Quarterly Inservice Test #4: Nutrition

As people age there are many physical and social changes that affect nutrition.

Lifestyle changes:
1. a change in living arrangements
2. death of a spouse
3. decreased income, affecting the ability to purchase food
4. social isolation
5. loss of ability to drive to the store alone to buy food

Physical Changes:
1. slow metabolism and a decreased need for calories
2. lack of chewing and swallowing ability
3. loss of smell or taste
4. slowed digestion
5. diarrhea and constipation
6. disease such as diabetes, arthritis and cardiac or breathing problems
7. lack of activity

Many elderly or infirmed people do not take the time to plan and cook meals since they are alone. If you are a caregiver take time to eat with your client and set the table so the meals look attractive to the client. In a facility have the client eat in the dining room if possible to encourage socialization and give the client something to look forward to. Encourage family members to visit at meal time or take the client out to eat occasionally, if possible. Please remember that you can suggest healthful diet tips to your clients but the ultimate decision of what they will eat is up to them and their family. If you have concerns about your client’s diet or the availability of foods, please call the office and the nurse will follow up with your concerns.

The USDA food guidelines follow the FOOD GUIDE PYRAMID (see picture).Serving sizes are as follows:
1. grains- 1 oz ceral,1/2 bagel,1/2 cup of pasta or rice, 1 slice of bread
2. fruit and vegetables- ¾ cup (6 oz) juice, ½ cup fruit, 1 cup salad type vegetables,1 medium piece of fruit
3. protein foods- 2-3 oz meat, poultry or fish, 1 egg, 2 Tablespoons peanut butter,1/2 cup cooked beans
4. dairy- 1 cup (8oz) milk and yogurt, 2 oz cheese, ½ cup cottage cheese
5. fatty foods and sweets- use in moderation- butter, margarine oils and salad dressings cakes, pies candy etc.

Making healthy choices is also important. Choose fish and beans as a low fat alternative to meat for several meals a week. Eat a variety of fruits and vegetables every day. Choose whole grain breads and cereals .If you are choosing whole wheat bread, be sure that the ingredients say WHOLE wheat, if it says just wheat it is not high in fiber. Low fat or non fat dairy products are a healthier alternative to high fat dairy products. Sugar and salt should be used sparingly.

Fiber is important to provide BULK in the diet and aid in digestion and reduce constipation. Eating at least 5 servings of fruits and vegetables, eating whole grain breads and cereals will increase fiber intake. Eating cooked beans peas and lentils is a great way to increase fiber without adding fat. Vegetables and fruits are also a source of important vitamins needed in the diet.

Water is vital to health, 6 to 8 glasses of water a day are recommended daily. Lack of fluid intake leads to dehydration, especially in the elderly. Drinking fluids mostly in the morning and afternoon can decrease the need for extra trips to the bathroom at night. Other fluids can take the place of water but water is the best choice. Two to three cups of coffee or caffeinated tea or cola a day should be the limit for caffeinated beverages. Decaf tea and coffee are better choices for the elderly. Proper hydration aids digestion, prevents constipation, prevents urinary infections, colds and flu. It is also important to give your client extra fluids in hot weather to help cool their bodies and keep them hydrated.

Sugar should be used in moderation in the diet. Sugar has no fat, minerals, vitamins or fiber but it is a carbohydrate. Processed foods are a primary source of excess sugar, read labels and if possible, choose foods where sugar is not listed in the first few ingredients. All sugars are the same, white sugar, raw sugar, brown sugar, honey and corn syrup have the same effect on the diet. When you read labels check for clues like dextrose, fructose and sucrose, any ingredients that end in OSE are sugar. People loose taste buds as they age and they do not taste added sugar, salt etc and tend to use more to get better flavor in their foods. Try using other spices like cinnamon and eating sweet tasting fruits in place of sugary sweets. Diabetics will have special diets ranging from diets that are free from added sugar to specific diets prepared for them. Please be sure you understand the specific requirements for your client or call the office and have the nurse come out and explain it to you and answer questions.

Fat has more than twice the calories per gram as carbs or proteins, each gram of fat has 9 calories. A normal diet should contain no more than 30% of the calories from fat. People with heart disease or inactive adults should further reduce their fat intake to 20%. Read labels for fat contact, processed foods or convience foods usually have higher fat contents than food you prepare yourself. Saturated fats are found in meats, eggs, dairy products and some plant oils such as palm and coconut oils and cocoa butters. Saturated fats raise LDL “BAD” cholesterol and should be limited. Monounsaturated fats lower LDL cholesterol and should be part of a healthy diet. Sources of monounsaturated fats are olive oil, peanut oil, avocados, nuts, chicken and fish. Polyunsaturated fats help lower your total cholesterol. Sources of polyunsaturated fats include corn, sunflower, safflower, walnut and canola oils. In a normal 2,000 calorie diet the total fat should be 65 gms or 585 calories.

1. Broil or bake food instead of frying after removing fats and skin
2. meat portion size should be 2 -3 oz.
3. eat more fish and poultry, eat red meat less often
4. eat more beans, legumes, peas and grains
5. try skim and reduced fat dairy products
6. read labels and avoid hydrogenated oils, palm and coconut oils and cocoa butter
7. use herbs and spices to season food instead of butter and fatty sauces

Our bodies need 500 milligrams of salt daily, most of us get much more. Excess salt causes high blood pressure and the likelihood of developing high blood pressure increases as we age. Beside salt other sources of sodium are baking soda, baking powder, MSG, soy sauce and prepared seasoning (read labels). Sodium is also present in high concentrations in many processed foods and canned goods. Again, read labels and look for low sodium versions of foods and avoid processed foods. Try cooking without salt and adding salt substitutes or limited salt after food is prepared. Many clients will be on a restricted salt diet that is 2 Gm. or 2,000 mg of salt, in any diet an excess of 2,500 mg is probably too much salt.

    *3 in-service credit hours

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    #1: The base (bottom) of the food pyramid is:

    #2: According to USDA guidelines an average serving size is:

    #3: How much water is recommended daily for good health?

    #4: Sugar is a:

    #5: How much fat should the average diet contain?

    #6: Salt or sodium is found in:

    #7: A diet that contains more than _____ of salt is probably too much salt:

    #8: To reduce fat:

    #9: Saturated fats are found in:

    #10: Lifestyle changes that affect nutrition in the elderly are:

    #11: According to the USDA Food Pyramid how many servings of fruit should be consumed daily:

    #12: The serving size for fruit is:

    #13: The serving size for cheese is:

    #14: Which food is high in protein?

    #15: If your client complains of constipation, what food choice would help?

    #16: What food will add the most fiber to the diet?

    #17: What disease requires a low sugar diet?

    #18: To encourage increased socialization at meals times in an assisted living facility, you would:

    #19: What is NOT a common physical change of the elderly?

    #20: What is a normal calorie intake per day?

    #21: What is a good choice for a protein food to replace meat?