Chapter 13 Nutrition for Older Adults
A client is trying to understand where cheese fits into the MyPlate for Older Adults. The nurse explains that according to this plan, cheese is in which section? A) Protein B) Milk C) Dairy D) Fat
Ans: A Feedback: Cheese, yogurt, and cottage cheese are part of the protein group in the modified MyPlate for Older Adults. Milk is in the liquid category.
A family member is concerned that an elderly family member is not eating correctly. Which of the following is a risk factor for undernutrition among the elderly population? A) Eating alone B) Daily Meals on Wheels delivery C) Traveling to a local center for a hot meal D) Having home health assistance three times a week to fix meals
Ans: A Feedback: Eating alone is a risk factor for poor nutritional status among older adults. Efforts should be made to eat with friends and relatives whenever possible, either at home or at another location. Utilizing the various programs that are available in the community such as Meals on Wheels or having in-home help will also help improve the nutritional status of the older clients.
Nutrition therapy in the elderly has different goals than at other times across the lifespan. What is a primary goal of diet intervention for the elderly? A) Maintain quality of life B) Prolong life C) Prevent the development of complications D) Treat chronic disease
Ans: A Feedback: Genetic and environmental "life advantages" have positive effects on both length and quality of life. Other major determinants of successful aging are physical activity and healthy eating.
The nurse is preparing a meal plan for a client who will be assisted by a home health aide. The nurse recognizes the overall goal of nutrition therapy for this older adult is which of the following? A) Maintain or restore maximal independent functioning B) Reduce chronic disease deterioration C) Prevent chronic disease D) Decrease the use of medication
Ans: A Feedback: Overall goals of nutrition therapy for older adults are to maintain or restore maximal independent functioning and health and to maintain the client's sense of dignity and quality of life.
The 74-year-old client in the nursing home has developed a pressure ulcer on her sacrum. What could be a cause of the development of this ulcer? A) Inadequate food and fluid intake B) Turning freely in bed C) Overhydration D) Lack of vitamins B and C
Ans: A Feedback: Pressure ulcers may be a symptom of inadequate food and fluid intake. They are also often the result of a client either sitting or lying in the same position for long periods of time, therefore frequent turning and repositioning is recommended every 2 hours.
Over the age of 50 years, the body needs a higher intake of vitamin D. What is a good source of the vitamin D needed by older adults? A) Fortified milk B) Green leafy vegetables C) Lean red meats D) Nuts
Ans: A Feedback: Sources of vitamin D include fortified milk and soy milk, fatty fish, and some fortified ready-to-eat cereals.
The nurse is working with a client who has chronic constipation. After evaluating the clients' food intake, it is determined that the client needs to ingest more fiber. What is the recommended daily intake of fiber for this 55-year-old female? A) 21 g/day B) 25 g/day C) 30 g/day D) 38 g/day
Ans: A Feedback: The AI for women from 19 to 50 years is 25 g/day and drops to 21 g/day thereafter. For men through age 50 years, the AI is 38 g/day and drops to 30 g/day afterwards.
The nurse is doing nutritional screening on older adults at a health fair. What would be an important question to ask while screening an older person for nutritional risk? A) About the use of three or more prescribed or over-the-counter daily medications B) If the person is over 62 years old C) If they had an unintentional weight loss of 3% or more in 60 days D) If they are living in a household with more than one older adult member
Ans: A Feedback: The elderly are at risk for developing drug-induced nutrient deficiencies because they have more chronic illnesses, are often on long-term drug therapy, and polypharmacy increases with age.
A 79-year-old client has been admitted to a long-term care facility that follows a liberal diet approach. The family is concerned that this will hurt the client due to a long history of high cholesterol and desire a low-cholesterol diet. How might the nurse respond? A) Malnutrition is a greater threat than hypercholesterolemia. B) The client is too old to worry about it now. C) The facility does not offer specialized, individual diet options. D) If the cholesterol hasn't gone down yet, it never will.
Ans: A Feedback: The nurse should always show respect to the family. It should be explained to the family that the relationship between high cholesterol and all-cause mortality in older adults is under debate. Because malnutrition is a greater threat, this should be the focus.
The children of a sedentary 90-year-old ask how to combat malnutrition in their parent. What would be the best response to this question? A) Make meal time as enjoyable as possible. B) Feed the parent only heart-healthy food. C) Give the parent a liquid dietary supplement twice a day. D) Feed the parent before the rest of the family.
