Nutrition in Geriatrics Flashcards
Physiological changes associated with aging
1. Musculoskeletal:
i. Reduction in total body protein/ lean body mass
ii. Increase in total body fat and changes in
distribution of fat stores
iii. Reduction in body water
iv. Decline in bone density
v. Loss of skin integrity
- Sensory
i. Changes in taste and smell
i. Loss of Appetite and Enjoyment
ii. Taste and smell stimulation induces metabolic
changes
ii. Sight/Touch
i. Affects functional abilities, safety
iii. Reduced thirst perception
- not good feedback mechanism
thirsty = 1% dehydrated already
- Oral Health
i. Poor dentition
ii. Ill-fitting denture or edentulous
iii. Xerostomia
iv. Dysphagia -small freq sip of fluids, non-alcoholic mouthwash
big imact on their health difficulty chewing tougher cuts of meat eat less or avoid them, at risk of deficiency lose interest in meals
- Gastrointestinal Function
i. Dysphagia: coordnation of muscle and nerves, atrophy can be serious, weakened muscles to protect airway, propel food, tongue
ii. GERD (Gastro-Esophageal Reflux Disease)
iii. Changes with digestion and absorption
iv. Early satiety
v. Constipation, Diarrhea
common, mutifactorial
- Hepatic/ Renal Function
- Immunocompetence
- Endocrine/Metabolic Function
- Neurologic Function
- Hepatic/ Renal Function
i. Drug metabolism
ii. Hydration concerns ( increased frequency) - Immunocompetence
i. Higher risk for infection - Endocrine/Metabolic Function
i. Increased insulin resistance - Neurologic Function
i. Cognitive decline
Malnutrition:
defintion
A nutritional disorder. “Inadequate intake of protein and/or
energy over prolonged periods of time resulting in loss of fat
stores and/or muscle stores including starvation-related
malnutrition, chronic disease or condition-related malnutrition
and acute disease or injury-related malnutrition”
Sarcopenia:
u A muscle disease. “Progressive loss of muscle mass and
strength with a risk of adverse outcomes” associated with the
aging process
Cachexia
“Severe body weight, fat and muscle loss due to an
underlying illness”. Catabolic and inflammatory processes
are at play, which can be difficult to reverse by nutritional
support
What impact does malnutrition have on the
elderly?
Ø Feelings of unwell, Weakness, Low endurance
Ø Functional decline, Decreased quality of life
Ø Reduced heart and lung function
Ø Increased risk of infection
Ø Increased risk of developing pressure ulcers
Ø Impaired wound healing
Ø Longer rehabilitation, hospital stay
Ø Increased level of care on discharge
Registered Dietitians
u Identify Nutrition Risk
u Nutrition Assessment
Identify Nutrition Risk
Nutrition Screening tools used:
Helps to identify factors for malnutrition and
recognizes poor nutritional status
u Key : EARLY identification of patients at nutrition
risk
Common Screening Tools:
ü CNST
ü SGA
CNST: Canadian Nutrition Screening Tool
lost weight in past 6 mon unintentionally?
eating less than usual for more than 1 week?
yes to either –> at risk –> subjective global assessment
SGA: Subjective Global Assessment
physical build of person
SGA A – Well nourished
SGA B – Moderately malnourished
SGA – C severely malnourished
- temporal muscle wasting
Nutrition Assessment
Nutrition Care Process
• Standardized assessment tool in Alberta Health Services, implemented in 2008. • Incorporates the Nutrition Care Process: Four step process: 1. Assessment 2. Diagnosis 3. Intervention 4. Monitoring and Evaluation
- Nutrition Assessment
u Components include:
A. Medical and social history
B. Medications
C. Biochemical Data (labs), Tests, Procedures
D. Anthropometrics and Physical findings
E. Food and Nutrition history * - unique to dieticians
F. Estimated requirements
- Nutrition Diagnosis
• Standardized nutrition diagnosis language.
• PES Statement:
Problem
Etiology
Signs and Symptoms
“Malnutrition risk related to loss of appetite and poor
intake; as evidenced by low BMI of 17, significant
weight loss of 7% BW x1mo, diet history report of 1
meal/d eating pattern and low interest in eating.”
- Nutrition Intervention
dieticians can offer to pt: • Therapeutic diet modifications • Diet texture modifications • Vitamin/mineral supplementation • Oral nutrition supplements • Alternative to oral intake • Community supports
Nutrition Intervention:
Oral Nutrition Supplements
- Drinks: Milk-based, Juice-based Calorie-dense, High Protein, Fiber-enriched Renal, Diabetic Med Pass: calorie dense supplement (2calories/mL) given with medication, nutrition supp for pt, hip practure protocol - Puddings - Powders: Protein or energy - Other: Cookies, bars, desserts
Nutrition intervention has been shown to:
- improve protein and energy intake
- improve muscle mass (increase function)
- improve body weight
- improve quality of life
- reduce hospital readmissions
- reduce length of stay
- Monitoring and Evaluation
Monitoring: Food/Fluids: Intake, Tolerance/Acceptance, Compliancy/ Education Weight, Bloodwork, Medications Investigations, Rehabilitation, Dispo Evaluation: Nutrition Diagnosis: Resolved/improving, Ongoing/Worsening New
Registered Dietitians and the
Pharmacist
u Interdisciplinary and multidimensional approach to care. u Information Sharing u Collection u Collaboration u Consultation u Education
Discharge planning:
Promote adequate nutrition after discharge
Registered Dietitians (RDs) in the Community: Ø Outpatient RD ( i.e. RAH, SROP) Ø Home Care RD/ Supportive living RD Ø Primary Care Network Ø Community based programs: ü day programs ü senior centres ü recreation centres
