MHSc 8.431 Nutrition: Elderly Client Case Study & Diet Plan Analysis

This case study focuses on Mr. John, a 72-year-old male client in a nursing home, to analyze his nutritional requirements and formulate a dietary plan based on his physical activities and health status. The study calculates his Basal Mass Index (BMI), arm and calf circumferences, fat-free and body fat mass, and evaluates his mini-mental and mini-nutritional assessment scores. It outlines his physical activities in terms of Metabolic Equivalent of Task (MET) and calculates his resting, activity, and total energy expenditure, along with his physical activity level. The dietary plan includes a detailed breakdown of meals, nutrient values, and caloric intake throughout the day, followed by a critical analysis comparing it with New Zealand's Ministry of Health guidelines for elderly nutrition, emphasizing the importance of balanced macronutrient distribution and micronutrient intake to prevent malnutrition and chronic diseases associated with aging. Desklib provides access to similar case studies and solved assignments for students.

Running Header; THE ELDERLY NUTRITION. 1
The special population nutrition
Institutional affiliation
Course name
Students name

ELDERLY POPULATION 2
Introduction
This is an essay that requires formulation of a case study of a client who fits in a special
population. The nutritional requirements will be outlined and a dietary plan will be formulated
taking into consideration the physical activities. The essay will critically analyze the
determinants and the concepts of the nutrition of the given client in relation to their health. This
will be done by evaluating the Ministry of Health guidelines and the peer-reviewed literatures on
the nutrition of the given special population. Lastly, a conclusion will be given to summarize the
essay.
The case study.
A case scenario of Mr. John, a male client who lives in a nursing home. He is 72 years
old, has a height of 155cm, weighs 65kgs, has a Basal Mass Index (BMI) of 27.0kg/m2, his arm
circumference is 27cm, his calf circumference is 34cm, his fat free mass is 34kgs, his body fat
mass is 25kgs, his mini-mental score is 28, his mini-nutritional assessment is 26.5 while his
timed up and go is 9.9 seconds. His physical activities were as followed; the vigorous activities
are 8.0 Metabolic Equivalent of Task (MET), for the moderate activities is 4 METs while
walking is 3.3METs. Her resting energy expenditure is 1250Kcal/day, his activity energy
expenditure is 200Kcal/day, his dietary induced thermogenesis is Kcal/day, his total energy
expenditure is 1700Kcals and lastly his physical activity level is 1.3. Lastly, his energy intake
requirement is 32.395MJ or 7737.54Kcals.

ELDERLY POPULATION 3
Calculations
BMR= weight/height (M2)
= 65/ (1.55*1.55)
= 27
The caloric requirement = 0.038 * weight in kg + 2.755
= 0.038 * 63 + 2.755
=7737.54Kcals.
The energy sources; 45% -65% carbohydrates 3868Kcal
20%-25% fat 2254 Kcals
15%-25% proteins 1747Kcals
4 Kcalories = 1 gram of carbohydrate therefore = 967grams
4 Kcalories = 1 gram of protein therefore = 436.75grams
9 Kcalories = 1 gram of fats therefore = 250.44grams

ELDERLY POPULATION 4
John’s diet plan
Time of
the day
Meal Contents Food
in
grams
Kcals
of
the
meal
Nutrient value.
0600hrs Breakfast ½ cup of
porridge
1 ½ bread
roll
½ cup
cooked
vegetables
1 banana
130g
75g
80g
130g
520
300
------
483
Carbohydrates
Dietary fiber
Vitamins
Vitamin A (green and yellow
vegetables)
Vitamin C (from the dark-green
vegetables)
Minerals; magnesium and
potassium
1000hrs Snack Tea, herbal,
infusion
2 muffins
1 apple
200g
160g
130g
800
640
-----
Carbohydrates
Dietary fiber
Vitamin B complexes except B12.
Minerals; magnesium, calcium,
iron and zinc
1300hrs Lunch 1 medium
fillet of
cooked fish.
100g
200g
400
800
Proteins
Carbohydrates
Higher proportions of saturated

ELDERLY POPULATION 5
Bread garlic,
herb
2 scoops of
ice cream
½ cup of
mixed
vegetables
1 tomato
140g
135g
560
----
-----
-----
other than unsaturated fats.
Vitamin A, B12, D
Minerals; Calcium, phosphorus,
iron, zinc.
1600hrs Snack ½ cup of nuts
1 large glass
of calcium
fortified soy
milk.
3 plain sweet
biscuits
50g
200g
4g
200
800
28
Proteins
Carbohydrates
Higher proportions of saturated
other than unsaturated fats.
Vitamin A, B12, D
Minerals; Calcium, phosphorus,
iron, zinc.
2000hrs Dinner Chicken
tikka masala
Cooked rice
2 small
plums
1 large glass
200g
150g
100g
250g
800
600
-----
1000
Proteins
Carbohydrates
Dietary fiber.
Vitamins B12, A, D
Minerals; calcium, phosphorus,

