Nutrition And Ageing

Question 1

Causes of ageing (endogeneous and exogeneous)

Answer 1

• endogeneous: electron transport chain, enzymatic reactions, Fenton reactions
• exogeneous: sunlight, ionising radiation, alcohol, cigarette smoke, drugs, iron overload, air pollution

Question 2

Problems with ageing: sarcopenia, frailty, dysphagia

Answer 2

• sarcopenia: loss of muscle mass, function and integrity (fat infiltration). Pathological when 2SD lower than the mean. Lose 33% muscle mass with age, and 50% of >80 years. Decreased VO2 max, walking speed and increased disability
• frailty: Fried et al (self reported exhaustion, low PA, unintentional weight loss of 4.5 kg in a year, weakness (HGS, TUG), slow walking speed), Rockwood (as Fried but with low mood, social enviroment, disability)
• dysphagia: occurs in 15% of those >18 years. May be due to issues with pharynx, oesphagus, psychological, infection, poor dentition, aspiration

Question 3

Reasons for dysphagia: primary and secondary

Answer 3

• primary: stroke, dementia, brain injury, MS, PD, scleroderma
• secondary: CVD, rheumatoid, ankylosing spondylitis, infection, gastro-oesophageal reflux

Question 4

Subnutrition: prevalence, people factors, medication, social factors, psychological factors, stroke, dementia, parkinson’s disease

Answer 4

• prevalence: 15% community, 12-70% institutionalised, 20-65% hospital, 37-85% care-homes
• people factors: individual (dribbling, catabolism, not enough time to eat, positioning, edentulous, resources), staff (ignorance, poor medical management, pre and post op)
• social: isolation (missing bus), financial, abuse/neglect, institutionalisation
• psychological: depression/anxiety, phobia of swallowing, sitophobia (i.e being around other dribbling people), psychoses/paranoia
• stroke: 18% have nutritional problems, 17% have eating problems, have increased dependency due to weakness
• dementia: not given sufficient time to eat, only 1 in 6 have a normal swallow, 26% aspirate
• PD: dysphagia common

Question 5

Subnutrition: dysphagia (oesophageal changes, oral health, saliva)

Answer 5

• oesophageal changes: decrease is lower oesophageal sphincter relaxation and upper oesophageal pressure, delayed emptying, increase in non-peristaltic contractions
• oral health: difficult to eat with dentures (81% of elderly have them), with 50% having a yeast infection and 25% reporting difficulty with them. Need to have good tongue function to wear
• saliva reduces with age

Question 6

Subnutrition: medication

Answer 6

• metformin and corticosteroids decrease appetite and energy intake
• some cause a dry mouth: diuretics, anticholinergics, Ca channel blockers, alpha blocks
• affects absorption of vitamins: isonizaid (for TB, decreases niacin absorption), MTX (decreases folate absorption)
• affects absorption of minerals and electrolytes: diuretics, NSAIDS

Question 7

Consequences of subnutrition: financial/social, clinical, deficiencies (C, D, B12, folate)

Answer 7

• financial/social: 31% more likely to consult a GP, more expensive
• clinical: increased mortality, bed sores, cognitive deficits, increased falls, depression, increased nosocomial infection (30-60% malnourished on long stay ward, 54% of all nosocomial infections in those >65 years)
• deficiencies: vitamin C (scurvy, Fe deficiency, neuropathy, cataracts), vitamin D (54% in housebound, 38% in nursing home, may increase osteoporosis, may be due to renal impairment malabsorption), B12 (pernicious common, bacterial overgrowth or tape worm, leads to dementia like symptoms), folate (poor cooking and diet, MTX malabsorption, supplements may help slow cognitive deficits)

Question 8

Identification of subnutrition: screening, plan (food, environment, brain injury, community, mediterranean diet, tumeric, increasing dairy and fiber, cognitive function

Answer 8

• screening: SGA, MUST. Assess sadness, ability to go food shopping, loss of weight, eating problems, albumin <40g/dL, cholesterol <4.14mmol/L
• food factors: allow time to eat, make sure palatable
• environmental factors: supervision, free choice of food
• brain injury: manage behavioural problems, allow for grazing/familiar foods, appropriate consistency, nutritional supplements
• community: food vouchers
• Mediterranean diet: increased fruit/veg/pulses, decreased meat and dairy products, 9% reduction in CVD and mortality, 6% reduction in cancer mortality, 13% reduction in PD
• tumeric: anti-inflammatory component, reduces phosphorylation of tau protein
• increasing dairy: increases skeletal muscle mass, improves grip strength and TUG
• increased dietary fiber: increases bowel motility and reduces constipation
• improves cognitive function: glucose and caffeine, vitamin E, avoiding B vitamin deficiency

Question 9

Different feeding methods: oral, NGT, PEG, rectal

Answer 9

• oral: improves strength and QoL. Sip feeds may be beneficial for post surgical patients
• enteral: NGT (tend to be pulled out and impacts body image), PEG ( better tolerated, does not treat dysphagia), rectal feeding