CASE STUDY 4 | CARE FOR OLDER ADULTS

Complete Parts I & II of this Case Study. Please type/print your answers.

Part I:

Mrs. Holden is a pleasant, older woman who comes to you for a nutrition appointment with her daughter, Leah. Her chart shows that she is 75 years old and has a history of Type 2 Diabetes(T2DM), hypertension and elevated cholesterol levels. Her primary care doctor referred her to you for unintentional weight loss. Her highest adult weight was 200 lbs. She now weighs 165 lbs, down 15 lbs in the past 3 months.

Leah explains that Mrs. Holdens husband passed away 6 months ago and this has been very challenging for her mother. She is now at home alone and the loss of companionship has been very tough on her. Additionally, she is still trying to learn how to take care of herself without her husband s support. Mr. Holden did most of the cooking and Mrs. Holden only knows how to make basic meals. Her children do prepare meals for her, but she is worried about being a burden on them.

Leah also mentions that Mrs. Holden is becoming more forgetful. A review of her pill box shows that she has not been taking her medications consistently.

Baseline Data (10/17/20):

Caucasian, female

Age: 75      Ht: 66 inches         Wt:  165 lbs     BP: 150/90 mm/Hg

Laboratory values (9/10/20):

HbA1c 8.8% (high)                 FPG Glucose 172 mg/dL (high)

Medications: Glypizide (diabetes), Olmesartan (high blood pressure), Atorvastatin (high cholesterol)

Diet history or relevant eating behaviors:

Frozen dinners, eating easily prepared foods such as cold cut sandwiches and canned soup, little meat, occasional healthy choices when her family cooks for her.

Physical Activity:

Very little, no organized or planned physical activity at this time

1. Calculate Mrs. Holdens BMI using her highest adult weight and today s weight. What BMI classifications correspond to these weights?

• Based on the Determining the Severity of Unintended Weight Loss resource from the Academy of Nutrition and Dietetic s Evidence Analysis Library, how would you interpret Mrs. Holdens weight loss? Explain your answer and show all relevant calculations.

• Do you think that further weight loss, at this time, is clinically indicated for Mrs. Holden? Why or why not?

• Using the Academy of Nutrition and Dietetics and Society for Nutrition Education and Behavior Position Paper on Food and Nutrition Programs for Community-Residing Older Adults, identify 4

factors that place Mrs. Holden at risk of malnutrition. 

• You realize that Mrs. Holdens blood pressure and HbA1c are still elevated, despite her weight loss. Identify 2 barriers to blood pressure and blood glucose management and offer suggestions for improving each.

• Are HbA1c targets for older adults with T2DM any different than targets for younger adults with T2DM? Justify your answer using any current article discussing the treatment of T2DM in older adults.

• Describe 4 specific nutrition-related topics or dietary modifications that you would discuss with Mrs. Holden and state why you chose those. 

• Why is physical activity harder for older adults like Mrs. Holden?

• Due to Mrs. Holdens age, explain 3 physiological factors that could possibly have an effect on her nutritional well-being?

1. What 3 vitamins/minerals should Mrs. Holden pay special attention to and why?  What recommendations would you give her in regards to these vitamins/minerals?

1. Explain 2 nutrition education resources developed specifically for older adults dietary recommendations that you could share with Mrs. Holden?

1. List three ways that you should modify your nutrition education when counseling older adults and explain why these modifications are necessary.

1. You speak with the family about Congregate Meals. Apart from the nutritional benefits of this program, what other benefits could the program provide Mrs. Holden? What are 4 other possible food programs that could aid Mrs. Holden in selecting and preparing her food?

Part II:

At her 6 month follow-up visit, Mrs. Holden is doing much better. She has been meeting with the dietitian on a monthly basis and her weight has stabilized. Today s blood pressure was 130/80 mm/Hg and her last HbA1c was 7.5 %. She has learned to cook a few meals and has also been participating in a congregate meal site. Both of these changes have allowed her to get foods from all food groups, including fruits, vegetables, and protein foods. Overall, Mrs. Holden reports increased quality of life, including more energy to do the things she loves.

1. What 4 topics would you address with Mrs. Holden regarding her progress? Why did you choose these topics?

1. Leah comes with questions about nutrition supplements such as Ensure and Ensure Plus that she has seen advertised for older adults on television. Do you think these products are clinically indicated for Mrs. Holden? Provide an explanation of why or why not.

1. What do you think the weight goal for Mrs. Holden should be at this time? Justify your response.

1. List 2 Food-Focused Goals for Mrs. Holden to work on before she sees you at your next visit? Why did you choose these goals?