Nutrition in the Older Adult Review Flashcards
Pharmacological agents such as histamine-2-receptor antagonists and proton pump inhibitors are commonly prescribed for a variety of GI disorders such as prevention and treatment of gastric ulceration. Prolonged use of these medications may most commonly contribute to the deficiency of. . .
Vitamin B12
In order for vitamin B12 to be properly absorbed, it requires adequate ______ ,which decreases with age, to cleave B12 from protein in food. Then free B12 travels to the small intestine where it binds to ____ for adequate absorption
gastric acid
intrinsic factor
An 85year old female is admitted to the hospital with a history of stroke, dysphagia, poor apetite with decreased intake x 1 month and 10% weight loss. The patient is evaluated by the speech pathologist who recommends a pureed, HTL diet. What is the most appropriate nutrition intervention ?
Initiate nocturnal EN to supplement the oral diet
Medications that cause diarrhea while on EN create a hyperosmolar environment in the GI tract pulling fluid in, creating a laxative effect, these medications include:
magnesium, sorbitol, and kayexelate
antibiotics can cause diarrhea because they decrease
the amount of beneficial bacteria within the GI tract increasing the risk for CDiff infection
Narcotics such as codeine decrease GI motility and contribute to
constipation
long term use of opioids can lead to this type of constipation
obstipation
what is appropriate to tell the family regarding nutrition at the end of life: Dying patients rarely feel ____ or ____ due to decreased normal functions, _____ calories are needed at the end of life, patients shouldn;t be made to feel guilty if _________ and decreased ___ and ___ are a natural part of they dying process
- hunger or thirst
- fewer calories
- they don’t wish to eat
- food and fluid intake
A patient in a persistent vegetative state has made their wishes known regarding artificial nutrition via an advanced directive. The decision to terminate enteral feeding for this patient is based on the ethical principle of
autonomy
if a patient is not competent and there is no advanced directive available, which 2 ethical principles are important to consider
beneficence and non-maleficence
the ethical principle based on respecting and upholding the patient’s right to self determination
autonomy
the ethical principle based on health care providers who actively seek the good of the patient above all other priorities
beneficence
the ethical principle of “to do no harm” and relates to health care providers actively seeking to prevent, minimize and relieve needless suffering and pain, avoiding harming the patient
non-maleficence
the ethical principle that is related to the fair distribution of resources
Justice
A Do Not Resuscitate (DNR) or Do Not Attempt Resuscitation (DNAR) orders should be a contraindication to the provision of artificial nutrition and hydration in any state; true or false
false, if indications for ANH exist, ANH should be started even if for a limited time trial
ANH can be withheld or withdrawn in patients with a DNR or DNAR if
all concerned parties agree ANH is not meeting the agreed upon goals of the patient
those who forgo ANH experience ____ side effects as the analgesic theory proposes that starvation boosts the production of ketones, thereby having an anesthetic effect
decreases
aggressive artificial nutrition and hydration can be _____ during the end of life
more harmful and life threatening causing edema, ascites, nausea, vomiting, or pulmonary aspiration/congestion
A patient has an advanced directive stating a desire to forgo medical technology including nutrition and hydration in order to prolong life. The patient is now in an irreversible, vegetative state. in deciding whether or not to continue nutrition and hydration by medical means, the patient’s surrogate decision maker must:
honor the patient’s expressed wishes to withdraw nutrition and hydration by medical means
documents that allow individuals to document their treatment preferences and identify a surrogate or proxy decision maker to act in the patient’s state when he or she loses the ability to make decisions.
