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LONG-TERM CARE OF THE ELDERLY
Because of increasing longevity, the number of elderly people requiring long-term care is increasing.
It is estimated that the majority of people 85 and over have at least one chronic disease such as arthritis, osteoporosis, diabetes mellitus, cardiovascular disease, or mental disorder. These conditions affect their attitudes, physical activities, appetites and, thus, nutritional status. PEM is a major concern for this population.
Anemia can develop if the client has insufficient iron intake. It can contribute to confusion and depression but may go unnoticed because one of its major symptoms, fatigue, may be simply thought to be a characteristic of old age. It is helpful to make sure there is sufficient animal protein and vitamin C (an iron enhancer) in the client’s diet.
Pressure ulcers (bedsores) can develop in bedridden clients. The ulcersdevelop in areas where unrelieved pressure on the skin prevents the blood from bringing nutrients and oxygen and removing wastes. Healing requires treatment of the ulcer, relief of the pressure, a high-calorie diet with sufficient protein, and vitamin C and zinc supplements. Prevention is a must.
Constipation can be caused by inadequate fiber, fluid, or exercise; by medication; by reduced peristalsis; or by former abuse of laxatives. It can be relieved by increased fluid, fiber, and exercise (if possible).Diarrhea can be caused by lack of muscle tone in the colon. It will reduce the absorption of nutrients and can contribute to dehydration. An increase of fiber in the diet combined with supplemental vitamins and minerals may be helpful.
The sense of smell declines with age, and the appetite diminishes. A reduced sense of taste can be caused by medications, disease, mineral deficien-cies, or xerostomia (dry mouth). The addition of spices, herbs, salt, and sugar (if allowed) can be helpful. Xerostomia can be caused by disease or medications. Drinking water, eating frequent small meals, and chewing sugar-free gums or sucking on hard candies may be helpful. The inadequate amount of saliva in these clients contributes to increased tooth decay.
Dysphagia (difficulty swallowing) can result from a stroke, closed head trauma, head or neck cancer, surgery, or Alzheimer’s and other diseases. A swallow study needs to be done to determine the consistency of diet needed by clients with dysphagia. A swallow study is done by a speech therapist using a video fluoroscope. While being videotaped, the client is given liquids, semi-liquids, pureed food, and solid food to determine the consistency of the bolus (food mass) that he or she is able to swallow without aspirating. Many dysphagia clients must have thickened liquids. Dysphagia clients should always be in an upright position when eating.
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