Geriatrics Flashcards
Energy requirements for a geriatric patient involves a caloric ___ to increase longevity.
restriction
Geriatrics should decrease energy level (caloric intake) by ___% while still meeting ___ needs.
decrease caloric intake by 25-30% while still meeting protein, vitamin, and mineral needs
energy requirements
Fontana et al. research showed that reducing ___ may slow the rate of aging.
metabolic rate and oxidative stress
energy requirements
When reducing metabolic rate and oxidative stress, you may be slowing the rate of aging by reducing ___ and promoting ___.
You still need to maintain ___.
Fontana et al.
reducing inflammation and promoting nutrient intake
maintain base metabolic rate
macronutrients
How many calories per serving is considered low, moderate, and high for geriatrics?
Low: 40 calories
Moderate: 100 calories
High: 400 calories or more
macronutrients
Geriatrics should limit saturated fat and trans fat to ___%.
less than 10%
macronutrients
When looking at total carbohydrates/fiber, if that number is above ___, geriatrics should stay away from that food.
10
macronutrients
For geriatrics, ___ or more is considered “high fiber”.
5 grams
macronutrients
What is the recommended daily intake of sugar for geriatric men?
What is it for geriatric women?
Men: 37 grams
Women: 25 grams
The average American is eating ___ servings of veggies a day.
less than one
macronutrients
According to NANES 2017-2018 data, men and women over 50-years-old consume excess ___, and not enough ___.
excess sugar
not enough fiber
micronutrients
There is a ___ in skin’s ability to make Vitamin D as we age.
four fold decrease
micronutrients
How much Vitamin D is recommended daily for elders?
What is the upper tolerable limit for elderly?
2000IU daily (especially in winter months)
upper limit = 4000IU
micronutrients
Vitamin B12 is naturally less available in elderly.
30% of elderly suffer from ___ and ___.
atrophic gastritis and decreased absorption of B12
micronutrients
Symptoms of Vitamin B12 deficiency in geriatrics may be causing ___ signs/symptoms.
neuropathy
micronutrients
What would be advised for an elder with Vitamin B12 deficiency?
“Food first” supplementation:
- emphasize protein in diet
- look for food fortified with B12
micronutrients
Which vitamin increases with age in plasma and liver stores, making older adults more susceptible to toxicity?
Vitamin A
micronutrients
What would be advised for an elder with Vitamin A toxicity?
- Whole foods first
- Retinoic acid/retinal at or under 700mcg or 2333IU
micronutrients
Which vitamin is associated with enhaced cognitive function and improved immune function in elders?
Vitamin E
micronutrients
Actual geriatric intake of Vitamin E from food is ___ than RDA.
significantly lower
need supplementation
micronutrients
An elder should supplement Vitamin E up to ___IU.
What are the risks of higher doses than this?
up to 400IU
Higher doses increase heart disease risk and longer blood clotting times (hemorrhage)
micronutrients
How much calcium is recommended for women aged 50 to 64 not taking estrogen supplement?
How much calcium is recommended for menopausal women taking estrogen?
Not taking estrogen: 1500mg
Taking estrogen: 1000mg
micronutrients
All men and women after age 65 should take ___mg of calcium daily.
1200mg
RANKL pathway
After menopause, declines in estrogen often lead to excessive bone ___ activity.
remodeling
osteoporosis
OPG is made by ___ to inhibit ___, thus ___.
made by osteoblasts to inhibit RANKL, thus osteoclastic activity
RANKL leads to maturation of ___.
osteoclasts
osteoporosis
Why do bones thin and weaken postmenopause, sometimes leading to fracture?
- Less estrogen increases RANKL
- RANKL overwhelms OPG
- More osteoclasts than osteoblasts
- Osteoblasts can’t keep up
In postmenopausal women, as estrogen declines, ___expression increases.
RANK Ligand
osteoporosis
Elevated RANK Ligand levels in postmenopausal women leads to increased ___.
osteoclast formation, function, and survival
osteoporosis
micronutrients
Males over age 31 should consume ___mg of magnesium daily.
Females over age 31 should consume ___mg of magnesium daily.
Males: 420mg
Females: 320mg
micronutrients
The average older adult male consumes ___mg of sodium per day.
However, an older adult should have no more than ___mg of sodium per day.
average male consumes 4900mg sodium/day
should have no more than 1500mg sodium/day
micronutrients
Adequate potassium intake for an elder is ___mg per day, and will balance ___ intake.
4700mg per day, and will balance sodium intake
micronutrients
What are some good sources of potassium for older adults?
- Fruits and veggies
- Juices and drinks e.g. coffee, tea, orange juice
eating well
What is meant by “DASH diet”?
Dietary Approach to Stop Hypertension
DASH diet is low in ___ by containing fewer ___ than the typical American diet.
low in saturated fat, cholesterol, and total fat by containing fewer sweets, added sugars, sugary beverages, and red meats
Which foods are focused on by a DASH diet?
- Fruits, vegetables, and fat-free or low-fat dairy products (7-8 servings fruits and veggies/day)
- Whole grains, fish, poultry, beans, seeds, and nuts
Successful diets are ___ changes.
slow and steady
What are some physiological changes that may alter eating habits in elders?
Sensual awareness changes:
- Taste and smell due to olfactory impairment
- Oral health: chewing and swallowing
- Appetite and thirst
How might a geriatric patient’s oral health be contributing to their eating habits?
- 25% of people over 60 have no natural teeth
- Saliva becomes thick resulting in difficult swallowing foods
How does appetite and thirst change eating habits in geriatric patients?
Appetite regulating cues in elderly are blunted
If chronically underfed or overfed, they will continue to do so
inability to adapt to changes
What is the acronym for risk factors towards geriatric eating habits?
DETERMINE:
- Disease
- Eating poorly
- Tooth loss/mouth pain
- Economic hardship
- Reduced social contact
- Multiple medicines
- Involuntary weight loss/gain
- Needs assistance in self care
- Elder years above age 80
Elderly are at a ___ risk of food poisoning.
higher
What are some reasons geriatrics may be at higher risk of food poisoning?
- Limited vision
- Decreased sense of smell
- Forgetfulness
What is considered the “true fountain of youth”?
Physical activity
Physical activity such as walking can be recommended for any patient to improve ___ and ___.
cognitive function and balance
What type of physical activity can be recommended to an elder to maintain or improve balance?
- Resistance or weight-bearing activities: muscle strengthening involving all major muscle groups 2 times per week
- Aerobic exercise: at least 150 minutes of moderate intensity per week
What are some recommendations for an elder to avoid irritants (chemical or mechanical) of GERD?
- Avoid food sensitivites
- Eat smaller meals
- Sit upright for two hours before bed
- Lower fat meals and less alcohol
- Eat protein throughout the day
- Weight loss
What are some risk factors for constipation in elders?
- Dehydration
- Medications (especially NSAIDs)
- High iron and other mineral supplements (antacids)
What are some remedies for elders with constipation?
- Adequate fluid intake (mineral water)
- Slight increase in insoluble fiber
- Magnesium (400mg or more)
What are some recommendations for elders with osteoarthritis in order of most to least evidenced?
- Weight loss
- Plant-based diets
- Vitamin D
- EFAs
- Chondroitin and glucosamine ( seemingly more effective with herbs such as Boswellia)