Ans: A Feedback: There are various strategies that may be used to encourage adequate intake. They include making mealtime as enjoyable as possible, encourage family participation, and honoring their food preference.
A liberal diet approach is a holistic approach toward meeting client's nutritional needs. This approach takes into consideration which of the following? Select all that apply. A) Individual personal goals B) Risk/benefit ratio C) Overall prognosis D) Quantity of life E) Family requests
Ans: A, B, C Feedback: A liberal diet approach is a holistic approach that includes the individual's personal goals, overall prognosis, risk/benefit ratio, and quality of life. A liberalized approach has been shown to promote a better intake, lower the incidence of unintentional weight loss, and improve quality of life.
A family is meeting with the nurse to discuss their concern about their 78-year-old family member who is having difficulty chewing food. The client is refusing a pureed diet. Which of the following are examples of food the family can offer? Select all that apply. A) Ripe bananas B) Soft melon C) Cooked carrots D) Fried potatoes E) Roasted chicken
Ans: A, B, C Feedback: Examples of fruits and vegetables that are easily consumed by people who have difficulty chewing include ripe bananas, baked winter squash, mashed potatoes, stewed tomatoes, baked apples, canned fruit, soft melon, citrus sections, and cooked carrots.
The client has not been eating well since he was admitted to the long-term care facility. When the advanced practice nurse (APN) comes to the facility to see her clients, the nurse mentions her concerns about the nutritional status of this client. The APN notes that one of the client's orders is for a can of liquid dietary supplement to be given between meals three times a day. What may the client be experiencing as a result of taking this supplement? Select all that apply. A) Loss of appetite B) Increased sugar and fat C) Decreased calcium D) Taste fatigue E) Increased hunger
Ans: A, D Feedback: Residents at risk of malnutrition or with poor intakes may be given oral supplements to boost overall calorie and protein intake. Although they may be useful, these supplements may not be well accepted or tolerated on a long-term basis. Taste fatigue and lack of hunger for the meal that follows may occur.
The nurse is meeting with the wife of a client who has Alzheimer disease (AD). She is concerned about her husbands' nutritional status. What can the nurse tell her to watch for that would indicate a possible nutritional problem? Select all that apply. A) Forgetting he had eaten and eating again B) Forgetting which are green vegetables C) Forgetting what food category bread is in D) Forgetting what time to eat E) Forgetting how to shop for food
Ans: A, E Feedback: Impairments in memory and judgment may make shopping, storing, and cooking foods difficult. The client may forget to eat or may forget that he or she has already eaten and eat again.
The nurse is conducting an assessment on a new client who is being admitted to the long-term care facility. The client is a 69-year-old gentleman who is moderately active. What is the recommended calorie per day intake? A) 2000 cal/day B) 2200 cal/day C) 2400 cal/day D) 2600 cal/day
Ans: B Feedback: A moderately active 69-year-old male should eat 2200 cal/day to meet his nutritional needs.
The elderly population has a mean intake below the dietary reference intake (DRI) for several nutrients. Which of the following falls into that classification? A) Sodium B) Potassium C) Chloride D) Manganese
Ans: B Feedback: According to NHANES data from 2007 to 2008, the mean intake of several micronutrients is deficient in the diets of older adults—namely, vitamins A, D, and E; calcium; magnesium; and potassium. Conversely, their intake of sodium is too high.
Sarcopenia is the loss of muscle mass and strength. It is related to a sedentary lifestyle and less than optimal diet. It is a process that begins in the fourth and fifth decades of life. This loss of muscle mass can be halted or reversed with which of the following? A) Aerobic exercise B) Strength-training exercises C) A high-protein diet D) A high-protein diet, high-calorie diet
Ans: B Feedback: As of now, the only option to improve body composition is a balanced diet with adequate protein and strength-training exercises using progressive resistance.
The intake of adequate nutrients is a recommendation to reduce the risk of nutrition-related concerns across the lifespan. Obesity impacts quality of life in the elderly. Along with weight reduction, what vitamins are recommended to help with bone health? A) Vitamin B12 B) Vitamin C C) Vitamin B6 D) Vitamin E
Ans: B Feedback: Bone health is dependent on calcium and vitamin D; other nutrients that are important are vitamins A, K, C, and magnesium.
