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Moving into an assisted-living facility affects many aspects of an elderly individual's life, including their nutritional, social and psychological well-being. As we age, nursing homes must ensure that the dietary needs of all residents are met, especially those who require a specific diet, such as those with Diabetes Type 2 and Dementia. When residents leave their homes they are often placed into a strange environment, which can lead to feelings of isolation and loneliness. For this reason, it is important for residents to have access to social activities, such as Tai Chi, Gardening, and other engaging interests. Lastly, due to the increase in psychological problems in the elderly, it is important that the facility provides extra support to residents, especially those suffering from disorders such as depression and dementia.

Contents

[edit] Proper Nutrition in Nursing Homes

[edit] General Dietary Needs of the Elderly

Malnutrition is a common problem that affects many residents in nursing homes. [1] As individuals age, our lifestyles change, causing us to consume fewer calories and resulting in a lower intake of nutrients. [2] When this occurs over a long period of time in the elderly and becomes severe, the individual can be at higher risk for health complications such as, diabetes mellitus, dementia and cardiovascular disease, and even death. [2] In addition to this, malnutrition can also exacerbate the progression of pre-existing disorders, such as angina, congestive heart failure and osteoporosis. [3] Reasons for malnourishment may be due to a decrease in taste and smell sensitivity, a loss of appetite due to medication side effects, an inability to chew and/or swallow, natural swelling (distension) of the stomach and longer digestion that makes people feel full for longer periods of time.[2] [4] [5] However, when individuals are in a nursing home, things such as depression, social isolation, stress and the long delay between meals can also have an effect on food consumption. [2] [4] [6]

Research suggests that meal-plans in nursing homes that are based on the food guide do not provide residents with enough daily nutrients, and that a vitamin and mineral supplement should be considered. [1] In addition to considering the dietary needs of elderly residents in a nursing home, it is also important to take into consideration their ability to feed themselves, and the impact that has on their overall food consumption. In studies that have been conducted on feeding assistance in nursing homes, it has been found that a variety of different interventions can help to significantly increase both food and liquid intake at mealtimes for all residents. [7] These interventions included one or a combination of: social stimulation and encouragement, nonverbal cues (such as rearranging food on the plate to be more accessible), verbal cuing, partial physical assistance (where items were held while not in use), and even fully assisted feeding. [7]

A video further explaining the nutritional needs of seniors, and how it can be achieved.


For those residents who are in better health, being fed meals enriched with protein, iron, calcium and Vitamin A and D may be a step in the right direction towards eliminating malnutrition, as these are the nutrients that individuals are commonly deficient in as they age. However, for those who require a modified diet; such as those who have diabetes mellitus type 2, or those suffering from dementia, additional steps may need to be taken in order to encourage proper food intake.[1] [8]

[edit] Diabetes Mellitus Type 2

Diabetes mellutis type 2 occurs when an individual’s pancreas does not produce enough insulin to control glucose levels in the body. [9] The pancreas is an organ in the digestive system which secretes hormones and chemicals to help digest food. Insulin is one of these hormones, and helps to regulate glucose levels in the blood. [9] [10] As we age, this type of diabetes progresses, and these sugar levels become harder to control which can lead to depression, heart disease, stroke, kidney disease, and even blindness. [11] [9]

For residents with diabetes, it is very important that they have a well-balanced and healthy diet, which includes restricting the amount of fruits, soft drinks, alcohol and sugar-filled desserts. These types of foods, due to their high sugar content, cause extra glucose to build up in the body, and make sugar levels even more difficult to control. [12] In addition to this healthy diet, it is also important that residents consume plenty of Vitamin D, as it promotes the production and release of insulin into the body, which as mentioned, helps to stabilize glucose levels. [12] [13]

Image:Diabetes.jpg
An example of a well-balanced diet for a Type 2 Diabetic[14]

[edit] Dementia

Dementia is a term that describes a variety of symptoms including, but not limited to, an inability to perform regular tasks (such as getting dressed and preparing meals), difficulties solving problems or controlling emotions, as well as personality changes, mood swings, and seeing and/or hearing things that do not exist. [15] In nursing homes, residents with dementia may not be able to feed themselves, understand directions, or verbally express their hunger, which puts them at a higher risk for malnutrition. Social stimulation and interaction with others may be helpful in increasing food intake in patients with dementia, as they require more emotional support and encouragement.[16] There is currently no cure, and so it is important that staff focus on reducing the risk of dementia in residents.[16] [17] Studies have shown that the healthy fats and nutrients found in fish oil can help to initially slow the progression of dementia, and because of dementia’s connections with cardiovascular disease and diabetes, Vitamin D is also very helpful in preventing the disease. [17] [13]

