measures have been suggested in the references taken by this study. Such measures have been suggested and recommended, as well as tested in some cases, by the authors in the span of their study. Such measures were suggested to effect the curtailment of this pressing concern. A. Nutritional Assessment This recommendation is a preventive measure. Several recommendations call for a nutritional Malnutrition of Elderly People in Nursing Homes assessment of the elderly people in many periods. Such periods include the time before they are committed to such health care nursing homes and a little while after they have been admitted. This is premised upon the idea that prevention is still better than cure and that if any conditions are seen in the initial assessment, the health care provider will be able to effect treatment immediately in order to prevent its adverse effects from manifesting. Such nutritional assessment is only proper in order to insure that the health of the elderly person is in good condition (Ney, et al., 2003). B. Treatment of Oral Conditions, Functional Disabilities, and Other Similar Conditions | Dissertation Paper | Navarrete| Page22

The treatment of oral problems and such other related concerns is also among the many recommendations for such cost effective measures (Ney, et al., 2003). Treatments may range from something as simple as medication, to therapy or the more drastic consideration of surgery. Such treatment is highly recommended as a preventive measure since such treatment will thwart the fruition of adverse effects that directly affect the food consumption of the elderly persons concerned. However, the mode of treatment should be taken with great judgment and discretion as the recovery time needed from elder adults are longer than the average younger adult at the prime of his or her life.

C. Improvement of Eating Environments Making them Conducive to Eating Another recommendation is the improvement of dining systems and areas in the nursing home making them conducive to eating. Some of the matters complained of are the unappealing presentation of food where they are served in trays in ones bedroom. One study shows that family style meals and meal times help in improving the atmosphere of the dining and make the mood of the residents a lot lighter making them have better appetite as they eat (Nijs, et al., 2006). Another study suggested that the taking of preferences in food and taking them into consideration also helps (Feldblum, et al., 2007). One major consideration is the texture of the food itself that makes the food undesirable and unappealing to the elderly people. These were the small preventive and responsive measures suggested by the studies taken as | Dissertation Paper | Navarrete| Page23 Malnutrition of Elderly People in Nursing Homes references. These recommendations will be discussed more in detail in the chapter containing the Recommendations.

Theme 4: The Role of the Health Care Professionals

The role of health care professionals regarding this matter of malnutrition, its prevention and its treatment, is not one so trivial. In fact, a heavy burden lies in their person from the very first day the elderly person is committed to their care. From the very beginning, the health care professional has the role of properly assessing the health and well being of the elderly person placed under his or her care. Unfortunately,

studies show that many nurses and other health care professionals are not properly informed and oriented in this aspect resulting to the wrong or faulty screening or assessing of the actual facet of malnutrition that the elderly may be experiencing (Maher, et al., 2011). With this wrong assessment, no proper treatment or intervention program may be created and applied in order to uplift the condition of the patient at the time. On another aspect, the health care professional also shares a hand in the proper consumption of food that the elderly may take during their stay in the nursing home. According to a research study effected in 2010, feeding assistance interventions are one of the most effective methods in curbing malnutrition and raising the food intake of the elderly people as it helps in promoting food consumption as well as fluid intake resulting to the desirable weight gain among the elderly admitted in the nursing homes who are currently at risk of weight loss (Simmons, et al., 2010). Through such optimal feeding assistance, the elderly person is supervised of the amounts of food that they eat, and they are able to regularly voice out their opinions regarding their experiences, food preferences and the like, making the experience more enjoyable and raising the food consumption paired by a healthy appetite. The application of regularly scheduled meals with varied options depending on the preferences of the elderly person has also been found to be very helpful (Simmons, et al., 2010). Even if the elderly person has no appetite, the regular serving of meals and snacks throughout the day prompts them to eat more and meet their daily nutritional needs. Some measures of intervention and responsive measures may also originate from the initiative of the | Dissertation Paper | Navarrete| Page24 Malnutrition of Elderly People in Nursing Homes health care professional him or herself. The encouragement as well as empathy shown to the elderly person also helps in the curtailment of malnutrition as they are regarded and cared for.

Conclusions
Malnutrition is a very well recognized condition in todays times but such conditions in the nursing home setting often go unrecognized. Factors that contribute to the malnutrition and under nutrition of the elderly people are of quite a variety and encompassing.

Such factors come from different fields such as psychological, physiological, social and environmental. Among the more rampant factors are the psychological factors of depression and adjustment issues which often go unnoticed and unrecognized and as a result, comes to aggravate the already worsening situation. Social factors include the anxiety brought about by the new set of faces that the elderly person will have to familiarize once more. The separation from ones family and peers result into social isolation which is very detrimental to the social and psychological stability of a person. In the physiological sense, pathological and non-pathological conditions, as well as impairment in the functional status of an elderly person are among the factors which contribute to the decline of their nutrition and their weakened state. While the issue of malnutrition is one which is so grave, this does not mean that the elderly people will find no refuge in such conditions. Intervention measures which serve as preventive measures as well as responsive measures for improving the state of the elderly person may be applied. Among these preventive and responsive measures, three recommendations have been the most common among the sources gathered. The first is viewed as the most effective scheme in the prevention of malnutrition which is the nutritional assessment of the elderly. The second is also a preventive measure which curbs the possibility of medical and functional conditions that may have adverse effects on the well being and nourishment of the person concerned. And finally, the improvement of the environmental and social factors to which the elderly person is exposed to. These are the three most effective recommendations for the intervention, prevention and addressing of concerns relating to the malnutrition of the elderly people in nursing homes. And finally, it has been found from these sources that the role of the health care provider in addressing this very specific concern enjoys great weight. In both the prevention and addressing such concerns, the participation of the health care provider is well needed. This is the very reason why the lack of awareness and knowledge from the part of such health care professionals are viewed as something very detrimental to the health and well-being of the elderly person. The elderly person committed to the care of a nursing home relies and depends greatly on the health care provider for most of his or her needs. It is only proper that the caregiver be well informed and trained in order to meet the needs of the patient. Not only should the health care provider be well equipped with the information he needs in order to provide for the needs

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of the elderly person, he also needs to have a keen mind in order to remain aware of the state and condition of the person concerned. And of course, genuine care and empathy should also never be absent.

