aging and critical care Flashcards
What makes a diet senior
Lower
Protein
Phosphorus
Calories
Higher in fiber
Have joint support
Cognition support
Muscle support
No actual regulation to label it as a senior diet
Diseases associated with aging
Thyroid conditions
Chronic renal disease
Osteoarthritis
Cardiac disease
Dental disease
Neoplasia
Cognitive dysfunction
Endocrine disorders
Changes associated with ageing
Alterations in cognition
Weight gain
Weight loss
Muscle wasting
Decreased skin elasticity
Slower wound healing
Digestive changes
Decline of senses
Energy for seniors
As a result of the increase in MER in cats above 12yrs , some guidelines suggest increasing caloric intake by up to 25% in senior patients
However the change in MER is not uniformly seen in all senior animals, so why should we make uniform recommendations?
What if this change in caloric intake was made in a cat whose MER had not yet increased?
Obesity
Obese cats over 8 years have mortality risk 3x that of cats with optimal BCS
Exacerbate comorbidities common in older animals
Diabetes mellitus
FLUTD
Osteoarthritis
obesity and osteoarthritis
52% of dogs and 41% of cats with OA are also obese
Weight loss of as little as 6% has been shown to improve lameness in arthritic dogs
Weight loss plans should be considered in obese pets even if ideal BCS cannot be achieved
Risk of being underweight
Having BCS < 5/9 also associated with increased mortality risk
Animals with poor BCS should be evaluated carefully for comorbidities
Adjust caloric intake as needed to maintain BCS
Higher caloric density may be necessary
Reasonable starting estimates for caloric needs in mature animals:
Cats 1.1-1.6 x RER
Dogs 1.4 x RER
Fat for senior diets
Senior cats may have reduced ability to digest fat
Occurs in 10-12% of cats 7-12 years of age
33% of cats greater than 12 years of age
Essential fatty acids (ie, linoleic) can help maintain normal skin and coat condition
Providing appropriate levels of fat can:
Increase caloric density
Improve palatability
Sarcopenia is
muscular atrophy as a result of aging
Common cause of muscle weakness in older animals
Cachexia is
muscle loss due to medical conditions
Chronic kidney disease
Heart failure
Protein and muscle mass
Important in maintaining lean muscle mass, protein synthesis and immune function
Some evidence of decreased protein digestibility in senior cats
20% of cats over the age of 14
In dogs, an increased protein-to-calorie ratio may be necessary
Ensures appropriate protein intake with lower caloric needs
Protein- quality vs quantity
Adequate protein is necessary to maintain lean muscle mass and meet dietary needs
Improving protein quality can assist in meeting protein needs without adjusting amounts
Consider amino acid profile and bioavailability of protein
Fibre in older patients
Constipation common in older pets
Reduced water intake
Limited activity
Reduced colonic motility
Dietary fibre promotes normal intestinal motility
Also decreased postprandial glycemic effects in diabetic dogs
Decreases caloric density
Can promote weight loss
Also aids in satiation
Poor option in underweight seniors
Minerals of concern for seniors
Ca
Phosphorus
Na
Calcium in older patients
Osteoporosis not commonly diagnosed in pets
However some loss in bone mass is seen in older cats (+7 years)
Older cats maintain lower urinary pH
Increased risk of hypercalcemia (idiopathic, neoplastic, renal)
Increased risk of calcium oxalate urolithiasis
Moderate calcium levels recommended to reduce risk of calcium oxalate
Phosphorus in older patients
Restriction of phosphorus important in the management of CKD
25% of dogs and 30% of cats affected
Often not diagnosed until later stages
Moderate restriction of phosphorus can be helpful to protect against advancement of subclinical CKD
Sodium in older patients
May be harmful in patients with hypersensitive conditions
Obesity, CKD, endocrinopathies
Dogs with cardiac disease have decreased ability to eliminate excess Na
Moderate restriction could be helpful to reduce risk in these patients
Antioxidants for older patients
Normal oxygen metabolism results in highly reactive free radical molecules
Prolonged oxidative stress (ie, aging) results in free radical damage
May account for many associated degenerative changes of aging
Antioxidants have excess electrons available to donate
Eg: Vitamins C & E, Selenium
Normal oxygen metabolism results in highly reactive free radical molecules because
Oxygen molecules split into single atoms with unpaired electrons
Scavenge the body to find matching electron
This can result in body damage
Cognitive decline with seinors
Physical changes occur in the brain associated with ageing
Atrophy of tissues
Loss of neurons and synapses
Reduced glucose utilisation
Chronic inflammation
