Training Manual, part 4, sections 3 (126kb, pdf)

SECTION 3 

GENERAL ASSESSMENT OF FOOD AND 

NUTRITION ISSUES 

OHT 3.1 

OHT 3.2 

OHT 3.3 

OHT 3.4 

OHT 3.5 

OHT 3.6 

OHT 3.7a 

OHT 3.7b 

OHT 3.8 

OHT 3.9a 

OHT 3.9b 

OHT 3.10a 

OHT 3.10b 

OHT 3.11a 

OHT 3.11b 

OHT 3.12 

OHT 3.13 

OHT 3.14 

OHT 3.15 

OHT 3.16 

Summary of General Assessment Issues Which Can Affect Food 

and Nutrition 

Financial Difficulties 

Social Problems 

Personal Hygiene and Food Hygiene Problems 

Mental Health Problems 

Mental Health Problems for the Older Person: Simple 

Interventions 

Poly-drugs 

Poly-drugs (an example of One Person’s Daily Medication) 

Gastro-Intestinal Problems 

Nausea and Vomiting 

Nausea and Vomiting: Simple Interventions 

Diarrhoea 

Diarrhoea: Simple Interventions 

Constipation 

Constipation: Simple Interventions 

Incontinence 

Breathing Problems in the Older Person 

Medical Problems 

Diabetes 

Cardiovascular Disease 

RM 4.0; OHT 3.0 

Identifying and Planning Assistance for Home-Based People Who are Nutritionally at Risk: A Training Manual (2001) 

103

Summary of General Assessment Issues 

which can Affect Food and Nutrition 

Social Problems 

Financial Difficulties 

Household Management Problems 

Personal Hygiene and Food Hygiene Problems 


Poly-drugs 

(more than three types of medication daily) 

Gastro-intestinal problems 

• Nausea and vomiting 

• Diarrhoea 

• Constipation 

Incontinence 

Breathing problems 

Medical problems 

RM Section 4.1; OHT 3.1 


105

Financial difficulties 

(I don’t always have enough money to buy food) 


107 

• Possible restriction of the variety and amount of food bought 

• Possible restriction of nourishing foods which may be more expensive (for 

example meat, fresh fruit) 

• Vulnerable people may not spend enough on food, even when they have 

enough money 

• An adult person may not get enough nourishment, if this person spends less 

than $30 per week* on food for himself/herself every week 

* 1999 ($22 in 1995) 

This can result in poor nutrition, poor quality of life and poor health 

RM 4.2; OHT 3.2

Social problems 

(I eat alone most of the time) 

• Eating is usually a social activity 

• Reduced food intake is common in social isolation, 

bereavement and depression 

• The vulnerable person may be less motivated to 

eat and drink 

• Eating alone can lead to reduced interest in food 

and eating 

• Increased use of ready prepared snack foods 

rather than maintaining one’s cooking skills), may 

result from eating alone 

RM 4.3; OHT 3.3 


109

Personal Hygiene and Food 

Hygiene Problems 

• Possible food contamination-possible client 

comments: 

-I have a stomach ache 

-I have diarrhoea 

-I am going to the toilet a lot today 

• Further questions: 

-Are you taking fluids? 

-What did you eat yesterday? 

-Where did you get this food? 

-What is the diarrhoea like (colour and texture)? 

• Observations: 

-Try to identify the problem 

-Diarrhoea: what is the colour and texture like? 

-Check the food in the kitchen and rubbish 

This can be a client safety issue: If a number of 

clients have this problem, always report it 

RM 4.4; OHT 3.4 


111


• Poor mental health can be related to alcoholism, 

dementia, depression, and other common medical 

problems affecting brain function 

(Parkinson’s disease, dementia, Alzheimer’s) 

