Case Study of Mr. John

Discuss about the Special Population Nutrition.

This is an essay that requires formulation of a case study of a client who fits in a special population. The nutritional requirements will be outlined and a dietary plan will be formulated taking into consideration the physical activities. The essay will critically analyze the determinants and the concepts of the nutrition of the given client in relation to their health. This will be done by evaluating the Ministry of Health guidelines and the peer-reviewed literatures on the nutrition of the given special population. Lastly, a conclusion will be given to summarize the essay.

A case scenario of Mr. John, a male client who lives in a nursing home. He is 72 years old, has a height of 155cm, weighs 65kgs, has a Basal Mass Index (BMI) of 27.0kg/m2, his arm circumference is 27cm, his calf circumference is 34cm, his fat free mass is 34kgs, his body fat mass is 25kgs, his mini-mental score is 28, his mini-nutritional assessment is 26.5 while his timed up and go is 9.9 seconds. His physical activities were as followed; the vigorous activities are 8.0 Metabolic Equivalent of Task (MET), for the moderate activities is 4 METs while walking is 3.3METs. Her resting energy expenditure is 1250Kcal/day, his activity energy expenditure is 200Kcal/day, his dietary induced thermogenesis is Kcal/day, his total energy expenditure is 1700Kcals and lastly his physical activity level is 1.3. Lastly, his energy intake requirement is 32.395MJ or 7737.54Kcals.

Calculations

BMR= weight/height (M2)

= 65/ (1.55*1.55)

= 27

The caloric requirement = 0.038 * weight in kg + 2.755

= 0.038 * 63 + 2.755

=7737.54Kcals.

The energy sources; 45% -65% carbohydrates 3868Kcal

20%-25%   fat 2254 Kcals

15%-25% proteins 1747Kcals

4 Kcalories = 1 gram of carbohydrate therefore = 967grams

4 Kcalories = 1 gram of protein therefore = 436.75grams

9 Kcalories = 1 gram of fats therefore = 250.44grams

Breakfast

½ cup of porridge

1 ½ bread roll

½ cup cooked vegetables

1 banana

This meal is rich in carbohydrates from the porridge, bread roll and banana. The carbohydrates are from whole grain which is healthier. They are important in the body as they provide energy and also they form the major part of the stored food to be used to produce energy later. They are also important in fat oxidation. Lastly, they are converted into proteins and stored (Baghurst, Baghurst & Record, 2016). The meal also has micro-nutrients Vitamin A, C and magnesium and potassium. Vitamin A is for night vision, healing of the epithelial cells and the development of teeth and bones. This is very important in the old age. Vitamin C helps in wound healing and in absorption of iron. As mentioned above, intestinal motility decreases with age so providing dietary fiber is very important so as to ease toileting. The minerals aids in bone and muscle development (Public Health Advisory Committee, 2015). In summary breakfast provided Stefanie’s body with the required nutrients as per her phase of life.

Calculations

Snack

Tea, herbal, infusion

2 muffins

1 apple

This food is rich in carbohydrates, dietary fiber, Vitamin B complexes excluding B12, magnesium, calcium, iron, and zinc. As mentioned above carbohydrates provides the largest portion of energy in the body. The vitamin B complexes are important in metabolism of proteins, carbohydrates and fats. The minerals help in wound healing, muscle contraction, (Gifford, O’Connor, Honey & Caterson, 2014)

Lunch

1 medium fillet of cooked fish.

Bread garlic, herb

2 scoops of ice cream

½ cup of mixed vegetables

1 tomato

This food is rich in proteins, vitamin B12, iron from cooked fish, it has carbohydrates from the bread, ice cream and it has vitamin A, D, calcium, iron, phosphorus, zinc from the vegetables and tomatoes. Proteins provides the amino acids that makes up the cell structure. They are involved in synthesis of antibodies and in repair of cells incase injury. They are also used in energy provision in case of starvation. The B12 complex is important in erythropoiesis. Vitamin D is important in iron absorption. Iron is important in erythropoiesis. The minerals are important as they are anti-oxidants, bone development and repair, important in healthy eyes and also in healing and tissue repair (Stanner, 2009).

