In This Issue

	National Nutrition Month
	If you answer yes to any of these questions, Hurley Elder Care Law can help
	Life Care Planning Goals
	The Nuts and Bolts Guide to VA Benefits

National Nutrition Month

	Each year the American Dietetic Association (ADA) designates March as National Nutrition Month. This campaign encourages the public to make informed food choices as well as develop sound eating and physical activity habits. These topics are particularly important to older adults. The combination of slowed metabolic rates and lower levels of physical activity means that most older adults tend to need fewer calories as they age. For example, there is about a 2% decline in metabolic rate per decade of age. Older bodies, however, still require the same or even higher levels of nutrients for optimal health outcomes.
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To attend our monthly Professionals’ Luncheon please call Louise Morris at 404-843-0121 or email her at lmorris@HurleyECLaw.com

If you answer yes to any of these questions, Hurley Elder Care Law can help.

		Has the elder been diagnosed with a mentally or physically debilitating disorder such as Alzheimer’s, Parkinson’s, ALS, stroke or a decline in functional capacity?
		Is the elder isolated due to the recent death of a spouse, or have family that either lives too far away or is too busy to provide adequate care?
		Is the elder soon to be discharged into a care facility or currently receiving in-home care?
		Does the elder have a variety of healthcare providers and need coordination and advocacy for quality care?
		Does the elder seem unusually concerned about costs of medication and services, indicating he or she may be having financial troubles?
		Does the elder have assets that fall between $50,000 and $400,000 – enough to finance a short stay in a care facility but not enough for an extended stay?
		Does the elder have a spouse whose financial needs must be considered in light of the elder’s medical condition?

Life Care Planning Goals

1. Meeting the elders’ immediate health care and long-term care needs.
2. Making sure the elder/family is making good health care and long-term care decisions.
3. Helping the elder/family sort through the maze of their long-term care options including residential options.
4. Identifying and accessing public benefits and resources to pay for care should the elder meet the qualifying criteria.
5. Help with asset management, including the burden of home ownership and personal property.
6. Providing the entire family the peace of mind that comes from knowing their loved one is monitored by a team that combines legal and financial expertise with specialized knowledge of the elders’ physical, mental and emotional health.
7. Ensuring the highest level of independence the elder can achieve, while ensuring safety.

