Case study of a homeless man living in a low set house

K is 176 m and his current weight is 50 kg that is much less in comparison to the height. K’s food habit and lifestyle indicates that his nutritional intake is insufficient as per is age and needs to be reviewed by an approved dietician. K’s diet and recommendations are required (Choi et al., 2013). Although Weetabix can be a low calorie breakfast idea and is good for losing weight, but it has to be remembered that Weetabix are high fibre

Running head: Case study
CASE STUDY
Name of the Student
Name of the university
Author’s note

1Case study
Case study
The essay centres round the case study of Mr. K, who is an 82 year old male who stays in
a low set house independently, without any home help. His family visits weekly and has found
that food intake of Mr. K has decreased drastically. Height of Mr. K is 176 m and his current
weight is 50 kg that is much less in comparison to the height. Hence according to the Body Mass
Index (BMI) he is underweight as his BMI is resulted to be 16.1 (Abarca-Gómez et al., 2017).
Mr. K’s food habit and lifestyle indicates that his nutritional intake is insufficient as per is age
and needs to be reviewed by an approved dietician. Mr. K starts his day with a Weetabix in the
morning with a bit of honey. He consumes spaghetti or baked beans or toast and peanut butter.
As per his statement, he does not have a heavy dinner, but largely depends on microwave meals.
Sometimes he has or two cups of tea with some powdered milk. Mr. K is a heavy smoker, with
almost 40 cigarettes, a day. He had admitted that he drinks occasionally but certainly whenever
he watched football. Mr. K had stated that he had tried to take a couple of laps of the backyard,
but it was hard to maintain. He has a past medical history of Emphysema, hypertension with
persistent cough. He is currently under short acting beta agonist long lasting beta agonist for
hypertension and anticholinergic and inhaled corticosteroids for his persistent cough.
Focussing on the dietary condition of Mr. K, he is having some major dietary deficits that
needs to be reviewed. Although there is a high prevalence of overweight in the elderly people,
one of the main concern with the elderly, is a reported decline in the intake of food. Leading an
independent quality of life and health is important for the elderly adults. One of the major threat
to an independent living is the loss of bone mineral density, loss of muscle mass and strength that
occurs with time. Hence, proper nutritional assessment of Mr. K’s diet and recommendations are
required (Choi et al., 2013).

2Case study
The case study reveals that Mr. K consumes a Weetabix for the breakfast. Although Weetabix
can be a low calorie breakfast idea and is good for losing weight, but it has to be remembered
that Weetabix are high fibre biscuits , that might constipate people, consuming it regularly
(Warin et al., 2017). As an alternative, Mr K can have milk and brown bread for the breakfast.
Mr K again consumes baked beans and a toast for lunch the. Baked beans has been found
to be a good source of low fat proteins, vitamins and carbs, that are good for managing weight
This might be one of the factors why Mr. K had lost weight so much. Again, it has to be
remembered that baked beans are canned products and might contain one or more sweeteners
like maple syrup or sweetener (Appleton, 2016). Canned baked beans have high sodium content,
which might be concerning for Mr. K, having high blood pressure. Again canned baked beans
contains some additives that can easily be avoided like modified corn starch, used as a thickening
agent , caramel colour containing chemicals called 4-methylimidazole , which is has been found
to be some carcinogenic property. Finally, the proteins that are present in beans called lectins
that can interfere with digestion, damage the intestinal lining and interfere with the hormonal
balance in the body (Franzke et al., 2018). Furthermore, the chemical, Bisphenol A (BPA) can
leach in to food (Trasande, 2014). According to Wolfe, (2012), older adults should include more
protein in their diet as the while losing weight. During this lifespan, the body generates less
amount of protein in comparison to actual need to maintain bone health, muscle mass and other
physiological function of the body. As per the recent researches, older adults who consume more
proteins are less likely to lose functioning of the body (Appleton, 2016). In a 2016 study
conducted over more than 2900 seniors, it has been found that people who ate more proteins are