By providing residents with nutritious diets enriched with plenty of Vitamin D in addition to dietary support and encouragement for social interaction, nursing homes can help residents lead healthier and longer lives. [9]

[edit] Socialization in the Nursing Home

When elder people are admitted into a nursing home, they experience many changes both physically and emotionally.[18]. Common feelings that are expressed in many elder individuals after entering a nursing home are loss of freedom, loss of control, feelings of loneliness and even a sense of failure. [18] Many patients related staying in a nursing home to living in a jail due to the fact that they feel they have no freedom of movement, no privacy and they feel they lose control over many things in their lives. [18] Changes in their physical environment and level of physical activity are not the only changes elders experience in the nursing home, changes also take place in their daily life routines, social networks and supports. [18] Lack of control in their lives is a major problem in nursing homes. [19]. Nurses who work with elders in nursing homes quite often view them as children and they tend to enforce power over them which leaves the elders dependent on the nurses for everything. [19] This causes them to isolate themselves, but having activities in the nursing home like gardening programs and Tai Chi classes allow them to socialize, make new connections and form new relationships which will better their quality of life. Lack of control over personal decision making seems to affect life satisfaction. [19] Social support networks and activities in the nursing home are important in preventing a decline in life satisfaction, socialization and cognitive dysfunction. [18]

An example of a nursing home that focuses on socialization.

[edit] Activity 1: Tai Chi Classes

The first activity that has been successful in increasing and maintaining socialization once in the nursing home is Tai Chi, which is an exercise that involves the mind and body. [20] It is really good for elder people to participate in because it is not too intense, and it does not incorporate anything that requires them to be extremely physically fit. [20] It is a series of dance-like movements strung together but done at a very slow pace. [20] Four major styles of Tai Chi exist, which are Chen, Yang, Sun and, Wu. [20] It also involves deep breathing exercises as well as mental concentration.[21] It is suggested that exercises like Tai Chi help to maintain and promote psychological well-being. [21] Studies have shown that Tai Chi classes can promote state self-esteem, enhance health-related quality of life, improve mood, lower stress levels, and they are an excellent way to increase socialization within the nursing home. [21]

Most Tai Chi programs and classes run two to three times a week and are one hour long, which contains of a 15-minute warm-up phase, a 40-minute activity phase, and lastly, a 5-minute cool down phase. [21] One of the most popular types of Tai Chi done in these environments is the Yang-style Tai Chi because it is low intensity. [20] After a few weeks of taking the Tai Chi classes, the elders seem to be more lively, vital and energetic, and seem to enjoy the social aspect of these classes as well as the low intensity movements. [20] To help promote the well-being of elders in nursing homes, it is suggested that Tai Chi programs be incorporated into more nursing homes. [20]


An example of a Tai Chi Seniors class.

[edit] Activity 2: Gardening Programs

Gardening programs in nursing homes have been shown to enhance socialization and life satisfaction and to reduce loneliness. [18] They also give elders a chance to have daily physical activity which can help to enhance muscular strength and improve fine motor skills. [18] Gardening activities enhance enthusiasm and give elders a sense of responsibility and has the group work as a team. [22] Gardening allows an opportunity for elders to extend their social networks by providing them with opportunities to foster social interaction with each other. [18] These programs can involve activities like maintenance of parks, spreading gravel on the paths, raking, weeding flower beds, planting flowers and hanging flower pots. [22] These programs are effective in increasing life satisfaction and socialization and decreasing loneliness for the elders in the nursing homes. [18] Most of the elders who participate in these gardening programs describe the experience as being very positive and they express feelings of pleasure and happiness, a sense of responsibility and they engage in social activity. [18] They give the elders a chance to share their ideas and knowledge with each other in the care of their plants. [18]


