Assessing and Documenting Eating Disorders in Older Persons

Subjective Section

Concerning Mrs. Sunshine requiring close supervision while feeding, her daughter noted that “Oh yeah, every day. You cannot leave her alone there to eat. Somebody needs to feed her.” About requiring physical help to feed, her daughter confessed that she must always be assisted in her feeding, claiming that “You saw this morning, she cannot tell the difference between a fork and a knife. You have to sort of put the spoon in her hand.” The patient’s daughter also confirmed spillage of food while feeding, as much as the spillage was not much. “Sometimes, she cannot figure out whether the food is going out or in.” On the last supervision question touching on leaving food on the plate at the end of the meal, the response was, “She never eats all of it. I cannot remember the last time she ate a whole meal.” Concerning eating behavior, the patient was confirmed of at times refusing to eat, noting that “There is something already in her mouth, I think she means her tongue.”

Objective Section

A notable set of characteristics have been associated with the client’s behavior, linking the easting disorder to old age. About the behavior presented by Mrs. Sunshine, often is the patient unable to feed on her own, forcing her to get assisted. Additionally, the patient needs a lot of supervision in her feeding program and process, requiring an extra person’s assistance in delivering to the feeding activity (Bahji, Mazhar, Hudson, Nadkarni, MacNeil & Hawken, 2019). From the patient’s behavior and health status related to feeding and eating, close supervision is needed for the patient while feeding. The above observation is an indication that there is a high rate of leadership required for the patient to maintain a positive eating pattern and behavior. Additionally, the patient needs physical help while feeding due to her age.

Notably, the patient cannot differentiate between a spoon and fork at times. At other times, the patient can also not open her mouth, her daughter instructing her on opening through illustration. From observing the patient while feeding, there is notable spillage while she is providing. Although not at all times, as her daughter confirms, Mrs. Sunshine at times spills food while feeding. Above and beyond, at every meal, as approved by the patient’s caretaker cum daughter, the patient leaves food on her plate. The symptom is also a vivid indicator of the patient having an eating disorder out of her old age. From the feedback gathered, Mrs. Sunshine refuses to eat at frequent times, an issue that bothers her daughter at all times. Additionally, if the patient accepts to eat, frequently will she turn her head away while eating (Dalton, B., Bartholdy, Robinson, Solmi, Ibrahim, Breen… & Himmerich, 2018). Nonetheless, the patient’s condition is not that wanting, out of her portraying positive feedback from analysis done. For instance, the patient never refuses to open her mouth, nor does Mrs. Sunshine spill food while being fed. Moreover, Mrs. Sunshine does not leave her mouth open, allowing food to drop out or, in any case, refuse to swallow food.

Assessment Section

Notably, our patient’s current food intake is low since low proportions are fed to the patient, and the patient does not consume all of the food offered to her. The diet is notable sufficient for the patient, but more focus should be on the foods’ nutrient value and not the amount since the patient is currently a poor feeder. About any supplements being fed to the patient, there are notable no oral or syringeal supplements given to the patient (Devlin, King, Kalarchian, Hinerman, Marcus, Yanovski & Mitchell, 2018). The avoidance of food is currently persistent, a vivid indication that the eating disorder is an established problem already. Mrs. Sunshine’s weight has notably reduced in the past few weeks, the reducting being attributed to her poor feeding behavior, specifically her avoiding feeding effectively. Her body mass index has recorded a reduction of 20%, instead of increasing or being static (Bahji, Mazhar, Hudson, Nadkarni, MacNeil & Hawken, 2019). Iron deficiency has also been noted, vividly indicating her fault in nutrition and malnutrition—the above results from poor and low food intake and lack of a balanced meal. Moreover, the patient is not aware when hungry, as her physical and verbal feedback is. However, the avoidance is not associated with any sensory aspect or distress in her aversive behavior.

Plan

In reaction to the above patient’s behavior and from supervising our patient, we have several recommendations that will assist the patient in achieving ultimate feeding for her health. Moreover, we have take-homes for her daughter, which will play an essential role in ensuring her mother is comfortably feeding. First, the patient’s mouth should be apparent in between bites. Second, a cue should be provided to the patient to clear her throat and swallow again between the feeding sessions and times (Dalton, B., Bartholdy, Robinson, Solmi, Ibrahim, Breen… & Himmerich, 2018). The action will ensure the patient feeds effectively without food being left in her mouth after eating. Also, while feeding, Mrs. Sunshine should sit upright and be provided a softer diet for adequate feeding and swallowing. By so doing, the patient will be comfortable with swallowing and eating small mouthfuls of food. Aside from being offered and fed small amounts of food, setting up a plan to extract all of her loose teeth and replace them with artificial but strong teeth should be enacted (Werlang, Sim, Lebow & Lacy, 2018). Moreover, maintaining good oral care for the patient using an electric toothbrush and frequently brushing her teeth should be a plan passed to increase her health status, although it is an indirect plan. Lastly, the patient should be offered fluoride rinses and fed less dense foods to eliminate her eating disorder effectively.

References

Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019). Prevalence of substance use disorder comorbidity among individuals with eating disorders: A systematic review and meta-analysis. Psychiatry research, 273, 58-66.

Dalton, B., Bartholdy, S., Robinson, L., Solmi, M., Ibrahim, M. A., Breen, G., … & Himmerich, H. (2018). A meta-analysis of cytokine concentrations in eating disorders. Journal of psychiatric research, 103, 252-264.

Devlin, M. J., King, W. C., Kalarchian, M. A., Hinerman, A., Marcus, M. D., Yanovski, S. Z., & Mitchell, J. E. (2018). Eating pathology and associations with long‐term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. International Journal of Eating Disorders, 51(12), 1322-1330.

Werlang, M. E., Sim, L. A., Lebow, J. R., & Lacy, B. E. (2021). Assessing for eating disorders: A primer for gastroenterologists. Official journal of the American College of Gastroenterology| ACG, 116(1), 68-76.