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FN 3344 > Lecture 10 - Nutrition Assessment of Adults and Elderly > Flashcards

Lecture 10 - Nutrition Assessment of Adults and Elderly Flashcards

1
Q

What are the classifications of elderly people?

A

65-74= young old
75-84=Middle old
85-99= Old old
>100= Oldest

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2
Q

what kind of screening is used for the elderly >65 and when is it appropriate?

A

Mini Nutrition Assessment (MNA)

  • with normal nutritional state
  • At risk of malnutrition
  • Malnourished
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3
Q

What is determine used for?

A

your nutritional health checklist, used for nutritional screening

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4
Q

What does determine stand for?

A 
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
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5
Q

When we are taking a patient history, what information should we gather?

A

Chronic disease

  • CV health
  • Bone health
  • Dental/oral health
  • mental health

Medical Tx
Prevention of disease
Prevention of disease complications
Family History

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6
Q

During patients history what should we consider about meds?

A

Over the counter vs prescriptions

Polypharmacy

Drug nutrient, nutrient drug interactions

ex: laxatives, meds to manage diabetes, hyperlipidemias

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7
Q

How do medicines and nutrition go together?

A

People sometimes think that medical drugs do only good, not harm

Both prescription and OTC meds can have unintended consequences
-causing harm when they interact with the bodys normal use of nutrients

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8
Q

What effect to foods, nutrients and herbs have on drugs, caffeine and tobacco?

A

Nutrients increase/decrease drug action/metabolism/excretion

Herbs modify the actions of drugs

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9
Q

What effects do drugs, caffeine and tobacco have on food, nutrients and herbs?

A

Drugs increase/decrease nutrient action or excretion

Drugs modify appetite and taste

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10
Q

What effects go both ways for food, nutrients and herbs on drugs caffeine and tobacco?

A

Enhance/delay/prevent absorption

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11
Q

What information should we obtain for socio economic history when taking patient history?

A 
Age
Support System
Personal Situation
-resources, isolation
Lifestyle
-Stress, physical activity, work
Autonomy
-transportation
-housing
-activities of daily living
-Self image
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12
Q

What kind of anthropometric and body comp data do we take?

A

Wt, ht

  • Wt change: voluntary vs involuntary
  • Wt history
  • BMI
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13
Q

How do we evaluate body comp?

A 
Including muscle mass and fat deposition
-Waist circumference
-Waist to hip ratio
BMI
BIA
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14
Q

What is the BMI shift?

A

In the older person, involuntary weight loss deserves immediate attention

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15
Q

What BMI is considered underweight for >65years

A

BMI<23kg/m2 and has been associated with increased risk of mortality

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16
Q

what should the BMI range be for >65?

A

BMI should be between 24-30kg/m2

-the increase weight acts as a nutritional reserve, padding to protect bones during a fall

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17
Q

What do we monitor in seniors?

A 
Bone Mass
-tends to decrease
Fat mass
-tends to increase
Muscle Mass
-tends to decrease
Sarcopenic Obesity
-use special equipment
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18
Q

What is sarcopenia?

A

Decrease in strength and muscle mass

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19
Q

What is sarcopenic obesity?

A

Decrease strength
Low muscle mass
Excess body fat

20
Q

What is primary sarcopenia?

A

Skeletal Muscle Mass loss related to aging

No other evident cause

21
Q

What Is secondary Sarcopenia?

A

Causes other than or in addition to aging

Muscle loss related to disuse, inflammation and malnutrition

22
Q

How do you classify acute vs chronic sarcopenia?

A

Acute <6months

Chronic >6months

23
Q

What is frailty?

A

A multidimensional syndrome with sarcopenia as the key pathophysiological feature
-describes a state of increased vulnerability to poor health outcomes

24
Q

What is the 5 criteria for frailty?

A 
Slowness
Weakness
Low physical activity
Exhaustion
Shrinkage
25
Q

What happens with patients that have a chronic disease?

A

Appear to be predisposed to frailty-inflammation

26
Q

What kind of biochemical lab data do we look at?

