Mrs. Heraldo is a 78 year old Latina woman brought in by her niece to you, her n

Question

Mrs. Heraldo is a 78 year old Latina woman brought in by her niece to you, her new primary care provider. The niece is concerned that Mrs. H looks much thinner. Mrs. H seems unconcerned about her weight loss and just repeats she is old now and “just not hungry.”

Mrs. H has no idea if she has lost weight. However, her chart documents that she is 5’4” tall and weighed 174 lbs (BMI 29.9 kg/m2) 3 months ago. Today she weighs 154 lbs (BMI 26.4 kg/m2).

Mrs. H has hypertension and hyperlipidemia, which were diagnosed 15 years ago.

The niece explains that her aunt lives alone in a subsidized, senior housing facility. Mrs. Heraldo tells you that her two children, both grown, live in California and Arizona and she sees them about once a year. Her husband died 5 years ago. Her eyes tear a bit as she tells you this.

She says that she eats two meals a day and that she eats pretty much the same thing every day. Her 24 food recall for yesterday is:

Morning: 1 cup of instant coffee with non-dairy creamer, 1 tsp sugar and 1 slice toast with 1 tsp margarine and 1 tsp jam.
Noon: 1/2 can chicken noodle soup, 3-4 saltines and 1 slice American cheese.
Evening: 1 broiled chicken thigh, 1 spoonful of string beans and 1 spoonful rice.
She drinks at least 5 cups of water a day and sometimes has a cup of tea with 1 teaspoon sugar and 2-3 vanilla wafer cookies before bed.
She takes a daily multivitamin/mineral supplement.

Discussion Questions

What is the percentage of body weight that Mrs. H has lost in the last three months?
Given that Mrs. H’s BMI is still in the overweight range, is her weight loss currently a significant issue? Why or why not?
What should our weight goals for Mrs. H be at this point?
Is Mrs. H’s weight loss to be expected at her age? Why or why not?
Which factors may be responsible for her feeling of “just not hungry”?
Suggest some diet modifications for Mrs. H to minimize her weight loss and health deterioration.

I'm just not hungry" Geriatric Nutrition Case Study

Explanation / Answer

Answers--

1] Mrs. H. was 174lbs 3 months ago and now she weighs 154 lbs. This means she has lost 20 lbs in the last 3 months. Her %age loss will be about 11.49. [ 20/174 * 100 = 11.49 % approx]

2] No, her weight loss is not a significant issue . She has hyperlipidemia. This means that there is already more fat in her blood than required . Trying to gain weight might further increase the fat level which might not be good for her because at her age she might not be able to burn the extra calories.

3] The weight goals for Mrs.H should be to be constant. She should neither lose any more weight nor should she gain any. If the weight loss persists , even if there is no change in her diet or lifestyle, then it might be a matter of concern. A thorough check - up on her will be required. But if she maintains a constant weight then we have no cause for worry as this is what it should be for her given her age and lifestyle.

4] If Mrs.H. keeps on losing weight steadily then it will be a matter of concern. If her weight is stable, that is very little fluctuation, and she is overall as active as she can be at her age, then we do not need to worry. People at her age have a slower metabolism rate and do not use up all the calories , so a slight weight loss is normal at her age. Only it should not show a steady downfall.

5] Several factors might affect Mrs.Heraldo's feeling of " just not hungry ". This could range from physical to psychological.

As one grows older, the body's metabolism slows down. There is very little physical activity amongst the old people so their need for energy is also limited. They just need enough to sustain their body.

In Mrs Heraldo's case , there must be some psychological reasons too. She is living alone, on government subsidy, even though she has two children. Her children donot seem to be much concerned about their mother as they only visit her once in an year. This becomes very obvious as it is her niece who is more concerned about her health and takes her for a check-up. This must have made Mrs.H. unwanted and uncared for by her own children.

She has lost her life partner a few years back. So, she must be lonely too. All this is enough to make a person lose interest in life. So, maybe she is not much concerned about her life as she might be feeling that she has nothing "to live for". We all know that good health does not come only from physical well-being but also from mental well-being.

6] Mrs.H. should cut down on her sugar intake and include more of green vegetables in her diet. Instead of jam and margerine, she should go for fat free yoghurt and a fresh fruit. For lunch, she should have fresh salad along with proteins. In short, she should avoid fat and sugar and include more of fresh fruits and green vegetables. This will improve her fibre intake which is completely lacking in her diet. Her digestion will improve with this and maybe she will feel like eating more. There is too much fat and sugar in her diet [ given her age and her condition of hyperlipidemia]. She has to reduce this to improve her health.

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