[edit] Conclusion

Feelings of loneliness begin to take over and they report spending a lot of time by themselves while being surrounded by strangers and 'sick people'. [18] Experiencing these negative feelings can have major effects on health status, leading to a poor quality of life. [18] These elders will feel a great sense of loss at leaving their homes, families and neighbourhoods. [18] It is very important for elders in a nursing home to maintain their socialization. If this does not occur and the elder shuts down emotionally, it is very possible for their life satisfaction to decrease which could have serious negative effects on their physical and psychological well-being. [19] They are experiencing major changes in their lives like leaving their homes, their families, and many actually see it as the final step or 'rite of passage' before death. [19]

[edit] Psychological Problems Faced in the Nursing Home

Old age is a stage of life in which psychological, emotional, and physical support should always be readily available. Due to the increasing population of senior citizens there is an abundance of psychological problems being faced by the elderly. [23] Close to twenty-five percent of this fast growing age group live in nursing homes and are having to cope with their individual illnesses in an entirely new environment with unfamiliar people. Dementia, strokes, heart disease, depression, and paranoia are just some of the disorders that are being dealt with by this growing population. On the contrary having lost a spouse, a sense of purpose, and a noticeable decline in cognitive impairment can all be contributing factors to negative emotions leading to different psychological problems. [24] Research in a recent study done revealed that these different mental disorders appear differently in men and women. The results show that older women display more anxiety and emotional problems whereas men were shown to mainly suffer psychological disorders related to drug abuse withdrawal. [25] Although being placed in a retirement home should be an overall positive thing, research shows that depression rates are the highest in nursing homes. It would be safe to assume that elders in these environments are able to meet new friends, participate in activities and events, and lastly are close to health care and medical services, so these results are somewhat surprising.[25] Since elders living in nursing homes are unable to have as much contact with family and old friends, it is crucial that both emotional and psychological needs are met on a constant basis by employees to help elders cope with their individual problems.

Image:Image033.jpg

Percentage of elders with a psychological disability

[edit] Depression

After being placed in a nursing home coping with the change can be very difficult for elders. Although it may be a positive experience for some, there are usually many negative emotions when dealing with this change. Having to leave one’s home and being placed in a group residence can bring feelings of loneliness, disappointed, fear, confusion, frustration and anxiety. [24] Elders faced with these feelings usually have a difficult time taking part in activities that they once enjoyed. Overeating or loss of appetite is also quite common. [26] Furthermore it becomes much more difficult to make rational decisions when in this state of mind. We learn from one specific study that over 50 percent of the interviewees placed in a nursing home were clinically depressed or were having negative feelings about their current state. Those that were being interviewed told the researchers that the depression was mainly related to not wanting to come to the nursing home. It was also noted that for the majority of these patients the depression lasted anywhere for 2 months to a year. [27] It is important to promote quality of life in elders by helping these patients through their depression. Whether being a family member, nurse or friend because going through these changes can be extremely difficult and much support is needed. [28]

[edit] Dementia

In recent history dementia is the leading psychological problem elders are facing.[29] By definition this mental condition is the progressive loss of cognitive ability usually found in aging people [30]. The three most common types of dementia in elders are Alzheimer’s disease, Vascular dementia and Frontotemporal dementia. [29] Alzheimer's disease is the most frequent type of the three, and furthermore researchers have recently suggested that over half of all elders over the age of 80 develop Alzheimer’s.[31] Canadian demographics are not only informing us that this disease is becoming more common, but furthermore it is showing how rapidly it’s spreading across the nation. The number of people with this disorder is believed to double every 20 years, due to the dominance of seniors there will be in the next few decades. [29] Living in a nursing home with this psychological problem can be very tough, for both the patient as well as the caregiver for many reasons. Caring for these specific elders requires much skill and training in order to properly respond to the patients demands as well as the questions they ask and things they are unaware about. [31] It is very important that there is both excellent care and proper diagnosis with those dealing with this illness. All three of these different types of dementia can be difficult to treat and early identification when aging is extremely necessary [29]. In the nursing home it is important to help those elders with dementia by getting them involved in different activities and games that are stimulating and will be beneficial to them. [32]


Image:Dementia_piechart.jpg

A pie chart of dementia statics among the elderly


A short video showing an example of how a nursing home can help enhance cognitive function in patients with dementia.

