Transcription:
Malnutrition Awareness

Melanie Cole (Host):  Welcome to TVH Health Chat with Temecula Valley Hospital. I’m Melanie Cole and today, we’re discussing malnutrition. Joining me is Caryn Olson. She’s the Clinical Nutrition Manager at Temecula Valley Hospital. Caryn, it’s a pleasure to have you join us today. This is a really interesting topic. And I think one that doesn’t really get enough air time. It doesn’t get enough play and people don’t necessarily think about it and they don’t even always know what it is. So, start by defining malnourishment for us. What does it mean to be malnourished?

Caryn Olson, RDN, CNSC (Guest):  Malnutrition occurs when patients don’t eat enough calories or take in enough protein. This usually happens over a prolonged period of time which can result in weightloss and the weightloss results in decreased muscle and decreased fat stores, which in the elderly, can be especially concerning.

Host:  Well tell us a little bit about the elderly then. Are there certain populations that you can point to that have a higher incidence of malnutrition, risk factors? And if we have elderly loved ones, what are some signs that we might recognize that would tell us this person is not getting enough nutrients?

Caryn:  Certainly the elderly are at highest risk for malnutrition. Studies have shown that those age 85 or older, are at the highest risk. Things you can look for include are they losing weight when you take them to the doctor visits. Is their weight progressively decreasing? Are their clothes getting looser? Are they skipping meals or no longer eating their favorite foods? Are they starting to fall? Are they less steady on their feet? These can all be signs of malnutrition.

Host:  Tell us what happens in your body and specifically the bodies of our elderly loved ones when they are malnourished. What’s happening to them?

Caryn:  What happens in our elderly patients is as they lose weight, they lose muscle and with this muscle loss, comes a decrease in what we call functional status. Now functional status can mean something as simple as getting out of a chair and walking across the room. Being able to get out of bed by themselves. What we see here in the hospital in our malnourished patients, patients who were previously independent with what we call their activities of daily living. They could shower themselves; they could prepare meals for themselves; they could get out of bed by themselves. When they become malnourished, they can no longer do these things on their own. Sometimes they cant even get out of bed by themselves. They may require a walker, or they may require assistance with doing things that they were previously able to do. And this is because of that muscle loss that occurs from the malnutrition.

Host:  Caryn, why do some individuals that are malnourished have a higher incidence of hospital stays?

Caryn:  Well it all comes back to that weakness. Studies have shown that people who are malnourished actually stay in the hospital two days longer than somebody who isn’t malnourished. They have higher risks of developing infections. They are slower to heal wounds. And they have a two times higher risk of developing a pressure injury or a bedsore. So, we see this in the hospital like I said, where previously they were independent and then these elderly come in, they get sick, they lose a lot of weight, they lose a lot of muscle so it can take time to rebuild that muscle loss and strengthen their bodies to get back to where they were prior to their hospitalization.

Host:  People tend to think of someone with malnutrition as being very skinny and drawn but some of our elderly loved ones are heavy and maybe have comorbid conditions. Can you be overweight and still have malnutrition?

Caryn:  Most definitely. You can be obese and have malnutrition. I have had patients here. there six criteria that we look at when we are diagnosing malnutrition. We get an in-depth history from the patient. How long have they not been eating well? Are they skipping meals? How much are they actually eating? And over what period of time? We look at the percent weightloss in relation to the period of time that they lost that weight. And then here at Temecula Valley, our dieticians are extensively trained on what’s called a nutrition focused physical exam. So, we underwent special training to perform these exams where we assess patients for muscle and fat loss as well as potential vitamin and mineral deficiencies.

Host:  Well tell us a little bit more about your team of Registered Dieticians at Temecula Valley Hospital. Tell us how they’ve been trained? You just spoke about that a little bit. But tell us what that means and how do you work with patients? What are some of the treatments that you have available?

Caryn:  The Dieticians here have all be extensively trained. We attended many seminars. We actually hosted seminars here at our facility and we’re one of the first facilities in this region to start diagnosing malnutrition. We’ve done a lot of extra training and a lot of extra certification to make sure that we’re very competent in diagnosing our patients. Once a patient is diagnosed with malnutrition; we work with the patient and the patient’s doctor to determine what would be the best course for getting some good nutrition into these patients. Sometimes it might mean liberalizing their diet, making sure that they are able to order their favorite foods off our menu. A lot of times, it involves a protein supplement or a shake that will give them the extra calories and protein that they need to help their body recover.

Sometimes it might be that they need nutrition support if they are not able to eat by mouth. Nutrition support involves either feeding them through an IV or through tube in their stomach. So, that we can ensure that they are getting good nutrition to help with their recovery here in the hospital.

Host:  What precautions, you know you’ve given us what treatments are available and what signs to look for and what you do as far as an evaluation. But what about prevention? Because I think that would be our best defense against malnutrition and keeping an eye on our loved ones or anyone else, we think might be suffering from it. Is there a way to prevent it from happening?

Caryn:  Most definitely. I think in our elderly, a lot of them tend to live alone. So, checking in with your loved one, assisting with meal plans, maybe you make extra for your family that night and you take them a couple of meals over. You want to make sure that they have access to food and access to meals. Inviting your loved one over for dinner or breakfast and encouraging them to eat with friends. The elderly tend to eat alone and when you eat alone, you tend to not eat as much as you would if you were with a group.

Host:  So Caryn, what would you like the take home message to be? As you’ve given us good advice on possible prevention, treatment options, what would you like the take home message to be and if people have loved ones or patients they are concerned about and they want to get them to eat something; please also in this wrap up, cover some of the things you mentioned a few shakes and things. do you have any favorites. What foods do you think are calorie dense but filled with nutrients as well? Kind of wrap it up for us with your best advice and what you’d like us to know about malnourishment.

Caryn:  Well what I’d like everyone to know is that anybody can be malnourished. It does not matter how much you weigh. If you have a loved one that is not eating, that is losing weight, that you notice getting weaker; those could be signs of potential malnutrition. In terms of helping to prevent that malnutrition, if they’re not eating enough, if they’ve lost their sense of taste which happens in the elderly; trying to find things that they do like. Calorie dense foods and I will say we don’t restrict food in patients that are malnourished or potentially malnourished. Nutrition sometimes trumps therapeutic diets or the need to eat a heart healthy diet or a diabetic diet because if somebody is not eating anything that they do eat is going to be a help. So, with that being said, eating foods that are high in calories, things such as nut butters, avocados, letting them add cream soups. A lot of the elderly like soups but they tend to choose broth based soups so choosing a cream soup can be helpful. Whole milk instead of low fat or skim milk. Things like that can be helpful.

The other thing is to encourage protein shakes or oral supplements. I don’t particularly have a favorite. My favorite is the one that the patient will drink. So, there’s many options out there. You have Boost products, you have Ensure products, Carnation Instant Breakfast. Some of my patients even will make ice cream smoothies or ice cream shakes. At the end of the day, it’s about making sure that you’re getting adequate calories, adequate protein and adequate vitamins and minerals and with that being said, it’s also a good idea to take a multivitamin daily for the elderly who are at risk for malnutrition.

Host:  That’s really great information. Caryn, thank you so much. It was really usable information that people can look at their loved ones right now and say is this what’s going on and help them to see it and know what to do about it. And for more information, You can visit www.temeculavalleyhospital.com/services/nutritionalservices to get connected with one of our providers. That concludes this episode of TVH Health Chat with Temecula Valley Hospital. Please remember to subscribe, rate and review this podcast and all the other Temecula Valley Hospital podcasts.  Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. I’m Melanie Cole.