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Week 8: Team Presentations Critique a team presentation other than your own, and include what the presentation taught you and what is identified in the nutritional analysis. 2.  What changes in the presentation would you recommend? Why? 3. Ask questions! Each team is responsible for responding to questions asked of their presentation.  Remember to include sources of literature in your posts to back up the statements you make. Remember, we are all about evidence-based practice! APA format (6th ed.) and is free of errors        Grammar and mechanics are free of errors free of Plagiarism    References: Use your book, the outside source must be within the last 5 yrs, Scholarly Article or Nurse journals within the last 5 yrs Type out the questions and respond to the question in APA format with citation and very detailed responses Printed by: [email protected] Printing is for personal, private use only. 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No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. 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No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Printed by: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publishers prior permission. Violators will be prosecuted. Nutrition RUA The Aging Adult: Assisted Living Facilities Introduction This presentation seeks to highlight the nutritional needs for the aging adult in the setting of assisted living facilities. A few of these health considerations may include: Lack of taste or smell Decreased hunger or appetite Health care concerns Allergies Special diets Cultural backgrounds Personal preferences Our group, Jessica, Alexa, and Gabriel worked on this presentation with the purpose of comparing food choices that are selected in the South East Texas region for older adults (ages 65 and up) in assisted living environments. Assisted living facilities have a wide range of health considerations to evaluate when planning a menu for their residents. This can make menu planning especially difficult. Menu 1 This menu is from Bellaire Senior Living Facility. This area’s demographic is predominantly non-Hispanic White. As you can see there is a wide variety of options throughout the week for each meal. Striving to create a menu that can accommodate everyones preferences and other considerations. Most of the breakfast meals contain classic breakfast dishes that include a main protein option with additional sides to complete the meal. The lunch and dinner menus are very diverse with a variety of different protein choices including ham, pork, turkey, tilapia, meatloaf, chicken, and beef. These meals also include a rotating variety of vegetable side dishes and ending with deserts. Menu 1 Analysis Monday Breakfast The first meal of the day in this facility is high on simple sugars and fats with items such as french toast, hash browns, and bacon. Monday Lunch In the lunch menu, they are serving honey glazed ham, brown rice, parsley carrots, a baked roll, and pear crisps. Monday Dinner For dinner, a Philly Deli Sandwich is the entree, the sides are fresh fruit salad, roasted tomato, and steak fries. The food items in the breakfast menu are not good for the elderly population to eat, especially in the morning. The foods are high in simple sugars (added sugars) and fats which could help raise blood pressure, and increase the risk for heart disease. These types of foods are not good for a population that is already at a higher risk for heart disease. Furthermore the foods offered for breakfast are not nutrient rich. According to the USDA MyPlate for older adults, older adults need to focus on getting more potassium, calcium, vitamin D, B12, and fiber. (USDA, 2020) The food item for breakfast would have some of these nutrients, but not enough to be adequate. To improve this breakfast menu, it would be good to limit the added sugars and high fat sources. To do this, it would be beneficial to replace the french toast or hashbrowns with complex carbohydrate rich foods such as a fruit salad or whole grain meals such as oatmeal, and replace the bacon with a more lean choice of meat such as turkey bacon. LUNCH The lunch menu is much more balanced than the breakfast menu. It has a protein and fat source with the honey glazed ham, a source of whole grains from the brown rice, a fruit source from the pear crisp, and a vegetable source from the parsley carrots. However, it is missing a source of fat from dairy. This menu would benefit from finding a different way to flavor the ham. Honey glazed ham is ham (which is salty) that is covered in a glaze which is melted brown sugar mixed with honey. This makes