Written by Caryn Straker
In our last article, GERACARE: The Trans-disciplinary approach to optimize quality of life, we introduced the Geriatric Giants, those factors that cause the biggest decline in the functionality of the ageing person. These five Geriatric Giants are: Impaired Homeostasis, Confusion, Falls, Incontinence and Iatrogenic Disorders. In this article we are going to look at impaired homeostasis in more detail and specifically how it affects older persons.
Impaired homeostasis (or homeostatic imbalances) can be described as a condition in which the human body’s internal environmental variables become disturbed. It can be caused by a number of factors which include the aging of the person’s organs and the organ’s control systems or feedback mechanisms, external disruption, such as hot weather, or an internal disruption, such as a fall in blood glucose levels.
These resulting imbalances can manifest in a variety of ways that can hugely impact on the older person’s wellbeing and functionality. Common problems such as confusion, irritability, aggression, anxiety, listlessness, delirium, increased heartbeat, low blood pressure, fast breathing, decreased urine output, constipation and falls can be a direct consequence of a homeostatic imbalance. Dehydration or electrolyte imbalance, low oxygen levels, low blood glucose levels or malnutrition can all be reasons for the neurological and physical symptoms so many older persons present with on a daily basis.
Dehydration, low blood glucose levels and malnutrition are just some of the homeostatic imbalances that can be prevented by simple measures.
Dehydration
There is often emphasis placed on the importance of vitamins and minerals in the diet, but the importance of water is often not mentioned. Approximately 50 to 60% of the human body consists of water, our most important nutrient. Dehydration is potentially a very dangerous problem in older persons that could easily be prevented.
A decreased thirst sensation is one of the body changes that go hand in hand with the aging process. It can lead to an inadequate fluid intake as one does not feel thirsty. Older persons are further at risk for dehydration as they have a smaller percentage of water in the body. This is due to lower muscle mass and the kidneys which are limited in their ability to retain water. Older persons with diarrhea or a fever have an even bigger risk for dehydration. Medication like diuretics and laxatives also contribute to further loss of fluid from the body.
A 10% decrease in body water can lead to serious medical problems, while a 20% loss in body water can be fatal.
To prevent dehydration in older persons the following guidelines should be followed:
- Older persons should be encouraged to drink at least six to eight glasses of fluid daily.
- A minimum of 1500ml of fluid should be taken in unless there is a fluid restriction in place due to heart or kidney disease.
- Water is the drink of choice but tea, coffee and fruit juice can also contribute to total fluid intake.
- Soup can also be served as part of a meal to increase fluid intake.
It is very important that records should be kept of the fluid intake of frail residents in care homes. Staff should be enouraged to document fluid intake accurately – in other words only to document what fluid is actually drunk. This makes it far easier to determine how much fluid someone has taken in and if additional measure are required.
Low blood glucose levels
Low blood sugar levels in the older person are usually caused by the following:
- missing a meal or snack
- not eating enough low GI carbohydrate foods
- delaying a meal or extended periods without eating
- over administration of insulin or diabetic medication
- vomiting and diarrhea
Older persons often have a smaller appetite and don’t eat much at mealtimes. Poor or inadequate intake may be further exacerbated by restricted food options in residential or care facilities. Often these older persons may not be able to chose what they eat and diabetic meals are often bland and unappealing with no choice of dishes. Where possible residents should be offered a choice of main courses and cooks preparing special diets need to be properly trained to ensure they are serving nutritionally appropriate yet visually appealing and tasty meals.
The type of carbohydrate served will also influence blood sugar control. Meals provided should preferably be based around low GI carbohydrates with adequate protein to help control blood sugar levels.
If there are long periods between meals, a suitable snack should be offered. This is especially important at night where there is often a 14-15hr gap between supper and breakfast the next morning.
Malnutrition
World-wide, the elderly population is increasing, and with it, the prevalence of malnutrition. Data from around the world estimates that nearly 40% of hospitalized elderly and 50% of those in rehabilitation facilities are malnourished, and 86% are either malnourished or at risk for malnutrition. Up to 67% of elderly in nursing homes are malnourished or at risk for malnutrition. Of elderly living in the community, 38% are malnourished or at risk of malnutrition.
There are many different causes of malnutrition and one often leads one to another; here are just a few examples.
- Physiological – denturesthat do notfit properly, loss of teeth, difficulty handlingutensils, decrease insense of smell andsense of taste, reduced secretion of saliva, leading to dry mouthand difficultyswallowing, decreased appetiteandthirst sensation, dementia, etc.
- Psychological -depression, anxiety abouthealth, future, finance,loss ofloved ones, loneliness, etc.
- Pharmacological – medicationsandfoodnutrientinteractions
As mentioned malnutrition is one of many homeostatic imbalances that can occur. It is important that we screen our older population for malnutrition so that it can be addressed sooner rather than later.
Nutrition assessment is an integral part of GERATEC’s approach to the wellbeing of our older persons. The next article in this series is about Nutrition: from assessment to intervention, where we will look in more detail at nutrition screening for older persons.