Recommendation
The following are recommendations that have been prepared by author as proposals to be considered for the improvement of a future study which may be based on this humble paper as well as recommendation for nursing homes who are trying to curtail the rampancy of malnutrition within their administration.

I. Recommendations on the Pursuance of the Study

A. Testing of Recommendations
One of the major recommendations for this paper is the testing of theories, suggestions and recommendations that have been drafted and derived from the various sources gathered. As the character of this study is a dissertation paper, the findings gathered were limited to its sources which were published scientific papers and reference texts. No other method other than such comparative study was effected. The author believes that better recommendations may be made if the same were applied and tested further.

B. Dedication of a Longer Period of Study

A longer period of study would also be advantageous for the improvement of this study. Paired with the first recommendation of testing the proposals for intervention and improvement by the application of such methods through a sample study and a control group, the dedication of a greater length of period of study would prove to be of aid to the improvement of this study. | Dissertation Paper | Navarrete| Page26 Malnutrition of Elderly People in Nursing Homes

C. Gathering of Data Beyond Online Sources

The author does not dismiss the possibility that some scientific journals and research studies may not have been available and published online at the time this research has been made. Some valuable text may still be in hard copy form and may be found only in science journals

distributed. The author recommends that it is most advisable for authors, researchers and fellow students alike who wish to pursue this subject matter to find sources beyond what is available online, if there is any, in order to optimize the data available and be able to make a more comprehensive study and in turn make better recommendations that not only more complete, but also more up to date with the times.

II. Recommendations on Intervention Programs

The following are recommendations prepared by author as proposals to be considered in creating an intervention and response program for nursing homes in order to address concerns regarding malnutrition

A. Implementation of an Early Assessment Before and After Admittance to the Nursing Home and Scheduled Follow-ups and Proper Screening
Based on the premise and common concept that prevention is indeed better than cure, an early assessment and proper screening would be very helpful in determining the health and medical needs of the elderly in nursing homes. While the studies have recommended the same, the author recommends that such assessment and screening be made from time to time and in a fixed schedule. The author feels that such scheduled assessments will help in monitoring the health condition and well being of the elderly person and will help in ascertaining the proper intervention programs that should be applied in order to address the unique and personal needs of the elderly concerned. | Dissertation Paper | Navarrete| Page27

B. Application of a Continuous and Committed Monitoring System

A committed monitoring system will greatly benefit the institution, the health care provider and the elderly person alike as it would provide as a good reference for everything and anything that needs to be addressed for the elderly patient. Such monitoring system may be implemented by the fixed periods of check ups as mentioned in the earlier recommendation as well as a fixed evaluation period. During such time, the state and well being, as well as the overall health status of the elderly is gauged and evaluated. Should there be any area of

Malnutrition of Elderly People in Nursing Homes

concern, the same may be corrected and such programs to be implemented by the health care provider or caregiver will be tailored to specifically fit the needs of the elderly involved.

C. Performance of Therapies and Proper Treatment

After a proper evaluation and assessment, as well as diagnosis, it is very important that any health and medical concerns be immediately addressed. Should a diagnosis for certain health conditions be seen, it is only proper for the part of the health care professional to have the elderly person treated and that a specific feeding program tailored for the needs of the patient be made so that it will be made sure that the patient does not only receive proper treatment, he or she will also meet the dietary requirements of his body to maintain his health.

D. Evaluation of Medication and Treatment to be Applied to the Elderly Persons

Some elderly persons admitted into the care of health care institutions and nursing homes are suffering from pathological and non-pathological conditions. Due to such conditions, they require treatment and medication. While such treatment and medication alleviates them of such conditions, there are times that these treatments and medication have negative effects on their bodies. Some medications have adverse effects on the nutrition and food consumption of the elderly people. It is essential that such medication be assessed and properly evaluated, and if they possess such character, that alternatives be sought for in | Dissertation Paper | Navarrete| Page28 Malnutrition of Elderly People in Nursing Homes order to provide for a greater aid and care for the well being and nutrition of the elderly.

E. Consideration of Personal Preferences

Usually, the food served in nursing homes is in a fixed basis with only one option of dishes every day. While it may seem more costly, it would be advisable to take into consideration the preferences of the elderly people in the homes. Not only does it insure that they are well nourished, it also prevents any wastage. It is undeniably more cost effective than cooking and

producing pounds of food that will only go to waste simply because none of the elderly find the food appealing and enjoyable.

F. Devising and Application of the Most Effective Dining Setting

As discussed above, different people have different needs. It is important to evaluate the needs of the elderly people under ones care in order to determine which kind of dining setting is most effective in encouraging them when it comes to taking their meals. Some prefer eating alone while some prefer to eat in a family style setting. It would be very helpful to evaluate which among these options are preffered by the elderly people and that the same be applied for them. That way, they would be able to maintain a good appetite and would remain well nourished.

G. Adequate Training and Information of Health Care Professionals Tasked to Care for the Elderly People in Nursing Homes
And last but not the least, is the adequate training and information of health care professionals. All recommendations found in this chapter of the study are to be effectively implemented with the keen commitment and participation of the health care professional involved. It is important that such care givers are well trained and education in order to effectively meet the needs of the elderly person under their care.

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