ELDERLY POPULATION 6
of milk,
250ml
zinc
Water 6 glasses 1500g ----- Hydration
Totals 7737Kcals
Criticism of John’s diet plan.
Breakfast
½ cup of porridge
1 ½ bread roll
½ cup cooked vegetables
1 banana
This meal is rich in carbohydrates from the porridge, bread roll and banana. The
carbohydrates are from whole grain which is healthier. They are important in the body as they
provide energy and also they form the major part of the stored food to be used to produce energy
later. They are also important in fat oxidation. Lastly, they are converted into proteins and stored
(Baghurst, Baghurst & Record, 2016). The meal also has micro-nutrients Vitamin A, C and
magnesium and potassium. Vitamin A is for night vision, healing of the epithelial cells and the
development of teeth and bones. This is very important in the old age. Vitamin C helps in wound
healing and in absorption of iron. As mentioned above, intestinal motility decreases with age so
providing dietary fiber is very important so as to ease toileting. The minerals aids in bone and

ELDERLY POPULATION 7
muscle development (Public Health Advisory Committee, 2015). In summary breakfast provided
Stefanie’s body with the required nutrients as per her phase of life.
Snack
Tea, herbal, infusion
2 muffins
1 apple
This food is rich in carbohydrates, dietary fiber, Vitamin B complexes excluding B12,
magnesium, calcium, iron, and zinc. As mentioned above carbohydrates provides the largest
portion of energy in the body. The vitamin B complexes are important in metabolism of proteins,
carbohydrates and fats. The minerals help in wound healing, muscle contraction, (Gifford,
O’Connor, Honey & Caterson, 2014)
Lunch
1 medium fillet of cooked fish.
Bread garlic, herb
2 scoops of ice cream
½ cup of mixed vegetables
1 tomato
This food is rich in proteins, vitamin B12, iron from cooked fish, it has carbohydrates
from the bread, ice cream and it has vitamin A, D, calcium, iron, phosphorus, zinc from the
vegetables and tomatoes. Proteins provides the amino acids that makes up the cell structure.

ELDERLY POPULATION 8
They are involved in synthesis of antibodies and in repair of cells incase injury. They are also
used in energy provision in case of starvation. The B12 complex is important in erythropoiesis.
Vitamin D is important in iron absorption. Iron is important in erythropoiesis. The minerals are
important as they are anti-oxidants, bone development and repair, important in healthy eyes and
also in healing and tissue repair (Stanner, 2009).
Snack
½ cup of nuts
1 large glass of calcium fortified soy milk.
3 plain sweet biscuits
This food is rich in fats, carbohydrates, calcium, phosphorus, zinc, iron, vitamin A, B12,
D. Fats are important in energy production after carbohydrates (Baghurst, Baghurst & Record,
2016)., they are stored in delicate tissues for insulation (absorb shock). As mentioned above
carbohydrates provides the required energy. Calcium is important in bone development. The
other micronutrients are important in erythropoietin, wound healing, improves the eye sight,
boosts the immunity and helps in muscle contraction and fluid balance (Saunders, & Friedman,
2017).
Dinner
Chicken tikka masala
Cooked rice
2 small plums

ELDERLY POPULATION 9
1 large glass of milk, 250ml
The food is rich in protein, carbohydrates, dietary fiber, vitamin A, D, B12, Calcium,
phosphorus, zinc, calcium. As mentioned above the proteins are important in tissue repair and
wound healing. The carbohydrates are important in energy production. Calcium is important in
bone development, important as an anti-oxidant, important in wound healing and in
erythropoiesis process (Stanner, 2009).
Water
John takes 1500 liters of water this is very important as it acts as a solvent to transport nutrients
to the cells and the wastes for elimination. It is also important for body temperature regulation,
lubrication, insulation and metabolism (Stanner, 2009).
The New Zealand Guideline on diet for the elderly.
The following are the guidelines; the diet should ensure that the body weight is
maintained by eating well and also by performing physical activities daily. This is achieved by
including different nutritious food from the four major groups of foods. That is, plenty of fruits
and vegetable, plenty of bread, cereals which are wholegrain, ensure they take milk and the milk
products especially those that has low or reduced fat and eat lean meat, eggs, nuts, seafood and
legumes. Secondly, drink lots of liquids, especially water daily. Thirdly, ensure that the meals,
snacks and drinks have very minimal added fats especially if they have saturated fats, have
low/little salt and if sweetened they have little added sugar. Fourthly, ensure that they take three
meals a day with nutritious snacks in between. Fifthly, ensure there is food safety when
preparing and purchasing. Sixthly, if they take alcohol, reduce the intake. Lastly, ensure that they