3Case study
less likely to become functionally impaired compared to those who consumed less proteins
(Appleton, 2016). It is recommended to eat smaller meals with high calorie value throughout the
day rather than eating two larger meals. It is seen that smaller meals helps in the process of
digestion which in turn helps in gaining of weight (Franzke et al., 2018).
It can be clearly seen from the case study that the Mr. K lives independently and does not
have a home help and thus consumes ready meals every day. Nutrients can be lost from meals
due to the some cooking process. It has to be remembered that some of the makers of ready
meals might compromise health by the substitution of healthy ingredients with the ones that are
less healthy. Due to the consumption of the ready-made meals, it has been found that the elderly
people are not getting adequate heart and brain healthy omega-3-fatty acids and vitamin B,
vitamin D or minerals like magnesium calcium and selenium (Padma, 2014). According to the
findings by Padma, (2014), lost nutrients are only not the concern. Meats when roasted or grilled
at high temperature produces carcinogenic compounds like heterocyclic amines. This
information is in context, that Mr. K often takes roasted meals whenever he meets his family at
the weekends. Hence, regular consumption of roasted food is not a god option for Mr. K, due to
health condition of Mr K and consumption of these food might deteriorate the condition of his
heart.
As per the case study, Mr K is an avid smoker and smokes up to 40 cigarettes in a day.
Multiple studies have shown that, Cigarette smoking is a risk factor of cardiovascular diseases
and smoking cessation is the most important life style intervention that could be done to prevent
a large number of cardiovascular diseases. Some of the harmful effect of smoking are the
impairment of endothelial function, inflammation, arterial stiffness, lipid modification and the
alteration of the prothrombotic and the antithrombotic factors that leads to the initiation and the

4Case study
acceleration of the atherothrombotic process causing cardiovascular diseases (Messner &
Bernhard, 2014). Cigarettes exerts a hypertensive effect by the stimulation of sympathetic
nervous system (Messner & Bernhard, 2014). Smoking enhances the absorption of many
important vitamins and minerals such as calcium as well as vitamin C and D. Hence, it results in
decreasing the appetite and the individual suffer from low BMI index. Addition to this smoking
also affects the circulation process by narrowing the blood vessels and hence becomes blocked
due to huge fat deposition (Lohse et al., 2016).
It is evident from the case study that the patient had been hypertensive and his current
menu or meal plan clearly indicates towards protein deficiency. Several studies have identified
the fact that the elderly adults are less responsive to the anabolic stimulus of the low doses of
amino acid intakes in comparison to the younger individuals. Again studies have confirmed that
nutrition plays an important role in both the health and functioning of the elderly adults (Baum,
Kim & Wolfe, 2016). As the life expectancy of people are continuing to rise, it is necessary to
maintain the optimal nutritional recommendations for the improvement of the health outcomes,
quality of life and physical independence.
Another alarming fact that can be noticed from the case study is that Mr. K only drinks
water only when he has to take his tablets. Elderly people are more prone to dehydration because
of certain age related changes like reduced renal function, reduced sensation of thirst.
Dehydration can also occur due to the effect of some medicines for hypertension (Padma, 2014).
The most important way to prevent dehydration in older adults is to ensure that they are drinking
enough liquids. Furthermore poor intake of oral fluids can be another reason behind dehydration.
As stated in the Australian dietary guidelines, adults should take at least 64 ounces of fluids
daily. Caffeinated beverages are not recommended. Fluid intake can be increased by adding

