護理之家吞嚥困難個案之營養照護案例分享

Taiwan is an aging society in the world, 36.8% of the elderly were reported to be dissatisfied with their chewing and swallowing ability. Nutrition and diet supports are becoming important issues for the needs in elderly. We reported case at the nursing home case in Yilan. An 81-year-old woman had unintended weight loss and referred to dietitians. She had a coughing problem due to uncoordinated tongue muscles. This conditions further caused the patient having difficulty of meeting the recommended energy and sufficient food intakes. Nutritional diagnosis was insufficient oral intake (problem, P) due to physiological factors such as difficulty in chewing and difficulty in swallowing. Patients had limited food intakes (etiology, E), which was estimated at about 500 kcal/day and protein 31 g/ day, showing a shortage of 800 kcal/day compared to recommendation (sign/symptoms, S). Nutritional intervention was prescribed a texture-adjusted diet corresponding to level 2 of International Dysphagia Diet Standardization Initiative (IDDSI) for liquid consistency. The diet consisted a 27.5 g commercial formula with 1.0 g thickener was adjusted with 100.0 mL water to improve feeding condition. The patient had followed this modified diet for one month, and gained 5.9 kg weight during December 2017 to February 2018. Dietary energy and protein intake fed to patients were estimated to be up to reached 100% of the recommended levels, respectively. Modification of dietary texture for this case appeared to show improvement of intakes, and weight gain. In addition, this 81 years old case has chronic kidney dysfunction problem, so it is necessary to pay attention to the amount of dietary energy and protein to prevent the deterioration of renal function and maintain nutritional status. Dietary prescription was given based on the recommendation of Dietary Reference Intakes (DRIs) and that of Kidney Disease Outcome Quality Initiative (KDOQI), recommended dietary energy was at 1300-1500 kcal/day and dietary protein at 0.8-1.0 g/ kg/day. Following intervention for 2 months, 5.9 kg increases in weight was noted, and successfully prevented unintentional weight loss. During period of receiving nutrition intervention, no further deterioration of kidney function and unintentional weight loss was noted, optimal nutritional intake was also maintained.