Nutrition in Geriatrics

Question 1

Physiological changes associated with aging

1. Musculoskeletal:

Answer 1

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

Question 2

2. Sensory

Answer 2

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

Question 3

3. Oral Health

Answer 3

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

Question 4

3. Gastrointestinal Function

Answer 4

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

Question 5

4. Hepatic/ Renal Function
5. Immunocompetence
6. Endocrine/Metabolic Function
7. Neurologic Function

Answer 5

4. Hepatic/ Renal Function
   i. Drug metabolism
   ii. Hydration concerns ( increased frequency)
5. Immunocompetence
   i. Higher risk for infection
6. Endocrine/Metabolic Function
   i. Increased insulin resistance
7. Neurologic Function
   i. Cognitive decline

Question 6

Malnutrition:

defintion

Answer 6

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”

Question 7

Sarcopenia:

Answer 7

u A muscle disease. “Progressive loss of muscle mass and
strength with a risk of adverse outcomes” associated with the
aging process

Question 8

Cachexia

Answer 8

“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

Question 9

What impact does malnutrition have on the

elderly?

Answer 9

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

Question 10

Registered Dietitians

Answer 10

u Identify Nutrition Risk

u Nutrition Assessment

Question 11

Identify Nutrition Risk

Nutrition Screening tools used:

Answer 11

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

Question 12

CNST: Canadian Nutrition Screening Tool

Answer 12

lost weight in past 6 mon unintentionally?
eating less than usual for more than 1 week?

yes to either –> at risk –> subjective global assessment

Question 13

SGA: Subjective Global Assessment

Answer 13

physical build of person

SGA A – Well nourished
SGA B – Moderately malnourished
SGA – C severely malnourished
- temporal muscle wasting

Question 14

Nutrition Assessment

Nutrition Care Process

Answer 14

• 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

Question 15

1. Nutrition Assessment

u Components include:

Answer 15

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

Question 16

2. Nutrition Diagnosis

Answer 16

• 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.”

Question 17

3. Nutrition Intervention

Answer 17

dieticians can offer to pt:
• Therapeutic diet modifications
• Diet texture modifications
• Vitamin/mineral supplementation
• Oral nutrition supplements
• Alternative to oral intake
• Community supports

Question 18

Nutrition Intervention:

Oral Nutrition Supplements

Answer 18

- 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

Question 19

Nutrition intervention has been shown to:

Answer 19

• improve protein and energy intake
• improve muscle mass (increase function)
• improve body weight
• improve quality of life
• reduce hospital readmissions
• reduce length of stay

Question 20

4. Monitoring and Evaluation

Answer 20

Monitoring:
Food/Fluids: Intake, Tolerance/Acceptance, Compliancy/
Education
Weight, Bloodwork, Medications
Investigations, Rehabilitation, Dispo
Evaluation:
Nutrition Diagnosis: Resolved/improving, Ongoing/Worsening
New

Question 21

Registered Dietitians and the

Pharmacist

Answer 21

u Interdisciplinary and multidimensional approach
to care.
u Information Sharing
u Collection
u Collaboration
u Consultation
u Education

Question 22

Discharge planning:

Promote adequate nutrition after discharge

Answer 22

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