M.E. is an 83-year-old widowed female who has been referred to you by a local community outreach program. She lives in a small apartment within a government-subsidized public housing unit. Her apartment has cooking facilities, but they are limited. It is somewhat like a kitchenette. She has a small half cook-top with space for heating two pots and a small refrigerator-freezer. The kitchen area has very limited cabinet storage space. She makes all of her meals at home and eats by herself. She used to look forward to eating meals but recently she has noticed that food is not as easy to swallow and that it sticks to her throat. Since this has happened she decided to cook her food longer to make it softer and easier to swallow. Additionally, M.E. rarely consumes meat due to the recent swallowing and throat issues.
She reports feeling extremely tired and drained on many days. When she does not feel up to preparing a regular meal, she just pours herself a quick bowl of cereal with milk. She enjoys a good variety of canned fruits and vegetables. She uses canned types because of the price differences versus frozen or fresh fruits and vegetables and because the canned types are already softer and easier for her to swallow.
M.E. purchases her groceries at a nearby market within a half-mile of her apartment. Before she started feeling tired and drained; she previously walked to the grocery store and rode the bus home with her bags in hand. Now that she feels tired on most days she no longer walks to the store. Therefore, she rides the bus both ways for her groceries (approximately) every 3 days. She has made it a habit to go to the store about 2 times per week so she can handle the bags and so there is enough storage space in the cabinets and refrigerator.
Before the recent swallowing and energy level changes, she has always been considered in the healthy weight range per her BMI. This may be partly due to her previous bi-weekly walking routine to the store. However, recently she has noticed that her clothes are loose and at her last check-up the nurse told her she had lost weight. M.E. is now worried about her overall health status due to her recent weight loss, changes in swallowing, and decreased energy levels. She wants to know if a nutrition supplement may help her regain her prior energy levels and an overall feeling of wellness.
What physical changes have influenced the clients food intake?
What are some socioeconomic or psychological changes that may be influencing her nutrition intake?
Could these changes be impacting her overall nutritional status?
Which nutrients are likely to be low in her diet? Why?
What are your general concerns about her physical condition? What are the implications of her recent weight loss? Are there any particular nutrients she may be deficient or low in?
How have her dietary practices and choices impacted her nutrition and health status? (Be specific.)
What are your nutrition recommendations? (Include estimated calorie needs, protein needs, menu changes, the recommendation or not of an oral supplement, e.g., a vitamin/mineral or oral drink nutrition supplement.)
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