Older Adult Health

Question 1

What are some nutritional challenged faced by older people?

Answer 1

Decreased food intake​

Decreased basal metabolic rate, lean body mass, sense of taste/smell​

(Malnutrition is not a normal part of ageing​)

Question 2

Causes of malnutrition

Answer 2

Poor dentition​

Difficulty swallowing​

Declining coordination + eyesight​

Arthritis​

Low mood​

Cognitive decline​

Cancer, heart failure, CKD, hypothyroidism​

Coeliac disease + IBD can cause malabsorption​

Medications (diuretics, antihypertensives)​

Reduced physical activity​

Dependent on staff if in care homes etc.​

Question 3

Effects of malnutrition

Answer 3

Impaired immune function​

Poor wound healing​

Osteoporosis​

Cognitive impairment​

Mood disturbance​

Joint + muscle pain​

Calcium, vitamin D/C/B12, folate deficiencies​

Osteomalacia, anaemia, sarcopenia​

Question 4

How to assess malnutrition?

Answer 4

Changed weight/BMI​

Mental health​

Social/drug/past medical history​

Food and fluid diary​

MUST = malnutrition universal screening tool​

Question 5

Support for malnutrition?

Answer 5

Doctors, dieticians, occupational therapists, social care, speech and language therapist, dentists​

Question 6

What is OSA

Answer 6

Obstructive Sleep Apnea
Results from a partial/fully blocked airway​

Tonsils too large, jaw set too far back, excess weight​

Airway blocked in sleep → brain hypoxia → mini arousal → sharp intake of breath​

↑ risk of CVD/stroke/type 2 diabetes/severe depression/severe COVID-19​

Question 7

Diagnosis of OSA?

Answer 7

Loud snoring, pause in breathing, large gasp of air​

Excessive daytime sleepiness (EDS)!​

Ideally diagnosed with PSD – expensive + resource intensive​

Use STOP-Bang questionnaire​

Question 8

Risk factors of OSA?

Answer 8

Sleeping on back​

Anything impacting REM sleep (muscles are paralysed)​

Alcohol, some antidepressants​

Question 9

Treatment for OSA?

Answer 9

CPAP – gold standard but low compliance​

Lose weight, quit smoking, reduce alcohol​

Always consider bed partner!​

Question 10

What can insomnia be a predictor of?

Answer 10

Depression

Question 11

Causes of insomnia?

Answer 11

Continuously heightened stress​

Question 12

Diagnosis of insomnia?

Answer 12

Difficulty initiating/maintaining sleep​

Waking up earlier + resistance going to bed​

Difficulty sleeping without parent/caregiver​

Daytime difficulties due to sleep​

1-3 months = short term, 3 months = chronic​

Question 13

Treatment for insomnia?

Answer 13

Psychotropic medication not recommended – side effects can be worse​

First line = CBT​

Sleep hygiene, relaxation training, paradoxical intention, sleep restriction therapy​

Question 14

What is social isolation?

Answer 14

Social isolation – objective measure of the number of contacts someone has​

Is about quantity not quality of relationships​

Question 15

What is loneliness?

Answer 15

Loneliness – a subjective feeling about the gap between a person’s desired levels of social contact compared to the actual level​

Perceived quality of the person’s relationships​

Measurement: Community Life Survey, UCLA 3​

Question 16

What is social prescribing?

Answer 16

Social prescribing​ enables GPs, nurses + other primary care professionals to refer people to local, non-clinical services

Question 17

Professionals involved in social prescribing?

Answer 17

GP assesses patient needs and refers to link worker, who will signpost to a community organisation and follow-up the patient​

Question 18

Benefits of social prescribing?

Answer 18

Improves QoL + mental health​

Reduction in use of NHS services​

Question 19

Challenges of social prescribing?

Answer 19

Hard to measure outcomes due to the heterogenous nature of the programmes/service users/outcomes​

Without strong evidence to support, hard to commission social prescribing programmes​

Risk of seeming like you are trivialising the patient’s issues​

Question 20

Benefits of green spaces?

Answer 20

Improved social cohesion + interaction​

Reduced feelings of stress​

Improved attention and memory​

Reduced diastolic BP/salivary cortisol/HR​

Reduced risk of pre term birth/small size gestational age/all cause mortality/T2DM​

Reduced incidence of stroke/ hypertension/dyslipidaemia/asthma/coronary heart disease​

Reduced crime​

Increased job opportunities/work productivity​

Question 21

5 areas that benefit from physical activity?

Answer 21

1. Anti-inflammatory effects
2. Effects at mitochondrial level
3. Weight loss
4. CVD
5. Diabetes

Question 22

How does physical activity cause anti-inflammatory effects?

Answer 22

Reduced inflammatory visceral fat​

Anti-inflammatory. myokines during muscle contraction​

Question 23

How does physical activity cause effects at the mitochondrial level?

Answer 23

ATP use during muscle contraction reduces charge in mitochondria → reverses inflammation + telomere shortening (slows ageing process)​

Increases no. + size of mitochondria​

Question 24

How does physical activity cause affect weight loss?

Answer 24

Remember benefits of being active + overweight outweigh benefits of weight loss while being inactive​

Question 25

How does physical activity cause affect CVD?

Answer 25

Coronary artery disease - plaque regression​

Reduces blood pressure​

Can prevent rehospitalisation after an MI​

Question 26

How does physical activity cause affect T2D?

Answer 26

Aerobic/resistance exercise reduces mortality and increases insulin sensitivity​

Better HbA1c/blood lipids/waist circumference/BMI​