LC 3.10 Nutrition and the Elderly

Question 1

What are the age-related risk factors for malnutrition?

Answer 1

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

Question 2

What changes occur to the mouth with age?

Answer 2

• Dry mouth
  
  • Reduced taste and smell
  • Reduced mastication power

Question 3

What changes occur to the oesophagus with age?

Answer 3

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

Question 4

What changes occur to the stomach with age?

Answer 4

• Atrophic gastritis rates increase

* Delay in gastric emptying of liquids

Question 5

What are the consequences of atrophic gastritis?

Answer 5

Reduced stomach acid secretion, causing digestion problems

Question 6

What changes occur to the small intestines with age?

Answer 6

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

Question 7

What changes occur to GI orocaecal motility with age?

Answer 7

• Transit time unchanged, although colonic transit time can vary

Question 8

What can reduce colonic transit time?

Answer 8

Hypothyroidism

Question 9

What changes occur to the rectum with age?

Answer 9

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

Question 10

What can the rectal changes with age lead to?

Answer 10

Faecal incontinence

Question 11

How is nutritional status assessed?

Answer 11

• BMI
  
  • Anthropometric measures
  • MUST (Malnutrition universal screening tool)

Question 12

What are the anthropometric measures?

Answer 12

• Mid-arm circumference

* Skin-fold thickness

Question 13

What can make BMI unreliable?

Answer 13

• Ascites
  
  • Other fluid accumulation
  • Wasting diseases
  • Functional measures

Question 14

What are the steps of MUST?

Answer 14

• 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

Question 15

What functional measures can be used to assess nutrition?

Answer 15

Grip strength

Question 16

How often should nutritional assessment be carried out in hospitals?

Answer 16

Weekly and on first visit (all patients

Question 17

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

Answer 17

Admission and monthly

Question 18

How is malnutrition dealt with?

Answer 18

• 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)

Question 19

In what cases should enteral feeding be avoided completely?

Answer 19

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

Question 20

What are the potential complications of parenteral nutrition?

Answer 20

• Nutrient imbalances or deficiencies
  
  • Infection
  • Thrombosis
  • Occlusion

Question 21

What risk is associated with inserting a central line?

Answer 21

Pneumothorax

Question 22

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

Answer 22

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

Question 23

What causes vitamin D deficiency in the elderly?

Answer 23

• Loss of sunlight exposure

* Worse diet (no fish/meat/eggs)

Question 24

What can vitamin D and Ca supplements help to prevent?

Answer 24

Fractures

Question 25

What dose vitamin D is required for effective fall prevention?

Answer 25

800 IU per day (international units)

Question 26

What benefits can thiamine supplementation have?

Answer 26

* Improves appetite | * Reduced fatigue

Question 27

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

Answer 27

7% reduction

Question 28

What do food-drug interactions include?

Answer 28

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

Question 29

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

Answer 29

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

Question 30

Describe how food can alter drug absorption.

Answer 30

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

Question 31

Describe adsorption in terms of food-drug interactions.

Answer 31

Adhesion of a drug to food components

Question 32

Give an example of an adsorption food-drug interaction

Answer 32

Digoxin and high phytate foods (wheat, oatmeal)

Question 33

Give an example of an absorption food-drug interaction.

Answer 33

Bisphosphonates have negligible absorption if taken with food

Question 34

Give examples of drug-nutrient interactions.

Answer 34

* 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