PRESENTER: EBONY CRAMERI - PowerPoint Presentation

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PRESENTER: EBONY CRAMERI

Accredited Practising DietitianSlide2

Dehydration occurs when the amount of fluid consumed is less than the amount that is lost. Dehydration in aged care settings is a common and dangerous problem.

What is dehydration?Slide3

Carries nutrientsRegulates body temperature

Removes wastes The role of Hydration in the bodySlide4

Inadequate hydration is associated with many adverse consequences including:poor oral

healthpoor skin integrityConstipation urinary tract infectionconfusion & cognitive impairment which can lead to increased risk of falls and reduced quality of

life

electrolyte imbalances

Reduced

food intake and an increased risk of malnutrition

Inadequate HydrationSlide5

Dehydration can happen very quickly, often less than 8 hours.Residents are at an increased risk of dehydration due to the following:

Poor oral intake and appetiteRefusal of fluidDiminished sense of thirst despite having normal fluid requirementsInadequate

staffing to assist residents who have total or partial dependence on staff for fluid

intake

Medicines

such as diuretics

Why is dehydration common in the aged care setting?Slide6

Residents actively limiting intake to reduce need to go to the toilet often due to fear of incontinence (restricting fluids does not reduce urinary incontinence. Swallowing

difficulties or oral disorders making it difficult to drink Vomiting/ diarrhoea Limited range of fluids offered Poorly controlled diabetesInability to hold/manage a cup & limited access to assistive devices to aid in drinking

eg

/ a 2 handle

cup

Dislike

of thickened fluids

Continued

…..

Why

is dehydration common in the aged care setting?Slide7

Many people are aware of the risks of dehydration in the summer months however winter also poses a significant risk to residents hydrations due to:

heating in rooms illnesses such as the flu/fever and respiratory illnesses that require an increased fluid intake

Dehydration in Summer

AND

WinterSlide8

Dry mouth and tongueCracked lips

Dark urine and small outputReduced sweat in the armpitsRecent alteration in consciousness , confusion & irritabilityRemember residents may not complain of thirst, especially if their cognition is impaired.

Signs of DehydrationSlide9

Older People have similar fluid needs compared with young adults.Minimum

fluid intake for most residents is between 1600ml- 2000ml per day, more may be required if the resident has increased fluid requirements. Common conditions that require increased fluid intake include :WoundsFeverHot weatherFluid RequirementsSlide10

Any food or beverage that is liquid at room temperature. This includes:

What counts as fluid?

FOODS:

ALL BEVERAGES such as:

Soup

Jelly

Custard

Ice Cream

Yoghurt

Porridge

Tea

Coffee

Milk

High protein drinks such as

Sustagen

Cordial

Soft Drinks

JuiceSlide11

How much fluid in standard foods and beverages?

½ cup custard = 100ml

Coffee

cup of fluid = 150ml fluid

fluid Juice glass = 120ml fluid

200g carton yoghurt = 180ml fluid

½ cup sago/tapioca pudding = 80ml fluid

Fruit juice Tetra Pak of fluid = 250ml fluid

¾ cup thick soup = 150ml fluids

½ cup jelly = 100ml

Plastic feeder glass of fluid = 200ml fluid

2 scoops ice-cream = 70ml fluid

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MonitorObserve, record and monitor consumption of fluids

Identify residents at high risk if dehydrationWhat does your facility currently do?ACT

Practical Tips to Increase Residents Fluid Intake

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Fluid rounds at meals and in between

Small quantities of fluid frequently Encourage a full glass of fluid to be consumed with medicinesHave a fluid station available during all activity and therapy sessions. O

ffer

fluids every time a resident is assisted to the

toilet

H

ave

a fluid plan for nights

O

ffer

high fluid foods at mid meal snacks

Have

a wide variety of beverage flavours available to prevent flavour

fatigue

I

ncrease

variety of flavour of water by adding lemon, lime,

cordial

Introduce

special drinks for days of the week

eg

/ milkshake Monday.