Snack

½ cup of nuts

1 large glass of calcium fortified soy milk.

3 plain sweet biscuits

This food is rich in fats, carbohydrates, calcium, phosphorus, zinc, iron, vitamin A, B12, D. Fats are important in energy production after carbohydrates (Baghurst, Baghurst & Record, 2016)., they are stored in delicate tissues for insulation (absorb shock). As mentioned above carbohydrates provides the required energy. Calcium is important in bone development. The other micronutrients are important in erythropoietin, wound healing, improves the eye sight, boosts the immunity and helps in muscle contraction and fluid balance (Saunders, & Friedman, 2017).

Dinner

Chicken tikka masala

Cooked rice

2 small plums

1 large glass of milk, 250ml

The food is rich in protein, carbohydrates, dietary fiber, vitamin A, D, B12, Calcium, phosphorus, zinc, calcium. As mentioned above the proteins are important in tissue repair and wound healing. The carbohydrates are important in energy production. Calcium is important in bone development, important as an anti-oxidant, important in wound healing and in erythropoiesis process (Stanner, 2009).

John takes 1500 liters of water this is very important as it acts as a solvent to transport nutrients to the cells and the wastes for elimination. It is also important for body temperature regulation, lubrication, insulation and metabolism (Stanner, 2009).

Meal Plan and Nutritional Value

The following are the guidelines; the diet should ensure that the body weight is maintained by eating well and also by performing physical activities daily. This is achieved by including different nutritious food from the four major groups of foods. That is, plenty of fruits and vegetable, plenty of bread, cereals which are wholegrain, ensure they take milk and the milk products especially those that has low or reduced fat and eat lean meat, eggs, nuts, seafood and legumes. Secondly, drink lots of liquids, especially water daily. Thirdly, ensure that the meals, snacks and drinks have very minimal added fats especially if they have saturated fats, have low/little salt and if sweetened they have little added sugar. Fourthly, ensure that they take three meals a day with nutritious snacks in between. Fifthly, ensure there is food safety when preparing and purchasing. Sixthly, if they take alcohol, reduce the intake. Lastly, ensure that they are physically active by performing moderate physical activity at least for thirty minutes in most of the days of the week (Capra, 2016; Ministry of Health, 2008; Jorgensen, 2009).

In addition to this, it recommends at least five serving per day of fruits and the vegetables two and three servings respectively for each. A serving of dried fruits or blended juice counts as one serving. Secondly, there should be at least 6 servings of carbohydrates (cereals and bread) preferably the wholegrain. Thirdly, there should be at least 3 servings of milk and its products per day. Lastly, there should be at least one serving of proteins in day (New Zealand Guidelines 2013; Peter et al., 2008).

As mentioned earlier, Stefanie, who is 82 years old, requires 7737 calories per day. As per the Food and Nutritional Guidelines, carbohydrates should produce 45-65% of the energy required by the body, the fats should produce 20-25% of the energy and proteins, 15-25% of the energy. I energy provision in Stefanie’s case, carbohydrates produce 3868 calories which makes 50%, fats 2254 calories which is 23% while proteins produce 1747 calories 21%. This shows that the diet plan is as per the requirement.

In addition to this, the recommendations on servings are observed, she gets six servings of vegetables and fruits; three vegetable servings and three fruit serving. The carbohydrates servings are six, she gets two servings of meat, all white meat and one is seafood. She drinks milk and takes the milk products at least in three servings, she takes food in low salt, her fat sources intake was low in saturated fats and drank lots of water (Athar, McLaughlin, & Taylor, 2013).

