Eating is a social activity for most people. Sadly, many elders live alone or have limited social contact especially during mealtimes. Some patients live in long term care facilities where the environment may be fraught with patients who are confused, having swallowing difficulties, and noisy. A poor social setting for meals may impair the nutritional intake of the elderly. Nurses need to be aware of the impact that socialization may have and try to enhance the environment in order to maximize the potential for healing and maintenance of well being while caring for the elderly. Many of the challenges which the elderly face are also felt by people with sensory problems, physical, mental and emotional disabilities as well.
Where patients eat, how they eat, and with whom they eat may have a profound impact on what patients eat. Some tips follow that will aid you in your evaluation of your patients’ social status as it relates to nutritional intake.
Who does the patient eat with? Does he eat with others or alone? If he eats with others, is the atmosphere warm and inviting? Is it rushed and argumentative? Is the patient made to feel welcome and a part of the social interactions at the table? Are distractions such as television and noise present? Is the environment calm and relaxing?
Where does the patient eat? Is it in a home setting at a dinner table or in bed alone? Is it a long-term care setting such as a nursing home or assisted living facility? If he eats in a long-term setting, are multiple dining areas available, such as separate dining rooms or tables away from patients who may be disruptive at mealtimes.
In addition to the actual meal time, other aspects of the patient’s social status may impact his ability to eat well too. Assess the patient’s level of independence and resources as well. You may need to collaborate with other members of the health care team in order to obtain an accurate assessment. People who may provide valuable information include the patient and his family; home health aides and nursing assistants; licensed practical nurses who serve as charge nurses in long term care facilities; and social workers. Here are some questions to help guide your assessment:
If the patient lives in a private home, is he able to easily get to a grocery store? How does he get there? Does he walk, drive, get a ride, or require public transportation? Is he physically and mentally able to obtain groceries? Can he shop and carry grocery bags independently? If not who provides assistance? Can he see and read and understand food labels and prices? Does he have the mental capacity to choose healthy foods?
Are financial concerns hampering his ability to make healthy food purchases? Patients often eat food that is inexpensive, but not healthy. Does he need nutritional education regarding healthy food choices which are easy to prepare and affordable? Does he have the capacity to safely prepare meals?
The United States Department of Agriculture replaced the food pyramid in 2011. There is a new more user friendly tool called MyPlate available at http://www.MyPlate.gov. It has options for modified diets and offers recommendations of healthy food choices for older adults.
If there is not enough money to purchase food or the patient has difficulty handling money, refer the patient to social service agencies for assistance. Resources in the community may include veterans groups, agencies on aging, church groups and government assistance agencies.
As the geriatric population continues to grow and health care services in the home are expanded, nurses need to become increasingly adept at using the nursing process to assess, plan implement and evaluate nutritional and social needs of elders. This involves nurses in all settings, including home health nurses, hospital nurses, office nurses, and nurses in long term care facilities. The health and quality of life of the geriatric population depends upon nurses going beyond teaching about specific diets and recording intake. The whole person must be taken into account.