First, chiropractic and osteopathic manipulation was combined in a single variable, making it impossible to make conclusions about the characteristics or complaints of patients of either practitioner. This is an important distinction, since osteopathic scope of practice includes the use of drugs and surgery as well as manipulation, so it is possible that patients who see osteopathic practitioners for manipulation might have different characteristics and chief complaints than those who see chiropractic practitioners. The concept has been developed by Heiner Biedermann and medical doctors in Germany and contributed significantly to the development of manual therapy in children in that country.
Depression and other psychiatric disorders Environmental factors Limited access to or intake of food Food attitudes and cultural preferences Elder abuse Open in a separate window A comprehensive geriatric assessment also addresses psychosocial, environmental factors, and affective symptoms of weight loss in the elderly.
The loss of a caregiver, the inability to drive a motor vehicle, or moving into a new apartment or residence may precipitate a decline in oral intake and cause weight loss. Depressive symptoms such as these are important considerations when evaluating the nutritional health of a senior patient Hazzard et al ; Kane et al ; Williams ; Refai and Seidner It is especially important to ask older patients about alcohol intake, which may replace or suppress the consumption of foods with superior nutritional value.
Alcohol misuse in the elderly is associated with impaired functional status, poor self-rated health, and depressive symptoms St John et al Even slight weight loss in the elderly is an independent predictor of morbidity and mortality. The medical causes of weight loss may be compounded by psychosocial and environmental factors.
Nutritional issues associated with cognitive impairment and vascular risk factors Malnutrition has been associated with compromised cognitive capacity in the elderly. The decreased ability to prepare a meal, which may adversely affect an elderly patient's ability to ensure sufficient nourishment, has been cited as one of the earliest signs of mild cognitive impairment MCIa pre-Alzheimer disease condition Borrie et al For persons with moderate to severe Alzheimer disease, forgetting to eat, inability to access food, and apraxia with utensils may further impair oral intake.
Living alone, as Mrs E does, further compounds the risk of malnutrition. Vitamin deficiencies, particularly vitamin B12, B6, and folate, are associated with cognitive impairment Nilsson et al ; Gill and Alibhai ; Lehmann et al Deficiencies in these vitamins are also associated with hyperhomocysteinemia, which is an independent vascular risk factor.
The association of hyperhomocysteinemia with vascular disease is a direct dose-response association Stamphler et al ; Selhub et al Treatment with folate, vitamin B6, and vitamin B12 has been shown to reduce homocysteine levels Omran and Morley ; Nillson et al ; Lehmann et al ; Scott et alimprove vascular function in hyperhomocysteinemic patients with coronary artery disease Willems et aland result in cholesterol plaque regression Marcucci et al Although a recent secondary prevention randomized controlled trial failed to demonstrate a decrease in morbid vascular outcomes in stroke patients following supplementation with vitamins B6, B12, and folate over two years, it was suggested that confounding factors such as the initiation of folate fortification in grain supply concurrent with the study might explain the null findings Toole et al More research is needed to clarify the complex interactions between these vitamins and the modification of vascular risk factors.
The intriguing concept of the polypill Wald and Law ; Robinson and Maheshwari in the treatment of cardiovascular disease has potential for the primary and secondary prevention of cognitive impairment in elderly patients.
A vitamin polypill containing a statin class of cholesterol-lowering agents, three blood pressure lowering drugs eg, a thiazide, a beta-blocker, an angiotensin-converting enzyme inhibitor, aspirin, and folic acid might be a beneficial tool in the prevention and treatment of morbid, nutrition-related vascular conditions.
This approach to prevention and treatment requires a great deal of further investigation. This novel concept incorporates the influence of nutritional factors on health, especially interventions for patients like Mr T.
Nutritional interventions have an impact on vascular disease prevention. It is well established that a diet low in fat and cholesterol is beneficial to modifying vascular risk factors.
Emerging research suggests that supplementation with omega-3 fatty acids such as those found in salmon and other cold-water fishand consuming cruciferous vegetables such as broccoli, cabbage, and cauliflower are all associated with stroke prevention Joshipura et al ; Mozaffarian et al ; Robinson and Maheshwari and may be beneficial if integrated into the diet of all elderly patients with vascular disease or vascular risk factors.
Nutritional antioxidant supplements are generally believed to be beneficial in reducing free radical cellular and DNA damage. A large epidemiological study found the concomitant use of vitamins C and E is associated with reduced incidences of Alzheimer disease Zandi et al More generally, according to a randomized controlled trial, low blood vitamin C concentrations are strongly predictive of mortality in patients aged 75—84 years Fletcher et al The efficacy of vitamin E in the prevention and treatment of MCI and Alzheimer disease remains controversial.
Used alone in a three-year placebo-controlled study, a daily dosage of vitamin E IU was not shown to slow the rate of progression to Alzheimer disease in patients with MCI Petersen et al Health Assessment Test 1. STUDY. PLAY. Primary Prevention. A nurse is providing care for a patient who has a history of alcoholism.
What would be appropriate to include in this patient's discharge teaching? A nurse is conducting a comprehensive nutritional assessment on a patient with suspected malnutrition. Why would it be important to. in providing high quality nutrition care. individualized patient/client care and the predictability of the patient/client language.
• Developed by the Academy of Nutrition and Dietetics (AND) NUTRITION CARE PROCESS: ADIM 1. Assessment: nutritional health status 2. Diagnosis: interpret data 3.
Nutrition is an important determinant of health in persons over the age of Malnutrition in the elderly is often underdiagnosed. Careful nutritional assessment is necessary for both the successful diagnosis and development of comprehensive treatment plans for malnutrition in this population.
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