Arthritis is a leading cause of functional limitation among older adults. Osteoarthritis (OA) is the most common form of arthritis. What is the greatest known modifiable risk factor of OA of the knee? A) Nutritional deficiency of folic acid B) Overweight C) Moderately inactive lifestyle D) Inadequate intakes of calcium
Ans: B Feedback: Excess body weight is a well-established risk factor for OA, with 66% of adults with doctor-diagnosed arthritis being overweight or obese.
Quality-of-life issues are a priority in the elderly, especially in residents of long-term care facilities. What are the key components in meeting quality-of-life standards among older adults who are residents of long-term care facilities? A) Prevention of depression and diabetes B) Prevention of unintentional weight loss and pressure ulcers C) Prevention of weight gain and hyperlipidemia D) Prevention of low albumin and anorexia
Ans: B Feedback: Long-term care residents tend to be frail elderly with multiple diseases and conditions. Malnutrition has a negative impact on both the quality and length of life. Pressure ulcers may be a symptom of inadequate food and fluid intake. Loss of appetite is a key indicator for malnutrition which can lead to weight loss.
The nurse is doing client education for a 71-year-old woman who is a resident of a long-term care facility. The assessment indicates that she is at a high risk for malnutrition. What is one reason she could give you for this risk of malnutrition? A) "I eat most of my meals with friends." B) "I just don't have an appetite." C) "I take two different medicines every day." D) "I chew quite well with my dentures."
Ans: B Feedback: Loss of appetite is a key indicator for malnutrition. An inadequate intake of food means the supply of nutrients is reduced, which can lead to weight loss and depletion of essential nutrients.
The nurse is teaching a class of aides at a long-term care facility how to assess and document a client's nutritional intake. What mandates the documentation of nutritional intake for the residents of long-term care facilities? A) Maximum Data Set (MDS) B) Minimum Data Set (MDS) C) Regulatory Data Set (RDS) D) Maximum Regulatory Set (MRS)
Ans: B Feedback: To prevent malnutrition, ongoing monitoring of residents' intakes is vital so prompt action can be taken if needed. The MDS requires food intake be assessed so residents at risk can be identified.
The nurse has given the nutrition class the assignment of creating a list of strategies for enhancing food intake in long-term care residents. What strategies would you expect to find on this list? Select all that apply. A) Let residents eat in their rooms. B) Honor food preferences. C) Make sure the diet is heart healthy. D) Involve the family in mealtime. E) Encourage independence in eating.
Ans: B, D, E Feedback: There are various strategies that are successful in enhancing food intake. Honoring their food preferences, involving the family, and encouraging independence are a few.
The nurse is discussing with the nutrition class which dietary supplements older adults need to take. Which supplement is needed by older adults? A) Vitamin B6 B) Vitamin K C) Vitamin D D) Niacin
Ans: C Feedback: A study showed that the use of supplements significantly improved the status of several vitamins in elderly people, particularly for vitamins B1, B2, B12, folate, and vitamin D.
The nurse is caring for a client in a long-term care facility who is 77 years of age and overweight. The nurse is considering putting this client on a low-calorie diet. Some experts recommend that strict therapeutic diets be used in older adults only when a significant improvement in health can be expected. Which elderly clients would a restrictive diet be recommended for? A) Those with high cholesterol levels B) Those with high potassium levels C) Those with ascites D) Those with mild hypertension
Ans: C Feedback: Although carbohydrate and calorie-restrictive diets may be theoretically beneficial, the goals of preventing malnutrition and maintaining quality of life are of greater priority. Restrictive diets should be used only when a significant improvement in health can be expected, such as in cases of ascites or constipation.
Osteoarthritis (OA) is a disease that predominantly plagues the elderly. What can weight loss do for older people with OA? A) It has no effect on arthritis symptoms. B) It aggravates arthritis symptoms. C) It relieves symptoms in the weight-bearing joints. D) It relieves symptoms throughout the body.
Ans: C Feedback: Losing weight reduces strain on the weight-bearing joints, which will relieve the symptoms.
