Foreword
Acknowledgements
Contents
Part I: Nutritional Care in Geriatrics
1: Overview of Nutrition Care in Geriatrics and Orthogeriatrics
1.1 Defining Malnutrition
1.2 Nutrition Care in Older Adults: A Complex and Necessary Challenge
1.3 Malnutrition: A Truly Wicked Problem
1.4 Building the Rationale for Integrated Nutrition Care
1.5 Managing the Wicked Nutrition Problems with a SIMPLE Approach (or Other Tailored Models)
1.5.1 Keep It SIMPLE When Appropriate
1.5.2 A SIMPLE Case Example
1.5.2.1 S—Screen for Malnutrition
1.5.2.2 I—Interdisciplinary Assessment
1.5.2.3 M—Make the Diagnosis (es)
1.5.2.4 P—Plan with the Older Adult
1.5.2.5 L—Implement Interventions
1.5.2.6 E—Evaluate Ongoing Care Requirements
1.6 Bringing It All Together: Integrated Nutrition Care Across the Four Pillars of (Ortho) Geriatric Care
1.7 Summary: Finishing Off with a List of New Questions
References
Recommended Reading
2: Nutritional Requirements in Geriatrics
2.1 Nutritional Recommendations for Older Adults, Geriatric and Orthogeriatric Patients
2.2 Nutritional Recommendations for Older Adults
2.2.1 Energy Requirement and Recommended Intake
2.2.2 Protein Requirement and Recommended Intake
2.2.3 Micronutrients and Dietary Fibers
2.3 Nutritional Risk Factors in Older Adults
2.4 Estimating Intake in Older Adults
2.5 Nutritional Status of Older Adults, Geriatric and Orthogeriatric Patients
2.6 Summary
References
Recommended Reading
3: Nutritional Assessment, Diagnosis, and Treatment in Geriatrics
3.1 The Nutrition Care Process
3.2 Nutritional Screening/Risk Detection
3.3 Nutritional Assessment and Diagnosis
3.3.1 Nutrition Impact Symptoms
3.3.2 Nutritional Diagnosis
3.3.3 Etiologic Criteria
3.3.4 Estimating Requirements
3.3.5 Nutritional Diagnosis
3.4 The Nutrition Plan and Care Required
3.4.1 Nursing Care Required for Nutritional Therapy
3.5 Action and Monitoring
3.6 Evaluation and Adjustment of Nutrition Plan
3.7 Discharge from Hospital or Handover to Another Caretaker
3.8 End of Nutritional Therapy
3.9 Ethical Considerations
3.10 Summary
References
Recommended Reading
4: Malnutrition Prevention
4.1 Malnutrition and Its Risk Factors
4.2 Impact of Malnutrition on Older Adults, Healthcare Systems and the Community
4.3 General Nutritional Care and Prevention of Malnutrition
4.4 The Role of Physical Activity and Training in Malnutrition Prevention
4.5 Opportunities for Nurses and Other Healthcare Providers to Prevent Malnutrition
4.6 Additionally, Good to Know
4.7 Limits of Preventing Malnutrition
4.8 Implementation of Malnutrition Interventions
References
Recommended Reading
Training Courses (Selection)
5: Nutrition Support in Older Adults
5.1 Nutrition Support in Older Adults: A Hard Edge Best Balanced by Shared Decision-Making, Informed Consent, and Ethical Insight
5.2 Applying a Systematic Approach to Nutrition Support in Older Adults
5.3 Protein- and Energy-Dense and/or Fortified Foods, Fluids, and Menus
5.4 Oral Nutrition Supplements
5.5 Artificial Tube Feeding
5.5.1 Enteral Nutrition
5.5.1.1 Feeding Tube Types
5.5.1.2 Tube Placement
5.5.1.3 Tube Considerations and Care Requirements
5.5.1.4 Checking Placement
5.5.1.5 Flushing Tubes
5.5.1.6 Feeding Regimens and Modality
5.5.1.7 Formula Handling and Management
5.5.2 Parenteral Nutrition (PN)
5.6 Preventing and/or Managing Nutrition Support Complications
5.6.1 Medications
5.6.2 Aspiration
5.6.3 Gastrointestinal Upset
5.6.4 Delayed Gastric Emptying or Gastroparesis
5.6.5 Hyperglycemia
5.6.6 Refeeding Syndrome
5.7 Summary
References
Recommended Reading
6: Supporting Nutrition Care in Older Adults: An Essential Component of ‘Best Practice’ Nursing
