CLDC

NCM 214- Care of Older Adult

NUTRITIONAL CONSIDERATIONS
Objectives:
- Identify physiological and psychological factors affecting the nutritional status of
order adults
- Examine the modified food pyramid for older adults
- Describe techniques for assessment of nutritional problems
GENERAL ISSUES IN NUTRITION
Recommended for healthful aging

- Nutritional needs of those who are aging robustly, those who have chronic
illnesses or are “less robust, and those who are very frail for whom dietary
recommendations are available
GENERAL ISSUES IN NUTRITION
Recommendations for healthful aging
➢ The 2005 Dietary Guidelines (USDA, 2005) described the ABCs of nutrition as:
1. Aim ffor fitness
2. Build a healthy body
3. Choose sensibly
TUFTS Food Guide Pyramid for Older Adults (Amersbach, 1999)
TUFTS Food Guide Pyramid for Older Adults (Amersbach, 1999)
NCM 214- Care of Older Adult
PHARMACOLOGICAL CONSIDERATIONS
Objectives:
- Describe the age-related changes in pharmacokinetics
- Identify the effect of aging on drug metabolism
- List medications that may be inappropriate for older adult

EFFECTS OF AGING ON DRUGS

Normal aging is associated with certain physiologic changes that can influence
drug response.

PHARMACOKINETICS
The time course by which the body absorbs, distributes, metabolizes, and excretes
drugs (Beers& Berkow, 2000)
1. ABSORPTION- although the rate of drug movement through the body may
decrease with age, the extent of drug absorption is least affected with age
(California Registry, 2004)
2. DISTRIBUTION
- as patients age, total body water declines and fat stores increase
- this physiological change affects the distribution phase of highly water- and fat-
soluble drugs
- the volume of distribution might be decreased for drugs that are highly water-
soluble and increased for drugs that are highly lipid-soluble
3. METABOLISM
- With age, hepatic blood flow decreases
- Hepatic blood flow of medications is decreased
4. EXCRETION
- Renal blood flow is reduced
- This physiological change will decrease the amount of drug that goes through
excretion

PHARMACODYNAMICS
- Effects of similar drug concentrations at the site of action may be greater or less
than those in younger patients
- The potential for increased sensitivity to medications at the cellular level must be
considered when administering them to an elderly patient.
POLYPHARMACY
The prescription, administration, or use of more medications than are clinically
indicated in a given patient.
- Many older patients are prescribed multiple drugs, take OTC medications, and
are often prescribed additional drugs to treat the side effects of the meds that
they are already taking.
- Potential adverse outcomes include Adverse drug reactions (ADRs), increased
cost, and non-compliance
- Nurses play a key role by asking:
1. Is the treatment necessary?
2. Is this the safest drug available?
3. Is this the most appropriate dose/drug, route, and dosage?
4. Is the frequency appropriate?
5. Do the benefits outweigh this risk?

AMERICAN GERIATRIC SOCIETY

BEERS CRITERIA FOR MEDICATION LIST
- Used primarily by clinicians
- To provide an update using a comprehensive, systematic review and grading of
the evidence on drug-related problems and adverse events in adults.