the glaze very sweet and thus, has a notable amount of added sugars. This adds added sugars to the meal for the sake of palatability, though it is not detrimental a less sugary topping on the ham would be better. This is important because reducing added sugars are beneficial for the elderly populations health. DINNER The dinner offered is not balanced. It gets its protein source from the sandwich meat, grains from the sandwich bread and fries, its vegetable source from the roasted tomato, and its fruit source from the fresh fruit salad. It is not balanced because the meal lacks a source of whole grains and in effect, missing a major source of dietary fiber. This meal would benefit from the use of whole wheat bread for the sandwich bread. Whole wheat bread contains whole grains, which would makes this meal much more balanced. As for the french fries, the frying method of cooking adds saturated fats and sometimes trans fats into the food being fried. To mitigate this downside, baking the foods would help. FURTHER ANALYSIS For a full day this diet is close to providing adequate nutrition and is close to being well balanced; it just needs improvement Another flaw of this diet is that it seems that most of the protein sources available are meat based, which excludes dietary patterns such vegetarianism, veganism, etc. This diet is appropriate in the cultural context, as the population of this elderly home is mostly non-hispanic white. This diet is also appropriate for the age group of the population, they mostly have palatable foods that help with the decreasing taste buds of the elderly population, and they provide nutrients that are essential for the elderly. Menu 1 Sample Replacement Breakfast -2 eggs, whole grain cheerios cereal, mixed fruit, low fat milk, (water and either a coffee or orange juice) Lunch -Vegetable Beef soup, whole grain bread, watermelon, banana cream pie yogurt, (water/ tea) Dinner -Salmon, lemon basmati rice, Spinach, Sugar-Free chocolate pudding (water/ tea) Our sample menu uses information from MyPlate.gov to consider the unique considerations for healthy eating for individuals 60 years and older. Food choices with little to no added sugar, saturated fats, and sodium are optimal as the older adult is at a higher risk for chronic diseases such as diabetes, hypertension, and heart disease.Aging and certain medications can impair vitamin B12 absorption. Our menu seeks to provide enough protein and fortified foods (such as fortified cereals), to help our target demographic get enough vitamin B12 and help them maintain a healthy weight, (which also can be hard for the older adult). We have added beef soup, salmon, low fat milk and yogurt to promote sufficient B12 intake, bone health, and omege 3 fatty acids, and foods rich in vitamins and minerals. The yogurt is a good option because it is a good protein source but there are many flavorful option to encourage the older adult to eat who may have diminished tastes. Our sugar free dessert of chocolate pudding, salmon, rice, eggs, spinach, watermelon, soup and yogurt were all specifically chosen, after reviewing elderly.gov, so that each meal had foods that soften easily and would not limit any residents who have dentures or difficulty chewing. Sodium and sugar was also limited to avoid interactions with hypertensive and diabetic residents. Reference: Menu Planning for People with Chewing Difficulties. (2018). Department of Health. Elderly Health Services. https://www.elderly.gov.hk/english/carers_corner/diet/menu_planning_elders.html Using the Nutrition Facts Label: FOR OLDER ADULTS. (2020). MyPlate U.S. DEPARTMENT OF AGRICULTURE. https://www.fda.gov/media/135599/download Sample Menu Considerations for the Older Adult Recommended Nutrients for the Older Adult (60+) - Dietary Fiber is 28 grams (g) per day. -Calcium is 1,300 milligrams (mg) per day. -Vitamin D is 20 micrograms (mcg) per day. -Potassium is 4,700 mg per day *Based on a 2,000-calorie daily diet* Calorie needs may be higher or lower depending on age, sex, height, weight, and physical ability. Many older adults do not get the recommended amount of fiber, potassium, calcium, and vitamin D. The average older adult uses a variety of medications, some of which can lead to constipation or irregular bowel movements. Intake of fiber-rich foods may reduce this risk of constipation and help prevent cardiovascular disease. Calcium-rich diets reduce the risk of weak bones (such as osteoporosis). Vitamin D is important for calcium absorption, is essential for bone health, is involved in hormone production and immune and nervous system function. Potassium contributes to fluid balance, heart rhythm, muscle contraction, and