Nutrition Flashcards
What is the risk assessment tool used to assess nutrition?
Malnutrition Universal Screening Tool (MUST)
How is nutritional status assessed?
Clinical assessment - dietary history and clinical exam
Functional assessment - kitchen assessment
Swallowing assessment
Biochemistry tests
BMI
Other - skin fold thickness, muscle power
What are the underlying causes of malnutrition in older people?
General function - poverty, social isolation, difficulty getting to the shops
Cognitive impairment - dementia, reduced appetite and awareness, marked weight loss
Swallowing - can develop slowly (neuro) or suddenly (vascular events). Have a significant impact of quality of life
Dentition - poor oral hygiene, poor or painful dentition, gingivitis
Medication - side effects of commonly prescribed medication can interfere with nutrition
What is MUST?
It is a 5 step screening tool that is now frequently used in secondary care
What are the 5 steps of MUST screening?
Step 1 - measure weight and height and calculate BMI
Step 2 - note the percentage of unplanned weight loss
Step 3 - establish acute disease effect and score
Step 4 - add scores from steps 1-3
Step 5 - develop an appropriate care plan
When is intervention needed for high risk patients?
For a high risk (MUST score >2), intervention should start immediately with a diabetic input and close monitoring
What intervention is needed for medium risk patients?
Those at medium risk (score 1) need to be monitored with food charts for the first three days
What is a useful memoire to guide interventions?
MEALS ON WHEELS
Medications (e.g. consider stopping digoxin) Emotions (depression) Anorexia/alcoholism Late life problems Swallowing problems
Oral and dental disorders No money (poverty)
Wandering Hyperthyroidism/hyperparathyroidism Enteric problems Eating problems Low salt/low cholesterol Social problems e.g. shopping and food preparation
How should poor nutrition be managed?
Social eating - promotes intake and provides interaction
Specific nutrition deficits should be identified and corrected
Early dietician involvement is helpful
SALT involvement for swallowing problems
NG or PEG tube for acute swallowing problems
What are key causes of weight loss in older people?
Psych
- Depression
- Cognitive impairment/ dementia
- Delirium, psychosis
- Alcohol use
Iatrogenic disease
- medication
GI disease
- dysphagia
- malabsorption
Systemic disease
- any long term conditions
Ageing related changes
- diagnosis of exclusion
What is the clinical sign of vitamin B1 deficiency?
Wernickes
What is anaemia?
Fe, B12, folate deficiency
What is angular stomatitis and glossitis a sign of?
Vitamin B deficiency
What is gingivitis a sign of?
Vitamin C deficiency
What deficiency is bruising a sign of?
vitamin K, C
