Nutritional intervention for the elderly PPT

All unified intervention plans that are divorced from the elderly’s individualized eating habits, health foundation, and psychological needs are all ineffective. A 3-minute simple nutritional screening must be done before implementation, and then layered adjustments can be made before they can be implemented.

I have been working hard in a community nursing home for three years. In the first half of the year, I stepped on a hole that could go around the community twice. The one who impressed me the most was 72-year-old Aunt Zhang. At that time, the community issued a nutrition manual and asked the elderly to drink a glass of milk every day to supplement calcium. After drinking it for half a month, Aunt Zhang had diarrhea every day and lost 4 pounds. She secretly told us, "Isn't what you distributed not suitable for an old woman like me?" Later I found out that she was born with lactose intolerance and had never touched fresh milk for decades. We quickly changed the plan to 100ml of Shuhua milk and a small spoonful of sesame paste every day. After half a year, the bone density was measured and it was 0.02g/cm² higher than when she drank pure milk. It is precisely because I have fallen into the pitfall of "copying the guide but doing bad things with good intentions" that when I made this version of the PPT, I did not put the dietary pagoda on the first page, but first put a simplified version of the MNA micro-nutrition screening form - just 6 questions, such as whether the weight has dropped in the past three months, whether the meals have decreased, whether you can walk on your own, etc. Community volunteers and family members, even if they have not studied medicine, can complete the test in 3 minutes. The elderly are first divided into three categories: "normal nutrition, mild risk, and severe risk", and then talk about intervention.

At this point, some people may ask, should we follow the indicators or the wishes of the elderly? When our center held a seminar before, we had an argument about this matter once. Doctors from the nutrition department of a tertiary hospital belong to the "indicator school" and say that elderly people with hypoalbuminemia must supplement 20g of whey protein every day, otherwise their immunity will not improve and it is easy to cause infectious complications. ； But Lao Zhou, who has been the director of a nursing home for 12 years, belongs to the "life style". He said that many elderly people feel nauseated when they smell the smell of protein powder, and they don't even want to eat when they are forced to feed it. It is better to add two tea eggs and half a bowl of steamed eggs every day. Although the supplement is slow, the elderly are willing to eat, and the indicators will be stable in the long run. I included both views in the PPT. I didn’t say who was right or wrong. I just marked the applicable scenarios: the elderly who have just been discharged from hospital and are in the acute stage of the disease should give priority to following the indicators and improving their physical foundation first. ； Elderly people who usually take care of themselves at home and have no serious illness should give priority to their mood when eating. Even if the indicators are slightly off, there is no need to forcefully change their eating habits if they can eat and sleep.

Don't believe it, I have seen too many family members forcing the elderly to eat "healthy meals", which actually caused problems. Grandpa Li, who lives in Building 3 of our community, is 78 years old and has high blood pressure. His family members listened to popular science and told him to keep a light diet. He cooks white porridge with fried vegetables every day without adding more oil. He lost 8 kilograms in half a year. The last time he went downstairs, he could not carry two kilograms of apples. When he came to our center, his grip strength was measured at only 21 kilograms. He was already suffering from mild sarcopenia. Later, we adjusted the plan for the family members. Every meal must include a palm-sized piece of braised lean meat or three pieces of steamed fish. The old man likes to eat pickled radishes. He is allowed to eat half a plate at a time without completely prohibiting eating. After three months of adjustment, Grandpa Li gained 5 pounds in weight. Now he carries a vegetable basket to the vegetable market in the morning and can walk faster than the caregiver. I deliberately put this case into the PPT because I am afraid that people will equate "light" with "vegetarian and oil-free". The elderly have a slow metabolism and have higher protein needs than young people. If they drink porridge and eat vegetables every day, they will lose muscle faster than anything else.

I specially made a three-color distinction in the PPT, which is a bit like a traffic light: the blue block is for medical staff and community workers, and contains the intervention reference values ​​for different basic diseases and the applicable dosage of nutritional supplements, which is more professional.； The green blocks are for family members to see. They are all examples of home-cooked dishes. For example, how do elderly people with bad teeth stew meat until it is soft but not rotten? How do elderly people with diabetes mix grains with white rice to cook to slow down the increase in blood sugar? There is no need to memorize complicated formulas, just follow the instructions. ； The orange blocks are for the old man to see. They are all big pictures. The amount of meat he eats every day is matched with a picture of beef in the palm of his hand. The picture of an apple as big as his fist is matched with the picture of how much fruit he eats. There is no need to remember the grams, just look at the pictures.

To be honest, my biggest feeling after doing nutrition for the elderly for so long is that we should not regard the elderly as "patients who need to be corrected". How can they change the taste they have had for a lifetime? When we do nutritional intervention, to put it bluntly, we are "patching" their eating habits, making up for what is lacking, and not doing a major blood transfusion that "overturns the whole thing." Only when the elderly can eat comfortably can the effects be truly long-lasting. I didn’t put any grand summary on the last page. I just put a photo of an old man eating braised pork around the table, smiling with his eyes narrowed. Next to it was a line of small words: Eating well is better than anything else.