Betsy Case Study
Betsy Case Study (4)
1. Body Composition
Aging is known to be accompanied by many body composition changes. Some changes will happen no matter what preventative steps are taken but all can be delayed. Some of the changes commonly seen are decreased muscle mass, decreased muscle strength, and increased body fat. All of these problems can be counteracted with resistance exercise and eating enough protein (Little & Phillips, 2009). A good diet including enough protein and some exercise won’t make you stay physically the way you were at 50, nothing can do that, but these two steps can help slow the body composition changes that happen with aging and even reverse it.
2. Two physiologic,two nonphysiologic facts impacting nutrition/health status
There are a couple of things that are happening here that need some attention. First, physiologically, you have lost eighteen pounds in the last year and you don’t have that weight to lose since you only started at 118 pounds. You are not eating enough to keep your weight stable, which should be our goal. Also, you haven’t seen a dentist in a while and that really needs to be scheduled to make sure that dental issues aren’t affecting your eating issues. Non-physiologically, your test results on mental examination indicate some cognitive impairment. Have you been having difficulties staying on task and keeping things in your memory? This could be related to your reduced eating habits, or something else. We can figure it out – but the first thing you need to do is to eat more. Secondly, your loss of interest in everything you used to like to do sounds like depression to me. Would you consider seeing a counselor to talk about it and maybe consider some medication to help? If you regained your interest in activities your appetite might improve as well.
3. Two socioeconomic facts impacting nutrition/health status
I understand that you have a very tight income with being on social security and that probably is making buying food difficult. Do you think if you had access to more food choices or more money to spend on food you would eat more? Also, I understand your husband is doing the cooking, but he doesn’t really enjoy it. Would it make sense to have some meals delivered, like a Meals on Wheels program, or do some day visits to a senior center that can provide meals for both of you to give him a break? Or maybe he would like to take a class in low-cost, high nutritional value cooking? Also, we could look into whether there is any food available from a food bank or center that could add some variety into your diet.
4. Energy/nutritional needs comparison to age 40
One way to determine your energy needs is to do a measurement called resting metabolic rate (RMR) that will tell us how much you need to eat so you won’t lose weight (Lam, 2010). Although this rate is certainly less than when you were 40, because you are losing weight rapidly you do not appear to be eating enough to meet your current RMR. We need to keep up your lean body mass, so let’s figure out the minimum calories you need to be taking in a day to keep you from losing muscle you need to stay healthy. We can get a decent estimate using an equation where we put in your height and weight and activity level – we’ll use the weight we’d like to get you back to in order to make sure you’re eating enough and try to add in some simple resistance exercises to help build back some muscle mass.
5. Discuss two diseases with age risk. How can complications be reduced?
Two diseases that you are at risk for are depression and Alzheimer’s Disease. Depression does happen often in older age and can have a lot of different causes both psychological and physiological. Seeking treatment, including therapy and possibility medication, can reduce complications from depression. Because you are showing cognitive decline, you should have further testing to see if you are developing Alzheimer’s disease. There are pharmaceutical treatments for this disease as well that can slow the cognitive losses. It also makes sense to understand the future issues you may face so plans can be put into place. It may be that your lack of eating and weight loss is a complication from these two diseases and treatment will help address all of these problems.
6. What are at least two nutrition benefits provided by living in a senior center? Would you recommend Betsy and her husband consider this?
7. What are the ethical concerns for both Betsy and her husband, given her own personal rights as well as his concerns over her well - being?
Three issues specifically discussed by Mueller, Hook & Fleming that are present for this case are determining decision-making capacity, surrogate decision-making and recommending nursing home care (2004). It is clear from the fact pattern that Betsy’s husband is overwhelmed with her issues with eating and needs some sort of help in order to keep his wife from continuing to lose weight and become weaker and less healthy. However, this help should not come at a price of costing either his or her independence unless that is the absolutely necessary. This is particularly a problem given Betsy’s showing of cognitive decline, as she is less likely to be able to make solid decisions for herself and her husband could have to act as a surrogate.
8. What are the challenges with these dilemmas?
One particular challenge is the fact that both persons involved are elderly and may be unable to make clear decisions because of their own physical and mental decline. Additionally, some of these decisions involve very basic human individual rights, like freedom and self-care. However, as a professional involved in their care, it is essential that information provided or recommendations not gloss over the issues as quality of life during aging is a very important goal.
9. As a nutrition professional, what could you do to help resolve them?
The best thing I can do as a nutrition professional is provide as much solid information as I can in a form that the client (and her husband) can understand. It is also my job to make sure they have explored all of their choices in trying to solve the issues that are occurring, in relation to nutrition and health. Ultimately, it is their choice about what they do about these things while they age, but it is my job to make sure they are making these choices knowingly and are not aging more quickly due to ignorance or a solvable problem.
References
Lam, G. (2010). Energy needs of the elderly. Nutrition Educator. Retrieved from
http://lamgrace.webs.com/apps/blog/show/4733381-energy-needs-of-the-elderly
Little, J. P., & Phillips, S. M. (2009). Resistence exercise and nutirition to counteract muscle wasting. Applied Physiology Nutrition and Metabolism, 3495):817-28.
Meuller, P. S., Hook, C. C., & Fleming, K. (2004). Ethical issues in geriatrics: A guide for clinicians. Mayo Clinic Proceedings. 79(4):544-62.
