aging and critical care Flashcards by K S

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

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Diseases associated with aging

Thyroid conditions
Chronic renal disease
Osteoarthritis
Cardiac disease
Dental disease
Neoplasia
Cognitive dysfunction
Endocrine disorders

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Changes associated with ageing

Alterations in cognition
Weight gain
Weight loss
Muscle wasting
Decreased skin elasticity
Slower wound healing
Digestive changes
Decline of senses

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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?

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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

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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

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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

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Reasonable starting estimates for caloric needs in mature animals:

Cats 1.1-1.6 x RER
Dogs 1.4 x RER

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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

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Providing appropriate levels of fat can:

Increase caloric density
Improve palatability

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Sarcopenia is

muscular atrophy as a result of aging
Common cause of muscle weakness in older animals

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Cachexia is

muscle loss due to medical conditions
Chronic kidney disease
Heart failure

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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

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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

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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

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Minerals of concern for seniors

Ca
Phosphorus
Na

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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

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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

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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

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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

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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