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Geriatrics 1 > Nutrition & FTT > Flashcards

Nutrition & FTT Flashcards

1
Q

Changes in body composition with age

A
  • Decreased bone mass, lean mass, water content

- Increase total body fat (abd fat stores)

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2
Q

Lower muscle mass =

A

Lower BMR/BEE (basal energy expenditure)

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3
Q

BMR/BEE is essentially

A

Total body energy expenditure @ rest

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4
Q

Stress & activity increase expenditures (TDEE) in older adults….

A

Can be 1.2x to up over 2x normal limits

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5
Q

Protein needs

A

Females: 46g/d
Males: 56g/d

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6
Q

Carbohydrate needs

A

130g/d

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7
Q

Fiber needs

A

Female: 21g/d
Male: 30g/d

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8
Q

Recommended water intake

A

1.5-2L/day

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9
Q

Supplementation recommendations (prn)

A

Calcium, vitamin D, vitamin B12

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10
Q

Older adults are at higher risk for micronutrient/vitamin ______ than young adults

A

Deficiency

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11
Q

______ is the most common fluid or electrolyte distrubance in older adults

A

Dehydration

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12
Q

Fluid needs

A

Females: 2.7L/d
Males: 3.7L/d

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13
Q

Physiologic changes in elderly that cause dehydration

A
  • Decreased perception of thirst (normal aging)
  • Decreased response to changes in serum osmolality
  • Reduced ability to concentrate urine following fluid deprivation
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14
Q

Adequate intake of calcium

A

1200mg

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15
Q

Adequate intake of Mg

A

Females: 320mg
Males: 420mg

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16
Q

Adequate intake of vitamin D

A

15ug

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17
Q

Adequate intake of vitamin C

A

Females: 75ug
Males: 90ug

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18
Q

Adequate intake of folate

A

400ug

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19
Q

Adequate intake of B12

A

2.4ug

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20
Q

Adequate intake of thiamin

A

Females: 1.1mg
Males: 1.2mg

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21
Q

Common signs of dehydration

A
  • Decrease UOP
  • Orthostatics
  • Constipation
  • Mucosal dryness, xerostomia
  • Confusion
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22
Q

Causes of dehydration

A
  • Decreased PO intake
  • Diarrhea
  • Bleeding
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23
Q

Diminished sensations related to eating/food in older adults?

A

Taste

Olfactory function

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24
Q

Complaints of taste & smell dysfunction =

A

Common!

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25
Q

What can predispose older adults to unnoticed tooth destruction?

A

Age & history of prior restorative dentistry (makes teeth less sensitive)

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26
Q

Common oral cavity issues that DO NOT represent normal aging

A
  • Dry mouth
  • Tooth decay
  • Missing teeth
  • Periodontal disease
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27
Q

Common causes of tooth loss

A
  • Inability or unwillingness to access or pay for dental care
  • Loose teeth from gum dz
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28
Q

Implications of tooth loss

A
  • Diminished chewing

- Loss of preference for food choices that require vigorous chewing

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29
Q

What intervention is associated with tooth preservation later in life?

A

Preventative and restorative dental care in childhood/early adulthood

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30
Q

Are dentures covered by Medicare?

A

One would think but NO

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31
Q

Benefits of dentures

A
  • Aid in ability to speak clearly
  • Restore facial contours
  • Restore ability to chew
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32
Q

Risk threshold for low BMI =

A

18.5kg/m2

33
Q

Unintentional wt. loss of __% in 1 month or __% in 6 months is a useful indicator of nutritional risk and morbidity

A

5; 10

34
Q

Poor nutritional risk and high risk morbidity is predictive of

A
  • Functional limitations
  • Increased health care costs
  • Need for hospitalization
35
Q

Inadequate nutritional intake is defined as

A

Average intake of food groups, nutrients, or energy 25% to 50% below any RDA threshold

36
Q

Intake of ??

A

75??

37
Q

Around what percentage of NH residents do not meet standards for adequate nutritional intake?/

A

5-8%

38
Q

Low ____ is a risk indicator for morbidity & mortality

A

Albumin (NOT S/S)

39
Q

Does albumin synthesis decrease with age?

A

No

40
Q

Low albumin (<3.5) serves as a prognostic value for…..

