Nutritional Assessment: Geriatrics Flashcards
General principles of elderly nutrition
- reduced nutrient reserves
- reduced response to stress
Parameters to assess in elderly nutrtion
- history
- physical assessment
- swallowing problem
- chewing difficulty
What do you look at in the history of elderly in nutrition?
Weight loss (% over time) Insufficient energy intake
What do you look at during physical assessment in elderly and nutrition?
- loss of muscle mass
- loss of subcu fat
- edema (fluid status)
- diminished functional status (hand grip strength)
What can cause swallowing problem in elderly?
- age related changes in swallowing physiology
- age related diseases (stroke, dementia, parkinsons)
What can cause chewing difficulty in elderly?
- dental decline
- increased use of dentures
What is the most indicative parameter in malnutrition in elderly?
Weight loss
>10% in 1-3 months
Impact of weight loss in elderly
- greater significance
- less reserve capacity
- difficultly regaining weight
- loss of functional lability
Therapy for malnutrition in elderly
- oral
- tube feeding
- parenteral
1st step in Nutrition care decision process in elderly
At risk or not at risk
Nutrition care decision process in elderly if not at risk
Provide nutrient needs
Set goals
Monitor goals
Nutrition care decision process in elderly if at risk
Evaluate oral intake
Inadequate —> consider tube feeding —> set goals —> monitor
Adequate —> continue supplementation —> set goals —> monitor
Evaluating oral intake in elderly
- liberalize diet
- initiate oral supplementation
- diagnostic use of calorie count
Tube feeding benefits in elderly
- reverse anorexic cycle
- promote N balance
- stimulate appetite (may change TF administration to night)
Monitoring nutritional progress in elderly
- calorie count
- % of meals eaten
- weight change (account for fluid & scale)
- wound healing
- functional improvement
Do no harm in elderly
- low & slow: more gradual treatment, reduced ability to adapt
- longer repletion period (less reserves)
What parameters do you look at in well elderly nutrition?
- history
- physical assessment
History assessment in well elderly
- weight loss (% over time)
- insufficient energy intake
Physical assessment of well elderly
- loss of muscle mass
- loss of subcu fat
- edema
- diminished functional status
Guidelines in aging and optimal weight
- maximize function and QOL
- minimize disease risk
- identify unintentional weight loss
- attention to trends
Usual weight trend in aging
- peak weight at 75 yo
- gradual weight loss after 75 yo
Obesity in aging outcomes
- increase physical and cognitive disability
- increase risk of dependency and institutionalization
- increase health care costs, poor health outcomes mortality
Goal of obesity in elderly treatment
- To better manage health and maintain independence longer
- minimize loss of muscle mass
- minimize loss of bone density
- adequate nutrient intake
How can you minimize loss of muscle mass in obesity treatment of elderly?
- adequate protein
- exercise (aerobic, resistance)
How can you minimize loss of bone density in obesity treatment in elderly?
- Adequate calcium, vitamin D
- exercise (weight bearing)
Basal energy expenditure in aging
Decreases with aging
Physical energy expenditure in aging
Greater decrease with aging
Protein requirement in elderly
- less efficient protein synthesis
- requirement greater than previous RDA (0.8gm/kg)
What reduces protein intake in elderly?
- poor dentition
- cost of protein rich foods
Aging related causes of increased protein need
- inadequate intake of protein
- reduced ability to use available protein (insulin resistance)
- greater need for protein (inflammatory disease)
What can decreased protein intake cause in elderly?
Loss of functionality
- muscle, bone, immune systems
Sarcopenia
- loss of skeletal muscle mass, strength and quality
Rule of thumb in elderly nutrition
- 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)
Why is there a higher calcium/vitamin D requirement in elderly
- high incidence of osteoporosis
- less efficient absorption
- reduced conversion of inactive D
- reduced exposure to sun
Rate of osteoporosis in elderly
33% 60-70 y/o
66% >80 y/o
What is the lowest mortality BMI in elderly?
- 5 (considered overweight in adults)
- advantage to have extra weight!
T/F there is an increase number of people reaching older age as obese
True!
Rule of thumb of calcium intake in elderly
- 1000 - 1500 mg/day
- at least 1 dairy product/meal
Rule of thumb of vitamin D in elderly
- 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
Vitamin and mineral needs in elderly differences from adults
- increased B vitamins (B6, B12)
- increased Calcium & vitamin D
- reduced iron (no menstruation)
What % daily value of vitamins should you have in adult/elderly multivitamin?
100%
Avoid mega supplement
Questions to ask regarding diet restriction in elderly
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?
Goal of diet restrictions in elderly
Liberal diet to encourage oral intake
Geriatric problems with nutrition
Sarcopenia
Constipation
Dehydration
Swallowing
What is one of the most prevalent “perceived” problems in elderly?
Constipation
Why is constipation a problem in elderly?
Bowel motility decreases with age
Treatment of constipation in elderly
- dietary fiber >25g/day
Robertson’s rule of 2 in fiber intake
- 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
T/f thirst sensations increase with aging
FALSE!
Decreases
T/f fluid requirements increase with increased fiber
True!
Fluids in elderly
Encourage fluid intake 8-10 cups/day
Dehydration causes in elderly
- 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
Dehydration symptoms
- decreased skin turgor
- dry mouth and mucosal membranes
- decreased urine volume
- darker urine
- constipation
- acute weight loss
- CONFUSION
Dehydration treatment
- treat cause
- set fluid goal
- replace additional fluid losses
- drink fluid at and b/t meals
- use foods which have fluid value
What is the fluid goal in elderly?
30mL/kg or 1mL/Kcal
Swallowing symptoms (SWALLOWING)
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
Practical application of swallowing in elderly
Be alert to symptoms
Involve speech pathologist
Fluid and nutrition density
