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LC 3 > LC 3.10 Nutrition and the Elderly > Flashcards

LC 3.10 Nutrition and the Elderly Flashcards

1
Q

What are the age-related risk factors for malnutrition?

A
  • Isolation
    • Dentition
    • Difficulty swallowing
    • Malabsorption
    • Cognitive impairment
    • Medication (can affect appetite or cause nausea)
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2
Q

What changes occur to the mouth with age?

A
  • Dry mouth
    • Reduced taste and smell
    • Reduced mastication power
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3
Q

What changes occur to the oesophagus with age?

A

• Delayed pharyngeal phase of swallowing (particularly in dementia) - causes prolonged time of food in pharynx

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4
Q

What changes occur to the stomach with age?

A
  • Atrophic gastritis rates increase

* Delay in gastric emptying of liquids

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5
Q

What are the consequences of atrophic gastritis?

A

Reduced stomach acid secretion, causing digestion problems

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6
Q

What changes occur to the small intestines with age?

A
  • Increased bacterial overgrowth
    • Reduced zinc and calcium absorption
    • Fall in vitamin D receptor concentration
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7
Q

What changes occur to GI orocaecal motility with age?

A

• Transit time unchanged, although colonic transit time can vary

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8
Q

What can reduce colonic transit time?

A

Hypothyroidism

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9
Q

What changes occur to the rectum with age?

A
  • Reduced elasticity
    • Increased threshold rectal pressure
    • Reduced anal squeeze pressure (sphincter strength)
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10
Q

What can the rectal changes with age lead to?

A

Faecal incontinence

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11
Q

How is nutritional status assessed?

A
  • BMI
    • Anthropometric measures
    • MUST (Malnutrition universal screening tool)
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12
Q

What are the anthropometric measures?

A
  • Mid-arm circumference

* Skin-fold thickness

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13
Q

What can make BMI unreliable?

A
  • Ascites
    • Other fluid accumulation
    • Wasting diseases
    • Functional measures
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14
Q

What are the steps of MUST?

A
  • BMI score (0-2)
    • Unplanned weight loss score (0-2)
    • Acute disease score (0-2)
0 = low risk
1 = medium risk = observe
2+ = High risk = treat
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15
Q

What functional measures can be used to assess nutrition?

A

Grip strength

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16
Q

How often should nutritional assessment be carried out in hospitals?

A

Weekly and on first visit (all patients

17
Q

How often should nutritional assessment be carried out in care homes?

A

Admission and monthly

18
Q

How is malnutrition dealt with?

A
  • Change or increase in diet suggested first
    • Oral nutritional supplements
    • Naso-enteral feeding if swallowing problems
    • Naso-jejunal feeding if gastric emptying problems
    • Percutaneous-enteral feeding for long-term bypass of swallowing
    • Parenteral feeding (through vein)
19
Q

In what cases should enteral feeding be avoided completely?

A
  • Obstructions
    • Acute abdomen
    • Motility disorder
    • Insufficient gut (absorption area)
20
Q

What are the potential complications of parenteral nutrition?

A
  • Nutrient imbalances or deficiencies
    • Infection
    • Thrombosis
    • Occlusion
21
Q

What risk is associated with inserting a central line?

A

Pneumothorax

22
Q

What micronutrient deficiencies are common in the elderly? Which of these are associated with increased mortality?

A
  • alpha-tocopherol (E)
    • retinol (A)
    • cholecalciferol (D) - higher mortality
23
Q

What causes vitamin D deficiency in the elderly?

A
  • Loss of sunlight exposure

* Worse diet (no fish/meat/eggs)

24
Q

What can vitamin D and Ca supplements help to prevent?

A

Fractures

25
Q

What dose vitamin D is required for effective fall prevention?

A

800 IU per day (international units)

26
Q

What benefits can thiamine supplementation have?

A
  • Improves appetite

* Reduced fatigue

27
Q

What effect do mediterranean diets have on mortality according to the EPIC study?

A

7% reduction

28
Q

What do food-drug interactions include?

A
  • Drug-nutrient interactions
    • Effect of medication on nutritional status (e.g. drug causing nausea may cause reduced intake)
    • Absorption
    • Adsorption
29
Q

What body composition considerations must be taken into consideration with the elderly and why?

A

Elderly people have a higher ratio of adipose tissue, so fat soluble drugs may accumulate and increase the risk of toxicity

30
Q

Describe how food can alter drug absorption.

A

Presence of food in the intestinal tract may block absorption of drug

31
Q

Describe adsorption in terms of food-drug interactions.

A

Adhesion of a drug to food components

32
Q

Give an example of an adsorption food-drug interaction

A

Digoxin and high phytate foods (wheat, oatmeal)

33
Q

Give an example of an absorption food-drug interaction.

A

Bisphosphonates have negligible absorption if taken with food

34
Q

Give examples of drug-nutrient interactions.

A
  • Grapefruit/juice inhibits cytochrome enzymes of many drugs decreasing metabolism and increasing chance of toxicity
    • Warfarin works by preventing the conversion of vitamin K into active form, taking vitamin K in usable form will allow clotting factors to form, making the drug less effective

LC 3 (12 decks)

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