Lecture 24 - Older Adult Nutrition Part 2

Question 1

what are two nutritional issues in older adults

Answer 1

dehydration and malnutrition

Question 2

how does dehydration occur in older adults

Answer 2

water losses exceed water replacement
(caused by either an inadequate intake of fluid, or excessive loss (volume depletion) or both)

Question 3

dehydration in older adults contributes to …

Answer 3

• confusion
• constipation
• urinary tract infections (UTIs)
• risk of falls

Question 4

what are the 7 signs and symptoms of dehydration in older adults

Answer 4

1. upper body weakness
2. speech difficulty
3. confusion
4. dry mucous membranes in nose and mouth
5. longitudinal tongue furrows
6. dry tongue
7. sunken appearance of eyes in their sockets

Question 5

what are the physiological reasons to low intake dehydration

Answer 5

decreased thirst sensation, decreased concentrating ability of the kidneys, lower total body fluid stores

Question 6

what are the psychological reasons to low intake dehydration

Answer 6

cognitive impairment (forgetful difficulty expressing need, unable to recognise thirst), self restriction (fear of incontinence)

Question 7

what are the physical reasons to low intake dehydration

Answer 7

reduced dexterity, poor vision, poor mobility, reliance on feeding assistance

Question 8

what are the comorbidity reasons to low intake dehydration

Answer 8

poorly controlled diabetes, dysphagia, early satiety

Question 9

what are the environmental reasons to low intake dehydration

Answer 9

hospitalised / aged care - reliance on carers for fluid

Question 10

what is the method of prevention of low intake - dehydration in older adults

Answer 10

all older adults should be considered at risk and encouraged to consume adequate amounts of fluids

a range of appropriate drinks should be offered based on their prefernces

Question 11

what is the fluid recommendations for older adults

Answer 11

women : 1.6 litres

men : 2.0 litres

Question 12

why is the type of fluid not that important in older adults

Answer 12

less of a concern about energy dense fluids and just more focus on them consuming enough fluids

Question 13

ICD-10-AM (international classification of disease) defines malnutrition as

Answer 13

BMI < 18.5 kg/m^2 or unintentional weight loss of >5% with evidence of suboptimal intake resulting in subcutaneous fat loss and / or muscle wasting

a lack of adequate nutrients to meet the body’s needs

Question 14

globally what proportion of older adults are malnourished, or at risk

Answer 14

1/4

Question 15

unintentional weight loss is ….

Answer 15

BMI <18.5

weight loss of 5% or more of body weight in the past 3-6 months

not universally defined

Question 16

what are the potential causes of unintentional weight loss

Answer 16

• underlying, undiagnosed disease or illness
• protein energy malnutrition
• poverty
• functional decline

Question 17

what are ways you could notice people around you becoming malnourished

Answer 17

their jewellery is loose

not enjoying their favourite foods anymore

clothes are getting loose

Question 18

malnutrition can lead to

Answer 18

higher infection risk

increased risk of falls

longer hospital stays

loss of strength

poor immunity

reduced ability to do usual daily activities

reduced quality of life

shorter life expectancy

Question 19

what is the prevalence of malnutrition across australia and New zealand

Answer 19

up to 17%

Question 20

what is the prevalence of risk of malnutrition across australia and new zealand

Answer 20

up to 63%

Question 21

there is higher prevalence of malnutrition in

Answer 21

older adults > 80 years

women

multiple medications

Question 22

screening for malnutrition is recommended for

Answer 22

all older adults across all health settings to identify those who are malnourished and those at risk

Question 23

tools of malnutrition screening tools can be

Answer 23

anthropometry and questions around weight loss

Question 24

what does MNA stand for and what is it used for

Answer 24

Mini Nutritional Assessment (MNA) : grading system to determine if they are malnourished or at risk of being malnourished

Question 25

what is another assessment tool for determining if someone is being malnourished

Answer 25

the MUST tool

Question 26

what are the three causal subcategories of malnutrition

Answer 26

• disease related malnutrition driven by inflammation
• disease related malnutrition with no perceived inflammation
• malnutrition due to starvation not related to disease (either related to hunger, socioeconomic factors or psychological factors)

Question 27

nutritional assessment will often involve assessment of

Answer 27

• anthropometry, body composition
• biochemical markers
• dietary assessment
• lifestyle factors
• functional capacity
• hydration

Question 28

what factors may contribute to malnourishment in elderly

Answer 28

• appetite
• gastrointestinal issues
• medication
• economic reasons
• difficulty cooking
• psychological reasons
• activity and mobility

and many more

Question 29

what are the strategies for management / intervention of malnourishment

Answer 29

• food first strategies
• oral nutrition supplements
• re-screen

Question 30

what are the food first strategies to malnourishment

Answer 30

high protein, high energy extras

food fortification (meaning adding things like butter or cheese to something like mashed potatoes, so they don’t have to eat more food volume)

Question 31

what are oral nutrition supplements for malnutrition

Answer 31

OTC supplements

funded oral nutrition supplements (prescribed)

Question 32

what is the re-screen aspect of malnutrition management/intervention

Answer 32

• repeat MNZ
• comprehensive nutrition assessment

Question 33

what os the PHARMAC special authority

Answer 33

an individual may be illegible to apply for funding

Question 34

malnutrition affects what proportion of people in hospital

Answer 34

more than 1 in 3 patients are affected by malnutrition