nerve transmission. Reference: Menu Planning for People with Chewing Difficulties. (2018). Department of Health. Elderly Health Services. https://www.elderly.gov.hk/english/carers_corner/diet/menu_planning_elders.html Using the Nutrition Facts Label: FOR OLDER ADULTS. (2020). MyPlate U.S. DEPARTMENT OF AGRICULTURE. https://www.fda.gov/media/135599/download Comparison Breakfast Instead of french toast, hash browns, and bacon whole grain cheerios and low fat milk would be a better option Instead of the raisins, mixed fresh fruit would be better Lunch When comparing the honey glazed ham to a beef and vegetable soup, the beef and vegetable soup would yield more protein and carry much more nutrients while delivering very little added sugars. The watermelon is much more nutritious than the pear crisp in the original menu The banana cream yogurt adds what was missing in the original menu: a dairy food source and is a good source of probiotics (essential for gut health ). Instead of french toast and hash browns, whole grain cheerios and low fat milk would be a better option. The low fat milk would provide some fats and the nutrients that milk offers, and the whole grain cheerios would provide whole grains which are rich in dietary fiber. This would be a better choice because the low fat milk would deliver nutrients whilst delivering fat, and the cheerios would deliver nutrients that a whole grain would deliver and has much less sugar than french toast. Instead of raisins, mixed fruits would be better. While raisins have nutritional value, the drying process lessens its nutritional density. According to Sadler, et al., (2020) the drying process of raisins creates a net loss of vitamin C and other nutrients. In the lunch menu, When comparing the honey glazed ham to a beef and vegetable soup, the beef and vegetable soup would yield more protein and carry much more nutrients while delivering very little added sugars. It is much more nutritious because the broth catches the cooked away nutrients and the vegetables in the soup provide their nutrients as well.With The soup, you get protein, carbohydrates, vitamin a and c, calcium, etc. The watermelon is much more nutritious than the pear crisp in the original menu. This is because it is in its natural form with water and carbohydrates. The watermelon is a very hydrating food that can help elderly population who have a decreased sense of thirst. The banana cream yogurt adds a dairy source in the diet. Dairy products are rich in calcium and provide necessary fats. They are even associated with a lower risk of myocardial infarction, according to Kvist et al., (2020). Comparison contd. Dinner The salmon and lemon basmati rice combination is a much better combination than the philly deli sandwich The spinach is a good alternative to the roasted tomato because of its iron content, but the roasted tomato is a good option The sugar free chocolate pudding is a highly palatable food item that does not significantly add any added sugars. The salmon and lemon basmati rice combination is a much better combination than the philly deli sandwich. It is better because the protein source is from a salmon, which is rich in vitamin B12 and omega 3 fatty acids, and the carbohydrate source contains whole grains. On top of that, these foods are easier on the elderly who have dentures. The spinach is a good alternative to the roasted tomato because of its iron content, but the roasted tomato is a good option. They both are excellent choices for a vegetable. The sugar free chocolate pudding is a highly palatable food item that does not significantly add any added sugars, while the steak fries in the original menu has a lot of calories without any nutritional benefit. FURTHERMORE The menu put together is better than the original Each food item has much more nutritional value and was chosen with the nutritional needs of elderly people in mind (more K, Ca, Vitamin D, Dietary Fiber) The menu also keeps the taste of the food good, without increasing the added sugars Menu 2 This sample menu is from Carrington Court Assisted Living. Menu 2 analysis Monday Breakfast The monday breakfast offers hot/cold cereal or pancakes; a fruit; eggs/breakfast meat/breakfast potato; toast/muffin/pastry; margarine/jelly Lunch The lunch menu offers the choice of the soup of the day and an enchilada or hamburger tot casserole; Refried beans or tater tots; a fruit; red white green salad; butter milk biscuit or butter biscuit; and for desert: Long Johns (doughnut) Dinner The dinner menu consists of soup of the day and beefeater dip or the choice of chicken noodle soup casserole; mashed potatoes with gravy; corn on the cob; cranberry bread or butter