• Severe micro-nutrient deficiencies (folate, Vitamin 

B-12, thiamin, niacin) and dehydration can cause 

mental problems 

• Memory problems or confusion, depression, 

anxiety, or nervousness may affect ability to 

organise nourishment 

• Poor mental health (sadness, grief, confusion, 

depression, memory loss) affects motivation and 

the ability to nurture self and general health 

RM 4.5; OHT 3.5 


113

Mental Health Problems for the 

Older Person: Simple interventions 

Dementia 

• Avoid burns by not serving very hot foods 

• Reduce confusion with less food choice 

• Serve finger foods-if poor balance, coordination 

and reduced mobility 

Alzheimer’s disease 

Symptoms 

Agitation 

Loss of skills 

Confusion 

Medication effects 

Loss of memory Weight loss 

Depression 

Food strategies 

Reduce distractions Quiet, relaxing music 

Regular timed meals One course at a time 

Orient to food Time to eat 

Follow food habits Nourishing drinks 

RM 4.5; OHT 3.6 


115

Poly-drugs 

(More than three types of medication daily) 

• Many medications have side-effects that reduce 

food intake 

• Taking more than three medications daily 

increases the chances of side effects and weight 

loss 

• Drug-nutrient and drug-drug interactions are 

exacerbated by poly-drugs, ageing, marginal food 

intakes or existing nutritional deficiencies 

• Medications can alter the body’s response to 

nourishment 

• Food itself can in turn alter the action of a drug or 

drugs that are taken 

• If the effect of drug therapy changes, always 

review whether there has been a recent diet 

change 

Possible referrals: pharmacist, doctor, dietitian 

RM 4.6; OHT 3.7a 


117

Poly-drugs 

(An example of one older persons daily 

medication) 

Captopril 

Prazosin 

Diltiazen 

Lasix 

Slow K 

Prednisolone 

Pulmicort 

Atrovent 

Aspirin 

Nilstat 

Anginine 

Mianserin 

Coloxyl 

Panadol 

Eye drops 

bd 

bd 

tds 

mane 

mane 

mane 

bd 

bd 

mane 

qid 

prn 

nocte 

nocte 

prn 

qid 

RM 4.6; OHT 3.7b 


119

Gastro-Intestinal Problems 

• Nausea and vomiting 

• Diarrhoea 

• Constipation 

RM 4.7-4.9; OHT 3.8 


121

Nausea and Vomiting 

Nausea and vomiting can be caused by the 

following problems: 

• Poor personal hygiene 

• Poor food hygiene 

• Food contamination 

• Medication side effects 

• Illness 

Nausea and vomiting can lead to: 

• Dehydration 

• Reduced fluid intake 

• Reduced food intake 

• Weight loss 

After 24 hours, consider referral: doctor, trained 

nurse, dietitian 

RM 4.7; OHT 3.9a 


123

Nausea and Vomiting: 

Simple Interventions 

• Ensure medication is correctly taken, perhaps after 

meals 

• Refer to Doctor immediately, if medication is 

suspected 

• Encourage 1/2 cup of fluid every hour or so (best 

tolerance is achieved by cold clear sweet fluids 

and then anything the client likes) 

• Then encourage small quantities of plain dry or 

sweet biscuits, dry bread, progressing through 

plain foods according to appetite 

• Recommend small frequent snacks throughout the 

day, building up to the usual pattern 

• Anti-nausea tablets (for example, Maxalon) may 

be used before food 

Monitoring: until nausea and vomiting cease 

Check outcomes: no further episodes? 

RM 4.7; OHT 3.9b 


125

Diarrhoea 

Diarrohoea: 

• results from malabsorption of fluid and/or food 

(wasted food) 

• can cause abdominal discomfort, pain and 

distress, and reduced food and fluid intake 

• may be due to one or more possible reasons: 

-Poor personal hygiene 

-Contaminated food 

-Laxative abuse 

-Side effect of medication 

-Some sugar substitutes (sorbitol, fructose) 

-Stress 

-Lactose intolerance 

-Gastro-intestinal disease 

-Kidney disease 

RM 4.8; OHT 3.10a 


127

Diarrhoea: Simple Interventions 

Acute diarrhoea 

• Clear sweet or other clear fluids (not fruit juices or 

milk) for 24 hours 

• Then introduce other fluids and foods-avoid 

rough fibrous foods and fatty foods 

• Continue until usual food pattern is restored 

Chronic diarrhoea 

• Ensure a nourishing diet is taken 

• Seek advice: doctor, dietitian, visiting nurse 

Monitoring: until diarrhoea ceases 

Check outcomes: no further episodes? 

