Although Teresa is eating three meals a day she is not getting the recommended daily amount of nutrients from her diet. During her 24-hour diet recall, she only had 4 1/2 oz of grains and 4 oz of protein. She did not have any dairy, fruits, or vegetables.
Teresa’s total caloric intake was almost 1400 kilocalories short of the recommended intake value of 2100 kilocalories. The only nutrients she consumed enough of were protein with 45g, riboflavin with 1. 3mg, and selenium with 66 µg. Teresa was deficient in calcium with only 280mg, potassium with the only 935mg, iron with the only 6mg, phosphorus with the only 677mh, zinc with only 4 mg, Vitamin A with only 114 µg, vitamin B6 with only 0. 6 mg, vitamin B12 with only 1. 3 µg, vitamin D with only 1 µg, vitamin E with only 1 mg, folate with only 193 µg, thiamin with only 0. mg, and niacin with the only 11mg. Vitamin C was not even consumed. Teresa should start drinking at least 5 glasses of water and at least two glasses of milk a day. She should start eating green leafy vegetables, fruits, eggs, yogurt, and fishes to gain more consumption of vitamins (Lucke, 2011). To increase consumption of minerals like calcium, potassium, iron, zinc, and phosphorus Teresa should start consuming some dairy’s leafy green vegetables, whole-grain foods, fishes, raisins, red meats, and bananas (Ahders, 2011). Teresa can also talk about supplements to gain vitamin and mineral consumption.
A good multivitamin is One A Day Women’s, it is a complete multivitamin design specifically for leading health concerns of women (Bayer Healthclub LLC. , 2012). Overall, Teresa needs to consume more nutrients during the day to fulfill her daily requirements. Age-Related Changes That Can Affect Ms. Jenkin’s Diet As a 78-year-old woman, Theresa may experience many changes that affect her nutritional diet. According to Culross, changes may include loss of lean muscle mass (sarcopenia) and a decrease in bone density, which increases the risk of osteoporosis (Culross, 2008).
Weaker dental structure and reduced effectiveness of the digestive system such as low gastric acid secretion may complicate the absorption of vitamin B12 and other nutrients (Culross, 2008). Also, reduced taste and smell senses can lower the appeal of foods and reduce appetite. In Theresa’s case, emotional factors such as social isolation and depression due to the passing of her husband Theodore has led to a loss of appetite and can ultimately result in malnourishment. Based on her 24-hour diet recall, Theresa is certainly not getting enough daily kilocalories.
For individuals over 50 years old, total caloric intake decreases but the intake of nutrients increases (Drake, 2009). For example, Vitamin B12 may be at higher demand because of the decreased absorption rate in the digestive system. Deficiency in Vitamin B12 may result in depression and neurological disorders (Culross, 2008). According to Theresa’s case, depression and lack of social interactions may be in response to low caloric intake and deficiency in Vitamin B12. There also seems to be very little dairy intake in Theresa’s diet, so vitamin D and calcium levels are low as ell. Due to the loss of muscle mass, protein adequacy is also a problem in older adults because it is not advised to increase protein intake. Limited protein intake may result in vitamin A, C, D, calcium, iron, zinc, and other deficiencies (Grodner, 2012). Overall, Theresa’s small nutrient intake can result in many nutrient deficiencies. The Geriatric Depression Scale The Geriatric Depression Scale is a 30 question self-report assessment used to identify depression in the elderly (Mental Disorders, 2013).
The questions are answered with “yes” or “no”, and ask things such as “Do you feel happy most of the time”, or “Are you hopeful of the future”(NeuorscienceCME, 2013). The points scored on the test depend on the question; there is an answer grid. For example, the question “Do you feel that your life is empty” should be answered with no. It the elderly person answers with “no”, then no point is given. If they answer with “yes”, then a point is added (Mental Disorders, 2013). The lower you score on the test, the less likely you are to be depressed (NeuroscienceCME, 2013).
The Scale is also available in a 15, 5, or even 1 question format (Edelman, 2010). The assessment is useful because it allows health professionals to know how the patient feels, their mindset, which will allow that patient to receive treatment in the form of therapy or antidepressant medication (Edelman, 2010). Based on Ms. Jenkins’s score of 27, I would classify her as severely depressed. Looking at the answers she gave to certain questions makes this clear. For example, when asked if she found life very exciting, she said no. When asked if she felt like crying often, she said yes.
She also reported that she is not hopeful about the future (NeuroscienceCME, 2013). This would lead one to conclude that Ms. Jenkins has a dim outlook on life and may feel like she doesn’t have much left to live for. She feels sad and doesn’t see her situation getting any better. Behaviors that suggest that Ms. Jenkins is depressed are the fact that she moved in with her son and his family’s home, yet she feels alone. Her husband died recently, which makes her a grieving widow and causes her to feel alone. She not only misses her husband but her friends and home back on the east coast, where she lived before.
Ms. Jenkins is also behaving as an introvert, which is another sign of depression. She does not go out much except when to by personal hygiene products. The majority of her time is spent in her bedroom, away from others. Her eating habits are also unhealthy since she misses meals or doesn’t eat very much. This is apparent when looking at her since she appears to be getting smaller. Ms. Jenkins’ behavior is identical to that of someone who is depressed. Signs of depression include appetite loss, feeling helpless and hopeless, as well as the loss of interest in activities that were once appeasing (CDC, 2012).
Ms. Jenkins should receive some sort of treatment soon since depression in the elderly can lead to suicide (Edelman, 2010). Stage of Erikson’s Human Development Ms. Jenkins is in the ego integrity versus despair stage for older adults, which is the eighth and final stage of psychosocial development. It includes life review, where elders with integrity tend to have an honest acceptance of their past, being proud of all they have done while reflecting on the negative things that have brought them to where they are today.
They seek to share their unique experiences with the community, especially younger generations who have yet to experience more in life (Berger, 2011). Not everyone has this integrity. Many have the opposing aspect of despair where they feel they have yet to accomplish many goals in their life and realize that time is now too short to attempt many of them. It is a stage of regret, a realization of mortality, and an unsatisfied life (McLeod, 2008). This is one of the final crises in Erikson’s psychosocial stages. It is clear that Ms.
Jenkins is not in a stage of integrity but in a stage of despair. Her sedentary and unhealthy lifestyle along with her high score on the Geriatric Depression Scale all in the following months of the death of her husband indicates that she is grieving and needs interventions to help her through it. Being alone can do more harm than good, so a good intervention was moving into her son Tyron and his family’s home in the southwest because it allows there to be active listeners available and a sense of “being with” her (Lehmen & Kelley, 1993).
This way, Ms. Jenkins’ safety is accounted for and Tyson can monitor his mother’s health. His family can also contribute by encouraging her to join them for dinner and maybe even go out shopping like she used to. Antidepressants are the most common form of therapy for geriatric depression and work better when taken along with regular counseling sessions. This intervention should be taken with supervision from a mental health professional along with weekly follow-ups to monitor any progress.
Another intervention includes therapeutic recreation. Ms. Jenkins was already busy with dance lessons prior to the death of her husband, which combined music and physical activity. She can pick up dance lessons with a new group in order to effectively manage her depression and also get out of her habit of staying in her room all day and be socially competent again (Johnson, 1999). Being active again will also boost her metabolism and appetite, and can increase her calorie intake. If these interventions are successful and Ms.
Jenkins is showing signs of recovery, she may be able to rejoin her friends on the east coast and continue to live a healthy and active lifestyle.
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