5Case study
favours to the individual’s drink. Flavours like adding citrus fruits such as lemons, oranges
serves as great water enhancers and encourage the individual to drink more water. It is also
recommended to dilute sugary drinks with water and ice cubes and drink a glass of water before
meal (McCrickerd, Chambers & Yeomans, 2014).
It has been stated in the case study, that the patient resides in a retirement village and
most of the health issues of the residents are addressed by a community nurse. Maintenance of
nutrition and hydration is one of the important duty of a nurse, as nurses are ethically obliged to
cater to both the physiological and psychological needs of patients. Apart from helping the
patients to order meals, they are also responsible for special diets and taking meals to those
residents who cannot sit (Dudek & Dudek, 2013). Again the nurses can teach their patient about
the proper nutrients that each of the patients should consume (Nursing and Midwifery Boards of
Australia, 2017). Nurses are also responsible for the measurement and the control of the food
intake, assessing the nutritional requirement of the individuals. This responsibility of community
nurse is in compliance with Standard 4 of the NMBA standards, which states that nurses use
different assessment techniques for assessing the needs of the patient, i.e., nutritional assessment.
Again according to standard 5 of the NMBA nursing standard, a nurse set goals, plans outcomes
and timeframes to achieve patient goals (Nursing and Midwifery Boards of Australia, 2017).
Similarly, in order to restore a nutritional balance within Mr. K, a diet plan needs to be
developed.
In order to address the protein deficiency, proteinaceous yet low fat food can be taken.
Plenty of vegetables, legumes like chick peas, kidney beans, homemade beans, cereals including
rice, past, and bread can be taken (Nicklett & Kadell, 2013). Lean meat, fish, poultry can also be
consumed. Milk, cheese, yogurt and low fat varieties of dairy product can be chosen.

6Case study
Traditionally, protein recommendations has been based on the studies which estimates
the minimum intake of proteins necessary for maintaining the nitrogen balance. As per the
Australian recommended guidelines, all the adults over the age of 65 required an RDA
(Recommended dietary allowance) of 0.8g/kg/day protein. The RDA for the protein was based
on all the available studies, estimating the minimum protein intake necessary for avoiding a
progressive loss of the lean body mass as measured by the nitrogen balance (Franzke et al.,
2018).
Since the patient is hypertensive, too much sodium in the diet can cause the body to
retain body fluid that will again increase the blood pressure. Again, food should contain enough
potassium as it helps in maintaining a balance in the amount of sodium in the cells and not
getting enough potassium can increase the amount of sodium in the blood. The amount of
sodium has to be cut down to 1500 mg a day (Koliaki & Katsilambros, 2013). There are very less
number studies whether Vitamin D, supplements play any role in the treatment of high blood
pressure, the role of vitamin D in strengthening of bones cannot be overlooked. Vitamin D
deficiency might lead to diseases like osteoporosis, hip fractures and muscle weakness. More
vegetables has to be include both at the lunch and the dinner (Franzke et al., 2018). Although
canned products are easy to use, but since most of them has got added sugar, they should be
avoided. During breakfast Mr. K can take half of the typical serving of margarine or butter.
While taking milk, the milk has to be low-fat or skimmed dairy products (Nicklett & Kadell,
2013). It is better to avoid sweets or sweetened beverages and stick to nuts, low fat or fat free
yogurt.
Instead of going for canned food Mr. K needs to have more vegetables and salads for the
lunch. Foe an afternoon snack, Mr. K can take some nuts or a bowl of berries. For dinner, instead

7Case study
of microwave meal, salad of fresh green vegetables and seared salmon can be taken. It is
essential note whether the patient had any allergic history for salmon.
Although the above mentioned sections contain some evidence based recommendations,
yet there can be several barriers towards the maintenance of the diet plan. One of important
barriers towards the maintenance of proper diet are lack of appetite due to old age, reduced
functionality due to old age, isolated living and financial constraint. Socioeconomic factors like
income has been associated positively with lifestyle behaviours (Tsubota-Utsugi et al., 2016). A
study has demonstrated that older people living away from home, in isolation tend to have poor
dietary habits than those living with their family. It can be seen from the case study, that he lives
in a retirement village and is visited by his family, once in a week. Mr. K can be referred with a
home help, who can help him with cooking.
To summarise the entire essay, it can be said that Mr. K needs to have low sodium and
high protein diet to manage his hypertension and to increase his muscle mass. Hydration should
also be maintained. Mr. K can further be recommended with a home help, who can help Mr. K
with the daily chores of life like cooking and shopping, so that he does not have to consume the
ready-made meals.