For a long-term care resident, a restrictive diet could decrease quality of life. When should restrictive diets be used in long-term care facilities? A) When a resident has decreased intake and weight loss B) For hospice care C) When a significant improvement in health can be expected D) For one week a month
Ans: C Feedback: Restrictive diets have the potential to negatively affect quality of life by eliminating personal choice in meals, dulling appetite, and promoting unintentional weight loss. They should only be used when a significant improvement in health can be expected.
Magnesium is one of the nutrients that older adults often do not get enough of. What are the recommended sources of magnesium for the elderly? A) Fruit juices B) Carrots C) Yogurt D) Potatoes
Ans: C Feedback: Sources of magnesium include green leafy vegetables, nuts, legumes, whole grains, seafood, chocolate, and milk.
Dehydration can be a concern in the elderly population. The modified MyPlate for Older Adults recommends eight glasses of water per day. What is the AI for water for a 65-year-old male? A) 1.7 L/day B) 2.7 L/day C) 3.7 L/day D) 4.7 L/day
Ans: C Feedback: The AI for water, which includes total water from drinking water, other beverages, and water in solid foods, is constant from 19 years of age through more than 70 years old, with 3.7 L/day for men and 2.7 L/day for women.
Most recommended levels of intake for vitamins and minerals do not change with aging. An exception to this is the recommended dietary allowances of vitamin D, which are higher in adults over age 50 years. What causes the body's need for vitamin D to increase over the age of 50 years? A) The ability to absorb calcium, which decreases with age B) The potential risk for coronary heart disease, which uses vitamin D C) The increased consumption of coffee and tea interferes with vitamin D synthesis D) The ability to synthesize vitamin D from sunlight, which decreases with age
Ans: D Feedback: An older adult needs increased supplements of vitamin D due to the ability to synthesize vitamin D on the skin from sunlight decreases with age.
Which lunch is best for a healthy 65-year-old who lives independently? A) 6 oz of chicken noodle soup, 6 saltine crackers with 2 tablespoons of butter, 3/4 cup of ice cream, and 12 oz of diet soda B) 3 oz of hamburger, lettuce leaf, tomato slice, 1 slice of onion, 1 oz of processed cheese, 1 hamburger bun, 6 oz of French fries, and one 8-oz strawberry milkshake C) 6 chicken nuggets, 1/4 cup of ketchup, 4 oz cup of applesauce, and one 4-inch slice pumpkin pie with whipped cream D) 3 oz of tuna on whole wheat bread, 1 medium apple, and 8 oz of 2% milk
Ans: D Feedback: MyPlate for Older Adults encourages nutrient-dense food with a decrease in empty calorie foods that are high in solid fats or added sugar. The meal of tuna, whole wheat bread, apple, and milk is the better choice because it offers the more nutrient-dense meal. The other meal choices contain items that are high in solid fats and/or added sugar.
It has been established that many people over 50 years have low serum levels of vitamin B12. Where is it recommended that older adults get most of their vitamin B12 from? A) Citrus fruits and juices B) Red meats C) Milk and dairy products D) Fortified cereals
Ans: D Feedback: People over 50 years are advised to consume most of their requirement of vitamin B12 from fortified food or supplements because 10% to 30% of older adults may not be able to absorb natural vitamin B12 from food.
The client is a 65-year-old male. Approximately, how much longer can he expect to live? A) 15.8 years B) 16.5 years C) 17.3 years D) 19.2 years
Ans: D Feedback: People who live to the age of 65 years can expect to live an average of 19.2 more years; among people who live to age 85 years, women will survive another 7 years and men 5.9 years.
A 71-year-old female client has functional limitations, in part caused by obesity. The nurse is discussing the need to lose weight with this client but she is not receptive to the idea. What is one reason this woman might have for not agreeing with the suggestion to lose weight? A) The client feels that losing weight can cause a strain on the body. B) The client feels that she would feel worse if she lost weight. C) The client does not feel that her weight impedes her functionality. D) The client does not feel the need to make changes at this point in her life.
Ans: D Feedback: Promoting weight loss in obese older adults presents unique challenges. Many older people may not feel a need to make changes at this point in their life.
Older adults need adequate protein in their diet. What are the approximate protein needs per day for an older adult weighting 132 pounds (60 kg)? A) 24 g/day B) 36 g/day C) 44 g/day D) 48 g/day
Ans: D Feedback: The RDA for protein remains constant at 0.8 g/kg for both men and women from the age of 19 years on; therefore, 0.8 × 60 = 48 g/day.