Reduction of myelination
DISHAA is and helpful for
Tool to help evaluate cognitive decline
Disorientation
Social Interactions
Sleep/Wake Cycles
House soiling
Learning and Memory
Activity
Anxiety
Antioxidants for cognitive support
Vitamines c and e, selenium
Mitigate oxidative stress
Anti-inflammatories for cognitive support
Omega 3 fatty acids DHA and EPA
Reduce inflammation
Arginine for cognitive support
Neural activity during cognitive tasks is associated with increase in blood flow
Mediated by nitric oxide, which is metabolized from L-arginine
B vitmanins for cognitive support
Important for neurodevelopment and cognitive function
Medium chain triglycerides is and helpful for
Brain dependent on glucose for energy
Age reduces ability to utilize glucose
Reduce glucose metabolism may lead to brain cell death and loss of brain mass
Alternative energy source required to support normal function
Ketone metabolism unaffected by age
Ketones can provide energy to the brain during prolonged fasting and low glucose availability
Texture and palatability can be helpful because
Risk of dental disease increases with age
Pets with advanced oral disease may have difficulty grasping and chewing foods
Appropriate oral care important
Consider alternative textures when COHATs not an option
Sense of smell decreases
Primary driver of palatability in dogs and cats
Major consequences of malnutrition
Decreased immunocompetence
Decreased tissue synthesis and repair
Altered drug metabolism
How common is malnutrition in hospitalised dogs
Negative energy balance (defined as <95% RER) in hospitalised patients
73%
22% poorly written feeding orders
34% orders to withhold food
44% refusal to eat
What percent of RER did a majority of hospitalized dogs consume
84%
Who should receive nutritional support
High risk:
<80% of RER for >3 days
Anorexia for > 3 days
Weight loss
Underweight
Muscle wasting
Illness > 3 days
Growth
Hepatic lipidosis (cats)
Rule of thumb for nutritional support
3 days → healthy adult
Immediate → all others!
Why the 3 day rule for nutrition support
Malnutrition becomes more severe after 3 days
Metabolic shifts
↑ risk of metabolic complications
Enterocyte atrophy
↓ immune function
Healhy animals for food deprivation
Rely on ENDOGENOUS FUEL
Glycogen stores (very quickly depleted)
Fat tissues (variable storage)
Muscle protein
Fuel to meet metabolic needs
Maintain blood glucose
Food deprivation with trauma or illness
Muscle-sparing adaptation is absent
Catabolize lean muscle mass to produce glucose
Glucocorticoids, glucagon, inflammatory mediators
Starvation vs illness
Simple starvation → adaptation → muscle sparing
disease/trauma → no adaptation → catabolism
Benefits of NPO
Nil per os (nothing by mouth)
Fasting historically recommended for dogs with diarrhea and/or pancreatitis
Rest the gut
Benefits of feeding sick animals
Bacterial fermentation in the bowel procedures SCFA
Feeds enterocytes
Maintains epithelial barrier
Down-regulates inflammation
Voluntary intake for sick animals food is
Offer before each assisted feeding
Feed in quite location
Warm food
Hand feed/sit with animal
Avoid food aversion
Syringe feeding is used for
Not advised for longer tem
Poor intake of significant calories
Stress
Nausea
Feeding tube is used for
Proactive placement
Various sizes/routes
Long term option
Medication
Parenteral nutrition is utilized when
Intractable vomiting
Severe malabsorption
Neurological disorders
What to look for in recovery diets
Complete and balanced
Digestible
Tube feeding possible
Palatable
High protein (unless contraindicated)
High fat (unless contraindicated)
Glutamine is
Amino acid–important role in cellular processes
Concentrations decrease following injury and catabolic states
Conditionally essential during serious injury or illness
Studies show positive results of supplementing glutamines
Reduces rate of infectious complications
Reduces mortality rates in critically ill patients
↑ protein metabolism
Intestinal and pancreatic repair and regeneration
↑ nutrient absorption
Improved gut barrier function
Improved systemic immune function
Feeding amounts for sick animals
Dependent on duration of anorexia
Gradually increase to 100% RER over 2-7 days
Day 1: Provide 20-50% of RER
Divided into 4-6 feedings
Administer feedings over 10-15 minutes
Most tolerate 5-20 mL/kg per feeding
What happens if a patient is fed too much and/or too quickly?
Metabolic complications
Refeeding syndrome (rare)
GI side effects (nausea, regurgitation, risk of aspiration)
What to look for in nutrition for sick animals?
↑ blood glucose
↓ magnesium, potassium, and phosphorus
Ongoing monitoring for sick animals with nutritional needs
Once discharged, monitor q 1-2 weeks
Weight
BCS
MCS
Adjust feeding schedule to maintain weight and BCS