A

Injury, disease, or inflammation

41
Q

______ reflects short-term changes in protein status

A

Prealbumin

42
Q

Acquired _______ is a nonspecific feature of poor health status

A

Hypocholesterolemia (<160mg/dL)

43
Q

Hypocholesterolemia may reflect a ____________ condition

A

Proinflammatory

44
Q

Older adults with low albumin & low cholesterol have higher rates of __________ than those with one or the other

A

M&M

45
Q

Risk factors for poor nutritional status

A
  • Alcohol or substance abuse
  • Cognitive dysfunction
  • Decrease exercise
  • Depression, poor mental health
  • Functional limitations (limited mobility, transportation)
  • Inadequate funds
  • Limited education
  • Chronic disease
  • Medications
  • Poor dentition
  • Restricted diet, poor eating habits
  • Social isolation
46
Q

What is cachexia

A

Complex syndrome that combines weight loss, lipolysis, loss of muscle and visceral protein, anorexia, chronic nausea, & weakness

47
Q

Cachexia is likely d/t….

A

Cyctokine (IL-1, IL-6) and TNF-a

48
Q

Cachexia is common in what two patient populations?

A

Late stage CA

AIDS

49
Q

Define wasting

A

The involuntary loss of fat, muscle, and protein

50
Q

Wasting is common in what types of patients?

A

Chronic illness

Chronic organ failure

51
Q

What alleviates cachexia and wasting?

A

Treatment of underlying disease (NOT improved nutrition)

52
Q

Cachexia and wasting are strongly associated with

A

Death

53
Q

Define protein-energy undernutrition

A

Clinical (e.g. wasting, low BMI) AND biochemical (e.g. hypoalbuminemia) evidence of insufficient intake

54
Q

Treatment of protein-energy undernutrition

A

Treatment of underlying disease AND provide nutritional support

55
Q

Prevention of undernutrition

A
  • Cater to pt. food preferences
  • Avoid restrictive “therapeutic diets”
  • Provide assistance
  • Enhance comfort, taste, & appearance of food
  • Enhance social aspect of eating; provide adequate time
  • Address chewing discomfort/dysfunction
56
Q

Most serious complication of tube feeding

A

Aspiration

57
Q

Aspiration occurs in up to ____ of PEG tube pt.

A

Half

58
Q

Most older person require _____-_____kcal/mL solution over 24 hours to meet nutritional needs

A

1500-2400

59
Q

What causes refeeding syndrome

A

Results from overzealous feedings following severe undernutrition

60
Q

Refeeding syndrome is characterized by

A

Severe electrolyte abnormalities (hypophosphatemia) and fluid retention

61
Q

How to prevent refeeding syndrome

A

Cautiously advance nutritional therapy and closely monitor fluid & electrolyte status
- Consult RD!

62
Q

How to treat refeeding syndrome

A

Intensive multidisciplinary electrolyte replacement

63
Q

Two main approaches to older adults w/ eating difficulties

A
  1. Careful feeding by hand

2. Tube feeding

64
Q

PEG tube placement is associated w/…

A

Low procedure-related complication rates, substantial mortality (long-term studies)

65
Q

Median survival after PEG tube is

A

<1 year

66
Q

How many studies demonstrate improved survival, reduced pneumonia/infection, improved sx, or function, reduced pressure sores w/ PEG tube use?

A

NONE

67
Q

Complications of PEG tubes

A
  • Aspiration pneumonia
  • Metabolic disturbance
  • Local cellulitis
  • Diarrhea
  • Diminished social contact
68
Q

What can dictate withholding or terminated artificial feeding

A

Patient’s wishes

69
Q

Define FTT

A

A syndrome manifested by wt. loss >5% of baseline, decreased appetite, poor nutrition, and inactivity

70
Q

Sx ass. w/ FTT

A
  • Dehydration
  • Depressive sx
  • Impaired immune fcn
  • Low cholesterol levels
  • Physical dysfcn
  • Malnutrition
  • Cognitive impairment
71
Q

Causes of FTT are commonly

A

Unidentifiable or irreversible

72
Q

FTT is ass. w/

A
  • Increased infection
  • Decreased cell immunity
  • Hip fx
  • Decubitus ulcers
73
Q

Incidence of FTT

A

Hospital > NH > community

74
Q

Comprehensive assessment of FFT includes

A
  • Baseline functional ability
  • Social support
  • Environmental factors
  • Physical and psychological hx
75
Q

Goal of FTT w/u

A

Identify medical conditions (e.g. meds, ETOH & substance abuse, etc.) associated w/ FTT

76
Q

Functional assessment of FFT

A
  • Evaluate ADLs
  • Get up & go
  • Screen for causes of disabilities (vision, podiatry, neuro disorders)
77
Q

Most common psychiatric disorder in the elderly

A

Depression (can be cause or contribute to FFT)

78
Q

Elderly pt. with depression are more likely to present w/ physical complaints or mental/emotional complaints?

A

Physical

79
Q

Treatment of FFT

A
  • consider if you’ll treat what you find before you work it up
  • *consider tx if few risks (can worsen frailty)
  • Exercise as tolerated
  • Maintain adequate nutrition
  • Treat depression w/ SSRy or mirtazipine

Geriatrics 1 (8 decks)

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