Nutritional Management Of Elderly With Chronic Disease

Question 1

Sarcopenia

Answer 1

Visible loss of skeletal muscle mass, strength and integrity
Decrease in basal metabolic ratendue to a reduction in lean muscle mass
Declines approx 15% from 30-70
Increase in fat mass

Question 2

Reasons for muscle loss

Answer 2

Age
Illness- physiological changes following a period of inactivity- leads to functional decline, muscle weakness or decreased insurance
Nutrition related: periods of poor intake, especially associated with illness, will result in loss of muscle mass. BMI less than 22kg/ m is an indicator of low muscle mass

Question 3

Functional decline

Answer 3

Increased risk of loss of dependence
Onset of decline can occur as early as third day of admission
At 3 months post discharge, 50% of patients have permanent loss of function
Every kilo a person loses in hospital compromises their lifestyle

Question 4

Protein requirements

Answer 4

Do not decline with ageing
NRV: 0.8-1 but more like 1-1.3
Increased intake to meet the demand of specific diseases and to replete protein stores
Chronic disease may require 1.2-1.5

Question 5

Effects of malnutrition

Answer 5

Increased risk of infections 
Increased risk of pressure ulcers 
Increased risk of falls/ fractures 
Increased length of stay 
Delayed recovery
Increase in independence 
Increased mortality

Question 6

Identifying malnutrition

Answer 6

BMI <22kg or appearance of underweight
Loose fitting clothes, jewellery or dentures
Significant, unintentional weight loss over 3kg in the last 3-6 months
Recent loss of appetite
Poor intake and refusal of meals
Frequent infections
Constipation or diarrhoea

Question 7

Hospital contribution to malnutrition

Answer 7

Reduction in appetite due to illness or activity 
Lack of help 
Meal trays being far out of reach 
Inappropriateness of food service due to individuals cultural, religious or personal requirements 
Cognitive impairment 
Interruptions to mealtimes 
Fasting for tests 
Inappropriate positioning

Question 8

Nutritional goals for the elderly

Answer 8

Maintains or improve nutritional status
Early identification of malnutrition risk
Correct existing deficiencies
Prevention of illness or complications impacting on nutritional status
Impact on other domains of care- skin integrity, mobility, medication, dementia, continence, dietary interventions, dentition