6.1 What Is ‘Best Practice’ Nursing Nutrition Care?
6.2 Leading Supportive Nutrition Care for Older Adults with or at Risk of Malnutrition: An Example of Best Practice in Nursing Care
References
Recommended Reading
7: Preventing and Managing Hydration and Dehydration in Older People
7.1 Geriatric Orthopaedic Patients
7.2 Hydration in Geriatrics
7.2.1 Recommendations for Older Adults
7.2.2 Age-Related Changes Associated with Hydration
7.3 Dehydration and Other Hydration Disturbances
7.3.1 Screening and Assessment of Dehydration
7.3.1.1 Assessing Low-Intake Dehydration
7.3.1.2 Assessing Volume Depletion
7.3.2 Prevention and Treatment of Dehydration
7.3.2.1 Low-Intake Dehydration
7.3.2.2 Volume Depletion
7.3.3 Fluid Overload
7.3.4 Electrolyte Imbalances
7.4 Hospitalisation After Fall
7.4.1 Arriving at the Emergency Department
7.4.2 Preoperation Nursing at the Ward
7.4.3 Post-operation Nursing at the Ward
7.4.4 Best Practice at the Ward
7.5 Summary
References
Recommended Reading
8: Untangling Malnutrition, Physical Dysfunction, Sarcopenia, Frailty and Cachexia in Ageing
8.1 Preface
8.2 Definitions, Diagnosis, Prevalence and Relevance
8.2.1 Malnutrition
8.2.2 Low Muscle Mass, Physical Dysfunction and Sarcopenia
8.2.3 Frailty
8.2.4 Cachexia
8.3 Nutritional Treatment and Management Approaches
8.4 Key Levels to Implement Change
8.5 Conclusion
References
Recommended Videos
9: Bone Health, Fragility and Fractures
9.1 Introduction
9.1.1 Bone
9.1.2 Normal Bone Metabolism
9.1.3 Peak Bone Mass (PBM)
9.2 Nutrients and Bone Health
9.2.1 Calcium
9.2.2 Vitamin D
9.2.3 Vitamin K
9.2.4 Protein
9.2.5 Other Nutrients
9.3 Other Factors Influencing Bone Health
9.4 Osteoporosis
9.4.1 Risk Factors for Osteoporosis
9.5 Fragility, Fractures and Falls
9.5.1 Frailty, Falls and Bone Health Assessment
9.5.1.1 Frailty Assessment
9.5.1.2 Falls Risk Assessment
9.5.1.3 Bone Health Assessment
9.6 Supporting Those with Frailty, Fragility, Fractures and Osteoporosis
9.6.1 Lifestyle Advice to Improve Bone Health
9.6.2 Supplementation and Medications
9.6.3 Education, Training and Sociopolitical Action
9.6.3.1 Coordinated Care Opportunities to Optimise Bone Health, Fragility and Fractures in Older Adults
Example 1: Orthogeriatric Services
Care Example 2: Fracture Liaison Services
Example 3: Fracture Liaison Nurses
Example 4: Audit and Feedback
9.6.3.2 End-of-Life Care
9.7 Summary
References
Further Reading
10: Increasing Patient Motivation and Adherence to Nutritional Care: The Importance to Overcome Psychological Barriers
10.1 Introduction
10.2 The Relationship Between Older Adults and Food as a First Step Toward Overcoming Psychological Barriers
10.2.1 Age: Younger and Older Adults
10.2.2 Biological Sex: Older Male and Female
10.2.3 Personal Health
10.2.3.1 Physical Health
10.2.3.2 Mental Health
10.2.4 Lifestyle Choices
10.2.5 Social Environment and Conditioning
10.3 The Older Adult Perspective and the Quality of Nutritional Care
10.3.1 The Role of Caregivers and Community
10.4 The Effectiveness of Multidisciplinary Nutritional Care to Increase Patient Motivation
10.5 Summary
References
Recommended Reading
11: How to Sustain and Spread Nutritional Care Improvements
11.1 Getting Started
11.1.1 Definitions
11.2 Case Example: Improving Nutrition Care in Hospital
11.2.1 Initial Implementation and Considering Sustainability from the Beginning
11.2.2 Strategies for Sustainability and Spread
11.3 Tools for Sustainability and Spread
11.3.1 Sustainability Tools
11.4 Monitoring and Evaluation
11.5 Barriers and Facilitators
11.6 Considering Equity
11.7 Summary
References
Recommended Reading
12: Delivering Interprofessional Education to Embed Interdisciplinary Collaboration in Effective Nutritional Care
12.1 Introduction
12.2 The Role of Interdisciplinary Teams
12.3 Nutrition Education and Interdisciplinary Team Collaboration
12.4 Approaches to Interprofessional Education for Nutritional Care
12.4.1 Curriculum
12.4.2 Delivery