National Nutrition Month

New Food Pyramid Many of us may remember learning in school about balanced diets through the Food Pyramid. In 2005, the U.S. Department of Agriculture produced an interactive web-based program related to the Food Pyramid, located at www.mypyramid.gov. Users enter their age, gender, height, weight and exercise habits to produce individualized dietary guidance. The site can produce recommendations for dietary intake and activity levels, as well as be customized for children and women breastfeeding. Using the MyPyramid Tracker tool, users can receive assessments over time as to their progress on proper nutrition and exercise. The web-based guidance, while believed to be an improvement over prior food pyramid publications, did not translate well to print form, typically the preferred medium for older adults. In January 2008, Tufts University researchers published The Modified MyPyramid for Older Adults. The new pyramid is now a graphic print-out with icons representing foods, fluid and physical activity such as: Fiber sources, such as whole grains, bread and cereals, Vegetables and fruits, bright and varied in color, Dairy products, including yogurt, that are low in fat, Recommended protein sources such as dry beans, nuts, fish, lean meat and eggs, Oils which are low in saturated and trans fat, Fluids for proper hydration, and Physical activity http://nutrition.tufts.edu Malnutrition Despite all the data and tools available, coupled with the United States being the most abundant food producing nation in the world, many older adults simply do not receive the nutrients that they need. Malnutrition, a complicated issue, may follow. Defined as a diet low in calcium, protein and calories as well as inadequate fluid intake, undernourishment or malnutrition can be the result of one or more compounding factors. According to the Administration on Aging, factors that contribute to a lack of nutritional health in older adults include eating too much or too little, eating alone, neglectful caretaking, taking medications, suffering from chronic diseases or conditions, financial difficulties, and functional limitations. Malnutrition has been called “acute care’s skeleton in the closet,” because during an acute illness, an activity of daily living (ADL) that is commonly lost is the ability to feed oneself. There are also a number of natural age changes in the body that can contribute to undernourishment in the elderly. A natural byproduct of aging is a decline in taste and smell. For example, scientists estimate that many receptors in the nose (essential to taste) and approximately two-thirds of taste buds have died by the time an individual reaches age 70. Oral diseases such as tooth decay or loss, periodontal disease, or cancer can negatively impact nutritional intake. People with missing teeth or incomplete or missing dentures are at a high risk for malnourishment. Medicare does not pay for dentures, so if they are lost or stolen, it is important for families to help replace them or else potentially hasten the patient’s physical decline due to poor nutrition. Reduced absorption of nutrients and consuming too little food, common with the elderly, puts them at risk of vitamin and mineral deficiency. Medications and multiple drug interactions can affect appetite and deplete certain minerals. Changes in the digestive system may make eating less enjoyable and even difficult. Limitations on mobility, for example, from arthritis, may interfere with the ability to shop for food, prepare food and eat it. Social workers often find cases of malnutrition when the older individual has become more frail and unable to shop. Dehydration, another critical aspect of nutrition, occurs when water balance is negative – intake of water is less than its loss. Available body water in older adults often decreases because of losses in muscle mass, changes in cells as people age and less efficient kidney function. Older adults frequently have altered thirst sensations. As such, the brain does not trigger them to drink water as naturally as in younger adults. Other factors that contribute to dehydration may include difficulty in swallowing, fear of incontinence, inability to communicate, and medication side effects. The Modified MyPyramid for Older Adults attempts to address many of these issues in its colorful icons. The foundation of the new pyramid portrays the physical activities characteristics of older adults, such as walking, house work and yard work. Physical activity is one way to avoid weight gain in later years and its adverse consequences, such as chronic disease, obesity and hypertension. It can also improve quality of life for older adults. The pyramid stresses the importance of consuming fluids by having a row of 8 glasses as the second level of foundation. Food with high water content, such as fruits and vegetables, also contribute to fluid in an older person's diet. Packaged fruits and vegetables in addition to fresh examples are shown on the pyramid. For example, bags of frozen vegetables are easy to prepare, have a longer life than fresh vegetables, and can be resealed to minimize waste. These factors are very important with older adults who live alone or have limited mobility. The pyramid gives numerous examples of fiber rich foods which are critical to digestive health: whole grain products rather than highly refined forms, whole fruits and vegetables rather than juices, fresh, frozen, canned and dried fruits and vegetables. The top of the pyramid has a flag representing supplemental nutrients, such as calcium, vitamin D and vitamin B12, which are often needed since medications and the natural aging process can result in decreased absorption of vitamins and minerals. Doctors frequently recommend that people with an acute or chronic illness increase zinc, which aids in wound healing and immune function. Supplements, however, should only be taken under the supervision of a medical professional. Psychological Factors Two prevalent psychological culprits for malnutrition are depression and dementia. Living alone and recent widowhood often result in eating disorders leading to malnutrition. Stress, for example, from illness or caretaking and general unhappiness contribute to the poor quality of diets. Alcoholism, affecting 10% to 15% of older adults, often has roots in depression and can lead to severe malnutrition. Social isolation and decline in the simple social pleasure associated with eating are common with older adults. Depression may be the most common cause for weight loss, but depression in late life is significantly under-diagnosed. Individuals with advanced dementia are at major risk for malnutrition and dehydration. Food refusal (on account of lack of recognition of the food), apparent refusal (inability of the patient to open his mouth) and intense distraction at meal time are common with dementia patients. Such patients are also more likely to experience unintended weight loss from increased activity such as pacing. Solutions Sometimes a team of dietician, social worker and physiotherapist is needed to solve the complex issue of malnutrition and, most importantly, its underlying causes. As a result, medical nutrition therapy has become more prevalent in nutrition programs. This approach is designed to help assess and solve the nutritional status of older adults by having a dietician or team design a nutritional care plan. Nutritional therapy may help to improve functionality by restoring muscle mass and possibly even postpone mortality in the very old. For improving eating and nutrition in dementia patients, practitioners use a variety of techniques such as environmental design to reduce distractions, eating assistance, use of finger food and other adaptive devices. The Sundowner syndrome can dictate the appropriate time for meals to maximize efficacy. Whether related to dementia or as a loss of ADL, practitioners should balance feeding assistance with independence, and if possible, encourage independence to avoid the consequence of learned helplessness. Malnutrition contributes to the deterioration of physical and mental health in numerous ways. Solutions must recognize the complexity of the medical, social and psychological factors that make up each individual’s unique nutritional challenges and at all times help the older adult to maintain dignity and quality of life. American baby boomers, the wealthiest and most-highly educated group of seniors in history living in the most abundant dietary country in the world can help solve the nutrition problems faced by their own parents today and by themselves tomorrow. Sources: Lichenstein, A. H., Rasmussen, H., Yu, W. W., Epstein, S. R., & Russell, R. M. (2008). Modified MyPyramid for Older Adults, Journal of Nutrition, 138(1), 5-11. O'Donnell, D. M., (2006). Malnutrition in older adults: medical, economic and political solutions. Research paper, Gerontology Institute, Georgia State University.