Ministry of Health Guidelines

As people age special attention on nutrition is required as good nutrition translates to a good health. Maintaining a functioning health and a good quality of life is one of the major challenges for the ageing population (Khaw, 2008). In healthy ageing is influenced by the; physiological, lifestyle, cognitive, and social changes that influences the dietary intakes and the nutritional status of the individual. There is a high burden on risk of malnutrition and chronic diseases in the elderly (McLennan & Podger, 2018). Researches done in different communities shows that in the aged population, most of them has high blood pressure especially the systolic, high cholesterol in blood, high basal mass index, reduced physical activities and reduced intakes of fruits and vegetable.  Ageing causes decline in health therefore making them prone to chronic illnesses. Good health in the elderly aims at; preventing disabilities, preventing malnutrition, reducing the risks of getting chronic diseases and promoting physical functioning (McLennan & Podger, 2018).

The aging process takes place in all vital organs and every tissue. These changes significantly influence the nutritional status as it affects the metabolism of the body, the intake of nutrients, the absorption, utilization, storage of nutrients and excretion of nutrients, the nutrients requirement, and their ability to prepare different foods, choose different foods and eat different varieties of foods. The following changes occurs; Sarcopenia, arthritis,

Firstly, sarcopenia is the inevitable process of losing the lean body (the skeletal muscle and bones) mass in ageing and replacing this with fats over time. The decline in muscle 1-2% occurs from the age of fifty years (Rolland et al 2008) and a total of 5% after every decade from Fourty years (Greenlund and Nair, 2013). In women this loss is sudden following menopause. This loss causes a decrease in muscle strength which in turn causes fatigue, impairs mobility, causing imbalances which greatly causes disability. The solution to this is by having good nutrition and physical activities. This will improve the muscle mass and the muscle strength.

Secondly, arthritis, this is a group of disease in which one or more joints gets inflamed. The inflammation results from; an infection, an injury, accumulation of tear and wear or an auto-immune response. Osteoarthritis is one of the most common type of arthritis and in most cases in the old, it is as a result of the accumulated tear and wear. This causes disabilities although it can be managed by good nutrition and physical activity (Perissinotto et al., 2012)

Thirdly, bone loss in old age is associated with rapid bone resorption especially in women in the first five years that follows the menopause phase. The collagen matrix and the bone minerals are removed more rapidly than they are being replaced. This increases the risk towards developing osteoporosis and getting fractures as they get older. In addition to this, calcium absorption is decreased as one ages. It is therefore important to ensure that the nutrition is rich in vitamin D and calcium so as to minimize bone loss (Perissinotto et al., 2012).

Fourthly, gastrointestinal and the immune functions. As one ages the digestive and the absorptive function of the gastrointestinal system declines. The intestinal wall in the old age loses its elasticity, strength and the hormonal secretions changes which results to a slow intestinal motility. There is also atrophic gastritis in which the stomach mucosa atrophies causing a reduction in gastric acid secretion, pepsin and the intrinsic factors. This causes a decrease in the bioavailability of vitamin B12, calcium, iron and folate (Philips, 2013; Horwath & Van Staveren 2010). A study in New Zealand reported that 6.7% of the elderly population has atrophic gastritis (Green et al 2015). The fat and proteins digestion is greatly reduced as there is a decrease in production of pancreatic enzyme (Philips 2013). In addition to this, the aging process results to an alteration of the immune regulation leading to increases incidences of infections with poor recovery from illnesses. Poor nutrition is associated with a decrease in the immune status and causes poor immune status. As mentioned above good nutrition translates to good health.

Fifthly, dentition and oral health can either influence or be influenced by nutrition. The statistics by the Ministry of Health in New Zealand in 2016 indicated that there is an increment in the number of the elderly with teeth remaining that gets tooth decay. The oral health entails one’s ability to chew food which greatly relies on the saliva flow and the teeth. Philip, (2013) states that some of those with dentures complains of pain when chewing, this affects nutrition. Difficulties in chewing affects food enjoyment while eating which causes limitation of the foods. Elmadfa and Meyer (2008); Hung et al (2013) states that oral health has an influence on vitamin C, E, B12 and fiber intake. In addition to these ageing brings about dry mouth (xerostomia) (Hall and Wendin 2008; Thomas, 2015). This significantly affects chewing, swallowing and taste (British Nutritional Foundation 2009).