ELDERLY POPULATION 10
are physically active by performing moderate physical activity at least for thirty minutes in most
of the days of the week (Capra, 2016; Ministry of Health, 2008; Jorgensen, 2009).
In addition to this, it recommends at least five serving per day of fruits and the vegetables
two and three servings respectively for each. A serving of dried fruits or blended juice counts as
one serving. Secondly, there should be at least 6 servings of carbohydrates (cereals and bread)
preferably the wholegrain. Thirdly, there should be at least 3 servings of milk and its products
per day. Lastly, there should be at least one serving of proteins in day (New Zealand Guidelines
2013; Peter et al., 2008).
Comparison of Stefanie’s diet plan and the New Zealand guidelines.
As mentioned earlier, Stefanie, who is 82 years old, requires 7737 calories per day. As
per the Food and Nutritional Guidelines, carbohydrates should produce 45-65% of the energy
required by the body, the fats should produce 20-25% of the energy and proteins, 15-25% of the
energy. I energy provision in Stefanie’s case, carbohydrates produce 3868 calories which makes
50%, fats 2254 calories which is 23% while proteins produce 1747 calories 21%. This shows that
the diet plan is as per the requirement.
In addition to this, the recommendations on servings are observed, she gets six servings
of vegetables and fruits; three vegetable servings and three fruit serving. The carbohydrates
servings are six, she gets two servings of meat, all white meat and one is seafood. She drinks
milk and takes the milk products at least in three servings, she takes food in low salt, her fat
sources intake was low in saturated fats and drank lots of water (Athar, McLaughlin, & Taylor,
2013).
Elderly as a special population

ELDERLY POPULATION 11
As people age special attention on nutrition is required as good nutrition translates to a
good health. Maintaining a functioning health and a good quality of life is one of the major
challenges for the ageing population (Khaw, 2008). In healthy ageing is influenced by the;
physiological, lifestyle, cognitive, and social changes that influences the dietary intakes and the
nutritional status of the individual. There is a high burden on risk of malnutrition and chronic
diseases in the elderly (McLennan & Podger, 2018). Researches done in different communities
shows that in the aged population, most of them has high blood pressure especially the systolic,
high cholesterol in blood, high basal mass index, reduced physical activities and reduced intakes
of fruits and vegetable. Ageing causes decline in health therefore making them prone to chronic
illnesses. Good health in the elderly aims at; preventing disabilities, preventing malnutrition,
reducing the risks of getting chronic diseases and promoting physical functioning (McLennan &
Podger, 2018).
Aging process and its influence on nutrition.
The aging process takes place in all vital organs and every tissue. These changes
significantly influence the nutritional status as it affects the metabolism of the body, the intake of
nutrients, the absorption, utilization, storage of nutrients and excretion of nutrients, the nutrients
requirement, and their ability to prepare different foods, choose different foods and eat different
varieties of foods. The following changes occurs; Sarcopenia, arthritis,
Firstly, sarcopenia is the inevitable process of losing the lean body (the skeletal muscle
and bones) mass in ageing and replacing this with fats over time. The decline in muscle 1-2%
occurs from the age of fifty years (Rolland et al 2008) and a total of 5% after every decade from
Fourty years (Greenlund and Nair, 2013). In women this loss is sudden following menopause.
This loss causes a decrease in muscle strength which in turn causes fatigue, impairs mobility,

ELDERLY POPULATION 12
causing imbalances which greatly causes disability. The solution to this is by having good
nutrition and physical activities. This will improve the muscle mass and the muscle strength.
Secondly, arthritis, this is a group of disease in which one or more joints gets inflamed.
The inflammation results from; an infection, an injury, accumulation of tear and wear or an auto-
immune response. Osteoarthritis is one of the most common type of arthritis and in most cases in
the old, it is as a result of the accumulated tear and wear. This causes disabilities although it can
be managed by good nutrition and physical activity (Perissinotto et al., 2012)
Thirdly, bone loss in old age is associated with rapid bone resorption especially in
women in the first five years that follows the menopause phase. The collagen matrix and the
bone minerals are removed more rapidly than they are being replaced. This increases the risk
towards developing osteoporosis and getting fractures as they get older. In addition to this,
calcium absorption is decreased as one ages. It is therefore important to ensure that the nutrition
is rich in vitamin D and calcium so as to minimize bone loss (Perissinotto et al., 2012).
Fourthly, gastrointestinal and the immune functions. As one ages the digestive and the
absorptive function of the gastrointestinal system declines. The intestinal wall in the old age
loses its elasticity, strength and the hormonal secretions changes which results to a slow
intestinal motility. There is also atrophic gastritis in which the stomach mucosa atrophies causing
a reduction in gastric acid secretion, pepsin and the intrinsic factors. This causes a decrease in the
bioavailability of vitamin B12, calcium, iron and folate (Philips, 2013; Horwath & Van Staveren
2010). A study in New Zealand reported that 6.7% of the elderly population has atrophic gastritis
(Green et al 2015). The fat and proteins digestion is greatly reduced as there is a decrease in
production of pancreatic enzyme (Philips 2013). In addition to this, the aging process results to
an alteration of the immune regulation leading to increases incidences of infections with poor