Analysis - Mental Health - Malnutrition Of Elderly In Care
Research has shown that the prevalence of malnutrition among older people in hospitals, the community and care homes has been highlighted consistently during the last ten years (Lennard-Jones 1992 ) and Association of Community Health Councils 1997. As malnutrition remains an issue within the older adults, an increase of the same population, highlights the problem in our society in relation to mental health issues.
Recent studies shows that the fastest population increase has been r'n the number of those aged 85 and over, the ’oldest old‘. In 1983, there were just over 600,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.3 million in 2008. By 2033 the number of people aged 85 and over is projected to more than double again to reach 3.2 million, and to account for 5 per cent of the total population (Office for National Statistics 2009).
Most of the challenges and sometimes the cause of malnutrition in older adults are very similar and becomes more complex with the percentage of the elderly with a mental health problem. This is because, being malnourish could precipitate a mental health illness, while at the same time, suffering from a mental health problem could increase the risk of malnutrition. These factors include:
Normal aging progression and related difficulties: Aging is a constant, predictable process that involves growth and development. It can't be avoided but will vary from one person to another, depending on the differences in our genes, environmental influences, and life styles.
These expected biological changes to the aging body have various effects on the individuals nutritional status. Some of these changes include: paresis of the muscles and reduction of muscles and tissue mass. This aids a decrease mobility and coordination. There is also inability to shop or prepare food. Handling hot food becomes unsafe for this individual.
There are also difficulties in swallowing. As age affects locomotors, hence the joints are rigid with reduced lean muscles and a risk of osteoporosis, the nutritional status is affected by the inability to shop and cook, carry heavy loads and also impaired manual dexterity. As the immune decreases, immune function is reduced and the individual becomes prone to infection if food hygiene is poor.
Finally, gastro-intestinal changes can cause malabsorption and poor dentition. This will affect the ability to chew and bite, hence nutrients deficiencies. Skin and renal
related changes will also cause fluid imbalance and fear of incontinence.
With the accumulation of the above, older adults with any mental health illness, have twice the challenge because of the further impairments and vulnerabilities.
A key to understanding the mental health needs of older adults is to recognize that physical health and mental health are very much interconnected. For instance, people who have physical problems like heart problems and diabetes are more likely to develop mental health problems. People with depression or anxiety are more likely to develop physical problem such as lack of energy or stomach problems or difficulty concentrating.
Many people mistake the symptoms of depression, anxiety and other mental health problems for the ageing process itself. Unfortunately, many people think that confused thinking, irritability, depressed mood, and loss of energy are just signs that someone is getting older rather than signs that someone needs help. Hence the problem is under looked and misdiagnosed by careers and health care professionals.
Culture and religion can significantly influence food preferences, preparation and mealtime rituals in older people. Foods may be prohibited, such as anything derived
from the pig in the Jewish and Muslim faiths, or shellfish among Seventh Day Adventists. Food combining can be important — for example, the orthodox Jewish principle that meat and dairy products should not be eaten together (Fieldhouse 1986) and the belief held by some Asian people about the action of ‘hot’ or ‘cold’
While considering an older person with a mental health illness, especially those in live by themselves, reliance on others for shopping can limit food availability, while loneliness and social isolation may lead to dietary inadequacies and skipped meals (Walker and Beauchene 1991), particularly among widows and widowers (Callen and Wells 2003).
Social isolation may also cause depression and an associated anorexia while chronic illness or physical disability may cause dysfunction and will reduce appetite (Callen and Wells 2003). Cognitive changes may mean that meals are missed (Kayser—Jones 2000), while functional disabilities may limit food acquisition and preparation (Stechmiller 2003).
Malnutrition is strongly associated with dependency in eating, dyspnoea, slow eating, poor eating position, communication difficulties and mental impairment (Keller 1993). Hence the greater the range of difficulties the higher the nutritional risk (Wilson et al 2004).
Screening identifies those at risk, enabling early intervention. There are screening tools which are used to filter patients who are already malnourished, obese and also those who are at risk. This tool known as the Malnutrition Universal Screening Tool — also called the MUST Tool. It is also used to further formulate a management guidelines of the individual’s care plan.
Therapeutic interventions for older adults with a mental health illness with other older adults with medical conditions, for both institutionalised or community based, are usually similar. These will include simple steps such as encouraging relaxation during mealtimes and sitting with the patient’s at an eye level and make eye contact during feeding.
Actions to interrupt patients for procedures during mealtimes could male mealtime difficult for the patient, especially very confused and very ill patients.
Communication and strategies aimed at encouraging family members to visit at mealtimes could sometimes be of help. These relatives could help feed, since given foods s eaten at the same meal. (This concept of ‘hot’ and ‘cold’ is not related to heat or spiciness.)
Cultural and religious beliefs can influence the way food is produced, handled and prepared for consumption. Festivals such as Christmas and Diwali, as well as fasting periods in Lent and Ramadan, may contribute to weight-gain or loss.
It is important to remember that, even among members of the same cultural or religious community, individual beliefs and practices differ.
Major lifestyle changes such as retirement and bereavements can be one of life’s major upheavals. With planning this transition may be smooth, but it can also result in reduced income and increased isolation, particularly if most of the individual’s friends were those at work. Retirement can also lead to a more sedentary lifestyle which can result in weight gain. Financial problems or health changes can reduce interest in, and their ability to shop or cook. All of these factors can contribute to an inadequate diet.
Older people who take medication, whether prescribed by a doctor or bought over the counter, are vulnerable to drug-nutrient interactions. For example regular use of antacids may lower vitamin (Bobroff et al 2002). Food containing tyramine (such as mature cheeses, pepperoni, salami, soy sauce, tofu, sauerkraut and fermented beers) must not be used with monoamine oxidase inhibitors as the interaction can lead to a fatal rise in blood pressure (Thomas 1995). Ferrous sulphate interacts with captopril (Schaefer et al 1998) and grapefruit juice interacts with several drugs (Bailey et al 1998). Many drugs are affected by alcohol and, in older people, the combination can precipitate liver failure.