advanced directive
in the absence of an advanced directive, where evidence of an incompetent’s person’s previous expressed wishes not to be kept alive by medical technologies meets state evidentiary standards, the exercise of that choice by a surrogate decision maker must also be honored true or false
true
In an older adult who requires long term home EN, which complication is often overlooked
decreased urine output/dehyration
a decreased urine output likely indicates what in an older adult
inadequate fluid intake /potential for dehydration/AKI
Vitamin D (25,hydroxyvitamin D) deficiency is defined as a serum level of less than _____
20ng/mL
what is considered an adequate Vitamin D (25 hydroxyvitamin D ) level
30 ng/mL
Vitamin D (25,hydroxy vitamin D) deficiency can manifest as
muscle weakness
what is the hallmark of frailty seen among older adults
sarcopenia
age associated loss of muscle mass and strength is called
sarcopenia
a multifactorial syndrome that has various phenotypes in the older adult such as quality of life, vulnerability, and disability with symptoms of 10 lb weight loss in 1 year, unintentional weight loss , self reported exhaustion and weakness is called
frailty
What EN complication is the most potentially dangerous in the older adult
aspiration
___ and ___ is linked to the development of dysphagia in the older adult which can cause aspiration or oral secretions leading to possible PNA/death
sarcopenia/frailty
A 75 year old male with a history of aspiration PNA who was previously deemed unsafe for an oral diet is now experiencing aspiration while receiving continuous EN via his PEG. What long term feeding options are most appropriate
PEJ tube
_____ EN feedings are the preferred choice for patients with an increased risk of aspiration as they can minimize the potential of reflux.
small bowel feedings
An older adult getting PN may be more susceptible to metabolic complications related to _____ function. Older adults have increased problems with insulin resistance, impaired renal and micronutrient deficiencies
impaired cardiac function
which tool includes the assessment of a long term care resident’s ability to maintain adequate nutrition and hydration and is mandated by the center for medicate and Medicaid for certified long term care facilities
MDS: minimum data sheet
a ______ is completed by an intrer-professional team in a long term care facility to assess all aspects of clinical status and facilitate problem indemnification (triggers) to see if further planning or intervention is necessary
MDS: minimum data sheet
what vitamin deficiency is most likely to occur in a person who consumes alcohol of a regular basis
thiamine
what medication is most likely to contribute to hyponatremia in the older adult
hydrochlorothiazide diuretic
thiazide diuretics can lead to
hyponatremia
loop diuretics can diminish this electrolyte
potassium
An 80 year old NH resident with a history of constipation has a newly placed PEG tube. Which EN formula would be an appropriate choice to provide
standard 1kcalmL (has adequate fluid)
constipation is common in the elderly so adequate ____ should be given when providing enteral nutrition
water flushes
_____ addition to enteral nutrition can help propel waste through the colon
fiber
if fiber is added to enteral nutrition formula, how much fluid should be given
1ml/kcal
concentrated enteral formulas may not be appropriate for the elderly with constipation due to
not adequate in fluid
An assessment of functional status may aid in determining nutrition risk. What provides assessment of function status?
hand grip strength assessment
What vitamin consideration is most important in an older adult getting a TNA (3-in-1) PN as well as warfarin?
vitamin K
vitamin ____ is present in adult MVI preparations and in lipid emulsions which affects anticoagulation therapy so closely monitor______
INR
EN formulas supplemented with fiber are often used in the older adult population to prevent constipation. Which of the follow is most important if this is chosen?
provision of adequate water, at least 1mL/kcal
The Plan-Do-Study Act cycle is employed as a _____ model
quality improvement problem solving
What are the 4 steps of the Plan-Do-Study-Act Cycle
Planning phase, implementation phase, study phase, act phase
the ___ phase of the Plan-Do-Study-Act cycle is to measure the results of the improvement effort
study
the ___ phase of the Plan-Do-Study-Act is where the team will determine if changes made should be permanent an includes standardization and documentation of the processes
act
which classes of medication is used in the older adult population which can contribute to anorexia
SSRIs, antiarrhythmics, and NSAIDS (cardiac meds, psych meds and anti rheumatoid meds)
An older adult receiving digoxin and PN who is experiencing signs of digoxin toxicity should be assessed for
hypokalemia
Digoxins are anti-arrhythmia medications often paired with diuretics. Older adults are at risk for this electrolyte derangement when receiving digoxin as their kidney function are diminished and the excretion of this medication relies solely on renal excretion
hypokalemia
An older adult with poor oral intake over a 2 month period requires specialized nutrition support. What electrolyte abnormalities are associated with aggressive nutrition support ?