Sixthly, the sensory change specifically the taste and the smell. There is alteration of the chemosensory perception as one ages (British Nutritional Foundation 2009). Almost a quarter of the ageing population have a reduction of their ability to be able to taste and smell. This affects their enjoyment of food while eating. This affects the food selection, dietary varieties, food preparation and compromises their safety as they cannot discriminate spoilt food (New Zealand Food Safety Authority, 2016).

Seventhly, the knowledge and the skills on food. this knowledge affects the food intake and the nutrient intake which affects the nutritional status of the client. This is attributed to the lack of/inadequacy in the cooking skills or the lack of confidence in their skills. this brings about a barrier in widening of their food choices and in improving their dietary behaviors (Caraher et al 2012). The mental/functional capacity influences the choice and the intake of the ageing individual.

Eighthly, polypharmacy is the use of more than five medications simultaneously. In New Zealand there is a high rate of prescribing to the older population by the New Zealand general practitioners (Gerritsen, 2008). The older generation is at a higher risk of food-drug interactions. This affects their food intake, therefore affecting their nutrient status. The medication may have the following side effects; dry mouth, cognition changes, anorexia, dehydration, taste impairment, electrolyte abnormalities, parkinsonism and osteoporosis, these affects the food intake which in turn affects the nutritional status.

Ninthly, as people age there is a decline in the food intake (MacIntosh et al 2010). The following physiological changes causes a change in the appetite as they age; they become easily satisfied as their gastric emptying becomes slow and also the stomach capacity reduces. There are changes in the gut peptide hormones which stimulates or causes an inhibition in intake of foods. There is an increase in production of the cytokines (this includes serotonin) which are produced by the inflammatory cells, this causes a reduction/decrease in food intake and the body weight. There are changes in the central nervous systems which causes reduction in food intake. Lastly, the changes in dentition, smell and taste influences the food intake which in turn influences the nutritional status. This decline causes anorexia of ageing. Lower energy intake causes an inadequacy of the micronutrients which causes weight loss and malnutrition which are the key components in the frailty of the elderly.

Tenthly, the changes in the mental health and the cognition status, this psychological factors has influences on the nutritional status of the older people. Depression in the ageing population is increasingly recognized as one of the major health concerns. Depression hinders the old from performing the physical tasks; eating, cooking and it changes the appetite (Gonzalez-Gross et al 2013). It reduces the motivation to eat (Donini et al 2013). The cognitive functioning, dementia, Alzheimer’s and mental impairments has negative effects on the older population as it affects their independence and autonomy. This affects their nutritional status as they forget to eat, they may refuse to eat, have erratic and poor eating habits and due to their safety issues they are limited as they cannot assess the kitchen to avoid harming themselves (Keller et al 2008; McKenzie, 2008).

Lastly, the social and the community factors affects the food intake and the nutritional status of the ageing population. This include the living arrangement, social networks, and the habits of sharing meals. The socioeconomic, cultural, economic and the environmental factors that affects the nutritional status of the older status, these factors include, the economic factors, and food securities.

Conclusion

In summary, the aged/ aging are classified as the special population as maintaining a good health and a functioning body is a challenge in the old as the aging process causes changes in the body metabolism, change in the nutrient intake, changes in absorption, excretion and absorption, changes in nutrients requirement and the inadequacy to be able to prepare, choose and eat variety of foods. The specific changes include, sarcopenia, arthritis, bone loss, gastric atrophy, immune function reduction, oral health and dentition changes, changes in food intake, changes in the sensory (the taste and the smell), changes in the skills and knowledge of food, polypharmacy, changes in the mental functioning and the cognitive function, the social and the community factors affects the food intake and the nutritional status of the ageing population. This include the living arrangement, social networks, and the habits of sharing meals. The socioeconomic, cultural, economic and the environmental factors that affects the nutritional status of the older status, these factors include, the economic factors, and food securities. The New Zealand has specific guidelines on the serving of the older population. The diet plan for Mr. John has followed the guideline. This is so important as it ensures that his caloric intakes are met and also his health is boosted and his immune.

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