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Browse published articles attributed to Becky Dorner, with full-archive search.
We continue to receive questions from practitioners regarding whether it is appropriate to use serum albumin and/or prealbumin to determine nutritional status and/or nutritional repletion. To answer this question, I'll share some information from our book, The Complete Guide to Nutrition Care for Pressure Ulcers: Prevention and Treatment, Copyright 2012:
Recently we have had a few questions about meal times and the 14 hour rule from CMS for nursing facilities. The conce s are related primarily to the requirements for spacing of the evening meal and the next day's breakfast especially in the context of person centered dining. Facilities are trying to balance regulations with personal choice and this is fairly easy to achieve.
Critical illness or chronic conditions like trauma, injury, burns, wounds, pressure ulcers, major surgery, or sepsis cause a stress response that can result in hypermetabolism, increased catabolism, and loss of lean body mass (LBM). As a result, patients under stress may experience unintended weight loss and protein energy malnutrition (PEM), which contribute to immune impairment, weakness, and increased risk of pressure ulcers. Understanding the reasons why this happens can help practitioners understand how to treat patients under stress.
Have you ever swallowed and had food “go down the wrong way”? For an estimated 15-40% of adults over the age of 60 this is a constant concern. Dysphagia is simply defined as any difficulty or inability to swallow. It is not a disease, but a disruption of a normal process. Problems at any point during the swallow can result in difficulty swallowing. A person with dysphagia may have a delayed, incomplete or absent swallowing response. Potential causes include obstruction, nerve and muscle problems and miscellaneous issues such as trauma, medications, poor dentition and poor mouth care.
Health care professionals who care for older adults can help prevent and treat Sarcopenia Approximately 45% of the older adults in the U.S. are affected by sarcopenia, the progressive loss of muscle mass, function, quality, and strength driven by the aging process (1). Sarcopenia can lead to diminished strength and decreased activity levels, and can contribute to mobility issues, osteoporosis, falls and fractures, frailty, loss of physical function and independence (2).
Most of us can say that our lives have been touched by Alzheimer’s Disease or dementia in some way, and with the aging of America, the number of people affected by this condition continues to increase. The term dementia describes a variety of diseases and conditions that develop when neurons in the brain no longer function normally, causing changes in memory, behavior, and ability to think clearly. There are many types of dementia, but Alzheimer’s disease (AD) is the most common form, accounting for 60-80% of dementia cases.
Health care communities are making person-centered dining programs the center of attraction! Nursing homes and assisted living facilities alike are embracing the concept of changing their internal culture from institutional-based care to person-centered care where the individual is at the center of making decisions about their daily lives. Dining can be an important part of the transition to person centered care, and can in fact, dining can take center stage in a facility's culture change movement.
In the older adult population, the consequences of malnutrition can have a major impact on health, such as unintended weight loss, sarcopenia, frailty, and delayed healing of pressure ulcers. Serving healthful, nourishing meals is not always an easy task in long-term care settings, where staff are contending with food-medication interactions, anorexia, gastrointestinal issues, depression, chronic diseases, poor dentition, difficulty chewing and swallowing, and other issues affecting proper nutritional absorption.
The obesity epidemic challenges health care professionals who care for older adults.
I do my best to stay positive in my communications however, I have to say that I was sadly disappointed in the meal service during a recent visit to a nursing facility. Was it because it was a Saturday evening meal and they had less staff? Is that an excuse for serving soggy, ground up pizza and overcooked mushy green beans to a person who is unable to articulately communicate her dislike of the food? Certainly not.
Heart disease remains the number one killer in the U.S. for both men and women. February is a great month to encourage your clients to renew their commitment to heart healthy habits
One of my RDNs posed this question recently related to BMI levels for older adults: I've been seeing transfer notes from the hospital and other nursing homes with diet/nutrition histories where RDNs are charting that BMIs of less than 23 is underweight. For example, one note documented that a BMI of 21.3 was underweight "for age" for a man who was 92. State surveyors are also asking for a list of residents with BMI under 21 and wanting to see interventions on them. The MDS does not trigger for a low BMI until under 19. Do we need to adapt our practices?
Richard is an 88 year old male who was hospitalized post myocardial infarction (MI) for placement of a stent and management of heart failure. Other than a diagnosis of hypertension which has been under control with medications since age 70, he had been healthy and living independently with his wife in their home. Prior to the MI, he was eating a regular diet and either walking or using a stationary bike daily. However since the MI, his cardiologist has drastically restricted his physical activity, and ordered a low fat, low cholesterol, 2 gram sodium diet.
Richard is an 88 year old male who was hospitalized post myocardial infarction (MI) for placement of a stent and management of heart failure. Other than a diagnosis of hypertension which has been under control with medications since age 70, he had been healthy and living independently with his wife in their home. Prior to the MI, he was eating a regular diet and either walking or using a stationary bike daily. However since the MI, his cardiologist has drastically restricted his physical activity, and ordered a low fat, low cholesterol, 2 gram sodium diet.