Page 383 - Encyclopedia of Nursing Research

350 n NuTRITION IN THe eLDeRLy

physiological demands, and metabolic rate an inflammatory state (Franceschi, 2007),
(DiMaria-Ghalili, 2002) along a continuum it is essential for researchers to incorporate
N from undernutrition to overnutrition. A inflammatory biomarkers in future nutrition
nursing research agenda focusing on geri- studies.
atric nutrition is essential due to the aging By the year 2030, older adults will com-
demographics of the u.S. population and prise 20% of the u.S. population, due in part
the fact that most health care professionals to increases in life expectancy and aging
are not adequately trained in assessing the of the baby boom generation (IOM, 2008).
nutritional needs of older adults (Institute The new generation of elderly will be more
of Medicine [IOM], 2008). Although obesity racially and ethnically diverse (IOM, 2008);
is the most common nutritional disorder therefore, nurse researchers need to consider
in older adults (IOM, 2000), poor nutrition, the impact of racial and ethnic attributes in
undernutrition, and malnutrition are more future nutrition studies.
serious matters. The unmet nutritional needs The economic impact of malnutrition is
of obese older adults should be not be over- significant. For example, older malnourished
looked, as older adults with sarcopenic obe- hospitalized patients have longer lengths of
sity, defined as the coexistence of diminished stay and increased costs (Norman, Pichard,
lean mass and increased fat mass (Miller & Lochs, & Pirlich, 2008). In addition, an older
Wolfe, 2008), are particularly vulnerable to adult’s personal economic standing may be
functional impairment and disability (Miller a risk factor for undernutrition, especially if
& Wolfe, 2008). Older persons are at risk for there is not enough money to buy food. In a
malnutrition as a result of normal aging and recent report on Senior Hunger in America,
chronic disease, as well as dietary, economic, marginal food insecurity was found in over 5
psychosocial, and physical factors (DiMaria- million seniors (Ziliak, Gundersen, & Haist,
Ghalili & Amella, 2005). Twenty percent to 2008). Of these, 2.5 million were at risk of
60% of older home care patients, 40%–60% of hunger, and about 750,000 suffered from
older hospitalized patients, and 40%–85% of hunger due to financial constraints (Ziliak,
older nursing home residents are malnour- et al., 2008). Food insecurity and hunger in
ished or at risk for malnutrition (DiMaria- older adults are projected to increase by the
Ghalili & Amella, 2005). year 2025 (Ziliak et al., 2008).
Marasmus, kwashiorkor, and mixed Several contemporary practice perspec-
marasmus–kwashiorkor originally described tives underscore the significance of nutri-
the subtypes of malnutrition associated with tion research in the elderly. In gerontology,
famine, and these terms eventually char- malnutrition is a recognized geriatric syn-
acterized disease-related malnutrition. An drome, a clinical condition that does not fit
International Guideline Committee was orga- into discrete disease categories (IOM, 2008).
nized to develop a consensus approach to Frailty is also recognized as a distinct syn-
defining adult (including older adults) malnu- drome that can lead to disability (Fried
trition in clinical settings (Jensen et al., 2010). et al., 2001). Malnutrition (Morley, Perry, &
Inflammation is the cornerstone of the new Miller, 2002) and unintentional weight loss
adult-disease-related malnutrition subtypes (Fried et al., 2001) are contributing factors
and include starvation-related malnutrition to frailty. Nutrition issues in older adults
(without inflammation), chronic-disease- with advanced dementia center on eating
related malnutrition (with chronic inflam- and feeding challenges. The use of tube
mation of a mild to moderate degree), and feedings in older adults with advanced
acute-disease- or injury-related malnutrition dementia is ineffective (Sampson, Candy,
(with acute inflammation of a severe degree; & Jones, 2009), yet the practice continues
Jensen et al., 2010). As aging is considered (Teno et al., 2010).