bread; a cupcake for desert The monday breakfast offers hot/cold cereal or pancakes The cereals are nutritious, but the belgium pancakes are not. The cereals are nutritious because cold cereal is typically whole grain cereal mixed in with low fat milk, and hot cereal consists of boiled whole grains mixed in with low fat milk. The whole grain cereals are rich in whole grains and dietary fiber. The pancakes are made from a batter, which is a processed food. The processing strips some of the nutritional value of the original product. The breakfast menu als offers eggs, breakfast meat, or a breakfast potato. The eggs and the meat are good sources of lean protein for the meal. The potato does not meet this criteria, as it is mostly composed of starchy carbohydrates. The toast/muffin/pastry and the margarin/jelly is not a good carbohydrate source. They do not contain any whole grains and are largely nutritionally deficient. A good replacement for this would be fruits or vegetables, as they contain plenty of nutrients and fibers necessary for a balanced meal. The menu does come with a fruit. Fruits are a good source of vitamins and minerals along with dietary fiber. Lunch The lunch menu offers the choice of the soup of the day and an enchilada or hamburger tot casserole; Refried beans or tater tots; red white green salad; butter milk biscuit or butter biscuit; and for desert: Long Johns (doughnut). The main entrees (soup fo the day and enchilada, or the hamburger tot casserole) are high in saturated fat, high in sodium, and nutritionally deficient foods. They would be better replaced with a leaner meat such as a grilled pork loin or white meat from a chicken, as those are minimally processed and are lean protein sources. This meal is not balanced because it is very high in fat, lacks whole grains, and lacks a good source of dairy. The tater tots and the refried beans are high fat foods that offer little nutrition due to processing; these food options are better off omitted or replaced with a yogurt. The red white green salad is a great and healthy food selection. It includes a fruit in the form of apples and a vegetables in the form of green beans. It is a great source of nutrients and dietary fiber. The buttermilk biscuit/ butter biscuit is a high fat, high carbohydrate food that has low nutritional value. These would be better replaced with whole grain bread or a form of whole grain biscuit with minimal toppings. Lastly, the Long Johns, which is a a long donut, is a high fat, high carbohydrate, and nutrient deficient food. This is better to be replaced with a sugar free pudding, which has equal palatability, easier to digest, and does not have the needless calories. Dinner The dinner menu consists of soup of the day and beefeater dip or the choice of chicken noodle soup casserole; mashed potatoes with gravy; corn on the cob; cranberry bread or butter bread. The entrees would be better replaced with a leaner source of protein, less salty option, and a more nutritionally dense option such as cabbage and beef soup with reduced sodium. The sides like the bread have sugary or fatty toppings that add unnecessary simple sugars to the meals; the bread would benefit the meal if they were whole grain. These sides would be better for the meal if they were replaced with whole grain bread or whole grain cereal. The cupcake is also a high fat, nutritionally deficient food. It is best replaced with a sugar free option or a yogurt. Good foods to replace this to make it more balanced are fruit yogurts or sugar free puddings that are flavored. Menu 2 Sample Replacement Breakfast Whole grain biscuit, orange slices, turkey sausage links, full fat yogurt, water or fruit juice Lunch Grilled pork loin, pinto beans, low fat milk, green beans, apple sauce (no sugar added) Dinner Garlic Herb Chicken, spinach and tomato salad, Brown rice, french vanilla yogurt, and chopped bananas Once again for this menu, the information utilized was from the USDA’s MyPlate.gov website. We used this to structure the meals to fit the needs of the populations that is 60 years and up. The emphasis was on whole grain sources of carbohydrates, consumption of adequate fruits, vegetables, lean protein sources, and dairy products with each meal. The emphasis on lean meats and nutritionally dense foods are because of the need of the aging population need plenty of potassium, vitamin D, calcium, and B12. (USDA, 2020) Reference: Menu Planning for People with Chewing Difficulties. (2018). Department of Health. Elderly Health Services. https://www.elderly.gov.hk/english/carers_corner/diet/menu_planning_elders.html Comparison Breakfast Instead of the eggs/meat/potato brown and the