[edit] Notes and References

  1. 1.0 1.1 1.2 Greenwood, C. E., Wendland, B. E., Weinberg, I., & Young, K. W. H. (2003). Malnutrition in institutionalized seniors: The iatrogenic component. Journal of the American Geriatrics Society, 51(1), 85-90. Retrieved from http://web.ebscohost.com.proxy.library.brocku.ca/ehost/pdfviewer/pdfviewer?vid=7&hid=123&sid=03aa7606-806a-457a-9ac9-451e9ceaa6cd@sessionmgr115
  2. 2.0 2.1 2.2 2.3 Visvanathan, R. (2003). Under-nutrition in older people: A serious and growing global problem!. Journal of Postgraduate Medicine, 49, 352-360. Retrieved from http://www.jpgmonline.com
  3. Andres, E., Federici, L., Kaltenbach, G., & Serraj, K. (2008). Update of nutrient-deficiency anemia in elderly patients. European Journal of Internal Medicine, 19, 488-493. doi: 10.1016/j.ejim.2008.01.016
  4. 4.0 4.1 Bachrach-Lindstrom, M., Carstensen, J., Ek, A. C., & Johansson, Y. (2008). Malnutrition in a home-living older population: Prevalence, incidence and risk factors. a prospective study. Journal of Clinical Nursing, 18, 1354-1364. doi: 10.1111/j.1365-2702.2008.02552.x
  5. Healy, J., Maud, R., Webster, J., & , (2009). Nutrition in hospitalised patients. Nursing Older People, 21(10), 31-37. Retrieved from http://web.ebscohost.com.proxy.library.brocku.ca/ehost/detail?vid=10&hid=123&sid=03aa7606-806a-457a-9ac9-451e9ceaa6cd@sessionmgr115&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ
  6. Froelicher, E. S., Kayser-Jones, J., Martin, C. T., Porter, C., & Stotts, N. A. (2005). Factors contributing to low weight in community-living older adults. Journal of the American Academy of Nurse Practitioners, 17(10), 425-431. Retrieved from http://web.ebscohost.com.proxy.library.brocku.ca/ehost/pdfviewer/pdfviewer?sid=03aa7606-806a-457a-9ac9-451e9ceaa6cd@sessionmgr115&vid=4&hid=123
  7. 7.0 7.1 Schnelle, J. F., & Simmons, S. F. (2006). Feeding assistance needs of long-stay nursing home residents and staff time to provide care. Journal of the American Geriatrics Society, 54(6), 919-924. doi: 10.1111/j.1532-5415.2006.00812.x
  8. Bourdel-Marchasson, I. (2010). How to improve nutritional support in geriatric institutions. Journal of American Medical Directors Association, 11, 13-20. doi: 10.16/j.jamda.2009.04.003
  9. 9.0 9.1 9.2 9.3 Type 2 diabetes: The basics. (2011). Retrieved from http://www.diabetes.ca/diabetes-and-you/living/just-diagnosed/type2/
  10. What is pancreatic cancer. (2010, December 13). Retrieved from http://www.cancer.ca/Canada-wide/About cancer/Types of cancer/What is pancreatic cancer.aspx?sc_lang=en
  11. Araki, A., & Ito, H. (2009). Diabetes mellitus and geriatric syndromes. Geriatric Gerontology International, 9, 105-114. doi: 10.1111/j.1447-0594.2008.00495.x
  12. 12.0 12.1 Ardigo, S., Genet, C., Herrmann, F. R., Perrenoud, L., Registe-Rameau, Y., & Vischer, U. M. (2010). The high prevalence of malnutrition in elderly diabetic patients: Implications for anti-diabetic drug treatments. Diabetic Medicine, 27, 918-924. doi: 10.1111/j.1464-5491.2010.03047.x
  13. 13.0 13.1 Berthold, H. K., Gouni-Berthold, I., & Krone, W. (2009). Vitamin d and cardiovascular disease. Current Vascular Pharmacology, 7(3), 414-422. Retrieved from http://web.ebscohost.com.proxy.library.brocku.ca/ehost/pdfviewer/pdfviewer?vid=18&hid=123&sid=03aa7606-806a-457a-9ac9-451e9ceaa6cd@sessionmgr115
  14. Kaur, S. (Photographer). (2010). The balance of good health. [Print Photo]. Retrieved from http://healthmad.com/weight-loss/how-to-make-good-diet-chart/
  15. "What's the difference between dementia and alzheimers?". (2011). Retrieved from http://www.alzinfo.org/about-alzheimers/dementia?mtc=google&kwd=dementia&gclid=CLeP5O7GkKwCFYXrKgodDhJFmw
