Betsy, a 79-year-old woman, was evaluated in your office. She lives with her 81-year-old husband who is her primary caregiver. He reports that approximately 2 years ago his wife began to lose interest in the things she enjoyed like shopping, cooking, and sewing. Gradually she became less interested in food and has lost 18 pounds in the past year. He has tried commercial nutritional supplements but has not been successful getting her to consume them. He stated he is not much of a cook but has been trying his best. He is frustrated and concerned about his wife’s weight loss and lack of appetite. He feels he is constantly trying to get her to eat. He does not have any family support as he and his wife never had children. Her medical evaluation revealed cognitive impairment using the Mini-Mental State Examination. She does not appear to have any chewing or swallowing problems but has not seen a dentist in over three years. She takes one prescription medication for her arthritis. This couple is on a fixed income from social security. Her height is 5’1” and current weight is 100 pounds. Past weight was 118 pounds (1 year ago).
Answer the following questions about Betsy. Your responses should be phrased as though you were counseling the client. This means explaining your answers in detail. Please refer to the first question for an example of an acceptable response.
• As Betsy ages, how has her body composition changed from when she was 50 years old until now?
o Example Response: Betsy as you age your body will go through a number of changes such as X, Y, Z. For example, when you were 50 years old you may have been able to do X, but now at 79 you may be a little limited in doing that function.
• Based on Betsy’s scenario, what are at least two socioeconomic factors that are impacting her nutritional and health status?
• Calculate Betsy’s calorie needs (this requires you to use the Harris Benedict equation or the Mifflin St Jeor equation).
• Provide the percentages of macronutrients she should consume on a daily basis (i.e., 50% of total calories from carbohydrates)
• Based on Betsy’s scenario, design a 5-day meal plan for her that includes the proper portion sizes of each food (the portion sizes must adhere to the serving sizes set forth by the USDA: http://www.choosemyplate.gov/MyPlate). Each day of the meal plan must include a variety of foods. The meal plans must have breakfast, lunch, and dinner and at least 2 snacks. Also, include two micronutrients with the proper RDA’s that she needs to consume on a daily basis. Below is a template for you to use to design this meal plan.
Questions:
• What are the ethical concerns for both Betsy and her husband, given her own personal rights as well as his concerns over her well-being? Answer this question thinking more about the nutritional aspects of ethics. Examples of ethical concerns could be safety and abuse (for example, not feeding her the proper consistency of foods).
• As a nutrition professional, how would you address these concerns?
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