toast/muffin/pastry, rice and beans would be a better option Instead of the margarine/jelly, applesauce would be a more nutritious option yogurt is in the meal to have a dairy source Lunch Instead of the high in fat options such as the soup of the day and enchilada or hamburger tot casserole, the grilled pork loin would be a better option Instead of the refried beans or tater tots, a whole grain biscuit would be more nutritious. Instead of the red green white salad, green beans and corn could be easier consumed by certain populations Orange slices would be much more nutritious and fiber delivering than the buttermilk/butter biscuits Breakfast Instead of the eggs/meat/potato brown and the toast/muffin/pastry, rice and beans would be a better option. This is a better option because beans are an excellent source of protein and brown rice is a whole grain food and is rich in fiber. Instead of the margarine/jelly, applesauce would be a more nutritious option. Apple sauce is a highly palatable food that delivers the nutrients that an apple would, while staying easy to eat. This is friendly towards elderly people with dentures. Full fat yogurt is in the meal to have a dairy source. According to the USDA MyPlate, dairy foods are a good way to deliver life sustaining nutrients. (USDA, 2020) Lunch Instead of the high in fat options such as the soup of the day and enchilada or hamburger tot casserole, the grilled pork loin would be a better option. This is a better option because it is leaner and helps the person reduce saturated fat intake, which could lower risk for heart disease. Instead of the refried beans or tater tots, a whole grain biscuit would be more nutritious. This is more nutritious option and is more conducive to a balanced meal because it contains whole grains which can carry dietary fiber whilst providing carbohydrates to the body. Instead of the red green white salad, green beans and corn could be easier consumed by certain populations Comparison contd. Dinner Garlic herb chicken would better suit a balanced diet than the original dished (soup of the day and beefeater dip or chicken noodle soup casserole) The spinach and tomato salad would be a good alternative for the corn on the cob The brown rice would be a better option than the mashed potato and gravy The chopped bananas would be a more nutritious option than the cranberry/butter bread The french vanilla yogurt would be a better dessert than the cupcake Garlic herb chicken would better suit a balanced diet than the original dished (soup of the day and beefeater dip or chicken noodle soup casserole). The garlic herb chicken is a leaner source of protein and does not have too much salt like the casserole. The spinach and tomato salad would be a good alternative for the corn on the cob. The corn in the cob is a good option for a nutritious vegetable, but the spinach nd tomato salad would provide more nutrition. The brown rice would be a better option than the mashed potato and gravy. It would make a much better option because brown rice is a while grain food; the mashed potato and gravy is processed, has high fat, and is nutritionally deficient. The chopped bananas would be a more nutritious option than the cranberry/butter bread. The chopped bananas would be a better option because it has had minimal processing, meaning that it contains much more nutrients than a cranberry flavored bread, which is processed and likely has little nutrients left. The french vanilla yogurt would be a better dessert than the cupcake. The french vanilla yogurt is better than the cupcake because it provides a dairy source. Comparison contd. The menu we have put together is much better than the original within the context of the MyPlate standards Overall, the food is leaner, contains less salt, more diverse, easier to eat, and has more dietary fiber. Our menu is more tailored toward the elderly populations than the original menu in palatability, nutritional value, and how easy it is to eat. Barriers Barrier 1: Appetite loss It is common as the body ages that our sense of taste begins to diminish or even disappear Barrier 2: Difficulty Chewing or Swallowing Difficulty chewing or swallowing is a major barrier to overcome in the elderly population Barrier 3: lack of resources In the assisted living contect it can be very hard for individuals to acquire a balanced and nutrient dense food plan. Because of: The need for specialized diets Lack of funds Quantity of food needed Sustainability of the products Resident preferences As our bodies begin to age our senses begin to diminsh. In this case especially our taste and smell, which work hand and hand together. Throughout aging the number of taste buds we have