  16. 16.0 16.1 Dai, Y., Huang, G. S., Lou, M. F., & Yu, P. J. (2007). Nutritional status and health outcomes for older people with dementia living in institutions. Journal of Advanced Nursing, 60(5), 470-477. doi: 10.1111/j.1365-2648.2007.04442.x
  17. 17.0 17.1 Cole, G. M., & Frautschy, S. A. (2010). Dha may prevent age-related dementia. Journal of Nutrition, 140, 869-874. doi: 10.3945/jn.109.113910.
  18. 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 Tse, M.M.Y. (2010). Therapeutic effects of an indoor gardening programme for older people living in nursing homes. Journal of Clinical Nursing, 19, 949-958.
  19. 19.0 19.1 19.2 19.3 19.4 Jacelon, C.S. (1995). The effect of living in a nursing home on socialization in elderly people. Journal of Advanced Nursing, 22, 539-546.
  20. 20.0 20.1 20.2 20.3 20.4 20.5 20.6 Chen, K.M., Chen, W.T., Hsu, Y.C., & Tseng, H.F. (2005). Well-being of institutionalized elders after yang-style tai chi practice. Journal of Clinical Nursing, 16, 845-852.
  21. 21.0 21.1 21.2 21.3 Lee, D.T., Lee, L.Y., & Woo, J. (2010). The psychosocial effect of tai chi on nursing home residents. Journal of Clinical Nursing, 19, 927-938.
  22. 22.0 22.1 Heikkilia, K., Olofsson, L., Thelander, V.B., & Wahlin, T.R. (2008). Gardening activities for nursing home residents with dementia. Advances in Physiotherapy, 10, 53-56.
  23. Cohen-Mansfield, J., Marx, M. S., & Rosenthal, A. S. (1990). Dementia and agitation in nursing home residents: How are they related? Psychology and Aging, 5(1), 3-3-8.
  24. 24.0 24.1 Gerritsen, D. L., Smalbrugge, M., Teerenstra, S., Leontjevas, R., Adang, E. M., Vernooij-Dassen, M. J., & ... Koopmans, R. (2011). Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol. BMC Psychiatry, 11(1), 91-97.
  25. 25.0 25.1 Etemadi and K. Ahmadi, 2009. Psychological Disorders of Elderly Home Residents. Journal of Applied Sciences, 9: 549-554.
  26. Gaugler, J. E., Mittelman, M. S., Hepburn, K., & Newcomer, R. (2009). Predictors of change in caregiver burden and depressive symptoms following nursing home admission. Psychology and Aging, 24(2), 385-385-396.
  27. Choi, N. G., Ransom, S., & Wyllie, R. J. (2008). Depression in older nursing home residents: The influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy. Aging & Mental Health, 12(5), 536-547.
  28. Sung, H., Chang, A. M., & Lee, W. (2010). A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. Journal of Clinical Nursing, 19(7/8), 1056-1064.
  29. 29.0 29.1 29.2 29.3 Capuana, L. (2011). Abnormal cognitive decline [Powerpoint Slides]. Retrieved from: https://lms.brocku.ca/access/content/group/PSYC3P19D02FW2011MAIN/power%20point%20slides/lesley%20capuana%20atypical%20cognitive%20aging.pdf
  30. Cunningham, C., McClean, W., & Kelly, F. (2010). The assessment and management of pain in people with dementia in care homes. Nursing Older People, 22(7), 29-36. Retrieved from EBSCOhost.
  31. 31.0 31.1 Boekhorst, S., Depla, M. A., De Lange, J., Pot, A., & Eefsting, J. A. (2009). The effects of group living homes on older people with dementia: a comparison with traditional nursing home care. International Journal of Geriatric Psychiatry, 24(9), 970-978.
  32. Norton, M. J., Allen, R. S., Lynn Snow, A. A., Michael Hardin, J. J., & Burgio, L. D. (2010). Predictors of need-driven behaviors in nursing home residents with dementia and associated certified nursing assistant burden. Aging & Mental Health, 14(3), 303-309. doi:10.1080/13607860903167879
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