Nutrition and Hydration in the Elderly

The elderly often show less interest in eating and weight loss can become quiet noticeable. They may also stop drinking as much - especially if they have problems with incontinence. In the face of advanced dementia and/or a terminal illness, this disinterest in food and drink can become even more pronounced. Family dinners become less of a social event and more a battle of wills as children focus their energy on what is being eaten and how much is being eaten. If there is extreme weight loss, artificial nutrition or hydration may be considered.

Before considering alternative methods of nutrition and hydration there are certain questions that need to be asked:

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• Has there been a swallow study (Modified Barium Swallow) done to rule out a physical problem which makes swallowing difficult? Muscle strength typically decreases as we age. This decrease in muscle strength can effect the muscles involved in swallowing. Strokes or TIAs ("mini"-strokes) can affect the muscle control needed to swallow effectively.
• Are ill-fitting dentures or poor dentition to blame for a decrease in eating? If dentures do not fit well, eating can become problematic and even painful. Chewing and eating can also be difficult if natural teeth are broken or missing.
• Is there a fear of drinking or eating because of problems with incontinence? The elderly often have problems with incontinence and may refrain from eating or drinking if they are afraid that they may have an "accident" or not have easy access to a bathroom when needed.
• Is depression a factor? Clinical depression can cause a lack of appetite which may result in weight loss. Depression can also cause a lack of interest in activities such as family dinners, eating out, etc.
• Are medications to blame? Many medications can cause a lack of appetite or make food "taste funny".
• Is dementia a factor? Elderly people with dementia may forget how to prepare food, how to feed themselves, or how to chew and swallow.
• Is a decrease in appetite the result of a terminal illness? One of the problems encountered with terminal illness is a natural decrease in hunger and thirst as the body prepares for death. Medical professionals should be involved in helping patients and their families to understand the disease process and its impact on nutrition and swallowing.

If alternative means of nutrition and/or hydration are being considered certain questions should be considered:

• Will alternative nutrition/hydration improve nutritional status?
• Will alternative nutrition/hydration decrease the risk of disease or prevent disease?
• Will alternative nutrition/hydration help to increase life expectancy?
• Will alternative nutrition/hydration improve the quality of life?
• Is alternative nutrition/hydration a short-term or long-term intervention?
• What are the risks involved with alternative nutrition/hydration?
• Are there any considerations if alternative nutrition/hydration is provided, but there is a "change of heart"?

All of these questions need to be considered very carefully before taking steps to pursue alternative means of nutrition. Professionals need to educate families on the benefits and contra-indications of tube-feedings, nutritional supplements, appetite stimulants, etc. before a decision is made. This education needs to be specific to the patient involved and take into consideration the overall medical condition of the patient.

Nutrition and Hydration in the Elderly

Susan Ross has been a speech pathologist for 33 years and has worked in a variety of settings. She is a lifelong learner who most recently received two ACE awards from the American Speech and Hearing Association for her efforts in pursuing continuing education opportunities. In addition to her clinical expertise, she has over 20 years of management experience in the geriatric care continuum (SNF, ALF, ILF, home health and wellness). She has received awards for customer service and retention, clinical programming, training and consulting, and employee retention.

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Sports Nutrition: Water - Hydration - & Athletic Performance

Every athlete has a different hydration requirement, which changes due to weather conditions. Generally, it is recommended that everyone drink 64 ounces of water a day to stay in a fully hydrated state. Sweating, which often occurs during physical activity, releases water and sodium from the body. To function at their peak, athletes need to replenish this loss through water and sports drinks. Neglecting to replace both fluid and sodium loss results in dehydration, which causes impaired mental focus, impaired energy metabolism, and an imbalance in electrolyte levels. It also results in rapid fatigue and decreased energy.

As a general rule, athletes should drink 16 ounces of water or sports drink 2 hours before activity. They should then consume another 8 ounces 30 minutes before activity. During an activity, fluids should be readily available for athletes as they need it. Coaches should watch for athletes expelling a higher-than-normal amount of sweat and ensure that the athlete is drinking as much as they need. It is recommended that athletes replenish half of the fluid lost by sweat.

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Athletes involved in short-term activity lasting over 30 seconds are at a high risk for dehydration due to the intensity of the activity. These athletes should drink the recommended fluids before their activity and replenish the lost fluids as soon after finishing as possible. Short-term activity lasting less than 30 seconds has little effect on dehydration and does not pose a hazard.

Athletes involved in long-term activity, such as running, cycling, and skiing for more than 30 minutes need periodic fluid intake to reduce dehydration levels, even though this may cause cramping and gastrointestinal problems. To prevent such problems, athletes should train themselves to take in the necessary liquid to accustom their bodies to the fluid.

During an activity, athletes should drink 8 ounces of fluid every 20 minutes. For activities over 40 minutes, water is not sufficient, because it does not provide the necessary sodium intake to maintain electrolyte levels. If water is all that is available, mixing 1 teaspoon of salt per liter of water is enough to maintain the balance.

Too much water can cause another problem, hyponatremia, when the sodium levels in the body are too low. Symptoms of hyponatremia are nausea, muscle cramps, disorientation, slurred speech, confusion, and inappropriate behavior. This occurs when there is an intake of water to replace lost fluids, but no intake of salt to replace lost sodium. Hyponatremia is much more dangerous than dehydration, and it is important that coaches monitor how much fluids are taken in to ensure that their athletes do not run the risk of suffering from this potentially life-threatening disease. The old method of "drink as much as you can" is now seen as dangerous because of the effects it can have in lowering sodium levels.

If your athletes are still unclear as to how much fluid to drink, there is a simple urine test that determines the hydration levels of a person. Athletes should have clear urine, showing that they are fully hydrated. If the urine is dark or there is restricted flow, the athlete needs more fluids. There is not a set amount for each person, so it is important that as a coach, you train your athletes to learn what their individual bodies need.

Sports Nutrition: Water - Hydration - & Athletic Performance

Kenny Buford spent years playing baseball at the college level. Today, he coaches 3 youth development teams and shares his extensive coaching knowledge on his blog, you can visit him here: http://www.baseball-tutorials.com

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