A

sk

residents to drink rather than asking if they are thirsty (remember diminished sense of thirst

)

3. ACTSlide14

Malnutrition:

The skeleton in the nursing home closetSlide15

What is Malnutrition?Malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome

Malnutrition is both a cause and consequence of ill healthMalnutrition increases a patients vulnerability to diseaseSlide16

How Common is Malnutrition in Residential Aged Care Facilities?

Studies have shown the prevalence of malnutrition in residential aged care facilities to be between 40%-70%Malnutrition is largely under recognised and under diagnosed resulting in a continual decline in nutritional statusSlide17

Effects of aging on nutritionSlide18

Which resident is malnourished?Slide19

They all could potentially be malnourished or at risk of malnutrition!

Body weight and appearance alone is not an accurate predictor of nutritional status. Malnutrition can occur in residents who are normal, overweight or obese - not just those with an obvious wasted appearance!

Which resident is malnourished?Slide20

Loss of appetiteDecreased food intakeUnintentional weight lossLoss of lean body mass

Decreased functional capacityNausea/ vomitingConstipation and/or diahorreaSigns & Symptons of MalnutritionSlide21

1. Decreased Intake

2. Increased Requirements

3. Malabsorption/Nutrient Losses

Poor appetite

Infection

GI diseases

Needing assistance with meals

Post- surgical

Bowel resection

Lack of access to food

Would healing

Wounds/ drains

Dysphagia

Pressure ulcers

Alcohol Dependence

Cancer

Depression

Trauma

Malnutrition Results from…Slide22

Other factors that may lead to malnutrition

DiseaseDelirium & DementiaMedication- changing smell, taste, SE’s such as diahorreaSurgeryVomitingFistula lossesBurnsDrug abuse

Long hospital admissionsSlide23

Effects of Malnutrition

Increased infection rateIncreased risk of complications- pressure areas/ulcers, sepsis, falls, declining mental healthDecreases response and/or tolerance to treatmentDecreases quality of lifeDecreases life expectancyNegatively effects treatment outcomes

ALL EQUAL POOR PATIENT OUTCOMES

&

INCREASED HEALTHCARE COSTS!Slide24

Pressure Areas & UlcersPeople with malnutrition are twice as likely to develop a pressure ulcer compared to well nourished patients

Patients with infections often have poor appetites, resulting in lower nutritional intakePatients with pressure areas, ulcers and wounds have higher protein and energy needs in order to promote wound healingRefer to Dietitian as early as possible for nutrition interventionSlide25

Texture Modified DietsResidents can be at risk of malnutrition when on a texture modified diet

Residents usually require assistance with feeding- if not being assisted this can lead to reduced intake Residence may need prompting and encouragement to eat if they are having difficulties swallowing Pureed diet can lack variety & be visually unappealingEnsure patients are upright during feeding and for at least 30minutes post feedingIt is important that food is offered to residents at EVERY

meal, even if you personally find the food to be unappealing. Slide26

How to improve nutrition via meals

Encourage patients to: Drink nutritious drinks such as HP/HE supplement, milk, juice, cordial before other drinks such as water, tea, coffeeSlide27

How to improve nutrition via meals

Encourage patients to: Encourage residents to eat meat and dairy desserts before vegetables

Eat small frequent meals

Give residents plenty of time to eat their meal

If you notice a resident is enjoying a particular food- provide them with extras of that food

Make eating easier by setting the resident up for meals

Offer and provide assistance with meals

EAT FIRSTSlide28

What else can you do?

Screen patients using a screening tool such as Malnutrition Screening Tool (MST) to screen patients on admission and throughout their residencySlide29

What else can you do?

Refer patients to a Dietitian who:have pressure areas, ulcers or woundshave experienced unexplained weight lossare not eating at meal timesMonitor weight loss over six month period & identify residents who have lost > 5% total body weight over 6 months

Offer and provide assistance with feeding