A

CBC (rule out anemia)
Bone density measurement
Urinalysis to evaluate renal health and protein status
Vitamin D
Blood Lipid Panel (determine 10 year risk facto for CVD)
Blood Glucose measurement (screening for the present of prediabetes and Type 2)

27
Q

Why is Vitamin D important in the elderly?

A

As people age, synthesis declines 4x setting the stage for deficiency

Many older adults drink little or no Vitamin D fortified milk and feet little or no exposure to sunlight

28
Q

What are the recommendations for vitamin D in the elderly are?

A

50-70yrs: should get 600IU

Over 70yrs: 800IU

29
Q

Why is vitamin B12 important in the elderly?

A

Many people over the age of 50years lose the ability to produce sufficient stomach acid to make the protein bound IFF form of Fit B12 available for absorption

30
Q

What are the Vitamin B12 serum values?

A

Deficient <148pmol/L
Marginally Deficient >148-220
Adequate >220pmol/L

31
Q

What clinical examination data should we look for?

A 
Evaluation of Fluid status
Evaluation of Energy Status
Evaluation of 
-BP
-Body Temp
-Gi problems
32
Q

What are the signs and symptoms of dehydration or under dehydration?

A 
Thirst
Oliguria
Decrease skin turgor, pale skin
Dry mouth/lips, thick saliva
Coated, wrinkled tongue
Heartache, dizziness confusion
Decrease Wt
Body temp Increase 
Decrease BP
Increase HR
33
Q

Why is dehydration a major risk factor?

A

Because the thirst mechanism may become imprecise
-older people may go for long periods without drinking fluids

Kidneys become less efficient at recapturing water before it is lost as urine
-water loss causes some problems and worsen others

34
Q

What other clinical examination data should we look at?

A

Evaluation of swallow

Evaluation of presence of S&S of micronutrient deficiencies or disease states

Monitoring of changes in health using S&S

  • appetite
  • sensory losses
  • skin infection
  • Mobility
  • depression
35
Q

What do we look for when doing dietary assessment?

A 
Usual eating pattern
-Regular/random eating
-Snacking 
-Beliefs/habits
-Restriction
-Disrodered eating
Quantity, types, where and when food &amp; beverages are consumed
-Balance, moderation, alcohol, caffeine, food&amp;mood
Diet Hx
-Wt loss attempts/dieting
Who is responsible for food prep
-variety?
36
Q

Why do we look at energy and activity?

A

Energy needs often decrease with advancing age

  • # of active cells in each organ decreases
  • Reducing the bodys overall metabolic rate
  • Lean tissue diminishes
  • Older people often reduce their physical activity
37
Q

What happens after the age of 50 in terms of energy and activity?

A

The recommended intake for energy assumes a 5% reduction in energy output per decade
-leaves little leeway in the diet for foods of low nutrient density such as (sugars, Fats, Alcohol)

38
Q

What other dietary assessment data should we take into account?

A 
Energy intake and adequacy 
Macronutritent Intake and adequacy 
Micronutrient intake and adequacy
Fluids intake
Fiber intake
39
Q

What is the recommended protein range for older adults?

A

Can range from 1.0-1.2g/kg/d to as high as 2.0 per day
-used to be 0.8-1.0

Focus on

1) Type of protein
2) Timing of protein intake

40
Q

How much protein should >65yrs get?

A

25-30g/meal

2.5-2.8g leucine/meal

41
Q

What is the exception of protein recommendations for which group of elders?

A

Older adults with severe kidney disease has to have a protein restriction

42
Q

What is leucine?

A

Is suspected to be the only amino acid which can stimulate muscle growth and can also help prevent the deterioration of muscle with age

43
Q

What are high leucine containing foods?

A 
Sheese
Soy beans
Beef
Chicken 
Pork
Nuts
Seeds
Fish
Seafood
Beans
44
Q

What is the protein threshold?

A

Threshold of leucine exists needed to trigger muscle building
-small amount of protein at a time may not reach this threshold

May need to discourage nibbling/grazing go ensure sufficient hunger at mealtimes

45
Q

What is the recommended amount of protein per meal to stimulate muscle building?

A

30g protein/meal

FN 3344 (13 decks)

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