RM 4.8; OHT 3.10b 


129

Constipation 

Constipation can cause abdominal bloating and 

discomfort and reduced food intake 

Constipation may be due to one or more of the 

following reasons: 

• Reduced fluid intake 

• Reduced food intake 

• Low intake of dietary fibre-due to over-refined 

diet 

• Low activity level 

• Side-effect of medication 

• Laxative abuse 

RM 4.9; OHT 3.11a 


131

Constipation: Simple Interventions 

• Review medications and use of laxatives 

• Recommend at least 6-8 cups of fluid daily 

• Recommend a slow but steady increase in dietary 

fibre: 

-Wholegrain cereals such as porridge, muesli, 

All-Bran, Fibre Plus, Just Right, Sultana Bran 

-Wholemeal breads or high fibre white bread 

-Fruits such as pineapple, apricots, fresh fruit 

-Fibrous vegetables, legumes 

• Offer hot tea and coffee (caffeine) 

• Recommend mobility and activity as tolerated 

• Recommend regular toileting 

Monitoring: daily fluid and fibre intake 

Check outcomes: gradual improvement in 

bowel actions (months)? 

RM 4.9; OHT 3.11b 


133

Incontinence 

• Incontinence is very distressing and can lead to 

reduced fluid and food intake 

• Always seek expert advice from a continence 

adviser, doctor, visiting nurse, dietitian 

• Incontinence can be caused by one or more of 

the following: 

-Constipation 

-Weak anal sphincter 

-Poor mobility 

-Use of medications 

Bowel hydrating agents (lactulose, sorbilax) 

Diuretics, sedatives, anti-cholinergic agents, 

sleeping tablets 

-Medical problems 

Diabetes, urinary tract infection, obesity, 

stroke 

Parkinson’s disease, multiple sclerosis 

-Too much alcohol 

-Not enough dietary fibre 

Constipation 

-Insufficient fluid intake 

Constipation, decreased bladder capacity 

RM 4.10; OHT 3.12 


135

Breathing Problems in the Older Person 

• The extra effort of breathing uses up a lot more 

energy than normal breathing 

• One and a half times more food energy is required 

• It is difficult to take sufficient food energy to 

achieve a good body weight 

• Fat metabolism results in less carbon dioxide 

produced by the body to be expired 

• Increased fat intake will improve food energy and 

assist breathing 

Consider specialist referral: dietitian 

RM 4.11; OHT 3.13 


137

Medical problems 

• Medical problems which reduce ability to access 

and eat enough food and fluids 

-Decreased mobility 

-Breathing difficulty 

-Weight loss 

• Medical problems which increase the need for 

energy and nutrients 

-High body temperature, fever 

-Infection, impaired wound healing 

• Major medical disorders which change the need 

for nourishment and can cause feeding problems 

-Metabolic disorders 

-Cancer 

-Gastro-intestinal disorders 

RM 4.12; OHT 3.14 


139

Diabetes 

• Simple diabetes-treated by diet only 

• Moderate diabetes-treated by diet and tablets 

• Complex diabetes-treated by diet and insulin 

injections 

Simple interventions-it is best for the client to: 

• Keep a good weight 

• Be as active as possible without overdoing it 

• Take regular meals and snacks, and nourishing 

foods 

• Have assistance from the visiting nurse 

• Have the best and latest information to keep well 

Monitoring: 

• Regular medical check, thorough yearly review 

• Regular dietary check, thorough yearly review of 

dietary treatment with a dietitian 

• Referral to a diabetic educator if appropriate. 

Referral for particular advice: doctor, dietitian 

RM 4.12.1; OHT 3.15 


141

Cardiovascular disease 

Frail older adults: 

• Risk factors not so important as prevention of 

weight loss and frailty 

Active adults: 

• Reduction of risk factors and prevention of 

problem development more important 

Younger high dependency adults: 

• Risk factors not so important as prevention of 

weight loss and frailty 

Monitoring: 

• Body weight in normal range for age 

• Yearly review of blood cholesterol and blood fats 

(if the client is on a modified fat diet) 

Referral for particular advice: doctor, dietitian 

RM 4.12.2; OHT 3.16 


143

Training Manual, part 4, sections 3 (126kb, pdf)

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