8Case study
REFERENCES
Abarca-Gómez, L., Abdeen, Z. A., Hamid, Z. A., Abu-Rmeileh, N. M., Acosta-Cazares, B.,
Acuin, C., ... & Agyemang, C. (2017). Worldwide trends in body-mass index,
underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416
population-based measurement studies in 128· 9 million children, adolescents, and adults.
The Lancet, 390(10113), 2627-2642.
Appleton, K. (2016). Barriers to and facilitators of the consumption of animal-based protein-rich
foods in older adults. Nutrients, 8(4), 187.
Baum, J. I., Kim, I. Y., & Wolfe, R. R. (2016). Protein Consumption and the Elderly: What Is the
Optimal Level of Intake?. Nutrients, 8(6), 359. doi:10.3390/nu8060359
Choi, O. J. E., Cho, Y. G., Kang, J. H., Park, H. A., Kim, K. W., Im Hur, Y., & Yim, H. J.
(2013). Weight control attempts in underweight korean adults: Korea national health and
nutrition examination survey, 2007-2010. Korean journal of family medicine, 34(6), 393.
Dudek, S. G., & Dudek, S. G. (2013). Nutrition essentials for nursing practice. Lippincott
Williams & Wilkins.
Franzke, B., Neubauer, O., Cameron-Smith, D., & Wagner, K. H. (2018). Dietary protein,
muscle and physical function in the very old. Nutrients, 10(7), 935.
Hooper, L., Bunn, D., Jimoh, F. O., & Fairweather-Tait, S. J. (2014). Water-loss dehydration and
aging. Mechanisms of ageing and development, 136, 50-58.

9Case study
Koliaki, C., & Katsilambros, N. (2013). Dietary sodium, potassium, and alcohol: key players in
the pathophysiology, prevention, and treatment of human hypertension. Nutrition
reviews, 71(6), 402-411.
Lohse, T., Rohrmann, S., Bopp, M., & Faeh, D. (2016). Heavy smoking is more strongly
associated with general unhealthy lifestyle than obesity and underweight. PloS one,
11(2), e0148563.
McCrickerd, K., Chambers, L., & Yeomans, M. R. (2014). Does modifying the thick texture and
creamy flavour of a drink change portion size selection and intake?. Appetite, 73, 114-
120.
Messner, B., & Bernhard, D. (2014). Smoking and cardiovascular disease: mechanisms of
endothelial dysfunction and early atherogenesis. Arteriosclerosis, thrombosis, and
vascular biology, 34(3), 509-515.
Nicklett, E. J., & Kadell, A. R. (2013). Fruit and vegetable intake among older adults: a scoping
review. Maturitas, 75(4), 305-312.
Nursing and Midwifery Boards of Australia, (2017). Access date: 23.7.2019. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx
Padma, V. (2014). DASH Diet in Preventing Hypertension. Advances in Biological Research,
8(2), 94-96.
Trasande, L. (2014). Further limiting bisphenol a in food uses could provide health and
economic benefits. Health Affairs, 33(2), 316-323.

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Tsubota-Utsugi, M., Kikuya, M., Satoh, M., Inoue, R., Hosaka, M., Metoki, H., ... & Ohkubo, T.
(2015). Living situations associated with poor dietary intake among healthy Japanese
elderly: the Ohasama Study. The journal of nutrition, health & aging, 19(4), 375-382.
Warin, M., Zivkovic, T., Moore, V., & Ward, P. (2017). Moral fiber: Breakfast as a symbol of ‘a
good start’in an Australian obesity intervention. Medical anthropology, 36(3), 217-230.
Wolfe, R. R. (2012). The role of dietary protein in optimizing muscle mass, function and health
outcomes in older individuals. British Journal of nutrition, 108(S2), S88-S93.