Question

Case Study #1: Gina Farrell

Gina is a 72-year-old retired teacher who lives alone. She used to love gardening, but since moving to a condo, doesn’t get much time outside, and spends most of her days reading or talking on the phone. She presents to her doctor complaining of right leg and knee pain and weakness. Her laboratory results showed deficient vitamin D and reduced bone density, and a diet recall included:

• Breakfast: two hard-boiled eggs, 1 whole grapefruit with 1 tsp sugar, 12 oz. black coffee
• Lunch: cucumber sandwich (made with a ½ cup of sliced cucumber, 2 slices white bread, and 1 T mayonnaise), 1 oz. potato chips, 16 oz. unsweetened iced tea
• Dinner: pasta (1 c.) with meatless marinara sauce (1/2 c.), small white roll, 1 glass red wine, fun-size milky way

Gina is 5’4” and weighs 126# (57kg). She says she loves to cook, but since it’s just her, she usually just prepares something quick and easy. Every Sunday she goes to church and to the grocery store, but otherwise, she doesn’t leave the house much.

1. Estimate how much protein Gina is getting. How much does she need? Is her intake adequate? What recommendations do you have regarding Gina ’s protein intake?
2. Talk about Gina's total fluid intake relative to her needs? Is she getting enough water? What are potential consequences of not taking in enough fluid and why is dehydration of particular concern for the elderly?
3. Gina's mom had osteoporosis and she’s concerned about developing it too. How does her current diet impact her risk for osteoporosis? What steps can Gina take to maintain her bone health?
4. What is the role of vitamin D in preventing bone loss? How Gina ’s leg and knee pain be related to her vitamin D status? Why is vitamin D deficiency more common in the elderly?
5. Her doctor recommended a vitamin D supplement. What other ways can Gina  improve her vitamin D status? List some foods that are good sources of vitamin D.

Answer 1

Gina's protein intake seems to be adequate as her diet plan includes high class protein stuff.

As regards fluid intake it is relatively low resulting into developing dehydration in the long term. Loss of skin turgor is the first sign of dehydration. Besides dry lips, brittle hairs, coated tongue all adds in making the condition worse. Generally in the elderly period fluid intake gets reduced drastically which if not diagnosed early may land up in complications.

Fluid intake does not only include plain water but can be taken up by other sources also namely fruit juices, soups, beverages etc.

Vitamin D deficiency and osteoporosis:- vitamin D falls under far soluble vitamin category which is found mainly in seafood, meat and poultry products. Hence the are the good sources of vitamin D

Natural source of vitamin D is sunlight.

Vitamin D geared up with calcium supplements will help in increasing the bone strength and will thus reduce the possibility of being osteoporotic.

Osteoporosis is the medical condition in which the bones become weak soft and brittle which then increases the chances of fracture which is very common in elderly.