Lecture 10 - Nutrition Assessment of Adults and Elderly Flashcards
What are the classifications of elderly people?
65-74= young old
75-84=Middle old
85-99= Old old
>100= Oldest
what kind of screening is used for the elderly >65 and when is it appropriate?
Mini Nutrition Assessment (MNA)
- with normal nutritional state
- At risk of malnutrition
- Malnourished
What is determine used for?
your nutritional health checklist, used for nutritional screening
What does determine stand for?
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
When we are taking a patient history, what information should we gather?
Chronic disease
- CV health
- Bone health
- Dental/oral health
- mental health
Medical Tx
Prevention of disease
Prevention of disease complications
Family History
During patients history what should we consider about meds?
Over the counter vs prescriptions
Polypharmacy
Drug nutrient, nutrient drug interactions
ex: laxatives, meds to manage diabetes, hyperlipidemias
How do medicines and nutrition go together?
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
What effect to foods, nutrients and herbs have on drugs, caffeine and tobacco?
Nutrients increase/decrease drug action/metabolism/excretion
Herbs modify the actions of drugs
What effects do drugs, caffeine and tobacco have on food, nutrients and herbs?
Drugs increase/decrease nutrient action or excretion
Drugs modify appetite and taste
What effects go both ways for food, nutrients and herbs on drugs caffeine and tobacco?
Enhance/delay/prevent absorption
What information should we obtain for socio economic history when taking patient history?
Age Support System Personal Situation -resources, isolation Lifestyle -Stress, physical activity, work Autonomy -transportation -housing -activities of daily living -Self image
What kind of anthropometric and body comp data do we take?
Wt, ht
- Wt change: voluntary vs involuntary
- Wt history
- BMI
How do we evaluate body comp?
Including muscle mass and fat deposition -Waist circumference -Waist to hip ratio BMI BIA
What is the BMI shift?
In the older person, involuntary weight loss deserves immediate attention
What BMI is considered underweight for >65years
BMI<23kg/m2 and has been associated with increased risk of mortality
what should the BMI range be for >65?
BMI should be between 24-30kg/m2
-the increase weight acts as a nutritional reserve, padding to protect bones during a fall
What do we monitor in seniors?
Bone Mass -tends to decrease Fat mass -tends to increase Muscle Mass -tends to decrease Sarcopenic Obesity -use special equipment
What is sarcopenia?
Decrease in strength and muscle mass
What is sarcopenic obesity?
Decrease strength
Low muscle mass
Excess body fat
What is primary sarcopenia?
Skeletal Muscle Mass loss related to aging
No other evident cause
What Is secondary Sarcopenia?
Causes other than or in addition to aging
Muscle loss related to disuse, inflammation and malnutrition
How do you classify acute vs chronic sarcopenia?
Acute <6months
Chronic >6months
What is frailty?
A multidimensional syndrome with sarcopenia as the key pathophysiological feature
-describes a state of increased vulnerability to poor health outcomes
What is the 5 criteria for frailty?
Slowness Weakness Low physical activity Exhaustion Shrinkage
What happens with patients that have a chronic disease?
Appear to be predisposed to frailty-inflammation
What kind of biochemical lab data do we look at?
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)
Why is Vitamin D important in the elderly?
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
What are the recommendations for vitamin D in the elderly are?
50-70yrs: should get 600IU
Over 70yrs: 800IU
Why is vitamin B12 important in the elderly?
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
What are the Vitamin B12 serum values?
Deficient <148pmol/L
Marginally Deficient >148-220
Adequate >220pmol/L
What clinical examination data should we look for?
Evaluation of Fluid status Evaluation of Energy Status Evaluation of -BP -Body Temp -Gi problems
What are the signs and symptoms of dehydration or under dehydration?
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
Why is dehydration a major risk factor?
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
What other clinical examination data should we look at?
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
What do we look for when doing dietary assessment?
Usual eating pattern -Regular/random eating -Snacking -Beliefs/habits -Restriction -Disrodered eating Quantity, types, where and when food & beverages are consumed -Balance, moderation, alcohol, caffeine, food&mood Diet Hx -Wt loss attempts/dieting Who is responsible for food prep -variety?
Why do we look at energy and activity?
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
What happens after the age of 50 in terms of energy and activity?
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)
What other dietary assessment data should we take into account?
Energy intake and adequacy Macronutritent Intake and adequacy Micronutrient intake and adequacy Fluids intake Fiber intake
What is the recommended protein range for older adults?
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
How much protein should >65yrs get?
25-30g/meal
2.5-2.8g leucine/meal
What is the exception of protein recommendations for which group of elders?
Older adults with severe kidney disease has to have a protein restriction
What is leucine?
Is suspected to be the only amino acid which can stimulate muscle growth and can also help prevent the deterioration of muscle with age
What are high leucine containing foods?
Sheese Soy beans Beef Chicken Pork Nuts Seeds Fish Seafood Beans
What is the protein threshold?
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
What is the recommended amount of protein per meal to stimulate muscle building?
30g protein/meal
