Question

Ruth, 82 years old, was placed in a nursing home due to her family’s inability to meet her increasing health care needs in the late stages of Alzheimer’s disease. This was a very difficult decision for the family, especially for her husband, 85-year-old Dale. Ruth had been on a diet for diabetes at home, but now is refusing almost all meals and fluids. Her family has been asked to decide on their plan for provision of tube feeding and IV fluids should this become necessary. In the meantime, the dietary department is doing their best to offer foods to Ruth that she used to like, within the guidelines of a diet for diabetes. Ruth is completely unable to feed herself with utensils and she gets agitated when placed in the dining room with the other residents. She has been losing weight over the past two months since her admission. Dale is new to using warfin medication to control blood clots. Listed below is Dale’s 48-hour recall with his vitamin K levels indicated (data from the USDA nutrient data laboratory online).

Food or Beverage Item	Serving Size	Vitamin K (mg)
Day #1
Oatmeal	1 cup	1.2
Whole milk	1 cup	0.5
Orange juice	½ cup	0.1
Tuna salad	½ cup	21.2
Wheat bread	2 slices	1.1
Baby carrots	16	21.1
Roast beef	4 ounces	1.9
Baked potato w/ peel	1 medium	3.5
Butter	2 tsp	0.7
Sour cream	1 Tbsp	0.3
Tomatoes, fresh	½ cup	7.1
Applesauce	1 cup	1.5
	Daily Total:	60.2
Day #2
Special K®	1 cup	0.2
Whole milk	1 cup	0.5
Orange juice	1 cup	0.2
Roast beef	3 ounces	1.4
Wheat bread	2 slices	1.1
Salad greens	1 cup	111.5
Italian dressing	2 Tbsp	16.5
Baked chicken	4 ounces	2.7
Spinach, cooked	½ cup	554
White rice	1 cup	0
Grapes	½ cup	11.7
	Daily Total:	699.8

Questions:

1. What is the therapeutic benefit of a diet (e.g., for diabetes) when an elderly person is in long-term care? (5 points)
2. Should Ruth be required to follow a diet for diabetes at this time? (5 points)
3. What nutrition interventions might be helpful for Ruth at this time? (5 points)
4. Is Dale meeting his DRI for vitamin K on each day? (5 points)
5. What advice do you have for him regarding his vitamin K intake over these two days? (5 points)

Answer 1

Therapeutic benefit of the diet.

• Day , Less Vitamin K diet is because Vitamin K lessen the effectiveness of Warfarin.
• Prevent thrombosis
• Day 2, Availability of Vitamin K in blood levels improves cognition and behavioral performance
• Rich fiber diet leads to smooth digestion and avoid constipation.
• Improves immune system and prevent osteoporosis.
• Prevent coronary heart disease

Please ask remaining questions separately.