Lecture 26-Older adult nutrition -Part 2 Flashcards
Older adult nutrition -Part 2
What are the two main 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)
Important to understand the cause of dehydration in an individual as this will
Inform your intervention
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
4.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
What type of fluids is going to be beneficial for older adults
we are concentrating less on the concern of energy dense fluids and just focus more on them consuming enough fluids
ICD-10-AM (international classification of disease)= Malnutrition in older adults
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 definition
BMI <18.5- underweight
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
eating less
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
MNA stands for and used for??
Mini Nutritional Assessment (MNA) : grading system to determine if they are malnourished or at risk of being malnourished
Who can the MNA be carried out by
This tool can be used by anyone
Its very easy to use
Screening identifies …. not
risk it is not a diagnosis
What are the three casual 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)
Who usually carries out a nutrition assessment
Usually a dietitian, registered nutritionist or clinician with nutrition training
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
- Body image
- Appetite
- Economical reasons
- Mobility
- Psychological reasons
- Health conditions
etc
what are the strategies for management / intervention of malnourishment
- food first strategies
- oral nutrition supplements
- re-screen
Food first stretegies
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)
Oral Nutrition supplements
OTC supplements
funded oral nutrition supplements (prescribed)
Re-screen
repeat MNZ
comprehensive nutrition assessment
PHARMAC special authority
an individual may be illegible to apply for funding
only application from a dietitian or relevant specialist
malnutrition affects what proportion of people in hospital
more than 1 in 3 patients are affected by malnutrition
Early identification =
Early intervention
