General - older patients, safeguarding Flashcards
What is malnutrition?
Deficiencies, excesses or imbalances in a persons intake of energy and or nutrients
What is overnutrition?
Overweight - BMI 25-29.9
Obesity - BMI>30
Related to heart disease, stroke, diabetes and cancer
What is undernutrition?
BMI <18.5kg/m2
Unintentional weight loss of 10% body weight over 3-6 months
BMI of 20 and unintentional weight loss of >5% body weight over 3-6 months
What oral health conditions contribute to undernutrition?
Sore mouth/burning
Changes in taste sensation
Increased susceptibilty to oral infections
Problems with denture fit/impaired mastication
Swallowing difficulties
Why do people become malnourished?
1) Inadequate nutrient intake
2) Increased metabolic requirements i.e. are more active or at cellular level due to health condition, frugs, brain injury, cancer
3) Excessive nutrient losses e.g. B12 def from stomach removal
What screening tool is used in nutritional screening?
MUST - 5 steps 1) BMI 2) Unplanned weight loss 3) Acute disease effect 4) Overall risk 5) Action
What does it mean if nutritional support is
a) Parental
b) Enteral
c) Oral nutritional support
a) Delivery of nutrition IV
b) Delivery of nutritionally complete feed via tube into gut
c) Additional snacks, fortified food, oral nutritional supplements/sip feed
What is food fortification?
Addition of micronutrients or energy e.g. sugar jam, butter cheese, skimmed milk powder
What are the short term enteral methods for increasing nutritional uptake?
Nasogastric
Naso duodenal
Nasojejunal
What are the long term enteral methods for increasing nutritional uptake?
Percutaneous endoscopic gastrotomy (PEG) - in abdomen
Radiologically inserted gastrostomy (RIG)
Balloon gastrostomy
PEG with jejunal extension
Needle catheter jejunostomy
What are the indications for parental feeding?
Non functioning GIT e.g. Crohns, high output stoma, fistulae, short bowel syndrome
Inaccessible GIT e.g. intestinal obstruction
When enteral nutrition not feasible, contraindicated or not accepted by pt
What are the central methods for perental feeding?
Venous into superior vena cava or right atrium (TPN)
What are the peripheral methods for parental feeding
Short peripheral cannular or midline catheter (PPN)
What is the composition of these enteral feeds?
a) Polymeric
b) High protein/high energy
c) Semi-elemental or elemental
d) Disease specific
a) Whole protein 1kcal/ml
b) 1.2 1.5 or 2kcal/ml
c) Oligopeptides/amino acid formulations
d) Modified fats, hypoallergenic, immune enhancing e.g. omega-3 fatty acids
What is fraility?
Linked to levels of independence. Mental and physical resilience and recovery after injury/illness, at risk of severe deterioration in health from only minor insults
What is ageing?
Process where structural and functional changes accumulate in organism from passage of time - not due to preventable disease or trauma
Why do these changes occur in the CNS with increasing age:
a) Poorer short term memory
b) Harder to learn new skills
c) Increased postural hypertension and loss of bladder control
d) poorer co-ordination and fine motor control
a) Increased amyloid protein deposition in the cerebral cortex
b) Loss of neural tissue in the hippocampus
c) Blunting of baroreceptor complexes in the brainstem
d) Age related changes to vertebrae and discs increases pressure and slows conduction of impulses down motor neurones so reduced muscle strength
What is a pharmacokinetic interaction?
Modification of action of one drug (X) by drug Y because Y alters the concentration of X reaching the site of action
What is the pharmacokinetic interaction between chelates and tetracyclines?
There is an ABSORPTION interaction
Chelate stops tetracycline passing through gut wall
What are the following changes that occur in the musculoskeletal system with increasing age?
a) Muscles
b) Bones
a)
What are the changes in saliva with increasing age?
- Stimulated and unstimulated flow rates decrease from all SG
- Quality/composition unchanged
What a) medical conditions and b) drugs affect saliva flow?
a) Sjogrens syndrome, diabetes, dehydration, salivary gland disease e.g. surgery or radiotherapy
b) Calcium channel blockes, B- blockers, a-adrenergic blockers, anti-cholinergic, diuretics
What are the changes in the enamel with increasing age?
- Thins
- Loss of features e.g. mammelons
- Loss of translucency and darkens
- Cracks appear (more brittle)
- Coronal caries and tooth wear more prevalent
What are the changes in dentine with increasing age?
- Less water content - cracking
- Peritubular dentine (tubular occlusion)
What are the changes in the pulp with increasing age?
- Reduced pulpal space from tertiary and secondary dentine
- Pulp calcification
- Degeneration pulpal neurones
- Widening of apical foramen as increased cementum (large distance from radiographic apex)
- Vascularity and cellular content decreases
What are the changes in a) fibroblasts in the PDL b) Cementum c) PDL with increasing age?
a) Reduced rate of proliferation, decreased protein and collagen production
b) Thickness increases esp. in apical 1/3
c) Increased fibrosis, decreased cellularity
What are the changes in the oral mucosa with increasing age?
- Loss of elastic fibres
- Thickening and disorganisation of collagen
- Reduced microvasculature
- Impaired wound healing
What are the clinical implications for teeth that have gone through the ageing process?
- Decreased pain perception - more likely to have asymptomatic pulpitis
- Pulp testing unreliable - pulp stones, tubule occlusion, less water
- Non patent canals
What are the clinical implications for teeth that have gone through the ageing process?
- Decreased pain perception - more likely to have asymptomatic pulpitis
- Pulp testing unreliable - pulp stones, tubule occlusion, less water
- Non patent canals
What are the recommended interventions in the elderly?
Management of long term illnesses according to NICE guidelines
Falls assesssment
Medication review using STOPP/START tool
Comprehensive geriatric assessment
What are the implications when treating an elderly patient?
- Difficulty laying flat e.g. breathless from HF or spinal injuries
- Increased bleeding from procedures from drugs
- Difficulty tolerating long procedures e.g. toilet breaks
- Increased risk anaesthetics and sedatives
- Difficulty complying with instructions if confused
What are the definitions of
a) Impairment
b) Disability
c) Handicap
a) Physical damage caused by the disease process
b) Tasks that can’t be performed as a result of the impairment
c) Effect on the individuals lifestyle
What are the 4 geriatric giants?
Instability, Immobility, Incontinence, Intellectual impairment
What is the purpose of the National Service Framework 2001?
Rooting out ageism Person-centred care Immediate care and general hospital care Strokes falls and mental health Health promotion and disease prevention Medicines e.g. use lower doses
