Teo SL1, Amrita Tan RS.1
1Division of Nutrition & Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
RD, a 67-year-old Indian male with underlying chronic obstructive pulmonary disorder (COPD), type 2 diabetes (T2DM) and hypertension, was referred to the dietitian for nutrition optimisation. Patient presented to clinic with a weight of 62kg and a BMI of 23.8kg/m2. Prior, he has gained 3.3% of weight over 2 months. His blood results showed low potassium (3.2mmol/L), elevated total cholesterol (7.7mmol/L) and LDL (4.3mmol/L) with a HbA1c of 6.3%. RD has a tracheostomy. He is ADL-independent although he often feels breathless. This affects his appetite, where energy and protein intake varies between 960kcal-1900kcal/day and 35- 51 g/day respectively. His diet is further influenced by either mood, extensive food preferences and minor chewing difficulty. RD takes 2 anti-hypertensive medications and Salbutamol. He and his wife has the nutrition knowledge to manage his comorbidities. However, despite good support from family, RD is resistant to making changes, lamenting the need to alter and monitor his intake at this age, plus the reduction in quality of life (QoL) since getting COPD.
Not ready for lifestyle change RT limited value for behavior change AEB patient showing resistance towards change.
The aim is to optimise his nutrition status whilst maintaining good health-related QoL. His prescription is 1800kcal/day with 75g of protein. RD was counselled using motivational interviewing. Empathy was expressed, as discrepancy was developed between his current behaviour and his desired outcome for better QoL. His willingness to seek dietetic input was affirmed. Self-efficacy for change was supported as RD agreed to small changes of consuming regular meals with protein, and self-monitoring for potential contributors of erratic intake.
Monitoring & Evaluation
Until his next review in 3 months, parameters to be monitored include dietary intake, eating behaviour, weight, motivation for change and blood glucose levels. A future parameter to assess is muscle and fat status.