Lecture 24 - Older Adult Nutrition Part 2 Flashcards
what are two nutritional issues in older adults
dehydration and malnutrition
how does dehydration occur in older adults
water losses exceed water replacement
(caused by either an inadequate intake of fluid, or excessive loss (volume depletion) or both)
dehydration in older adults contributes to …
- confusion
- constipation
- urinary tract infections (UTIs)
- risk of falls
what are the 7 signs and symptoms of dehydration in older adults
- upper body weakness
- speech difficulty
- confusion
- dry mucous membranes in nose and mouth
- longitudinal tongue furrows
- dry tongue
- sunken appearance of eyes in their sockets
what are the physiological reasons to low intake dehydration
decreased thirst sensation, decreased concentrating ability of the kidneys, lower total body fluid stores
what are the psychological reasons to low intake dehydration
cognitive impairment (forgetful difficulty expressing need, unable to recognise thirst), self restriction (fear of incontinence)
what are the physical reasons to low intake dehydration
reduced dexterity, poor vision, poor mobility, reliance on feeding assistance
what are the comorbidity reasons to low intake dehydration
poorly controlled diabetes, dysphagia, early satiety
what are the environmental reasons to low intake dehydration
hospitalised / aged care - reliance on carers for fluid
what is the method of prevention of low intake - dehydration in older adults
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
what is the fluid recommendations for older adults
women : 1.6 litres
men : 2.0 litres
why is the type of fluid not that important in older adults
less of a concern about energy dense fluids and just more focus on them consuming enough fluids
ICD-10-AM (international classification of disease) defines malnutrition as
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
globally what proportion of older adults are malnourished, or at risk
1/4
unintentional weight loss is ….
BMI <18.5
weight loss of 5% or more of body weight in the past 3-6 months
not universally defined
what are the potential causes of unintentional weight loss
- underlying, undiagnosed disease or illness
- protein energy malnutrition
- poverty
- functional decline
what are ways you could notice people around you becoming malnourished
their jewellery is loose
not enjoying their favourite foods anymore
clothes are getting loose
malnutrition can lead to
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
what is the prevalence of malnutrition across australia and New zealand
up to 17%
what is the prevalence of risk of malnutrition across australia and new zealand
up to 63%
there is higher prevalence of malnutrition in
older adults > 80 years
women
multiple medications
screening for malnutrition is recommended for
all older adults across all health settings to identify those who are malnourished and those at risk
tools of malnutrition screening tools can be
anthropometry and questions around weight loss
what does MNA stand for and what is it used for
Mini Nutritional Assessment (MNA) : grading system to determine if they are malnourished or at risk of being malnourished
what is another assessment tool for determining if someone is being malnourished
the MUST tool
what are the three causal subcategories of malnutrition
- 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)
nutritional assessment will often involve assessment of
- anthropometry, body composition
- biochemical markers
- dietary assessment
- lifestyle factors
- functional capacity
- hydration
what factors may contribute to malnourishment in elderly
- appetite
- gastrointestinal issues
- medication
- economic reasons
- difficulty cooking
- psychological reasons
- activity and mobility
and many more
what are the strategies for management / intervention of malnourishment
- food first strategies
- oral nutrition supplements
- re-screen
what are the food first strategies to malnourishment
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)
what are oral nutrition supplements for malnutrition
OTC supplements
funded oral nutrition supplements (prescribed)
what is the re-screen aspect of malnutrition management/intervention
- repeat MNZ
- comprehensive nutrition assessment
what os the PHARMAC special authority
an individual may be illegible to apply for funding
malnutrition affects what proportion of people in hospital
more than 1 in 3 patients are affected by malnutrition
