With age, the independence of individuals can decrease, affecting their physical and mental health. People who maintain their autonomy, however, can also overlook problems that may occur as a normal part of aging or as an outcome of one’s changing health. Thus, it is vital to monitor older patients’ wellbeing as well as their awareness of preventive measures. In the present case, a 68-year-old woman is highly independent as she has no restrictions in mobility and can perform all activities of daily living (ADLs) by herself. Her height is 5’6,” and her weight is 120 lb, which makes her BMI 33.9 (National Heart, Lung, and Blood Institute, 2019). This number indicates obesity, a possible issue that may harm the patient’s future health. This paper will consider the screening tools for the client, her potential outcomes as well as nursing interventions and referrals to other specialists.
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To understand how the patient views her daily activity and nutrition, the nurse has to consider several tests. The first proposed screening tool is Seniors in the Community Risk Evaluation for Eating and Nutrition (SCREEN©). This test is developed specifically for older adults, and it can be used for communities with varying socioeconomic characteristics (Hamirudin, Charlton, & Walton, 2016). The tool includes questions about one’s frequency of eating, appetite, shopping and cooking, weight changes, digestion, food restrictions, and other crucial topics (Hamirudin et al., 2016). SCREEN© can help the nurse see whether the patient has any issue with eating or preparing food. Another tool to assess nutritional knowledge is the General Nutrition Knowledge Questionnaire (GKNQ), which contains questions about which foods are recommended by clinicians (Kliemann, Wardle, Johnson, & Croker, 2016). This particular test will show what the client knows about healthy dietary choices.
Physical exercise knowledge is another crucial factor in determining the patient’s problems. Resnick et al. (2008) suggest using the Exercise Assessment and Screening for You (EASY) instrument and show that it is helpful in the elderly population. The inquiries of this tool ask for information about the patient’s health and preparedness for an exercise program. Moreover, the test poses exercising as a positive addition to one’s daily living.
The client’s outcomes depend on her changes in wellbeing and her present health problems. The potential diagnosis of obesity may signify that the patient’s health will deteriorate. The first possible outcome is that the client has a poor understanding of nutrition and exercise, and her weight continues to grow without any muscle mass improvement. In this case, the patient can be at risk of diabetes and heart problems (Feinkohl et al., 2018). Feinkohl et al. (2018) also find a correlation between obesity and increased cognitive impairment. The first scenario presents the patient whose weight affects her cognition, cardiovascular system, and hormonal balance.
Another negative outcome is related to bone health affected by the patient’s weight and lack of physical activity. Shapses, Pop, and Wang (2017) argue that adiposity harms one’s bone density, leading to osteoporosis and increased fracture risk. Here, even if the patient’s weight remains stable, her possible muscle deterioration due to advanced age can change the adipose tissue mass and bring the dangers of low bone mineral density. The client’s mobility will decrease, and she will lose her independence in ADLs.
Both adverse outcomes can be combated with preventive and nonpharmacologic measures. For the first scenario, the initial intervention would be to see whether the patient’s weight is a serious problem or a part of the aging process. In this case, the discussed questionnaires have to be paired with a more reliable evaluation of the patient’s weight status than BMI. According to Cetin and Nasr (2014), the latter test does not always adequately measure older patients as their body changes muscle and fat distribution and mass. The second intervention has to improve the patient’s nutritional knowledge and advise her recipes that are healthy, affordable, and easy to make. Proper dietary choices are an essential measure of preventing malnutrition and promoting cardiovascular and cognitive health (Porter Starr, McDonald, Weidner, & Bales, 2016). Finally, the assessment of the patient’s current medication is another potential intervention that can reduce weight gain or help the patient lose weight (Porter Starr et al., 2016). Some medicines affect people’s weight and increase the risk of complications.
