Barriers to good nutrition unique to older adults
Dental/oral Health
Older adults are prone to dental problems such as cavities, loose teeth, missing teeth, dry
mouth, painful gums, ill-fitting dentures or missing teeth make it difficult to chew food.
Chewing problems in older adults are associated with malnutrition, which results in reduced
quality of life and poor health.
Swallow difficulties
Difficulty in swallowing may result diseases conditions such as stroke or esophageal
problems. This may lead to malnourishment if the adult is not fed with feeding tubes.
Physiological changes
Physiological changes that put older adults at risk for poor nutrition include a reduction in
lean body mass and the redistribution of fat around the internal organs. These changes result
in a reduction in available calories in older adults. Due to the fact that lean body mass
contains metabolically active tissues, it burns more calories and also requires more. . Finally,
changes in taste—which can be caused by medications, nutrient deficiencies, or taste bud
atrophy—can also alter nutritional intake.
Loss of Appetite
Loss od appetite may be due to alterations in hormonal that affect appetite. It may also be due
to changes in the central nervous system that reduce certain neurotransmitters that affect
appetite. Medications can also affect appetite as the side effects of some medications include
loss of appetite.
Mental and Psychological Health
Mental and psychological issues are common in older adults especially when they lose loved
ones. For example, depression is common among older adults which may cause significant
weight loss and malnutrition in older adults. Stress and anxiety may also make older adults
eat less than they need. Dementia and confusion are also mental health issues that impair an
older adult's desire to eat and their ability to feed themselves.
Disease condition
Older adults who suffer from an acute or chronic diseases may be at risk for poor nutrition.
These include medical conditions such as stroke, cancer, hyperthyroidism, Parkinson’s
disease, respiratory tract infections, etc. These may cause malnutrition.
Medications
Medications also affect nutrition in older adults by generating side effects such as reduced
appetite, nausea and vomiting, diarrhea, malabsorption of food and alterations in the senses of
taste and smell. Moreover, older adults are more at risk of polypharmacy which predisposes
them to more side effects.
Financial capacity
Older adults who have meagre funds may skip meals or eat less than their nutritional
requirements. E.g., eating bread and drink juice in place of more appropriate food.
Nursing interventions to overcome nutritional barriers in older adults
1. Alleviation of dry mouth: The older adult with dry mouth should be instructed take small
sips or mouthfuls of water at regular intervals. They should be advised to avoid caffeine,
alcohol, tobacco, spicy, salty, and highly acidic foods. The adult may be advised chewing
sugarless gum to stimulate the production of saliva (this is however not appropriate for
patients with dementia or dysphagia)
2. Loss of appetite can be helped with the following measures:
Check medications that cause loss of appetite provide an alternative where possible.
Encourage small meals with regular in-between snacks. Foods should be rich in
energy rich and protein
Maximise periods of good appetite, e.g., if the adult patient feels hungry in the
morning, a cooked breakfast (balanced diet) should be offered.
Meals and snacks should be appealing in size and appearance.
Encourage older adults to select favourite foods and let them eat it at any time of the
day.
Suggest that drinks should be taken after meals rather than before and during a meal
A short walk before meals can be helpful in stimulating appetite
Make mealtimes enjoyable and avoid interruptions or rushing
3. Chewing problem can be helped by:
Good dental and oral care
Offer soft foods that require little chewing
4. Serve food in appropriate consistency: Swallowing difficulties can be helped by
modifying the consistency of foods appropriately.
5. Provision of oral supplements
Provision of oral supplements that has high-calorie, nutrient-rich supplements are a good for
older adults who are unable to eat. Improvements in body weight and improved survival have
been demonstrated in patients receiving oral supplements.
6. Treatment of underlying diseases: Seek medical treatment for diseases that affect
nutrition.
In the healthcare facility, the following may help older adults that are on hospital
admission
7. Improvement of oral intake: Strategies to encourage eating at mealtimes including the
following:
Help adult patients with oral care and ensure that dentures are well fixed. Ask the
adult patient’s food preferences and make arrangements for it to be available.
Monitor the older adult patient at mealtimes to determine how much food is being
consumed and decide whether assistance is needed with feeding. Suggest small,
frequent meals with adequate nutrients to help patients regain or maintain weight. Ask
dietary services to provide nutritious snacks.
Remove bedpans, urinals, and emesis basins from patient’s rooms before meal is
served.
Administration of analgesics and antiemetics on a planned schedule to diminish the
likelihood of pain or nausea during mealtimes.
Serve meals to adult patients seated in a chair if they can comfortably get out of bed,
they can also be propped up in bed with the meal served in a tray.
Keep food warm if the patient is not ready to eat at the regular mealtimes.
Patients’ mealtimes should not be interrupted with rounds or non-urgent procedures
Encourage family members to visit patients at mealtimes and bring favorite home-
made foods according to the patient’s recommended diet.
8. Provide specialized nutrition support
Older adults should be given specialized nutrition if they have feeding difficulties such as
parenteral nutrition.