12.5 Interdisciplinary Collaboration for Nutritional Care in Action
12.6 Summary
References
Recommended Reading
Part II: Special Topics in Geriatric Nutrition: Editorial: Specialised Versus Supportive Nutritional Care in Ageing: A Conundrum
1.1 Summary
13: Multidisciplinary Nutrition Care: Benefitting Patients with Malnutrition Across Healthcare Sectors
13.1 Malnutrition, Assessment, and Screening
13.2 Multidisciplinary Roles in Malnutrition Care
13.2.1 Dietitian Role
13.2.2 Physician Role
13.2.3 Role of the Speech-Language Pathologist
13.2.4 Other Health Professionals
13.2.5 The Nursing Role in Malnutrition
13.2.6 Management and Healthcare Leaders
13.3 Multidisciplinary Models of Malnutrition Care
13.4 Standards and Policy Promote Multidisciplinary Malnutrition Care
13.5 Examples of Multidisciplinary Malnutrition Care
13.6 Summary
References
Recommended Reading
14: Physical Activity, Exercise, and Physical Rehabilitation
14.1 Importance of Physical Activity in Older Adults
14.2 Recommendations for Physical Activity
14.3 Benefits of Physical Activity
14.4 Nutrition Status and Physical, Functional, Exercise, and Rehabilitation Outcomes
14.5 Combined Nutrition Physical Activity/Exercise Interventions
14.6 Physical Rehabilitation
14.7 Enhancing Physical Activity Level Among Older People
14.8 Summary
References
Recommended Reading
15: Pressure Injury Prevention and Management
15.1 Pressure Injuries
15.2 The Aetiology of Pressure Injuries
15.3 The Link Between Malnutrition and Pressure Injuries
15.4 Prevention and Management of PIs with a Focus on Nutrition Care
15.5 Summary
References
Recommended Reading
16: Obesity and Health in Older Adults
16.1 Definition and Epidemiology
16.2 Changes in Body Composition with Ageing
16.3 Causes of Obesity
16.3.1 Health Consequences of Obesity
16.3.2 Obesity Paradox: Protective in Older Adults and Patient Population
16.4 Is Targeted Weight Loss Appropriate in Older Adults?
16.4.1 Summary
References
Recommended Reading
17: The Nutritional System
17.1 Introduction
17.2 Hormones Produced by White Adipocytes
17.3 The Adipose Organ
17.4 Browning of the Adipose Organ as a Therapy for Obesity and Related Diseases
17.5 The Physiology of the Mammary Gland Confirms the Plasticity of the Adipose Organ
17.6 The Obese Adipose Organ
17.6.1 Summary
References
Further Reading
18: Oropharyngeal Dysphagia in Older Patients
18.1 Oropharyngeal Dysphagia: Prevalence and Consequences
18.2 Causes of Oropharyngeal Dysphagia
18.3 Screening and Diagnosis of Oropharyngeal Dysphagia
18.3.1 Screening
18.3.2 Assessment
18.3.3 Oropharyngeal Dysphagia Diagnosis
18.4 Interventions for Oropharyngeal Dysphagia
18.5 Maximising Adequate Nutrition, Hydration and Diet Choices
18.6 Dietary Modifications
18.7 Oral Hygiene and Health
18.7.1 Swallowing Strategies and Manoeuvres
18.7.2 Opportunities for Interdisciplinary Management of Dysphagia
18.7.3 Summary
References
Suggested Further Reading
19: Nutrition and Delirium
19.1 What Is Delirium?
19.2 Who Is at Risk?
19.3 What Can Be Done to Prevent and Manage Delirium?
19.4 The Role of Enteral Feeding
19.5 Post-Hospital Support
19.5.1 Summary and Main Points
References
Recommended Reading
20: Food-Drug Interaction in Older Adults
20.1 Introduction
20.2 Food and Herbal Product Interaction with Drugs
20.2.1 Common Foods
20.2.2 Herbal Products
20.3 Effects of Drugs on Nutrition Status
20.3.1 Drugs Likely to Negatively Influence Nutritional Intake/Status
20.4 Drugs Likely to Increase Body Weight
20.4.1 Conclusion
References
Recommended Reading
21: End of Life, Food, and Water: Ethical Standards of Care
21.1 Background
21.2 Factors Associated with Nutritional Vulnerability
21.3 Malnutrition: A Commonly Identified Precursor to the End of Life
21.3.1 Nutrition at the End of Life
21.4 Artificial Nutrition and Hydration (ANH)
21.5 Voluntary Stopping Eating and Drinking (VSED)
21.6 Stopping Oral Nutrition for Incapable Patients
21.7 Conclusions and Take-Home Points
References
Recommended Reading