decreases, and the remaining taste buds also shrivel up. Saliva also helps in our ability to taste appropriately. A combination of these conditions and other considerations including the social ascept of eating, medications or side effects, diseases, smoking, and enviromental toxins can drastically affect the ability of our bodies to taste. As we age the body naturally declines in its energy and caloric intake requirements to sustain life and all the bodies fucntions, consequently this directly impacts a persons desire to eat contributing to our loss of appetite. BARRIER 1 As we age the body requires less caloric intake therefore decreasing the appetite Other factors that are included are: Lonliness Medication side effects and interactions Diseases and commorbidities Since this loss of taste many try to add flavors by adding more unneccessary ingredients to their diets such as added sugars and salts. BARRIER 2 Difficulty chewing and swallowing is a major barrier to overcome in the elderly population Many aging adults may have suffered from strokes and other life altering conditions which changes the ability to swallow and chew foods appropriately This can cause eating to be a very stressful and anxiety filled task for some individuals because of the possible complications that aspiration can cause such as aspiration pneumonia To help counteract this complication many aging adults are placed on a softened food, pureed food or thickened liquid diet However, while this provides a solution to the difficulty of swallowing and chewing many dislike the food options that are available further decreasing the desire to eat. BARRIER 3 In the assisted living contect it can be very hard for individuals to acquire a balanced and nutrient dense food plan. Because of: The need for specialized diets Lack of funds Quantity of food needed Sustainability of the products Resident preferences Teaching Points -Quality is more important than quantity when it comes food choices for the older adult. -The aging adult should aim to eat healthier while staying within calorie needs. -Encourage high protein meat alternatives. -The older adult requires an increase in vitamin D and calcium to maintain bone health. -Overall: A healthy eating plan emphasizes fruit, vegetables, whole grains and low-fat or fat-free dairy; includes lean meat, poultry, fish, beans, eggs and nuts; and is low in saturated fats, trans fats, salt (sodium) and added sugars. -As adults age, their caloric requirements decline, but some nutrients, especially calcium and vitamin D, increase. For a healthy eating plan, choose more nutrient-dense foods from the MyPlate food groups regularly. -Extreme or fad diets can to dangerous nutrient gaps. Losing weight quickly results in a loss of lean, healthy muscle mass, which older people need to stay healthy. -Many older adults do not get the protein they need to maintain muscle mass, fight infection, and recover from an injury or surgery. Meat and other proteins may also be difficult to chew for some older adults. -a tip to help meet these needs is select calcium-rich foods and beverages and aim for three servings of low-fat or fat-free dairy products each day. Summary The elderly population have certain needs that need to be met for optimal health when it comes to their diet It is often difficult to meet these needs without proper resources The elderly population have certain needs that need to be met for optimal health when it comes to their diet. They need to have a balanced diet that is minimal in added sugars and saturated fats, fruits and vegetables are very much a need due to its nutritional value. As seen by the two menus, the nutritional needs of the elderly are not met entirely. This is because it is difficult to meet these needs whilst keeping it economical. References Menu Planning for People with Chewing Difficulties. (2018). Department of Health. Elderly Health Services. https://www.elderly.gov.hk/english/carers_corner/diet/menu_planning_elders.html Sadler, M. J., Gibson, S., Whelan, K., Ha, M.-A., Lovegrove, J., & Higgs, J. (2019). Dried fruit and public health—What does the evidence tell us? International Journal of Food Sciences & Nutrition, 70(6), 675–687. https://doi.org/10.1080/09637486.2019.1568398 Using the Nutrition Facts Label:FOR OLDER ADULTS. (2020). MyPlate U.S. DEPARTMENT OF AGRICULTURE. https://www.fda.gov/media/135599/download Kvist, K., Laursen, A. S. D., Overvad, K., & Jakobsen, M. U. (2020). Substitution of Milk with Whole-Fat Yogurt Products or Cheese Is Associated with a Lower Risk of Myocardial Infarction: The Danish Diet, Cancer and Health cohort. The Journal of Nutrition, 150(5), 1252–1258. https://doi.org/10.1093/jn/nxz337