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pt: nutrition exam 1 > Nutritional Assessment: Geriatrics > Flashcards

Nutritional Assessment: Geriatrics Flashcards

1
Q

General principles of elderly nutrition

A
  • reduced nutrient reserves

- reduced response to stress

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2
Q

Parameters to assess in elderly nutrtion

A
  • history
  • physical assessment
  • swallowing problem
  • chewing difficulty
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3
Q

What do you look at in the history of elderly in nutrition?

A 
Weight loss (% over time)
Insufficient energy intake
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4
Q

What do you look at during physical assessment in elderly and nutrition?

A
  • loss of muscle mass
  • loss of subcu fat
  • edema (fluid status)
  • diminished functional status (hand grip strength)
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5
Q

What can cause swallowing problem in elderly?

A
  • age related changes in swallowing physiology

- age related diseases (stroke, dementia, parkinsons)

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6
Q

What can cause chewing difficulty in elderly?

A
  • dental decline

- increased use of dentures

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7
Q

What is the most indicative parameter in malnutrition in elderly?

A

Weight loss

>10% in 1-3 months

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8
Q

Impact of weight loss in elderly

A
  • greater significance
  • less reserve capacity
  • difficultly regaining weight
  • loss of functional lability
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9
Q

Therapy for malnutrition in elderly

A
  • oral
  • tube feeding
  • parenteral
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10
Q

1st step in Nutrition care decision process in elderly

A

At risk or not at risk

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11
Q

Nutrition care decision process in elderly if not at risk

A

Provide nutrient needs
Set goals
Monitor goals

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12
Q

Nutrition care decision process in elderly if at risk

A

Evaluate oral intake
Inadequate —> consider tube feeding —> set goals —> monitor

Adequate —> continue supplementation —> set goals —> monitor

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13
Q

Evaluating oral intake in elderly

A
  • liberalize diet
  • initiate oral supplementation
  • diagnostic use of calorie count
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14
Q

Tube feeding benefits in elderly

A
  • reverse anorexic cycle
  • promote N balance
  • stimulate appetite (may change TF administration to night)
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15
Q

Monitoring nutritional progress in elderly

A
  • calorie count
  • % of meals eaten
  • weight change (account for fluid & scale)
  • wound healing
  • functional improvement
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16
Q

Do no harm in elderly

A
  • low & slow: more gradual treatment, reduced ability to adapt
  • longer repletion period (less reserves)
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17
Q

What parameters do you look at in well elderly nutrition?

A
  • history

- physical assessment

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18
Q

History assessment in well elderly

A
  • weight loss (% over time)

- insufficient energy intake

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19
Q

Physical assessment of well elderly

A
  • loss of muscle mass
  • loss of subcu fat
  • edema
  • diminished functional status
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20
Q

Guidelines in aging and optimal weight

A
  • maximize function and QOL
  • minimize disease risk
  • identify unintentional weight loss
  • attention to trends
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21
Q

Usual weight trend in aging

A
  • peak weight at 75 yo

- gradual weight loss after 75 yo

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22
Q

Obesity in aging outcomes

A
  • increase physical and cognitive disability
  • increase risk of dependency and institutionalization
  • increase health care costs, poor health outcomes mortality
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23
Q

Goal of obesity in elderly treatment

A
  • To better manage health and maintain independence longer
  • minimize loss of muscle mass
  • minimize loss of bone density
  • adequate nutrient intake
24
Q

How can you minimize loss of muscle mass in obesity treatment of elderly?

A
  • adequate protein

- exercise (aerobic, resistance)

25
Q

How can you minimize loss of bone density in obesity treatment in elderly?

A
  • Adequate calcium, vitamin D

- exercise (weight bearing)

26
Q

Basal energy expenditure in aging

A

Decreases with aging

27
Q

Physical energy expenditure in aging

A

Greater decrease with aging

28
Q

Protein requirement in elderly

A
  • less efficient protein synthesis

- requirement greater than previous RDA (0.8gm/kg)

29
Q

What reduces protein intake in elderly?

A
  • poor dentition

- cost of protein rich foods

30
Q

Aging related causes of increased protein need

A
  • inadequate intake of protein
  • reduced ability to use available protein (insulin resistance)
  • greater need for protein (inflammatory disease)
31
Q

What can decreased protein intake cause in elderly?