hypophosphatemia, hypokalemia, hypomagnesemia (refeeding syndrome)
Elderly patient admissions due to adverse drug reactions can be decreased by recognizing this population has ______ sensitivity to warfarin and opiates
decreased
Altered medication pharmacodynamics are altered in the elderly as they have a decrease in ____, ____ ____ and _____ leading to medication sensitivity
decreased hepatic blood flow
decreased hepatic volume
decreased first pass metabolism
decrease in eGFR
the short form mini assessment used in adults 65 and older was derived from the mini nutritional assessment in order to
obtain high diagnostic accuracy for detecting nutritional problems in older adults w/ a brief screening tool
The Comprehensive Geriatric Assessment (CGA) tool includes: physical medical condition, nutrition status, mental health conditions, functional status, social circumstances and environmental as well as
anthropometrics, biochemical markers, meds, and quality of life
JD is an 85 year old male whose height is 63”, weight of 45 kg had a weight of 55 kg ten years ago. His weight loss has been non-volitional and gradual. he has no major health problems or changes in oral intake. What describes JD’s weight loss
decreased lean body mass tissue from sarcopenia
What is the most widely used tool to measure generic health related quality of life
SF-36
what is one of the most widely used tools to measure health related quality of life
SF-36 tool
this tool measures activities of daily living
Katz ADL
this tool measures instrumental activities of daily living (using the telephone, managing finances, meal prep, transportation)
Lawton-Brody’s IADL
this tool is used to measure functional independence in rehab settings
The Functional Independence Measure (FIM)
What body changes occur in older adults over time \_\_\_\_ bone mineral mass \_\_\_\_ lean body mass \_\_\_\_\_\_ fat deposition \_\_\_\_ total body water
decreased bone mineral mass
decreased lean body mass
increased fatty tissue
decreased total body water
Sarcopenia, the loss of lean body mass that occurs with aging is also associated with
decreased bone density, increased falls, glucose intolerance, decreased heat/cold tolerance, increased risk of malnutrition, increased oxidative stress
when using cyclic PN solutions for non-stressed patients age may be an important factor in monitoring for complications because older adults have ______ rates of insulin resistance, ________glycemia, _____ free fatty acids, and ____ fluid requirements
increased insulin resistance
hyperglycemia
increased free fatty acids
decreased fluid requirements
what is the recommended daily energy intake for patients getting hemodialysis >65 years old and <65 years old
> 65 years: 30-35 kcal/kg
< 65 years: >35 kcal/kg
A 65 year old who has complications associated with GI surgery was admitted to the ICU with pneumonia & septic shock. After she became hemodynamically stable, she was started on PN due to prolonged ileus. Prior to surgery, she was at her ideal weight. Currently has labs that include albumin 2.2, Cr of 1.0 & urine output is adequate. What best estimates her protein needs for initiation of PN
1.5 g/kg/day 2/2 her increased stress level
in an afebrile adult with intact skin, insensible fluid loss from the lungs and skin is approimately
1,000mL/day
An 87 year old female underwent a total abdominal colectomy. Her ileostomy output is 1.5-2 liters a day. Supplementation of which of the following micronutrients should be considered?
zinc from stool loss
older adults are increased risk of ____, ___, ___ deficiency from decreased intake, decreased absorption when having diarrhea or high ileostomy output
fluid, electrolytes and zinc
A decrease in food intake in older adults is most likely attributed to
decreased taste and flavor sensations
which senses are diminished in the older adult population
decreased taste/flavor sensation decreased hunger early satiety fear of incontinence with decr. fluid intake decreased smell/olfaction
A 68 year old with a history of cirrhosis is receiving EN with recent GI surgery. She has worsening hepatic encephalopathy what should be tried first
lower blood ammonia with lactulose and or rifaxamin
in liver cirrhosis, how much protein is recommended to prevent catabolism and promote gluconeogenesis
1-1.5 g/kg/day
if a patient with cirrhosis and hepatic encephalopathy fails to respond to medical management how much protein can be restricted to
0.6-0.8g/kg
branched chain amino acids formula is still debated but considered if
severe encephalopathy is not responsive to aggressive medical therapy
An 80 year old male living home alone has experienced a 15 pound unintentional weight loss in past year and a half. The clinician assessing his nutrition status finds that he has inadequate intake, what is the leas likely to contribute to his weight loss
a liberalized diet
decreased oral intake can be related to chronic medical conditions requiring dietary restrictions and numerus medications impairing food intake or alter digestion, absorption, metabolism and excretion true or false
true
social isolation, economic hardships, decreased functional capacity related to shopping, cooking, dementia, loss of taste and smell with difficulty chewing/swallowing impairs
oral intake
______ diets make meals more palatable and acceptable for older adults
liberalized diets
