Ch 36: Nutrition Support for Older Adults

Question 1

What are the principle interventions associated with treating sarcopenia?

Answer 1

Exercise and minimum protein intake of 1 g/kg/day; higher protein intake in adults has been associated w/ slower loss of skeletal muscle mass but primary role of nutrition in management is adequate overall intake

Question 2

What are general energy needs for older adults?

Answer 2

25-30 kcal/kg/day; MSJ equation w/ appropriate factors may also be used

Question 3

Which factors contribute to the development of sarcopenia?

Answer 3

sedentary lifestyle, myocyte apoptosis, oxidative stress, altered muscle protein metabolism in context of anabolic resistance, and reduced vit D level. Inadequate protein intake may also contribute

Question 4

What are general protein needs for older adults?

Answer 4

1.0-1.2 g/kg/day

Question 5

Low daily intake of what nutrients were independently associated w/ frailty in European cohort

Answer 5

Energy, protein, vit D, E, C and folate were independently associated w/ frailty in European cohort

Vit D levels less than 15 ng/mL were associated w/ increased risk for frailty after adjusting for season of the year/latitude

Along w/ vit D, carotenoids, creatine, dehydroepiandrosterone and HMB have been identified as potential therapies to treat frailty in older adults though studies are scarce

Question 6

When is EN not recommended for older adults?

Answer 6

Not indicated in end stage disease, including advanced dementia

Question 7

Which nutrient screening tools are thought to be most widely validated tools specific to older adults?

Answer 7

MNA SF and Nutrition Screening Initiative (NSI DETERMINE checklist)

MNA seems to be most valid tool for malnutrition assessment in ambulatory community living older adults and those residing in LTC facilities

Question 8

What are general fluid/fiber needs for older adults?

Answer 8

Fluid needs: 30 mL/kg (> 1500 mL/day) or 100 mL per kcal

Dietary fiber: 25-35 g/day

Question 9

Diagnosis of malnutrition is based on presence of at least 2 of which of the following 6 criteria?

Answer 9

Insufficient energy intake, weight loss, loss of muscle mass, low of subcutaneous fact, localized or generalized fluid accumulation and diminished functional status as measured by handgrip strength

Question 10

Which type of protein seems to stimulate post prandial muscle growth faster than other types of protein?

Answer 10

Whey protein (fast protein) stimulated post prandial muscle growth faster than casein (slow protein) and casein hydrolysate; this was attributed to combo of faster digestion and absorption kinetics and higher leucine content of whey. For optimum muscle protein synthesis, older adults may require meals containing more than 25 g protein or at least 10 g of essential AA

Question 11

What is frailty, and how is it diagnosed?

Answer 11

Multifactorial; leads to significant changes in QOL, vulnerability and disability in older adults

Loss of muscle mass/strength, is also a hallmark of frailty

Frailty may be diagnosed if 3 of the following 10 criteria met: unintentional weight loss of 10 lbs in the last year, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity

Question 12

What is sarcopenia and what does it increase risk of?

Answer 12

Age related decline in skeletal muscle mass, strength, and function; usually begins in 5th decade of life. Prevalence doubles in people 80 years and older

Increases risk of immobility, falls, fractures, cognitive impairment, and institutionalization

Question 13

Why are NGTs not recommended in older adults?

Answer 13

Increase risk of aspiration and presence of NGT to preclude ability/desire to eat by mouth

Question 14

What is sarcopenic obesity?

Answer 14

Associated w/ sarcopenia and high level of body fat; leads to worse functional outcomes, and higher mortality compared w/ sarcopenic lead/normal

Central adiposity in relation to loss of LBM underpins sarcopenic obesity and disease risk but is not identifiable by BMI alone

Question 15

Which micronutrients are needed in higher amounts in older adults?

Answer 15

Ca, vit D, and B6 are slightly higher in older adults than in younger

DRI for vit B12 is not increased for older adults; however, they are more likely to be deficient b/c of malabsorptive disorders r/t aging and prolonged use of certain meds such as PPIs and Metformin

Question 16

In which situations does EN improve QOL?

Answer 16

EN has been noted to improve QOL in the following conditions: CA of H/A, acute CVA w/ dysphagia, neuromuscular dystrophy, and growth failure (in children)

No improvement in nutrition related/functional status was found in patients w/ cachexia, anorexia, aspiration, or CA w/ a poor prognosis

Question 17

In an older adult who requires long term EN, which complications is often overlooked?

Answer 17

Decreased urine output; decreased urination likely indicates inadequate fluid intake while on enteral feeding and the potential for dehydration and risk for acute kidney injury

Question 18

Vitamin D (25, hydroxyvitamin D) deficiency is defined as a serum level of less than what?

Answer 18

20 ng/mL

Question 19

Vitamin D (25, hydroxyvitamin D) deficiency can manifest as what?

Answer 19

Muscle weakness

Question 20

What forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare and Medicaid called?

Answer 20

The Minimum Data Set (MDS). The MDS is a core set of clinical and functional status elements. The MDS is a part of the Resident Assessment Instrument (RAI), a problem identification model

Question 21

Which medications are common causative agents associated with hyponatremia in older adults?

Answer 21

Thiazide or thiazide-like diuretics are the most common causative agent associated with diuretic-induced hyponatremia.

Question 22

Which types of medications may contribute to anorexia in the older adult?

Answer 22

Narcotic analgesics, histamine receptor antagonists, and antihypertensive agents

Question 23

What are the components of the Comprehensive Geriatric Assessment tool?

Answer 23

assessment of anthropometric measurements, biochemical markers, and medications

Question 24

What is the most widely used tool to measure generic health-related quality of life?

Answer 24

The SF-36 is one of the most widely used tools to measure health-related quality of life

Question 25

Sarcopenia, the loss of lean body mass that occurs with aging, is also associated with

Answer 25

Decreased bone density

Question 26

Water output from the feces, skin, and lungs is considered insensible loss and can account for up to _____ of fluid loss per day.

Answer 26

1L of fluid loss per day.