A

Loss of functionality

- muscle, bone, immune systems

32
Q

Sarcopenia

A
  • loss of skeletal muscle mass, strength and quality
33
Q

Rule of thumb in elderly nutrition

A
  • 1.0 - 1.25gm/kg/day
  • 25-30 gm protein/meal
  • at least 1 high protein food/meal
  • physical activity: aerobic and resistance (maintain CV system & muscle mass)
34
Q

Why is there a higher calcium/vitamin D requirement in elderly

A
  • high incidence of osteoporosis
  • less efficient absorption
  • reduced conversion of inactive D
  • reduced exposure to sun
35
Q

Rate of osteoporosis in elderly

A

33% 60-70 y/o

66% >80 y/o

36
Q

What is the lowest mortality BMI in elderly?

A
  1. 5 (considered overweight in adults)

- advantage to have extra weight!

37
Q

T/F there is an increase number of people reaching older age as obese

A

True!

38
Q

Rule of thumb of calcium intake in elderly

A
  • 1000 - 1500 mg/day

- at least 1 dairy product/meal

38
Q

Rule of thumb of vitamin D in elderly

A
  • 600 IU w/ adequate sun exposure
  • 800 -1000 IU w/o adequate sun exposure
  • use vitamin D fortified products
  • encourage sun exposure 15-20 min/day
  • beneficial effect of weight bearing exercise
39
Q

Vitamin and mineral needs in elderly differences from adults

A
  • increased B vitamins (B6, B12)
  • increased Calcium & vitamin D
  • reduced iron (no menstruation)
40
Q

What % daily value of vitamins should you have in adult/elderly multivitamin?

A

100%

Avoid mega supplement

41
Q

Questions to ask regarding diet restriction in elderly

A

Will it have a negative impact on nutritional status?
What is the significance of the restriction on longer term health outcome?
Is there restriction practical for long term use?

42
Q

Goal of diet restrictions in elderly

A

Liberal diet to encourage oral intake

43
Q

Geriatric problems with nutrition

A

Sarcopenia
Constipation
Dehydration
Swallowing

44
Q

What is one of the most prevalent “perceived” problems in elderly?

A

Constipation

45
Q

Why is constipation a problem in elderly?

A

Bowel motility decreases with age

46
Q

Treatment of constipation in elderly

A
  • dietary fiber >25g/day
47
Q

Robertson’s rule of 2 in fiber intake

A
  • 100% bran cereal: 1/2cup, 10-14g
  • whole wheat bread: 2 slices, 4g
  • fresh fruit: 2 pieces, 4g
  • veggies: 2 servings, 4 grams

= 22-26g

48
Q

T/f thirst sensations increase with aging

A

FALSE!

Decreases

49
Q

T/f fluid requirements increase with increased fiber

A

True!

50
Q

Fluids in elderly

A

Encourage fluid intake 8-10 cups/day

51
Q

Dehydration causes in elderly

A
  • decrease thirst sensation
  • increase dependence on others to obtain fluid
  • decreased ability to concentrate urine
  • increase incidence of incontinence (self-imposed fluid restriction)
  • increase use of medications contributing to dehydration
  • increase losses: vomiting, diarrhea, fever
52
Q

Dehydration symptoms

A
  • decreased skin turgor
  • dry mouth and mucosal membranes
  • decreased urine volume
  • darker urine
  • constipation
  • acute weight loss
  • CONFUSION
53
Q

Dehydration treatment

A
  • treat cause
  • set fluid goal
  • replace additional fluid losses
  • drink fluid at and b/t meals
  • use foods which have fluid value
54
Q

What is the fluid goal in elderly?

A

30mL/kg or 1mL/Kcal

55
Q

Swallowing symptoms (SWALLOWING)

A 
S = swallowing difficult or hard to initiate
W = wet sounding voice
A = aspiration pneumonia in history
L= loss of fluid through nose
L = leakage of food or liquid out of mouth when eating
O = overt coughing or choking with oral intake
W = weight loss with inadequate nutritional intake
I = involve speech pathologist 
N = nutrient density
G = go for least restrictive
56
Q

Practical application of swallowing in elderly

A

Be alert to symptoms
Involve speech pathologist
Fluid and nutrition density

pt: nutrition exam 1 (12 decks)

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