In the case of bone density-related problems, the solution is also to maintain healthy habits. Thus, the first intervention lies in nutritional education to ensure adequate consumption of protein, calcium, and minerals for bone health (Shapses et al., 2017). Second, exercising is a factor that can help the client avoid or deter frailty. Asp, Simonsson, Larm, and Molarius (2017) recommend adding resistance exercises to one’s daily schedules because this type of activity is not too demanding while targeting fat reduction and muscle strength. Finally, bariatric surgery can be a solution if the patient’s health starts rapidly worsening (Asp et al., 2017). Overall, preventive efforts should be considered first before choosing more invasive procedures.
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Weakness and Referrals
One of the potential weaknesses in the client’s life is the fixed income that only allows her to lead a modest lifestyle. Laraia, Leak, Tester, and Leung (2017) find correlations between eating behaviors, food choices, and low income. The authors state that consumption in households with limited resources is linked to stress and poor sleep (Laraia et al., 2017). Therefore, one may assume that the client’s finances restrict her ability to eat healthy food and pay significant attention to getting enough nutrients.
To deal with the problems listed above, the client can benefit from visiting certain specialists. The first referral would be made to a dietitian who can evaluate the client’s current health and living conditions and create a more detailed plan for her nutrition. Second, a specialist in geriatric healthcare should be included in the list of referrals since this clinician may find other underlying problems in the patient’s case. Finally, a referral to social services will evaluate the patient’s environment and current support systems.
The presented case describes a client who is confident in her independence and mobility. Her health seems to be under control, but the high BMI results raise some potential risks to her wellbeing. To assess the client’s condition, one has to consider nutrition and activity education screenings, including SCREEN© and EASY. Some outcomes of obesity may include cardiovascular problems, diabetes, and osteoporosis. Nursing interventions have to establish whether the client has issues with body mass and muscle tone, provide education, and see which lifestyle changes are possible. Pharmacological and surgery options may not be as safe for the patient due to her weight, and preventive care should be the focus of the nurse’s program.
Asp, M., Simonsson, B., Larm, P., & Molarius, A. (2017). Physical mobility, physical activity, and obesity among elderly: Findings from a large population-based Swedish survey. Public Health, 147, 84-91.
Cetin, D. C., & Nasr, G. (2014). Obesity in the elderly: More complicated than you think. Cleveland Clinic Journal of Medicine, 81(1), 51-61.
Feinkohl, I., Lachmann, G., Brockhaus, W. R., Borchers, F., Piper, S. K., Ottens, T. H.,… Spies, C. (2018). Association of obesity, diabetes and hypertension with cognitive impairment in older age. Clinical Epidemiology, 10, 853-862.
Hamirudin, A. H., Charlton, K., & Walton, K. (2016). Outcomes related to nutrition screening in community living older adults: A systematic literature review. Archives of Gerontology and Geriatrics, 62, 9-25.
Kliemann, N., Wardle, J., Johnson, F., & Croker, H. (2016). Reliability and validity of a revised version of the General Nutrition Knowledge Questionnaire. European Journal of Clinical Nutrition, 70(10), 1174-1180.
Laraia, B. A., Leak, T. M., Tester, J. M., & Leung, C. W. (2017). Biobehavioral factors that shape nutrition in low-income populations: A narrative review. The American Journal of Preventive Medicine, 52(Suppl_2), S118-S126.
National Heart, Lung, and Blood Institute. (2019). Calculate your body mass index. Web.
Porter Starr, K. N., McDonald, S. R., Weidner, J. A., & Bales, C. W. (2016). Challenges in the management of geriatric obesity in high risk populations. Nutrients, 8(262), 1-16.
Resnick, B., Ory, M. G., Hora, K., Rogers, M. E., Page, P., Chodzko-Zajko, W., & Bazzarre, T. L. (2008). The Exercise Assessment and Screening for You (EASY) tool: application in the oldest old population. American Journal of Lifestyle Medicine, 2(5), 432-440.
Shapses, S. A., Pop, L. C., & Wang, Y. (2017). Obesity is a concern for bone health with aging. Nutrition Research, 39, 1-13.